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Dr. John Douillard discusses Ayervedic Longevity 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

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Dr. John Douillard is a globally recognized leader in natural health, Ayurveda, and sports medicine. Dr. Douillard is the founder of LifeSpa.com, one of the most popular Ayurvedic health resources online, and the author of seven books, including Body, Mind, and Sport, The 3-Season Diet, and Eat Wheat.  He has also served as the Director of Player Development for the New Jersey Nets, where he helped professional athletes use Ayurvedic principles to enhance performance and recovery. Dr. Douillard now directs the LifeSpa Ayurvedic Clinic in Boulder, Colorado, where he integrates ancient Ayurvedic wisdom with cutting-edge modern science.  His website is LifeSpa.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.

 

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Podcast Transcript

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

Welcome to the Rational Wellness Podcast. I’m Dr. Ben Weitz, and today I’m excited to be speaking with Dr. John Douillard, a globally recognized leader in natural health, our RDA and Sports medicine. Dr. Douillard is the founder of Lifespa.com, one of the most popular, our RDA TIC Health Resources online and the author of seven books, including Body Minded Sport, the Three Season Diet, and Eat Wheat.  He has also served as a director of player development for the New Jersey Nets, where he helped professional athletes use Ayurvedic principles to enhance performance and recovery. Dr. Douillard now directs the Life Spa Adic Clinic in Boulder, Colorado, where he integrates ancient Ayurvedic wisdom with cutting edge modern science.  Today we’ll be exploring what Ayurvedic can teach us about personalized nutrition, digestion, seasonal living, mind, body balance, and longevity. Dr. Douillard, thank you so much for joining us. Thank you, Dr. Ben. Good to be here. Good. So what is Ayurvedic and how does it differ from Western medicine?

Dr. Douillard: Ayurveda means life and veda means science.  So it’s a science of life. It’s a thousands of year old system of medicine. And what’s kind of really cool about it is sort of how prophetic they [00:02:00] were. They understood that there were circadian rhythms and they, you know, designed lifestyle when you should eat, when you should sleep, when you should exercise, when you should.  You know, work and mentally when she should pray. All these things were laid out, which we now know are based on our biological clocks turning on and off during different times of day, right? They believe it or not, they talked about invisible microbials, which. Were little or anals they called them, which were little microbes that they couldn’t see and they even talked about how they could be good for you or they could be bad for you, which we now know.  They also talked about how you don’t want to kill them, you want to change the environment. And support a healthy environment. Let the body take care of the bad ones. So it goes on and on. They talked about pran and breathing practices now, and we can talk more about that. That’s sort of how I got into it, was kind of looking for the, I was a [00:03:00] triathlete and I was looking for replicating the runner’s high.  And I stumbled upon some meditation and breathing techniques and it just sort of blew me away. But now we have so much science, you know, describing how these breathing techniques are so critical for us, and the list just goes on and on. And what I do@lifespot.com, I write about the ancient wisdom and the modern science.  And what I really love about that is that when you look at. Western medicine alone, it can prove whatever it wants. I mean, there’s diets, you know, there’s carnivore diets, there’s science on both sides of that aisle You can look at, you know, coffee’s good, coffee’s bad. Soy is good, soy is bad. Dairy, wheat, you name it, you’re gonna find science on both sides.  But when you have something that’s been around for a thousands of years. And you have modern science. I feel like that’s a really safe place for us to start when we’re trying to, you know, navigate through this crazy world of nutrition and, you know, online what you hear. Do you really know it’s, you know, true or not?  It’s very confusing. I think that’s a really good place for folks to start, [00:04:00] and that’s what I provide.

Dr. Weitz: Cool. And ayurvedic is an alternative to some people. Look at Oriental acupuncture as in ancient art. Some people look at other forms of eating, say, looking at the way people, the caveman ate for thousands of years.  But ayurvedic is something that’s not often talked about. As much as the other forms, but is probably the oldest and most well studied of these ancient medicines.

Dr. Douillard: Yeah. It’s also probably the original longevity medicine. They have an entire branch of their whole system based on longevity when it comes to diet.  It’s so incredibly logical and so simple. And they talk about eating seasonally, right? So the squirrels are eating nuts and seeds in the fall because they’re higher protein, higher fat, and they provide kind of the antidote to the coldest and dryness. [00:05:00] Of winter in the spring, the root vegetables, the dandelion, the burdock comes out of the ground.  The spring greens come outta the ground and those foods provide the antidote to the congestion and the allergy season of spring. In the summer, you have cooling fruits and vegetables that provide the antidote to the heat of the summer. And then you have on top of this, those. Amicable, which they talked about that are on these plants.  They talked about the microbiome that are on these plants and how the food that you eat is not just the chemistry of the food, it’s the microbiology as well. And the combination of those of which makes the food intelligent, inoculate your gut with the right bugs for the right season. But we eat everything the same thing every day of the year for all 365 days of the year.

Never really changing the microbiome from one season next, which we now have Stanford studies showing that the HAA tribe, their bugs change from one season to the next. Stanford studies also show that the so soil bugs [00:06:00] change, you know, and are attracted specific plants from one season to the next.  And what’s kind of cool is they said that not only do the plants have different qualities in each season that we’re sort of part of that. Like we have a body type and there’s people that we all know. That are hot all the time and they’re throwing the covers off all the time. Never wear a jacket. And then there’s people who are cold all the time.

They’re always putting the jacket on and putting the covers on. And those are qualities of nature that people who are constantly putting the covers on, they have a lot more winter qualities, coldness and dryness in them. So they’re gonna need more of the nuts and the seeds in the winter to antidote their tendency to get cold.  And people who are throwing the covers off have more. Summer qualities, they’re hot all the time and this is their constitutional makeup and they really need to be careful in the summer that they’re not eating meat and beer and wine and cheese and fermented food and spicy food and barbecue that takes a hot body and a hot season and heats them up and overheats them.  So they understood that everything was part of [00:07:00] nature and they did like a really in depth study of that, and we’re like, wow. We all have those qualities of nature and the foods have those qualities of nature, and they mapped out a plan for us to live our life going with the current of nature as opposed to plowing against it as we do in our culture today.

Dr. Weitz: And if we were living in nature, we wouldn’t be able to, we wouldn’t be able to get fruits and vegetables all year round the same ones. We’re only able to do that now because in the winter we can get the summer fruits imported from Argentina or somewhere else, and we’re able to have the same foods year round.

Dr. Douillard: Right. E. Exactly. And that’s why it’s so incredibly logical, like no one’s gonna argue the fact that we should be eating seasonally. ’cause that’s what everyone did up until probably a hundred years ago from the entire planet did that. So I wrote a book called The Three Season Diet, which was based on the three [00:08:00] harvests in nature.  What happened to the fourth season? It was there, but there’s a, there’s three harvest, okay? And there’s one season. Nature Takes is dormant. So you have a spring harvest. We all know we have a, it’s not much, but it’s there. We have a summer harvest, which is very abundant, and we have a fall harvest, which is extremely abundant.  And then we have, and that fall harvest is for winter eating. And winter takes a break. So there’s three major harvest in nature. So all you do is just eat. So what I did with the, with my book, the Three Season Diet, I just took the grocery lists. Here’s the winter grocery list, which we’re going into now, and you take all the foods that are grown from around the world.  For the winter, they have this warm, sweet, heavy, kinda nuts seed kind of higher fat, higher protein quality, and you eat more of those foods as organic as you can to get the right microbiology. And then when this next seasons change, you go to spring, you circle the foods on that and you don’t have to make a big fuss outta what to eat.  You just want to get sort of medicinal dosages of what nature intended, which was. The right foods for the right season and it makes it really easy. People can get this, like, this is for free on my website. Just go to my homepage, life spot.com and you can just download the free grocery list. It’s right there.

Dr. Weitz: That’s great. So how does Ayurvedic fit into the modern functional medicine model?

Dr. Douillard: Well, the modern functional medicine model is do the job for the body, but do it in a kind of natural way with digestive enzymes and natural laxatives and bioidentical hormones, things like that. Doing the job for you with a digestive enzyme as opposed to helping the body do it itself.  Where traditional systems, medicine like Ayurveda, they were all about. Helping the body do the job for itself, using herbs that have the natural chemistry of the plant, the microbiology of the plant to restore [00:10:00] function so you don’t become dependent on a pill or a powder. So that’s the goal of traditional medicine was do the job, help the body, do the job for itself.  Functional medicine, naturopathic medicine, do the job for you in a more natural way. Western your medicine, do the job for you any way we possibly can, and that may mean saving your life as well. And it’s like a buffet. I think we should all be understanding each of those three buffets. I wanna start with my patients.  To get them to do the job, not depending on a digestive enzyme or a natural laxative. I’d rather have them pooping and digesting on their own. Right. Without having to get, take a pill or, yeah,

Dr. Weitz: I’m not sure I fully accept that characterization of functional medicine. ’cause I do think in functional medicine, the way I understand it is we’re trying to restore that function of the body.  And we don’t all necessarily use digestive enzymes. We can use herbal bidders to get the body to start producing its own enzymes. We try to balance out the microbiome so the body does its own work and [00:11:00] produces its own chemicals. We’re not necessarily trying to just substitute a herb for a drug.

Dr. Douillard: No I agree with that. But the thing about functional medicine, and most of the nutraceuticals and the supplements are sterile. When you take an herb and you extract it in alcohol, like a bitters, for example, it’s a sterile product, okay? It doesn’t have its microbiome, right? So what I’m saying is this plan over here is gonna provide for you what you would really get if you’re eating off the land, right?  And, you know, the food, the biochemistry, and the microbiome. Where functional medicine, naturopath medicine, they more use these herbal extracts. We take the herb and we try to make it more potent, but when you do that, you make it sterile and you lose some of the intelligent. I’ve written many articles about the science behind why you want that microbiology as part of the foods you eat, and of course part of the herbs you take.

Dr. Weitz: Yeah. It sounds similar to the argument that standard process uses for their products.

Dr. Douillard: [00:12:00] Yeah. I didn’t know that. There’s, I didn’t know about that. That’s how they do it.

Dr. Weitz: Yeah. They have their own farms and everything is food extracts rather than concentrates or things like that.

Dr. Douillard: Nice. Nice. And if they ha and if they have actual microbiome, like when we get our herbs in from organic farms, we have to test them for the microbiology, the identity, heavy metals and everything. Twice soon as we get the plant from the farm and then we have to make our farm, then we have to test them again for the microbiology and what we find is when you actually take these old Ayurvedic formulas.  That the microbiome changes in a more positive way. When you put herbs together, like when we take turmeric for example, and you take 16 parts, turmeric, one part black pepper, anybody can do that and that will enhance the absorption of the turmeric by 2000%. So we got a batch of turmeric and a batch of black pepper came in and we tested it.  Everything was fine. We put ’em together, 16 to one. We put the formula together and my manufacturer calls me up and he says, John. [00:13:00] The microbiome has exploded in this. He goes, it’s not bad. They’re all really positive bugs. They’re like, it’s like a probiotic. But when you actually took the back, the black pepper and the turmeric together, the bugs you’re talking about the

Dr. Weitz: microbiome of the plant,

Dr. Douillard: The microbiome of the two plants,

Dr. Weitz: the black pepper.  So really you mean the bacterial content?

Dr. Douillard: The bacterial content exploded. Okay. So then we measure it once the formula is done, which is FDA required, right? We had this thing that was so alive and so functional as opposed to just something that was completely sterile and dead, and just the just the chemistry.  And that’s kind of what allows us to kind of get the people on off and to get on, get better and get off as opposed to being. Dependent on a pillar powder or take it long term. And I understand that Herbal extra, I use them, you know, in certain situations as well. But from the Ayurvedic perspective, you want to get as [00:14:00] natural as you can.  We have a, there was a study done in, in New Mexico and Arizona, and it was a Stanford study as well, and they measured the microbiome of the poop from ancient humans in a museum that were a thousand years old. And they saw that were, there were so much microbial diversity in their gut compared to modern humans that they’re calling that lack of diversity an extinction event for our species, right?  So whenever you can actually get the plant with its natural microbiome and you can inoculate your gut with that. Or the seasonal food and inoculate, you’re good with that. That’s such a critical piece of our puzzle today that we’re lacking versus taking sterile herbs, sterile extracts, or sterile, you know, foods that have been sprayed with pesticides or insecticides.

Dr. Weitz: Right. So Ayurvedic emphasizes one’s dosha, which is vada, pita, or kafa. Can you explain what these are and how they Yeah, that’s a,

Dr. Douillard: like we said, you [00:15:00] know, the doshas are just the aspects of nature. Like Vata literally means air, and in the winter we have wind and it’s blowing. So the environment is very windy and very cold and very dry.  And that’s a Vata constitution. So that winter constitution. Let’s call it winter. That body type is gonna be always cold, always dry, and always wanting more covers and hats and clothes and gloves and hats and all that. So what you would want to do with them is make sure during that winter months, they’re eating off the winter grocery.  More soups. More soups, more potentially more animal protein, more fats, more nuts, more seeds, more grains. Things that were harvested in the fall for winter eating are key to antidote the extreme quality. Of that season in it. But if you’re eating like, like you said, are we, what if this body type, which was cold and dry winter type, is eating frozen blueberry smoothies all winter long?

Right. First of [00:16:00] all, if you were living in Vermont in January, you couldn’t even get those right, right. Like in the 18 hundreds. So it’s impossible to even get that from a natural perspective, which is sort of like illogical. So, but if you were eating those cold foods on a cold body type in a cold season with cold drinks and ice in my beer and my wine and all this stuff, you’re just taking this body and making it more cold.  But if you take warm foods and soups and stews, then you’re gonna actually antidote. The qualities that are existing in nature, they can aggravate their constitution. Pitta, summer types. They have a lot of heat in their body type, so they need to actually eat foods that are cooling, like sweets and sour and astringent foods like vegetables and asparagus and pomegranates and watermelons and fruit.  They cool the body down. But if they’re eating spicy food and fermented food during that season, you’re gonna take a hot type and a hot season and inflame them. And that’s where the word inflammation comes from. In the spring you have [00:17:00] cough, which means congestion, cough, like think about coughing. That’s congestion.

So they have a lot more tendency to hold onto more water. ’cause in the spring. The Earth holds onto more water, and so we all hold onto more water in the spring. So nature provided the antidote, which was a low carbohydrate diet. There’s no carbohydrates being harvested in the spring. So from the Ayurveda perspective, we have a high protein, high fat diet in the winter to insulate you and rebuild you during the winter months.  We have a no carb or low carb diet in the spring, which is naturally occurring. We have a high carb diet in the fall, and now we have studies that show that the ant hunter gathers microbes in their gut. We’re more ba, more proliferate, proliferated with more what are called actinobacteria, which were bugs that in the springtime, that help them get energy from fat and fiber.  And in the summertime they get, they have more bugs in their gut called bacteria des, which are really good at getting [00:18:00] starches out of the gut into the blood free energy. So our fuel supply was supposed to change. But nobody talks about that. They say, just be a vegan or be a carnivore, or be a high protein.  Be a ho. You know, it’s like everybody wants to put on these diets for the entire year. But nature’s not like that. The nutritional cycle in nature is an annual cycle. We should change throughout the year, and they mapped that out thousands of years ago, and now we have the science to back it up and we’re just beginning to understand that’s probably not a bad idea for us to, you know, eat according to the seasons.  It’s not hard. Just circle the foods you like and eat them in each season. 

Dr. Weitz:  Get, but how do you balance out your dosha? With the seasons. Let’s say you’re whichever one of those where you’re Yeah. Always hot and yeah. And now it’s winter. You know,

Dr. Douillard: that’s a great, that’s a great question and the answer is really simple.  We should all. Be eating seasonally, all of us. Now, if I’m a super hot, [00:19:00] fiery body type, competitive driven, my skin is inflamed, my joints are inflamed, I’m inflamed, I’m a hot type, then what season do I really wanna be eating on? The straight and narrow? I want to take that. Summer grocery list, and I want to really eat off this list.  I don’t want to be a lot of spicy Mexican food, beer, wine, cheese, that are very acidic. I want to eat things that are gonna be very more Alka. They’re gonna cool me down, and that’s just exactly what nature’s harvesting at that time. If I’m a cold, dry, winter type and I can’t sleep at night, my skin is dry, my, you know, my intestinal tract is dry, I’m constipated.

I don’t want to eating cold foods and I want to eating warm soups and stews. And that’s, so what you do is you just emphasize. When you nearly need to be on the straight and narrow, right, based on your constitution. So the first thing, everybody changes their diet in the seasons. Like every bird flies south, every whale migrates, every leaf turns red and falls off trees seasonally.  We don’t do anything, [00:20:00] but this is what we were designed to do ’cause we were a part of those rhythms of nature, just like all the animals are as well. So just take the dice and just emphasize. Or eat seasonally. And then based on your body type, you can then, you know, be a little bit more proactive in a season that you’re more vulnerable in.

Dr. Weitz: Now, how do these body types correspond or conflict with modern ideas of biochemical individuality?

Dr. Douillard: Well, they overlap beautifully. I mean, they, you know, the, they, the day we’ve talked about for the last 50 years in America, they, there’s the ectomorph and the endomorph and the mesomorph. Well, the ectomorph is the Vata Winter body type.  The mesomorph is the Pitta kind of medium frame body type. And the endomorphs. The Kapha. Kapha is earth and water heavy, solid, thick, big football player, a linemen. Those are endomorphs. The PTO types are the fiery, competitive driven, you know, kind of [00:21:00] medium frame, but very muscular, inflamed. You know, workaholics, you know, go.  Fire fire. They are the mesomorphs and the ectomorphs. Are the thinner, more sensitive, artistic, you know, heightened radar. They can feel things. They were the scouts. They could perceive danger from a distance. The mesomorphs were the fiery competitive ones who’d fight the battles. And the endomorphs were the ones that were actually very big and very strong, but they were also, they had the earth and quality.  They were calm and easygoing. They were often the leaders because people like to follow. People who are calm and lead from a calm place, not from a, you know, angry perspective.

Dr. Weitz: Does your dosha change over time? Like, does it change as you age? Does it change as you move to a different place in the world?  Or does your diet modify it? How is it? Or is it something that’s you have a certain dosha and that’s you for the rest of your life? [00:22:00]

Dr. Douillard: Yeah, that’s a good question, Ben. It is sort of like you buy a Volkswagen in 1960. Okay. And now you’re still driving it. Okay. In 2025, right? It’s still a Volkswagen, right?  It is still the same old body type, but it is got some dents on it, right? So we have the, your birth body type, which you carry through your whole life. But you also have what’s called the current constitutional makeup, where that thing might have gotten a new engine, a new transmission. It’s got some dents in it, and that’s what, so there’s a current perspective, but for the most part, generally your body’s head carries you through your entire life with some, you know, morphing and adaptation based on lifestyle diet where you live.  It can all it, it can you, we adapt to that for sure along the way. And that’s why you would wanna take a body type questionnaire, not just once in your life. You take a body type care questionnaire, you can dig it. We have a really nice1@fy.com is free. You take it, find out what your [00:23:00] type is, take find out what your kid’s type is, what their strengths and weaknesses are, what their likes and dislikes are, you know, where they’re vulnerable, that kind of thing.  And then, you know, every couple years you take it again and see what’s happening with you.

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Dr. Weitz:  You wrote a book, Eat Wheat. And this challenges common perception especially in the functional medicine world that gluten tends to lead to leaky gut is harmful for most people.

Dr. Douillard: Yeah, it’s true. [00:25:00] That’s you know, it was important to write that because I wasn’t trying to get people to necessarily eat wheat per se, but what I was trying to make the case was that these underlying digestive imbalances, I can’t eat wheat. You know, when I first, and you and I probably first went into practice similar time.  We were taking people off of wheat and dairy back in the, you know, eighties and nineties, before it be anybody was talking about it. Absolutely. And now it became public enemy number one. But I noticed in my practice that I would take people off the wheat, they would get better, but then six months later, another digestive problem would pop up, take ’em off the dairy.  They get better and another problem. Then you give ’em a probiotic. Now they’re stuck on a probiotic for the rest of their life. You give ’em a digestive enzyme, they now, you’re, now you’re doing the digesting for them. It became really clear to me that I wasn’t fixing the actual problem. I was actually just putting out the symptomatic fire.  So [00:26:00] what it turned out to be is that wheat is a hard to digest protein, but what’s happened in our culture today is it had didn’t stop with wheat and dairy. Now we have functional medicine and biohackers saying, don’t eat wheat, dairy, nuts, seeds, grains.

Dr. Weitz: We have the low protein, low FODMAP diet. We have the low lectin diet, we have the low histamine diet.

We have the, yeah.

Dr. Douillard: How is that natural, those foods, those, and here’s the science behind that. You can’t bubble wrap your diet. That’s what’s happened in our culture and that’s why Ayurvedic medicine is so important. They say the problem is not those foods, it’s the digestion of those foods that’s broken down.  Right. They did a study, a really cool study. They then, I wrote a, I wrote an article on it called the Dangers of Gluten-Free Diet. They had people who ate wheat. And then they gave they, and then they compare that the people who were gluten-free, but they didn’t have to be right. And the people who ate wheat had [00:27:00] four times less mercury in their blood than people who were gluten-free, but didn’t have to be.  The people who ate wheat had significantly more killer T cells, less bad bugs and more good bugs in their gut than the people who are gluten-free. But didn’t have to be. And the studies go on two Harvard studies, both a hundred thousand people. In both of those studies, the people who ate more grains in wheat had significantly less heart disease and less diabetes than the people who are gluten free when people are celiac.  They, yes, you should completely go off of wheat, but that doesn’t, you know, that doesn’t solve their problem. They have longstanding nutritional deficiency as a result of being celiac. Taking the wheat out of the diet didn’t solve all of their problems. It just took the major aggravator out. These foods that are harder, that the lectins, the nightshades, the phytic acids.

These foods, their study after study of showing how beneficial they are for [00:28:00] us, but they don’t come like every day of the year either. They’re also seasonal, so the body rot, the nature rotates them in and out. So you don’t overwhelm your body with any of those, and they provide what’s called hormesis. A little bit of irritation in your gut that causes the body to respond with gut immunity, which is 70% of your immune response.  You take all those foods outta the diet bubble, wrap your diet. Now you have a compromised immunity. And that’s exactly what these studies show. And I’ll tell you one more study real quick and I’ll let you, you chime in here. There was a study with Amish kids and they found out that Amish kids had the lowest rates of asthma on the planet.  Their genetic cousins came from the same valley in Switzerland where the Hutterites, they came to America, they became sterile stainless steel, dairy farmers, the Amish, they became old fashioned farmers, sterning the milk in the old wooden containers, stuff like that. They measured and the hotter ice had the highest rates of asthma on the planet.

Their kids, Amish kids, [00:29:00] lowest rates, same genetic pool. Really cool study. They measured the dust in the barn that the Amish kids were running barefoot in the barns, had cows as pets. It was the dust that was creating a little hormetic irritation that triggered an immune response against them getting asthma.  We can’t continue to bubble wrap our diet and say, well, here, don’t eat. Don’t eat. Take digestive enzymes to do the, and take probiotics to fix your gut bone. That’s not how nature works. We need to get the body to digest properly, to inoculate the bugs, the gut with the bugs at the right time, at the right season, with the right bugs, and bring resiliency back and digestive strength back.  Because our digestive strength is linked to our di, our detoxification ability, and we live in a toxic world. And when you can’t digest your wheat, your dairy, your nuts, seeds, grains, legumes, nice shape. You can’t detoxify the 70 million tons that the EPA reports is dumped in our atmosphere every single year.  That filtered out on everything we eat and drink.

Dr. Weitz: [00:30:00] You made a lot of points. So if it’s okay, I want to make three comments. The first comment regarding the last one about growing up on a farm, many studies have shown that when you get exposed to more microbes, to bacteria, to viruses, to dirt, we have less autoimmune disease, we have less asthma, and we definitely know that to be the case.  So I definitely a hundred percent agree with that. Number two, when it comes to, we. The argument can be made that if we were eating ancient wheat. That would be much more digestible that over the years we’ve hybridized the wheat specifically to get larger and larger gluten molecules that are more and more difficult to digest.  And these so modern wheat doesn’t look at all like ancient. And the amount of gluten and the length of the gluten molecule is so much bigger. It’s so much more [00:31:00] difficult. Unnatural for us to digest is why modern wheat is a problem when ancient wheat might not be. And anecdotally, a lot of people say, oh, I went to Europe and I was okay eating the pasta over there, but I’m not over here.  And then number three a point I wanna make about specialized diets. Those of us in the functional medicine world who do with some patients recommend a specialized diet. Let’s say if somebody has SIBO and they put ’em on a low FODMAP diet. That diet is only intended to be used for a limited amount of time, and then as soon as we can, as soon as we’ve gotten their SIBO under control, by reducing the microbes that we don’t want in their gut.  The we always try to broaden their diet as broad as possible, as long as they’re not having reactions.

Dr. Douillard: Right. Yeah. So yeah, we’re both guilty as charge. I said too much and you said a lot. So let me just [00:32:00] respond to that. And I’m not trying to give you a hard time I’m just saying Oh no.  This is, I love discussion. No, this is exactly what I love to do. I would never suggest people go to the grocery store and buy the bread in the grocery store. That’s not that’s not what eat wheat was about. Right. Eat Wheat was about the literally thousands of studies on how grains are actually so beneficial because of the fiber and the impact.  The microbiome. So what I’m talking about is eating really healthy versions Now to push back a little bit, when they actually when our original ancestors first took the original wheat and they thrashed it and they took the wheat berries, they would select for the bigger wheat berry. ’cause it was wheat’s.  Really skinny. It’s really thin, almost very smaller than rice. So they would select for the bigger one and the bigger it was. The sweeter it was and the less gluten it had, [00:33:00] but the original wheat on this planet had significantly more gluten than the wheat that we eat today. Just so you know that when we go back and, oh, I wish you eat ancient wheat.

Well, the ancient wheat had more gluten, so really, was it the gluten? That was really the problem. That’s one thing. Now it is true that gluten is a hard to digest protein, and because of all the things we talked about, our digestive threats has been severely compromised. And I’m not saying you should eat weed if you feel bad, and isn’t the modern gluten molecule much longer?  Well, probably longer than it was, you know? ’cause what our ancient ancestors, they selected for wheat that was less gluten and more sugar to make it sweeter and it was bigger, easier for them to handle. But the actual original wheat on the planet. Was way more gluten than we eat today. And then they slowly started to hybridize it to make it kind of less glutenous.  And yes, you’re right, they did hybridize. Did we try to make it more glutenous so the bread would stick together? [00:34:00] It didn’t need to make it more glutenous. It was still, there was still plenty of gluten in the bread the way they were doing it to make it stick. But they do, if they really wanna make squishy bread, they add gluten to the bread these days.  Okay. But the thing is that the gluten. Is Yes. A hard to digest protein, and it’s been hybridized in ways that makes it more difficult. And then you add the glyphosate to it, that’s a problem. However, and has

Dr. Weitz: Alessio Fasano shown that it increases zonulin, increases leaky gut.

Dr. Douillard: Right? And that also has to do with the strength of our ability to digest it when people don’t have a really good.  Digestive fire, stomach acid, they can’t break down those proteins, so they go in completely digested. And I’ll quote you a study on this. When you don’t break down the protein in your stomach properly, the gluten or the fats, the environmental pollutants, well the studies say that it will go, they will go in completely digested into the intestinal tract.  And those [00:35:00] molecules will be too big to get into your blood and nourish you, right? They uptake it into the garbage can, which is the lymphatic collecting ducts around your belly, give you extra weight around your belly. Get into your brain lymphatic system, cause brain fog and all these symptoms that people have when they eat wheat, but that’s not a wheat issue.  That’s a inability to break down the protein issue. And I debated David Perlmutter, who wrote The Grain Brain two times. I was on his podcast. He was on my podcast and my mom said, I won that debate both times. So I’m Your mom said, yeah, I’m pretty sure I did. But the idea, and he, at the end of the second debate did say, yeah, if you eat real whole grain wheat.  Then it’s not gonna, but, you know, wonder Bread or either these croissants that are filled up with puffed with really refined flour. Of course, that’s not what we’re talking about, but I’m talking about we can’t bubble wrap the diet and that’s what we’ve done. And we don’t, and we’re not, I’m not hearing a lot of people saying, oh, let’s go back and.

[00:36:00] Let’s strengthen the stomach acid, the coordinated effort of the stomach making acid, the bile, liver, making bile, the pancreatic duodenal enzymes. Let’s reboot that coordination because that’s really where the rubber meets the road and most people. And when you eat bread, that is from the grocery store that’s full of seed oils, that is a preservative for the bread.  And that means when you eat that, the bugs in your gut that normally eat oil won’t eat that. Those seed oils. So all those seed oils go right to your liver. They create bile sludge in your liver. Bile is not al only an emulsifier for the fats, but it’s also a buffer for your stomach acid. So now what happens is when your stomach eats something that requires to a lot, has a lot of protein in it to break down the acid, it’s gonna need bile to buffer that acid.  But if that liver is congested with bile, slut ’cause of seed oils and pesticides and things and environmental pollutants. The body can’t respond, so your [00:37:00] stomach has to say, Hey, you guys stopped making the bile. You’ve eaten all those seed oils and all the toxic fats. I have to stop making the acid. And now your stomach acid bile flow are both dialed down.  And what Ayurvedic medicines say, let’s reboot those and turn them back on. And now I can eat. And studies show that you can, even if you have good stomach acid, you can break down glyphosate. So it’s not about, oh my God, the wheat in America is so terrible. You know, you should be able to digest anything without having a problem.  And because you eat something and you feel bad before you were blaming the food. How can I look at troubleshooting my digestive system? We have an article called your, you know, digestive health quiz where you find out what part of your digestion might be broken and how with herbs and foods you can reboot it so you don’t have to bubble wrap your diet for the rest of your life because there’s long-term consequences for that.

Dr. Weitz: And also the way we eat with fast food in a short period of time without chewing, [00:38:00] chopping it down while you’re driving in a car, while you’re under stress. So you’re, you’ve got a sympathetic environment in your body which impedes digestion, and then you’re getting reflux or you’re taking PPIs that are inhibiting your acid production.

On top of that.

Dr. Douillard: Just the stress of our culture is co compromising acid production. All the stress in our world these days is compromising it. You know, we’re, we go 90 miles an hour, you know, 24 7 in our culture that where everything is chronically going compared to our ancestors where they were living in harmony and ance with nature.  It’s a completely different. You know, environment that they lived in. And one of, and the response to our stressed out environment is exactly what you said is gonna naturally dial down stomach acid, but then all the processed food only makes it worse. But that doesn’t mean we can’t fight back against that.  That’s not hard to fight back against those things.

Dr. Weitz: Right. Do you still work with athletes today? Are there professional athletes using [00:39:00] a auric approach?

Dr. Douillard: Sure, absolutely. I, you know, constantly working and coaching different athletes based on my first book was what called Body Mind Sport, which was all about nose breathing versus mouth breathing exercise.  And we published studies on that way back in the early 1990s and worked with Billie Jean King and Martina Navratilova did the forward of my book and worked with New Jersey Nest. It all did worked with them for two seasons and you know. The logic of learning how to breathe. ’cause when you breathe through your nose, according to the research.  You change your brain chemistry, the brain actually slips into what’s called an alpha state, which is a meditative calm. And when you’re breathing through your mouth, obviously if you saw a bear in the woods, you would take that same breath. It’s gonna trigger a fight or flight response. The brain goes into beta, gets up a tree, save your life.

But that’s a degenerative chemistry. And if we’re living in that degener degenerative chemistry, and we’re. Exercising in that degenerative [00:40:00] chemistry, breaking our body down to build itself up. We’re gonna be limited by how much stress we can endure over time, and that’s where this approach is like, learn how to breathe properly, activate a parasympathetic.  You know, dominance during vigorous exercise so you’re not in full blown fight or flight. Use all five lobes of your lungs and activate a neurological comp, and that’s the runner’s high. That’s what athletes, you know, would say, my best race is my easiest race, and I was. Fascinated by that when I was in college competing as a triathlete.  And I went to a lecture. I was training for an Ironman back in early 1981. And I went to a lecture in Ayurveda. It was my first lecture, and I went up to the guy, said, Hey training for an Ironman and what do you think from the Ayurvedic perspective, this is a good thing. And he said, he goes do you meditate?  And I said, yeah. And he goes, do you sleep when you meditate? And I said, deeply. I get this really deep sleep. And he looked at me [00:41:00] and he said, well, meditation is not sleep. He goes, meditation is your alert and resting at the same time. I go like, oh, I’m completely knocked out, you know, sleep. And he said, you’re exhausted and you probably should stop all doing all that workout and meditate more.

So I started going to weekend meditation retreats and I ended up going, did that for like, like a year. Then I went on a two week retreat and I went into the zone. This true story, I started competing at a higher level winning medals. But not only did this and a lot of my friends started meditating, a lot of ’em started thought I was taking steroids.  Because I was doing this in the South Bay in la. That’s where I was training. It was work. So Marathon sort of really kicked off where you are and, and, but it was like, it was the capacity and the bandwidth that I had during my clinical internship, like for three months I was in this zone state where I could do, I do like, it was like I was doing nothing but accomplishing everything.  I felt like I, everything was effortless, but I was performing at a such high [00:42:00] level and that’s what got me. Kind of really fascinated by Ayurveda. ’cause I was in this, and then after three months it disappeared. Never came back and I was searched for it. So I went to India, came back, did research, published studies on it, and we found that when you breathe your nose, it’s a game changer.  It changes the brainwave pattern to make you in a meditative state, even while you’re in vigorous exercise, which was an unprecedented finding as well.

Dr. Weitz: Oh, are there any auric herbs or daily rituals that you recommend for overall longevity?

Dr. Douillard: There’s an herb called Ashwagandha. Many folks probably heard about it of course.  And it’s a really important herb, particularly if you use the root and use the whole root with the natural bugs on it. Not an extract. ’cause that’s where we’re just trying to be American. I’m gonna give you the same herb that’s really good at a hundred times potency. And it’s gotta be better, right?  Because it’s better. Bigger is better, right? America? No, it’s actually not. The more in [00:43:00] Ayurveda, the more subtle something is, the more powerful it is. And that’s the beauty of it. So I would use those herbs which first do no harm. ’cause you’re taking foods that were put in soups and ensues for thousands of years into your system.

The body recognizes them as whole. When you start to mess with the microbiome and it’s may take potent, make one constituent more potent by a hundred times. You’re creating something completely different than what nature intended. But Ashwagandha being a really powerful agent, it’s an herb you can take in the morning or run a marathon.  Studies show you can take it before you go to bed and sleep like a baby. It’s been shown to protect your mood, helps you handle stress mentally, physically, and emotionally. So that would better be, and with winter coming, it’s a fall harvested winter root. So it’s giving you the right bugs for the winter season to rebuild you.  And rejuvenate you. It’s a root. That’s why the roots are harvested in the fall and in the, and they build natural production. 

Dr. Weitz:  Now, what form do you recommend taking Europe? Is it are you making a tea out of it? Is [00:44:00] it in a capsule? What form do you prefer?

Dr. Douillard: You can make a tea out of it. If you add the actual root, you could just throw it in a pot and make soup out of it.  But I, what we do is we take the root, not the leaf, not the stem, just the root, and we grind it into, and why

Dr. Weitz: just the root.

Dr. Douillard: Because some of the constituents in the leaves in the stem are, they’re way more abundant. They’re cheaper in the marketplace, but they actually can cross some liver heat. Or sometimes if you take it long term, some people can have liver toxicity.  And this is why it’s really important to know what you’re doing because a lot of people say, oh take off. You’re gonna get the root to stand the leaf, grind it up, put in a powder. Now let’s make it more potent and give it to you as an extract that’s sterile versus taking only the root. With its natural occurring microbiome, that’s where the bugs go.  They go to the root first, and that’s, and that is safe to eat from an Ayurvedic perspective. And they knew that thousands of years ago, but now we have companies putting out root leaf stem herbs that’re not good for you. So it’s just [00:45:00] the ancient wisdom just carries a lot of weight. And then when you put the modern science together, it’s like, Hey, you know what?  They really didn’t know what they were doing and if they didn’t know what they were doing. They would’ve stopped doing it a, you know, a thousand or 2000 years ago. You don’t do the same dumb stuff. It’s not working for 5,000 years.

Dr. Weitz: Any other Ayurvedic herbs or daily rituals for longevity?

Dr. Douillard: Well, the other one is like, you know, in the summertime, the sun helps make serotonin in the body, helps stabilize your mood.  But in the winter. Sun goes to the southern hemisphere. We don’t have that, but nature had a plan for that, and that was in the roots like turmeric, ashwagandha, bacopa, they’re all roots of herbs. Bacopa is an herb that is used for mood stability, mantle focus, attention deficit. It’s a brain derived neurotropic factor A-B-D-N-F, which means it’s gonna build brain cells and may help you handle stress better.  Turmeric, we’ve already talked about a powerful anti-inflammatory, a ary, which means it heals the lining of your incest tract. Also supports [00:46:00] depression by 64% compared to the placebo. So it’s like, has really amazing properties because of its serotonin boosting ability. And those are herbs that are naturally occurring in the fall for the winter because of the roots.  And they give us that serotonin boost when we need it, when we don’t have the sun to make our serotonin forests.

Dr. Weitz: Interesting. Great. So, any final thoughts you have for us?

Dr. Douillard: Yeah, I would say that the other last piece of the puzzle, if there’s a last piece here would from the circadian rhythm perspective, you know, we have a lot of folks intermittent fasting today and one of the, yeah.

Dr. Weitz:  What do you think about intermittent fasting?

Dr. Douillard: You know, they used the word supper comes from the word soup or supplemental. So that was always a meal that was smaller and supplemental and across the world, everywhere except for America. To this day, the biggest meal of the day was the middle of the [00:47:00] day.

And our culture. When we were agricultural, the biggest meal of the day was the middle of the day meal. And so people would have a breakfast and then they have a big lunch, and then have a supper, a small supper. When intermittent fasting came along, we decided to skip breakfast, have a cup of black coffee, and then have lunch and dinner, and now we’re back loading our food.

And we’re eating more food. Towards the end of the day when the sun sets, the cooks go home, there’s nobody there to cook at the biological clocks. We’re eating turn off. So we’re eating a lot of food when the body can’t digest it, where the science now shows. And Achin Panda, who wrote the circadian code now is confirmed that he’s the researcher on this, that the best time to eat is your breakfast and your lunch and have a lighter dinner, which was been.

You know, understood, written thousands upon thousands years ago, and we’re still fighting over, I want to skip my breakfast and have a lunch in there because, yeah, it’s more convenient. But the, I mean, the takeaway here is. [00:48:00] Have your biggest meal in the middle of the day when your body’s biological clocks for eating are turned on, and try to eat a little bit less at night, a little less or a little earlier in the evening and in the morning.

Doesn’t have to be a massive, big old breakfast, but a little bit to tell the body. That it’s daytime and metabolism needs to get kicked on. You know what I mean? So if I’m gonna do intermittent fasting and wanna lose some weight, I’ll have a breakfast, a small breakfast, big enough to get to lunch, a nice big lunch, and then nothing for supper, and have a fast from lunch all the way till breakfast.  And you do that for two or three weeks, lose that extra five pounds, whatever you’re looking for. Then you can go back to having three meals a day as long as suppers earlier and smaller. You know, pig out at that nine o’clock meal because that’s gonna be there all night long and it’ll sit there in the morning.

Dr. Weitz: Yeah, I’ve actually been doing that sort of program for quite a number of years specifically on Monday, Wednesdays and Fridays only. ’cause I found it worked for me because those would be my [00:49:00] busiest days in the clinic, and I never liked the idea of eating late and going to sleep. And I’m an early riser, so I’ve been skipping dinner for years now, and it just worked for me.  I’ve always liked having a bigger breakfast and. For me, I, that’s my biggest meal, and then I have a medium sized lunch.

Dr. Douillard: Yeah, that’s great. I mean, there’s really good science on the benefits of a breakfast. You know, it protects people from long-term diabetes. It helps people from gaining weight. There’s, the research on it is really compelling.  And so it’s a metabolic activator and if you don’t have that, it doesn’t need to be, you make it for you. It works having a bigger, making your bigger meal, but it definitely needs to be something for folks, you know, and everybody’s gonna be a little bit different, but

Dr. Weitz: yeah. Yeah, I always find it helpful to start today with some quality protein to get my blood sugar on an even keel through the rest of the day.

Dr. Douillard: Yeah, that makes sense. Great sense.

Dr. Weitz: Good. So, since we’re [00:50:00] wrapping up here how can listeners learn more about you and your work?

Dr. Douillard: The way you can go to our website which is life spa.com, L-I-F-E-S-P a.com. In there we’ve got 1500 or so articles all about ancient medical wisdom. With the modern science.  We go to the extra mile to find that science and you can just type in your health concern and you’ll find. Probably multiple articles about, you know, the Ancient Wizard of Modern Science and see if it makes sense to you. I mean, it just makes sense to see the science and what the ancient practice was, so you’re not actually just out there on the next, you know, craze, trendy thing that might be here today.  And gone tomorrow. And there we have a newsletter. You can sign up for my newsletter there as well. Get that information regular. We’re constantly digging into more research and we have an Ayurvedic store. I’ve been formulating Ayurvedic herbs and skincare and different products. And my books and tapes are there@lifespa.com, at the store as well.  And I’m on all social channels as well, if you wanna follow me there.

Dr. Weitz: That’s great, [00:51:00] John. This was an enlightening conversation about our ayurvedic wisdom and how it can help us optimize our health.

Dr. Douillard: Yeah. I appreciate it, Ben. Thanks for having me. It’s been great to share this with you guys.

Dr. Weitz: Thank you very much.

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Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star ratings and review. As you may know. I continue to accept a limited number of new patients per month for functional medicine.  If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and wanna promote longevity. Please call my Santa Monica Weitz Sports chiropractic and nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.

 

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Dr. Matthew Budoff discusses Preventative Cardiology with moderator Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on September 25, 2025.  This was the second annual Dr. Howard Elkin memorial Preventative Cardiology lecture.

[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

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Dr. Matthew Budoff is a professor of medicine at the David Geffen School of Medicine at UCLA, Program Director and Director of Cardiac-CT, Division of Cardiology, Harbor-UCLA Medical Center and he is an investigator with The Lundquist Institute https://lundquist.org/matthew-budoff-md.  Dr. Budoff’s research is devoted to advancing procedures that can help doctors identify patients early that are at high-risk for cardiac events and progression of atherosclerosis. This early detection can lead to patients being placed on the correct therapeutic path to prevent a heart attack. Additionally, Dr. Budoff’s research focuses on determining the effect of different therapies on atherosclerosis and determine if heart disease can be reversed. His office is in Torrance, California and his office number is 310-222-2773.

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.

 

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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, dr whites.com.

Thanks for joining me, and let’s jump into the podcast. Welcome everybody to the Functional Medicine Discussion Group of Santa Monica. I’ve been running this event for the last nine years. I’m not sure what we’re gonna do going forwards. We’ve had a tough time since the pandemic getting everybody to show up.  So we may have to rethink how we do things. But as of right now, this is the last event for 2025 for sure. And so, if you’re not, if you’re a practitioner and you’re listening to this and you’re not on our closed Facebook page, jump [00:01:00] onto the Santa Monica Functional Medicine Discussion Group of Santa Monica, closed Facebook page.  I post scientific articles on a regular basis, and we have discussions about cases, et cetera, so we can continue the functional medicine discussions here. Also, I’m recording this and this’ll be part of my weekly Rational Wellness podcast. So if you don’t subscribe to that, listen to that. You can watch it on YouTube, you can listen to it on all the podcast apps and if you go to my website, you can get the complete show notes.

So today is the second annual Dr. Howard Elkin memorial preventative cardiology lecture. As most of you know how Dr. Howard Elkin was a beloved member of our functional medicine community, and he spoke regularly at our meetings. He attended most of our meetings. He was a good friend of mine. He worked out of my office last year.  He was [00:02:00] due to speak in August, and he passed. And so I gave the lecture using his notes as the first annual Howard Elkin memorial lecture. And so today we have Dr. Matthew Budoff, who’s a preventative cardiologist. He’s published hundreds of scientific studies and he’s also an expert on cardiology scans, like the coronary calcium scan and the CT angiogram with artificial intelligence.  If you’re not aware of what those scans are. They’re very important ways to not just get a sense of whether or not you might have plaque, but actually seeing the plaque and seeing what state it’s in. So, Dr. Budoff, thank you. Thank you so much for joining us.

Dr. Budoff: You knew Howard. I certainly an honor this speaker speaking, conferencing this name.  I’m not a really a formal functional practitioners. I do a lot of, I do a lot of therapies that are well [00:03:00] considered functional in some ways. And I certainly incorporate a lot of that into my practice. I called it LED practice, but I didn’t wanna out focus on lipids. I think there’s a lot of great data out there on alternative ways of lowering LDL, like treat and with hyperlipidemia.  I do think that lipids are generally a bad thing, although I just finished a keto study, which I’m not gonna study the heels like that. Oh. But the keto diet, which did show very high LDLs, they, the hyper responders or LDLs were in the two face, steep 300 gram hologram deciliter, FDL, and they didn’t have much changes in their plaque in a perspective one year study.  But we’ll leave that one off. But I do think lipids are important, and I do think generally that people are very high or elevating LDL cholesterol or offers us an opportunity to reduce cardiovascular risk. This study is called the UR study. It’s probably [00:04:00] one of the most important studies in cardiology and preventive cardiology because it shows us what the contributions are of different modifiable risks towards heart disease.  And you can see that they calculate was based on 30,000 patients. That the attributable risk adjusted for the risk factors that if you address all these things that you can reduce risk by about 90%. There’s still a little bit that we can do. We can. Maybe change your sex? Does change your risk?  I don’t think so. Certainly changing your age. Not possible to say why about it. And your genetics, we had changed, whatever. Anything else in effect? 

Dr. Weitz:  So when you talk about lipids, is this based on a basic lipid profile or is it an advanced lipid profile? This is not. Right. So what perc, what percentage better attribution would you get if you did a more extensive advanced lipid profile?  You looked at [00:05:00] homocysteine, you looked at omega threes, et cetera. 

Dr. Budoff:  I think you’re probably looking at maybe 70% of the answer. Okay. Yeah. This is just basic LDL, HDL, triglycerides, just the very basic paddles that we historically look at. You see informally, psychosocial issues are a big deal, stress, depression, anxiety.  It’s usual, but you know, things that wouldn’t normally be targeted very aggressively. Things like smoking. It’s important to get people to quit smoking, but less even than just allow EIC lipid at and hypertension, much less. So, not to say that we shouldn’t be getting people to quit smoking and controlling their blood pressure, but I think lipids represent the biggest opportunity for us to change people’s outcomes.  So understanding that we have alternatives to statins and this is one of them that’s relatively new. It’s called Bempadoic acid. It’s sold as Nexlitol and I’ll show you this combination pill with azetamide as well that’s [00:06:00] available. So STAs work here in the liver. This is the liver and this is where it makes cholesterol.  So normally in the liver, all almost 85% of your cholesterol in your body is manufactured in your liver. So your liver takes citrate, goes through a bunch of steps about seven enzymatic steps to create cholesterol. If we block cholesterol here in HMG coa, reductase the statins, we slow down this pathway and we decrease cholesterol.  But there’s another enzyme now that we can target called a two P citrate lily, an ACL or A two P citrate. Lyase is a enzyme that has different properties and different side effect profiles than targeting H and GCO reductase it. It also slows down the process. It also lowers cholesterol and it can actually be used together with a statin kind of two heads on the system and slow down the [00:07:00] process even more.  The reason that I think statins cause a lot of issues is because they’re active compounds. They’re not a prodrug, they’re active compounds. They can cause most of them can cause blood brain barrier and. All the other barriers that you can think of and really penetrate muscle and tissue.

And when they get into the skeletal muscle, which they can do quite readily, they also block H and B co and cause problems. We also have to get stat deplete coins on Q 10 and thus CO Q 10, which I’m not gonna talk about tonight. But we have, we actually did a very nice study showing that it improves endothelial function, but but statins cause muscle toxicity, ’cause it’s inactive compound beic acid, is that an inactive compound?  So it needs to be activated and the only place we know that it has any significant co conversion is in the liver itself. It gets converted by this enzyme, it gets activated and then it blocks cholesterol synthesis. It’s inactive. [00:08:00] Muscle, so it cannot cause muscle toxicity. So for those patients who have muscle toxicity from statins or don’t wanna take a statin, beic acid decreases cholesterol synthesis.  Now while without affecting the muscle, the other major factor, beca dark acid that people don’t recognize is that it not only has all the antiinflammatory properties of a statin, it actually might be more potent as a side effect of your lower inflammation, but it actually reduces diabetes. It’s the only lipid drug we know of that actually improves diabetes.  Whereas statins increased diabetes, right, worse than diabetes and the CT and the PCSK nine injectables also causing more diabetes. So we have a decrease in diabetes, a decrease in inflammation, and no muscle tone system. So I think for [00:09:00] those patients who need pharmacological therapy, OSIS a nice benefit.

I’ll show you the outcome gave in a

Dr. Weitz: moment. Another complaint that some patients have is brain fog. And there seems to be some data that at least in some patients that statins might be negative for the brain. What about Bempadoic acid on the brain?

Dr. Budoff: So statins definitely have a small but measurable effect on, on, on in some patients.  I don’t think it’s most, and I know most cardiologists are taking a statin and most of them every seem pretty clear to me. So I don’t think it’s everybody, but who knows Basically, like there were sharp before they start find be acid has not been shown to have that any activity in the brain.  It just doesn’t, it does, it can’t be activated the brain. So it should have no off target effects as we would think about it. So the problem with teric acid is that while it lowers LDL, it’s, and it lowers it by about 25%. It’s not as only as statin. Statins can lower LDL by 40, even 50% Persu statin, for [00:10:00] example.  But it does have a very nice effect on H-S-C-O-P. So is it anti-inflammatory? It has a robust benefit, and this is on top of a statin. So despite or improved on top of a statin, it lowers inflammation, which I think is a good thing for the body. And it can be combined with ezetimibe. Ezetimibe works completely differently.  It blocks absorption of cholesterol into the body, so you block reduction with pmp, doric acid, or a statin. You block absorption. With Ezetimibe and you end up with a nice adjunctive benefit. Now, when we add the two together, we get about a next lat instead of setting it inside the pill. So it’s a single pill.  It’s the same price as Nexlitol. It comes with a copay card. So it’s, I think it’s for most patients who have insurances five to $10 a month, but it does lower LDL by about 38%. And this on top of a statin. If statins are not in the mix, it’s actually a little more [00:11:00] focused than that. It’s probably about 45% LDL.  So this becomes statins as far as its LDL lowering without the brain fog, diabetes, or muscle toxicity. So just from a pharmacological perspective, this is a once a day pill. This is a dilation. We did an outcome study. I was parting this. I was one of these part principal investigators of this clear outcomes trial.  We randomized patients just to beic acid or placebo. We didn’t use Zetia part ’cause we didn’t wanna, we wanna see what just this drug did suffering. But I don’t use this drug without ezetimibe in most patients unless it had tolerated predictive or events. Three point mace, which is a primary endpoint, mi, stroke and death reduced by about 15% was significant was statistically significant.  Heart attacks reduced about 23% and revascularization about 90%. Do you choose. So a good benefit, a decent benefit, and certainly full [00:12:00] outcomes. Now with daic acid, if you add acetamide, which also has outcome benefit, you’re obviously gonna do better than this. So. What about other therapies? 12, you know, fish oils and in cardiology we don’t think that the mixed E-P-A-D-H-A has as much benefit as jerk EPA, at least for cardiovascular benefits.

So DHA for brain development as a young person or for eye development very important. But DHA disrupts the membranes and can decrease the efficacy of therapy. And that’s been shown now in a few different ways. But pure EPA has always consistently shown benefit. I’ll just show you two of the trials, but there’s now nine that show benefit if he has purified EPA, which is one of the two Omega where it’s only one of them.

So this is I’m sorry. This is EPA 1.8 grams. They did have statins on board as background therapy. The FDA requires [00:13:00] background therapy of statins for the clinical trials. So we don’t have any monotherapy with ETA outcome studies. But in this trial, I is from Japan, the jealous trial. EPA lowered cardiovascular events by 19 statin, which is pretty robust on top of a statin.

This was actually the first study ever in all of cardiology to have people on a statin. It improve outcomes further. ’cause we had great data in the early days with niacin cova. We added niacin to a statin. We didn’t see as much in net reduction. We had great data in the early days with fibrates like gem fibril.  When we added it to a statin, we didn’t see that same benefit. So we think that some of statins might have. Taking away some of the risk and then the residual risk was lower, or these agents overlapped too much with statins and didn’t really show the same benefit. But despite being on a statin, when you add EPA, you get additional cardiovascular benefit.  Sorry, did you say that [00:14:00] DHA interferes with the action? Yeah, so DHA, if I don’t have the mechanistic slides here, but DHA, we know from cardio, at least from a cardiologist point, it interferes in the lipid bilayer. And it makes that the lipid bilayer more permeable to things like oxidation. So, ’cause we’ve done, now, I don’t have the slide, but there are nine, nine outcome studies with EPH plus DHA.  Right. And all nine are negative. This shows no over benefit. We have nine studies with. Our EPA some anatomical studies and three big outcome studies, and all of them are positive. So we kind of should infer that DHA must take some of the

Dr. Weitz: benefit out. I’m gonna suggest that you consider at some point doing a study with EPA and DHA and also include tocotrienols, which are a vitamin E compound that reduces the oxidation.

Dr. Budoff: No, that’s a great idea. I think we need to be smart about our antioxidants. We didn’t do very good studies. I [00:15:00] wasn’t involved, but we didn’t do very good studies in cardiology of the antioxidants. We did a couple studies just kind of generic antioxidants and didn’t see a big benefit and kind of abandon that thought process.  But I think oxidized LDL. It’s bad. And I think if we can reduce oxidation, we’re gonna be in a better place Chief, and they plays not THA of the brain. Yeah. Yeah. So I think for the brain and for the eyes, THA is very good. I think once you’re fully developed, though, I don’t know if you need more, I don’t know if it, I don’t know how it works in adults, but I think for growing simple, DHA is very important also in children and infants and we, I mean, remember there’s very few pills that you can give pregnant women indiscriminately.  And one of them is fish oils because it’s so important to them and for the development of their child, right? So there are some prescriptions that are legitimate to give to pregnant women that we think are actually beneficial and have no risk upon. So. We had that trial from J [00:16:00] from the Jist trial, but that was a Japanese trial.  Like for some reason the FDA just will not accept trials that don’t have some US populations. Even though when we do US studies only and we export the data, we expect everybody to accept our findings. So it’s a little two-sided, but, so they made us do this trial and that was one of the principal in investigators for the REDUCE IT trial.  So the REDUCE IT trial took over 8,000 patients. They were on a statin ’cause the FDA acquired Statin background therapy and then Bobbi Triglycerides, and we randomized them to four grams of PPA. I, cosent. Ethyl is a precursor of EPA it or placebo and followed them for the next five years.  And in five years, this is the stat plus placebo arm, and the LDL was well controlled. It was well below 100 milligrams per deciliter, and they still had 20% event rate over five years. When you look at [00:17:00] the when you add fat cpa, you reduce their risk by 26%. So ENT ol, this is two of the trials jealous and reduce it.

There’s a third outcome study called Respect EPA, which ’cause nobody does and obviously seen in Japan. That also said about the 22% benefit. So 19 22, 20 6% benefit. I did a mechanistic study and these are just individual outcomes where you’ll see it’s very consistent. It lowers death by 20% and lowers stroke by 28% and lowered mi by 31% across the board benefits and so couldn’t be looked at.  There was benefit with being on EP. So I did a similar study of mechanistic study using CT angiography. So non-invasive angiography. We start an iv we would give a little bit of diet and he takes his pictures, we make three the images. Dr. Elkin was a big fan and ordered a lot of them for his patients.  And that’s how I [00:18:00] got to know Howard. But but the Evaporate study what we did, and I was the instance, I was the primary investigator for this trial was same triglycerides, a little bit up, LDL control Nystatin, and we looked at four grams of ient, ethyl, again, EPA, and this time this is statin monotherapy.

This is progression of apella above the line in red and in blue is the combination of EPA plus. Statin. And you can see across the board regressing of every block type that we measured calcified plaque doesn’t really change when it didn’t change over one period of time over 18 weeks, one and a half years wait I is DP administered in those studies?  Is this a pill something you take with It is a gel cap. Gel. Capsules, yeah. Two, two BID. They’re one gram each. So take two in the morning on empty stomach or, oh, it doesn’t matter. Doesn’t matter. Yeah. Alright. Okay. Yeah, and [00:19:00] they’re gel. It’s refined, so it’s not straight, short.  It’s refined. There’s nine. There’s knowing processes going from fish to purified. EPI, it has on average 98% pure EPI in the capsule. If you were to get, let’s say Mega Re or one of the other dietary supplements, they’re not those open seeing the production. But mega Re of 1000 milligram capsules has 300 milligrams of EPA and DHA and 700 milligrams of other, I don’t even know what it is.  This has 980 milligrams of EPA out of a thousand, so you might have 20 milligrams of other, so it’s much more purified. It’s also done in a highly controlled environment with no oxygen so that they don’t get that antioxidant and it doesn’t smell, which I think demonstrates the lack of some of the oxidation of and oxidative properties that we get.

Why fish becomes odor and more malodorous as it ages. [00:20:00] So it’s a odorless capsule if you were to break the little gel cap and take out the liquid. It’s not only CLIA but it’s also odorless. And we’ll talk more about odorless in a moment when you talk about garlic, ’cause it’s another process cap at Spring Strong to be able to purify garlic supplementation as well.

Cute. Yeah. This the one that is great. Oh, this is called vascepa. Oh, VAPA Prescription Claim. Prescription. Yeah. They have copay cards. It’s literally cheaper than in most, for most patients. It’s cheaper than buying a big bottle of fish oil tablets. ’cause it’s, I think it’s $8 with the, with a copay card.

Even though it’s a prescription. If they have. PPO or A CMO, they have coverage and there is a generic formulation as well. It wins. There is a generic formulation of out cepa, so it’s not, you don’t have to get the name brand and so it’s definitely something that I use in my practice. We only started even the [00:21:00] setting of high triglycerides, elevated triglycerides.

Chris, we always used to use fish oils as one of the ways that water triggers right. But we don’t really know if you’re total one, if you would benefit or not from this treatment. ’cause I just wanna show you testosterone just as a a little bit of a warning. I’m a fan of testosterone with plate treatments, but I literally saw patient this morning and it came in at his calcium score, went from a hundred at one 20 to over 400 in three years.

So he tripled, literally, it went up a hundred percent for a year, for three years in a row. And he’s healthy and he’s fit, and he works out and he’s thin and he says he eats well and he exercises a lot. And he couldn’t understand why. And I’m, and he shows me all his labs and his inflammation is normal and he doesn’t have diabetes.

His A1C is perfect and ZDL, his lipid profile is excellent, but his testosterone has been running about 1500 oh for three years in a [00:22:00] row. And I’m like, what? What? What’s going on? Like a lot of testosterone did this study, the testosterone trial, and we showed that if you overweight testosterone, this is progressing of testosterone of block.

All six types of plaque got worse. This is placebo, so it got worse for the placebo except for the calcification. It promoted more noncalcified plaque, more total plaque, more low attenuation plaque, fibro fatty plaque than wipe plaque. It actually increased the calcium score as well. Dense calcium is just a CT angio sub particle of calcification, but.

Well, it said clearly like you just, like, why would you take this much testosterone? I mean, I realize some people wanna, you know, pretty muscular, whatever. And he says it wasn’t a libido, it was that he was trying to get his free testosterone higher and he didn’t get it up until he was with pleading himself with that huge amount.

So I recommended that he goes down to 700 or lower [00:23:00] just because I think he’s driving. ’cause the only risk factory he had was this crazy testosterone level. But I do think he was over repleting. This testosterone and I do this it can cause

Dr. Weitz: significant issues. Do we know what the mechanism is? Is it because of a decrease in HDL?  Does it increase iron? Do we know what the particular…?

Dr. Budoff:  That’s a great question and I’m not sure we know all of the effects of testosterone. It, it was thought when we did the testosterone trials, which was seven randomized trials sponsored by the NIH. Taking men with low testosterone and giving them AndroGel.  So hypothesis was, it was gonna do a lot of good. It was gonna help with bone density, it was gonna help with muscle mass, it gonna help with libido, it’s gonna help with depression. And it was gonna help with plaque and coronaries. The endocrinologist fully believed that they, but their, these patients would be better at and they got worse.  And I think it’s, I think we just think a 75-year-old man at turning them into a 30 5-year-old man may be a little bit too much. But I don’t [00:24:00] know if we know the exact mechanism, lower level. I think a lower level is safe. At least be able to traverse trial. It shows that it’s safe and I think to address symptoms, just like I use hormonal placement therapy in my postmenopausal women.  I use it to replace plete their to help them with their symptoms. I keep the doses lower than we’ve historically used and we don’t see all of those negative effects. I think the same is true of test testosterone. We don’t need to turn up 70-year-old woman into a 30-year-old woman with high hormone levels screen, need to get her back to where she’s feeling better and not losing bone and other benefits of hormone replacement therapy.   I think the same is true in me but I think a lot of people just abuse it. ’cause once they’re on it and they’re getting more muscular, it’s. Might as well inject a little bit more. And we just know that we know it has a lot of adverse effects. ’cause we see all the bodybuilders who suffer long-term consequences.

Dr. Weitz: He’s saying you don’t see 1500 testosterone in men who use gel. It’s [00:25:00] pretty much from injectable. He was injecting.

Dr. Budoff: Yeah. He said he was injecting 0.2 twice a day, but I don’t know. Wow. But he, is it only 0.2? I try not twice, say twice a week. Oh. I think he was using more than that because Right.

We’re across the board. Right. And his, I don’t know, I don’t know his primary, I didn’t know recognize the doctor’s name, but I just told him I think that you have overt proof that your credit, we did CTAs as well. And the CT joke got words too. Wasn’t to the point where he needs bypass surgery, but.

In three years certainly looks worse from his coronaries on the outside. He looks great and all his labs are. So it was like scratching my head. I’m like, I have no idea until I saw his vesto levels. I’m like, I have right head out of what’s going

Dr. Weitz: on. Not everybody here probably knows the difference between a coronary calcium scan and CT angiogram.

Dr. Budoff: I’m gonna show that in minute. Okay. Yeah. I have some studies on garlic where we did CT angio and I’ll show you some pictures here, but thank you. So let me now go into garlic. I’ve been [00:26:00] studying garlic now for 20 some years and I actually came into this not as a believer in garlic supplements for heart disease, but this company WGA from Japan, in Japan, they study this as a pharmaceutical, so it’s a pharmaceutical.

Study called a pharmaceutical product in Japan. So we have this age called extracted it ages for nine to 18 months until there’s a certain amount of what they call s alleles cysteine in the SAC in the product. And then they stop aging and then they bottle it, or it have up, it comes in a liquid form or they make it into a gi.

So they came to me and said, look, we have a lot of trials to show lower blood pressure. They the lower cholesterol we want see if the lower plaque and coronary arteries. So I’m like, that’s fine. So they paid for a study and we did a randomized trial. She’s actually our second trial. We did a small study.

24 patients [00:27:00] all just randomized 24 patients. And it slowed coronary calcium compression significantly. And I was totally surprised ’cause I was just didn’t expect it to work. But I wanted to give them the benefit of the doubt. And they have a lot of trials in Japan that shows different types of benefit, but they never looked at the CT scan.

So we did this study, which was another coronary calcium scan and we gave them placebo or caric ion they matching. I don’t know why they’re not matching here. But anyway, this had a combination. This was a it was called a folic cyte reducing formula as well. And it tried maybe 12 fold gib being six L arginine along with aged garlic.

What was the point of the L arginine? The, this was their homocysteine, lord. Oh, okay. So they wanted they, this was at what the time that was when everybody was going after homocysteine very aggressively. And this was their formulation. It was a prepackaged formulation. Okay. And we did if you look at a flip bases, LDL went down nicely at [00:28:00] almost 20%.

HGL went up quite a bit. And total cholesterol came down, triglycerides came down as well. We didn’t placebo, we didn’t see much in action as we would expect. And then it had a significant effect on the lipids at one year. Then looked at endothelial function. So we had this cuff that we inflated, the deflating that looked at how quickly the capillaries we filled to show how robust the blood flow was.

That, and if it comes back nicely, it’s healthy. And if we show then yeah, lower is better for vascular function, decrease the. Less impairment of vascular function as compared to placebo. So having a overall vascular chain, but, and it slowed coronary calcium. So we did another study this time, firefighters again, looking at this time we use Coens and Q 10.

This was another one of their prepackaged formulations of [00:29:00] garlic h garlic plus Cote Q 10. And we looked at our firefighters and this time we looked at just corona calcium as the primary endpoint. And we followed these firefighters for a year, randomized either placebo or age garlic plus CO G 10 calcium progression slowed by 53% in the patients on age garlic.

We did see a, about a 30% slowing in the previous study. But this was a little narrow loss. We takes the endothelial. Function again in sleep to vascular health, improve by about 90% as compared to placebo and Creactive protein letdown significantly with this combination of H Quality in CO had.

But the, now we know, I don’t have more slides on it than this, but I think it does play a nice supplemental role with lipid lowering, especially if people are gonna use statins. I always add, I always put them on coq [00:30:00] 10 as a supplemental health balance outcome of, I think it does have a number of physiological properties that are helpful.

And we did see this in the trial. We did see inflammation benefits. We did see benefits on vascular health. And we did a separate study with a company that just makes CO G 10. And we actually showed improvement in endothelial function and vascular health. We again saw this nice reduction in C-reactive protein and another lppl A two, which is another, what we see as a more coronary specific antiinflammatory marker.

Both went down in this combination of co high H Dora Wasco Etan. So this combination, nice job on inflammation and a nice job on, on coronary calcium. But then we moved on to more advanced studies. Now we, there’s a couple years later we now have CT angiography and I’ll show you the pictures, but we can see really [00:31:00] elegant plaque types in the study I showed you with the fish oil, with the cepr and the testosterone.

We’re done with serial CT angiography where we inject dye into the corona areas. We can see noncalcified plaque, soft plaque. We can see vulnerable plaque. We can see the artery stenosis. So we get a lot of information. It’s just the clearly scan. It clearly is AI of that study. Okay. Yeah. So it’s a clearly the scan that we use and then send it to clearly ai.

Got it. Yeah. So this is 72 patients randomized, either coic with placebo. This time we just used coic by itself to try to see what the pure effects were of the h garlic. ’cause if we keep mixing with other things, we never really know what’s causing the benefit. These are some of the sample pictures.

Well, the dyes in the center here on its colorized green just to show the lumen. This is what it really looks like is white and we can see the artery and if there’s a blockage, we see a pinch, and then we can see the plaque type. And we can see all of this [00:32:00] redy blue stuff is noncalcified plaque and fibrous plaque in the artery.

And we cut the arteries into tiny thin slices, less than a millimeter. So we kind of cut the art like a little spread, very thin cuts. And we measure the plaque in every single spikes. So we get plaque at baseline, we get plaque of follow up, and we can see are people getting better? We’re getting worse under the influence of drug X or drug Y.

This is very ocular Now we’re doing trials with LP A, we’re doing trials with Lyran, we’re doing trials with Pcsq nine inhibitors. We’re doing trials with tirzepatide, the GLP one, GIP combo bill or her injection with lil. We’re doing all kinds of studies with these ages and basically if you use chi, like total plaque went up a tiny bit of this course said year one of the placebo, but went up significantly on more.

Same thing with soft plaque with noncalcified plaque. The dangerous plaque, which is a [00:33:00] primary influence such as low attenuation plaque, actually wipe down significantly. That’s a big change of low attenuation plaque and calcified plaque, again, stay stable. So we publish that work and said it slows down soft plaque and non ified plaque that lower attenuations what we call vulnerable plaque that got better with garlic.

We then did a meta-analysis. This was one of my former fellows. First home we did this meta-analysis of all of our studies and 210 patients total. Ron Garlic. We can see in the garlic group that the progression, the change over the course of a year was 10 points on the calcium score and the placebo group was 18, so it was about a 40% reduction in the rate of progression of coronary calcium.

Didn’t reverse calcification but exploded significant. This was four trials out of four, so every time we did another study in a [00:34:00] double blinded placebo controlled environment, Gox slows calciums regression. So I use a lot of this H golic extract. Because of this significant And how recurrent benefit, a very consistent benefit that we see on two pills twice a day.

It’s that’s the maximum dose. Yeah. They usually go one pill twice a day. But we did one of the studies we did at 1200 milligrams, which is two pills twice a day. That would be the most I would give somebody. But you can go up that hot. You I was just

audience: at the dose. It’s usually one twice a day.

Dr. Budoff: It’s usually 300 plus BID say just 600 milligrams a day. But you can go up to, I’m sorry, 600 BID, sorry, 600 milligram tablets twice a day, 1200 milligrams. But we did one of the studies we did at 2,400 Millers action. We did two pamphlets twice a day. It’s odorless. It’s again, it’s age and so there’s no odor.

So it’s nice ’cause they’re getting garlic without smelling like a clove. But it’s very few side effects. Most people tolerate it. There [00:35:00] is a small percentage of patients who will get upset stomach from the garlic, but it’s very well tolerated compared to trying to eat a lot of going on. It doesn’t act that same of issues.

These are the four studies. I say 1, 2, 3, and four for the four trials that happening. But anyway, for it slowed in garlic slowed calcium progression in first trial. In the second trial, in the third trial, adding the fourth trial to in benefits across all four studies. So, well, and then I was like, this is just, and then this is another benefit of garlic.

This was done by a Gar, a hypertension expert in Australia named Karen Reeb. She does blood pressure trials. She looked at all of the different published trials that have ever been done with NIK on blood pressure, and she saw consistent benefit of H Gold extract. All of these were h extract trials.

You can see they do a lot of studies like Karen [00:36:00] Reed herself in Australia did four different trials. And in our studies as well, we saw a consistent effect on blood pressure plus. So it does lu blood pressure, it does lower LDL. And it does lower cre, react protein salt, and then it lowers plaque in the cornine.

So I think it’s one of the nicer supplements, if you will. I think it’s cheaper. I eat a ton of garlic that they don’t need it. For sure. And part of the Mediterranean diet, if your fans, garlic is a big component of that. I think that might be one of the major benefits. It’s interesting ’cause garlic goes back thousands of years as a historical supplement on the Olympic athletes in Olympic greats.

The Olympic athletes used to use go as a performing Hansen before they compete. Huh? They read Go grave if they use. So yeah. So it goes back quite ways. It’s also about to have an anti-inflammatory, I mean an antiviral effect. So, so, yeah. All knock out Cool. Real. Yeah. Yeah. And I think if people are using it in COVID as well to try to help.

[00:37:00] Offsets some of the viral activity I saw. Okay. I’m not sure I caught accept things.

audience 2: Why each garlic would be superior to crush garlic.

Dr. Budoff: Well, so, I think the problem is when we crush garlic or dice it or cook it or saute that it might have release different properties. So it’s just an inconsistent effect.  There was a pro, a study done at Sanford where they gave garlic supplements. They gave it in, they, you sliced garlic and they put it in sandwiches just to look at the LDL effects and it didn’t have much effect, but. It might be the amount, the consistency, how you cook it, how you dice it. This is just a very consistent formulation.  But I agree with you, if they’re eating a ton of garlic already, I don’t supplement that is more garlic. But a lot of patients either can’t tolerate garlic or don’t like it or just don’t eat enough of it. And I think, you know, a capsule that gives you the same efficacy as a clove is probably beneficial for them in multiple [00:38:00] ways.  So, anyway, so lemme just move on to writing rice of a fan, actually.

audience 2: The cream. Yep. There’s a lot of variation in the quality of marshal garlic. Are there any Dan brands that or available that we can have?

Dr. Budoff: I think this is, this one I like the most. It’s called H Golf or Colac. This is the one that I Kyolic.  Yeah, it’s a Japanese, it’s made in Riverside, though. It’s actually not an, it’s actually a domestic product if you wanna support in us. But it is the, this fair company is a SSIS company called they’re in Hiroshima, Japan. I like this one. We studied it a lot. They have literally hundreds of publications of clinical trials that they’ve sponsored where it is lik, or a lot of these other companies have not, they’ve never done a trial.  They just strain package it. And as the state used to have Larry King. As this Spokeperson. But you know, they’re still on the radio. I saw them [00:39:00] recently. There were, there’s television they not too long ago. So they’re still advertising, but there’s just no science behind it. And maybe their formulation is just not as pure.

Just like the fish oil arguments, if you don’t have a purifying version, you might be getting a lot of junk. Remember the Food and Drug Administration by law is not allowed to oversee dietary supplements. That was a law passed. I don’t know why, but they will not ask by dear Nebraska or North Dakota.  One of the one of the senators there, practice law passed that says they’re not allowed to oversee production of dietary supplements. So all they can do is stop people from baking. Over claims of health, but if they want to put just talc, you know, in a capsule, then sell it as coq 10. They can do that.

And if they wanna put vitamin C and sell it as whatever, they can do that. Like there’s nobody, no, there’s no regulations on what they’re putting in their capsules and no, no oversight. So it’s always a little bit, you have to get the right product. Obviously while we’re talking about sub

audience 2: and just only, there are third [00:40:00] parties.

Dr. Budoff: There were some, but the problem is you ate a plague. So the third parties, you pay them to say that your product is pure. So I’m just. Not a hundred percent sure that’s an independent third party. It is a third party. But because you pay them to validate the product, I don’t know. There might just be a little potential for bias there.  It’s not like the an independent agency that’s doing this naturally. There’s a company in Australia that looked at 22 fish oil products and found like be 20 of them, had like high levels of oxidants in the capsules and a lot of saturated fat in the capsules. Just a totally independent study of these dietary supplements.  But you’re right, there are some consumer, what’s it called? Not consumer reports, but there is a consumer labs. Yeah, they do. I think. I think that’s it. And they do supervise things, but again, the only ones they supervise when the company themselves pay for the, [00:41:00] for them to endorse, to validate the product.  So it just might be a little funny compared to how we think about. Third party checking on the safety and efficacy of these, pure purity of these of these capsis. Red rice has really will bus data. Most of it’s outta Japan or chain of rather. So it is a little bit limited in our global understanding of how well it works.

But these studies that came out with pretty good high doses of Reggie’s rice did show very consistent benefit on LDL cholesterol. A little bit of an inconsistent benefit, but largely a slight raise in HDL and certainly a very dramatic drop in C-reactive protein. And I think we all recognize that RIN Twice is very largely a naturally occurring statin.

Say this is the statin event. But if you get to high enough doses, you get a very much a statin like effect in patients like it just because it’s not. [00:42:00] I don’t know, manufactured by the, for the big companies, but some of them there were, there are statin induced myopathies that have occurred with red reduced rice as well.

But it is a way that I get some of my patients who are one on a statin to be on a statin without calling it a statin. So it does work to get them on treatment, so our outcome studies as well, and the effects are quite good. Now, again, a lot of these are now this is the only one. The these three are heritage.

They, you can see the effect. It’s quite good. It was again, a Chinese study and there’s always a little bit of question about the accuracy of the data coming out of China. They tend to do things a little bit differently than we do, but almost 5,000 patients, four and a half years. And it did have a nice reduction in non-fatal MI and culinary gap which was up there with let’s say the four s trial, this indecent Bible study.

Also 4,000 patients, also five years. And another similar primary effect. So it does have [00:43:00] at least one good outcome study this Chinese coronary secondary prevention study. But I don’t think we have a lot of great. Data from this, like 20 years old, this study. So I think it’s a little jaded.

I,

Dr. Weitz: I think a lot of the studies at 12, 400 milligrams are really under dosing, and from what I’ve seen, I think 24 to 48 is really the sweet spot. I

Dr. Budoff: think I, I use mostly 2,400. I haven’t gone higher but I agree with you. I think you can get up to that really full effect of the drug, at least with 2,400.

You mentioned this vitamin E formulation. It is actually incorporating some of the red, these rice products. And it does have an antioxidative properties for sure, and it does have some di inhibition of Cory reductase like a statin. So it does have kind of cost is over towards ESE rice and they’re often combined with ESE rice as well.

So it does lower LDL, it does lower C-reactive protein. So [00:44:00] another option is this vitamin E product, which I think is the. Also the vitamin eight sub antioxidants. I think it’s probably the most ash above them.

Dr. Weitz: Yeah. Designs For Health has a product with Red G Rice and Tocotrienols also, yeah.

Combination. Yes. Which is the company designs for Health for Yeah, it’s, it got Barry Tan working with them, who’s the guy who really pioneered the Toco tree and s I’ll remember that design.

Dr. Budoff: And then something that I always thought was gonna make a huge splash. It was actually a company that was starting to market this probably a few years before COVID, a few years, about seven years back, and then they just disappeared.  I don’t think it was due to COVID, but I think they just never really got a foothold here with like Citrus Ide. This is afraid of mine. Peter Tele. It was a very full very well-respected lipidologist. Did this study. He took any subjects, he took patients with hypercholesterolemia and he gave them this oid d extract blood be [00:45:00] art.  He was 160 milligrams of flavanols, which is just a formulation of the Fibrate for six months. But he saw very nice drops in. Now, I’ll show you the benefit in LDL in just a minute. But he not only had a drop in LDL, had a nice increase in HDL and it caused a decrease in small dense LDL particles, which we think are the bad players.

And most impressively, the carotid INT, the carotid ultrasound decrease significantly from 1.2 millimeters to 0.1 millimeter, which is 25% in just six months, huh? So he said that this is abstract supplement, significantly reduced plasma lipids and improved the lip glypho poin profile and two is also reduced significantly over a relatively short timeframe.

When you look at the effect, even going from. The first quartile of fat all the way down to the board. There’s a pretty consistent effect of LDL [00:46:00] reduction, far from about 18% down to about 2020 2% LDL reduction. So as a nice, and this is just a six month trial nice reduction in again, small dense LDL particles went down, all the different particles went down.

It. A sma, I think it’s out there. Oh yeah. We use it all the time. Formulations. I don’t know if this one, okay. What? I don’t know if photographed is a Oh, sutras berg. Yeah. Yeah. SU’s matter, the formulation. So this is no, I don’t think so. This is the name of the supplements. Yeah. Yeah.

There’s different about it. No I think it’s a very effective one and the works completely differently than some of the other mechanisms. So it should be very complimentary to other ways of lower cholesterol. So we have beda acid, we can add it ezetimibe. We have ethyl Vascepa bapa. We have h garlic, you have Reggie’s rice with Choco triol.

We have the citrus bergamot. There’s others that I didn’t go into today just for the sake of time, but there’s [00:47:00] very nice data on stanols and sterols lowering LDL. There’s very nice data on ine, although that’s another one that kind of what. Lad out with, when we tried adding it to statins, it didn’t seem to have that same benefit, but I still use it for patients with very low HDL.

It’s a very nice supplement. It’s just gotta go slow. ’cause of the flushing,

Dr. Weitz: significant lowering of LP little a Yeah. Yeah. And it’s one of the few compounds that can increase LDL particle size and no, I think

Dr. Budoff: it has great lipid benefits. Unfortunately the big outcome studies that were done, I think just recruited the wrong patients.

They recruited and used the

Dr. Weitz: wrong product. One of ’em, yeah, one of ’em had niacin compared with a product that reduced the flushing. Flushing, yeah. Yeah. That is known to, yeah. Yeah. Yeah.

Dr. Budoff: So, and they also didn’t take patients with low HDL, which is where I think the MET is the greatest. They took patients with normal HDL, with kinda sewage.

So I know they really proved that Greg. Oh, what’s [00:48:00] his name? I gonna say Greg Stone, but that’s not it. Greg. Anyway, the person who did the hats and the fats trials, a lot of the early studies, he studied patients with high LDL and no HDL. He showed remarkable benefit plaque regression by doing coronary angiograms really nice benefits of adding niacin to, to patients.

And unfortunately when they did the big outcome studies, they studied a different population. It just didn’t work so well. They that it was largely abandoned. But I agree with you. I think it saw has some really nice properties and I saw a good number of patients. We take cin and then resin binders are actually really interesting because not only do they bin LDL in the gut, but they actually lower glucose significantly.

They actually lower hemoglobin A1C by about 20%. They’re actually listed in the American diabetes as an anti oral hypoglycemic agent separately from their LDL effects. We don’t use them a lot. Cholestyramine whole Cho, yeah. [00:49:00] Colestipol. But they actually lower LDL and hemoglobin A1C white Cate.

So di of curation agents. Yeah, there’s some, yeah, there’s some curation. Yeah, I mean, the chelation data, the big studies that we did, tact and T two tact showed a very nice benefit. Tattoo didn’t show as much of a benefit. But again, I think they were somewhat limited by sample size and selection of agents.

But chelation is another oral chelation. Now. Agents are a little more robust than it used to be as well back then. Back then we were doing weekly infusions for chelation. So I think that’s mostly what I wanted to show you. I leave you with this 5,000 year old concept of probably the English instead of the Chinese, that training medical superior doctor, preventive disease, medioc, doctors, tricky disease.

P before comes evidence and inferior doctors treat the full blown disease. And I think at least in cardiology, we’ve often waited for patients to [00:50:00] present with heart attacks with severe blockages needing stents. That I think we do a lot better with prevention. I’m not sure we totally prevent sclerosis and wise to the level of being a superior doctor in the eyes of East Chinese, but I think we can definitely do better than we’re doing in most of our practices.

Dr. Weitz:  So there’s been a lot of discussion in recent years about the endothelium, which is the lining of the arteries and that being a big issue in terms of plaque formation. And so there are various natural compounds that are fairly popular that can modulate the endothelium. They don’t necessarily lower LDL, but they potentially lower the risk for cholesterol to form plaques.  And one of them is something called arterial cell. I don’t know if you’re familiar with that. And then the other product that’s, there’s a series of products that are used to reduce, to increase nitric oxide [00:51:00] production. So we have products with fermented beets and have ni nitrates in them that are converted into nitrites and and needs have shown a lot of benefit.

 

Dr. Budoff:  What do you think about, I did a study with one of them German, remember the name of the one we did with the meth, nitric oxide raising? It was kind of the formulation, Zyme or Neo 40 or, oh, I’ll look it up. Okay. You, which for was, but no I think the endothelium is really important.  We know that’s part of the benefit of let’s say the sildenafil or, you know, Viagra. We did it pulmonary hypertension ’cause it was effect by the endothelium and it raises nitric oxide. There’s a new drug bur has for heart failure called siggu which. Ends up raising nitric oxide levels, basically type GP and we, we use Rios of it for pulmonary hypertension, and now they’re trying to formulate this new medicine for work [00:52:00] failure.  So those are all endothelials, direct endothelial benefits. But I agree with you. I think end the dealing’s really important. We have some good data with the garlic. I showed a little bit of the endothelial protection, but not, doesn’t probably work directly through nitric oxide, but I think that’s a really important additional aspect here to think about.

audience 2: I’ve seen a product a conference and I don’t remember exactly, but they were addressing the glycocalyx in they singing Yeah, the arteriosil,

Dr. Weitz: the art arterial. Yeah. That’s their, yeah. It has this special kind of seaweed that helps to support the lyco kx, what the

audience 2: name of the pump. They will have example, what you must have seen them do.

It’s up to spa is on

Dr. Budoff: up to, yeah, I’ve heard of Arteris silk for the GCL kill, so I’m sure there’s other products out eat right now. There’s never just one but yeah, it’s, I think

Dr. Weitz: brown seaweed is the important ingredient that supports the glyco. So

Dr. Budoff: anyway, I was hoping at the cherry [00:53:00]

audience 2: regarding the CT angiogram number one, how does this stack up?  Who gets the physical? DLA And how does clearly compare with the Tesla and number two, how do you approach like when to get out, like to mention someone in the forties, fifties versus exposing know to, right.

Dr. Budoff: Yeah, so I mean, unfortunately here on the west side, most of the scanners are pretty old and the radiation doses end up being pretty high when clearly takes the existing non-invasive angiogram.  The CT angiogram that we do that with an iv, we take pictures. A lot of those scanners that they’re using. Are just old and they give up ger radiation and it clearly takes those pictures those three dimensional pictures. And then it does additional analysis, ai analysis to give you plaque types.  So it’ll tell you how much vulnerable plaque you have, log calcified plaque, kinda what I showed you, those six [00:54:00] components, it’s the same thing that clearly does except those took us three hours per person to make those measurements. It clearly it takes seven seconds. I love that. Yeah. So, yeah, and I use it to follow patients over time because if their noncalcified plaque is getting worse, then I know that they’re not quiescent in there, in their disease state, which can look for targets maybe with all these different therapies and we can potentially apply it for them to them.  And so I think it’s a nice way to track. Patients over time.

Dr. Weitz:  Can you explain the significance potentially of soft plaque versus calcified plaque?

Dr. Budoff: Yeah, so we think, you know, we think the calcified plaque is basically just a marker of how much plaque you have in your body. So it’s kind of like a, almost a bystander.  It’s the old plaque that’s gotten scar, it’s like scar tissue and you end up with a lot of calcified plaque. If you have a lot of calcified plaque, you almost always have a lot of noncalcified plaque as well. We think it’s like, we think of it as the iceberg [00:55:00] where the, you know, 20% of the iceberg floats above the surface of the water when it satanic was going downstream and it’s an iceberg.  Florida didn’t send divers down below the water to say, I wonder if there’s anything that could rip the hole. We know that it was there. Calcium score is the same, or calcium scan, no contrast, no iv. Just a simple stent. Always low dose can give you how much calcified plaque you have, and that’s not the dangerous stuff, but it’s a marker of how much dangerous stuff you have.  The clearly exam the CT angiogram can now tell you exactly how much noncalcified plaque you have, which is this dangerous stuff. That’s the stuff that can rupture and cause mis and blockages, and then you can watch it convert from noncalcified plaque to calcified plaque and become stable. So inly with serial scanning, you can see people’s plaque hopefully go from a lot of noncalcified plaque to a lot of calcified plaque, so the calcium score goes up.  The soft plaque goes down.

Dr. Weitz:   Let’s say you are working with somebody who’s 30 years old and they have really high cholesterol and the coronary calcium scan, it’s relatively low. It may get like a two or a five or something, which is not zero. But should you do the CT angiogram? Because they might, because a calcified plaque is generally older plaque, and they might have younger plaque, so they might, for the

Dr. Budoff: younger patients, right.

Middle age patients, they could have a lot of noncalcified plaque. And the older patients, they might have less value. ’cause a lot of those patients have. Converted a lot of their calcium or to a lot of their calcified plaque already. And they tend to have a lot of plaque regardless. But I think in the younger patients, they can even have a score of zero and then we could start seeing noncalcified plaque in younger people.

So I, I do think that then now more value probably where we expect to see more noncalcified plaque that be younger people, women more so than let’s say a 75-year-old male. We [00:57:00] use the CT angiogram, but not clearly as much as just to say, do you have blockages? Do I need to think about stents bypass surgery?

Dr. Weitz: It’s one of the potential benefits of statins is that they tend to cause plaque to become calcified, making it stable. Do we know if any of these natural agents in current that that’s

Dr. Budoff: a great question. We have some data with ent, but we actually just studied semaglutide which is we wegovy or ozempic.

And it actually converted some of the Noncalcified plaque. Ified plaque. So we think that might be one of its mechanisms because it does lower cardiac events by about 20%, but we didn’t know how. So that might be part of its mechanism. I don’t think we have great serial CT angios in most of them being is studying except for Coex.

But we don’t have data on the other ones just ’cause we haven’t studied them as well yet. And again it’s the old, it’s a problem of these nutraceuticals just don’t have the research budgets that sure big pharma

Dr. Weitz: does. [00:58:00] And then do we know if the patients who are on a statin and they’re, and they get an increase in their coronary calcium scan potentially because the plaque is becoming calcified, do we know for sure that their noncalcified plaque is decreasing?

Dr. Budoff: Well, we know that with Dabent YL and with garlic. ’cause we’ve had some studies. Okay. But we don’t know with these other ones, arterio still. Okay. Or some of the other there, you know, the Reis rice. Right. Although we just presume since it has a statin mechanism that it would work at the C way.

Dr. Weitz: Is it important that a Reggie Rice supplement.  Not have will lovastatin in it. ’cause as some of the companies say, we make sure we test ours and make sure there’s no lovastatin in ours. To me,

Dr. Budoff: yeah. I mean I thought it was like kind of naturally occurring lovastatin, so I’d be worried if they say they have no lovastatin, that’ll have no effect.

I think that how would work if it now the stat, it’s like that’s kind of what it is, [00:59:00] right? Well, supposed 10. Well,

Dr. Weitz: but I lovastatin but I think my understanding is there this mixture of them sta like compounds and not having the lovastatin means you’re gonna get. Potentially the benefits without maybe some of the negative muscle effects.

Yeah. I would just hope

Dr. Budoff: you just have to make sure the LDL comes down, right? Yeah. We have niacin there. You know, niacin had the terrible flushing, so some companies started coming out with different formulations, right? Yeah. And no flushing, right. But also had no, no ine on the lipids, right? So there’s no flush niacin, but it had no niacin in it.

Right. So I’d be worried if you’re, I just felt, I don’t know. But if you’re taking out the active component, rid of the side effects, well then the product, the effect anymore. Well, so yes. I don’t know. I mean, it’s having a, that’s a placebo then I’ve seen a pretty soon lowering with that products talked about.

Yeah. They dry and other things that might be in there that might be [01:00:00] more similarly beneficial, but I’m just make sure it’s working right. There’s literally no flush. Niacin has no niacin and it all, it’ll have no effect on LDL or HDL, but they won’t flush. So it’s like that. What about the importance of iron levels?

Yeah. On iron is bad. I think high iron is bad. I’ve been trying to get a study through the NIH right to show that, to do CT angio and then give patients iron infusions or placebo. ’cause we use, some people use iron for heart failure. You and I think you have anemia and you give them iron, that’s fine. I think what exceeding back to normal is probably fine.

But I think my theory is that men have more heart disease than women, partly because they run higher iron levels. ’cause women lose iron every month for a long term iron and men don’t. And I think women tend to run low iron levels and that might be one of the reasons why men present with curlier.

Heart disease and why women when with the menopause and they stop having that iron loss and [01:01:00] that that they end up starting to catch up to men. So I think iron is part of that theory. It’s not all hormones. I think iron is, I think iron’s

Dr. Weitz: often overlooked and it often overlooked. It turns out that 30% of the population has at least one copy of a gene that makes them store iron.  The hemochromatosis, there’s three different hemochromatosis genes and so we started doing full iron panels on all our patients. And men usually don’t get iron measured. They’re all, and a lot of women just get a minimal and you’d be surprised how many people have high iron level. Sweet. I’ve seen vegetarians with Yeah.  Storing iron and. Everybody assumed they needed iron, so they just automatically gave ’em an iron supplement without even testing. Kind of seen it as a marker

audience: of inflammation. I have so ferritin. The ferritin, yes, definitely. And I think people who have high carbohydrate diet. Drink a lot of alcohol.  They tend01:02:00] to have high ferritin

Dr. Budoff: change the diet. It goes down. It’s also an acute phase reactive, so it goes up to make sure goes up within ferritin also is reacting. Interesting. Okay. It works both ways, goes your iron stores, but also can go up and down with in Summations. Rudo, I appreciate

Dr. Weitz: together.

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Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine if you would like help.  Overcoming a gut or other chronic health condition and want to prevent chronic problems and [01:03:00] wanna promote longevity, please call my Santa Monica White Sports Chiropractic and Nutrition office at 3 1 0 3 9 5 3 1 1 1 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.

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Dr. Maria Sophocles discusses The Musculoskeletal Syndrome of Menopause 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

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Dr. Maria Sophocles is a board-certified OB/GYN who specializes in women’s health across the lifespan.  She is the Medical Director of Women’s Healthcare of Princeton www.princetongyn.com and she is the author of a forthcoming book, “The Bedroom Gap,” on sex in midlife.  Dr. Sophocles is also the CMO of EMBR Labs, a Boston-based wellness device company EMBRLabs.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.

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Podcast Transcript

 

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

Welcome to the Rational Wellness Podcast. Our goal is to bring you the latest insights in functional medicine, integrative health and wellness, so you can live a healthier and more optimal life. Today I’m very excited to be joined by Dr. Maria Sophocles, a board certified O-B-G-Y-N, who specializes in women’s health across the lifespan.  She is the medical director of Women’s Healthcare of Princeton, and she’s the author of a forthcoming book, The bedroom Gap on Sex In Midwife.  We’ll be discussing an emerging and important topic, the Musculoskeletal Syndrome of Menopause, a concept described in a recent paper from Dr. Vonda Wright from 2024. [The Musculoskeletal Syndrome of Menopause.]

While most people are familiar with hot flashes, mood changes, and genital urinary symptoms as part of the menopausal transition. What’s often overlooked are the significant effects on muscles, bones, joints, and connective tissues. This paper points out that once estrogen levels drop in the menopausal period, women have a 71% increased risk of musculoskeletal pain as compared to premenopausal women, and this is related to an increase in inflammation.  A loss of muscle mass known as sarcopenia, a loss of bone known as osteopenia, a decrease in satellite [00:02:00] cell proliferation, and an increase in cartilage damage and osteoarthritis. These changes can impact mobility, independence, and long-term health span for women. Dr. Sophocles, thank you so much for joining us.

Dr. Sophocles:  It’s so great to be here. Okay, so thanks, Ben. 

Dr. Weitz:  Before we go into the musculoskeletal aspect, the musculoskeletal syndrome, let’s have a brief discussion about hormones. What happens during perimenopause, menopause and where we are in terms of our thoughts about hormones in the medical community, et cetera.  So how should we think about the perimenopausal and menopausal periods of a woman’s life? And I mean, just a brief discussion because I know we could talk for an hour about that, or several hours.

Dr. Sophocles: Well, we’ll try it in five minutes. So, so we are born women with ovaries. Women who have two x chromosomes are born with two little almond sized organs called ovaries.  Those ovaries are hormonal powerhouses. They make estrogen, progesterone and testosterone. That’s right. Women make testosterone, but a hundred percent of women experience menopause, meaning the ovarian function ceases and we stop making all of those hormones in the ovaries. This has enormous effects on many aspects of our health, our bone, our brain, our heart, our skin, our hair, our ability to to make lean muscle mass, but before it just stops. It’s not really a light switch. Like Tuesday, you’re not in menopause, and Wednesday you’re menopausal. Not like that at all. There’s a sort of eight to 12 year period preceding that when the ovarian function [00:04:00] is wonky.  It’s irregular.  it’ll make hormones, but in a sort of irregular way. So if you think of before perimenopause, hormones are made in certain cyclic fashions.  They rise and fall in a specific way that allows women to either become pregnant or if they don’t get pregnant, have a period. That beautiful regular cyclicity of making the hormones starts to falter in the forties, sometimes even the late thirties, and we call this perimenopause.  It’s pretty chaotic. It’s like hormonal chaos. You can get irregular periods, infertility, mood issues, lots of things. Then at some point, there’s not a wonky production of hormones. There’s just a decrease to almost zero. That’s when you become menopausal and you stay like that for the rest of your life, which is about a third of your life.

Women live a third of their lives without ovarian function. And the reason this kind of sucks is that once you’ve lost ovarian function, you have an acceleration of loss of bone density. Okay, so the bones begin to become weaker, starting around 35, and then around 50, they really begin to lose bone mineral density.  In fact, the first five years after you become menopausal, that is the most rapid loss of bone in your entire life. So there’s no way that there aren’t effects on the skeleton related to the loss of estrogen. What we now understand much better in large part, thanks to this paper by Dr. Vonda Wright, who’s an orthopedic surgeon, is that estrogen doesn’t just affect the bones, it leads to osteoporosis, which we also knew.  Estrogen loss affects joints and it affects muscles and it affects our ability to build lean muscle mass. It affects the strength that we can mount with the muscles we have, and it affects sort of the lubrication of the joints. Fluid, right? That keeps them easy to move.  Like our shoulders and our elbows and our hips and our knees. Think about, you know, a car. If you had the oil and the lube, the the, if all the parts of a car suddenly instead of a lubricant had a thick, sticky, non lubricating thing, the car parts wouldn’t work as well. This is what happens, and this is why women develop things like frozen shoulder. Why arthritis accelerates in women after menopause, why they’re more prone to injury. So even if you’re doing the same running routine or the same lifting routine, you’re going to get less muscle strength, you know, less bang for buck from the same exercises. Increased risk of injury and less ability to have movement. Less flexibility. Sorry, that’s a long-winded answer. That’s okay. About hormones. We’re going to, we’re going into hormone a little bit later,

Dr. Weitz: I think. I think we’re into the musculoskeletal, so let’s focus on that now. So, so women have this greatly increased risk of pain.  Musculoskeletal pain, joint pain, muscle pain, and you mentioned frozen shoulder, which is a particularly baffling syndrome where people suddenly have pain in their shoulder and then they stop moving it and the capsule shrinks and then they can’t lift it at all and [00:08:00] they come in to see me for chiropractic work and unfortunately I have to tell them that it could be a year of therapy to get things restored.  So that’s a particularly horrible condition. So explain the mechanism, how horrible you get joint pain like that from that it results from menopause and lack of estrogen.

Dr. Sophocles: Right. So what I was saying is that when you decrease the amount of when.  Make less estrogen. There are estrogen receptors and you know, the terms better, the actual, I think it’s the synovial fluid, right? Right. That allows our knees to bend smoothly or our shoulders to rotate through it. It actually thickens almost like you took I don’t know some baby oil and left it out in the sun for a month or something.  It gets thick and sticky. There are even specific and so it just can’t move it. You’ve lost the ability to actually have one part of the shoulder moving against the other. Please correct me. ’cause as I said, I’m not a shoulder specialist. And so when you lose the fluidity that it becomes viscous.  You, you literally are not able to move the shoulder easily. There are actually cells that begin to form that are inflammatory, so now you accelerate inflammation. On top of that, estrogen is actually an anti-inflammatory. So when we take that away, we remove the ability to keep inflammation down in joints, right?  So we’re more likely for any given motion to get inflamed or even injured.

Dr. Weitz: And that’s really the first takeaway, I think, which is that estrogen is anti-inflammatory and the loss of estrogen increases inflammation in the [00:10:00] body. And that can have negative effects on joints, on heart health, on all kinds of things, on brain health, et cetera.

Dr. Sophocles:  So, yes, because we Right. We know. So the number one killer of women, let’s pivot for just a second. Number one killer of women is heart disease. Right. Just what doesn’t, what we do every day or what I do every day, but if we just look at numbers. Sure. Right? So we know now that it’s not just cholesterol that makes plaques.  I mean it is, but we know that inflammatory processes in the coronary arteries accelerate the formation of those plaques that lead to heart attacks or strokes. So same thing. There are estrogen receptors on the coronary arteries, so once you deprive them of estrogen, you allow inflammation to accelerate the development of plaques and you accelerate your time to a heart attack or [00:11:00] stroke.  It’s it’s depressing if you think about it, except that women can safely take estrogen. I mean, there’s a lot of fear around it based on outdated studies, but when we look at women who take estrogen and those who don’t, we see changes in coronary artery disease. Rate of heart attack and stroke and cancer rate, and even in joint and injury issues in arthritis, things like that.  So, I didn’t mean to pivot away from the muscular.

Dr. Weitz:  No, that’s okay. That’s okay.

Dr. Sophocles:  It’s worth repeating that The inflammatory thing right. Is actually hits us everywhere.

Dr. Weitz: Yeah. The inflammasome. So, estrogen is important and we women should consider talking to their doctor about estrogen replacement as a way to keep their inflammation down and reduce musculoskeletal pain.  Now we all know about the Women’s Health Initiative from [00:12:00] 2002. Which basically caused Yeah. Prescriptions for hormones to be, to drop to near zero because of the conclusions from that study, which was that if women take estrogen and progesterone, that they’ll have an increased risk of breast cancer and heart disease.  And I think we’re now at the point finally where most of the mainstream medical community no longer really believes that’s the case. But I don’t think we’re quite the, I don’t think the mainstream medical community is quite there yet. Or maybe they’re getting there, you might know better, that it’s generally safe to use estrogen and progesterone, as long as the right forms are used.  They’re used at the right time. And there’s still a lot of talk about the timing hypothesis. So where is the mainstream medical community on prescribing hormones for women after [00:13:00] menopause? Where do, yeah, we are?

Dr. Sophocles: So the mainstream medical community, we are getting there. Okay, we’re getting there. Okay. Where the national societies such as we are, and I say we’re getting there because national societies such as the Menopause Society, it was formerly called the North American Menopause Society. And the American College of OB, GYN both support the use of estrogen for women with no uterus or estrogen and progesterone for women with the uterus for treatment of symptoms of menopause, hot flashes, night sweats, things like that.  But also for, prevention of osteoporosis or even treatment of existing osteoporosis. They’re pretty slow still to say. Delay for delay of dementia, reduction of cancer, reduction of heart disease. They haven’t thrown all their weight there, but progressive menopause experts like [00:14:00] myself who read the data, know that those are also stunning statistics from very good studies.  That all-cause mortality is decreased, including from many different cancers. 40% reduction in colon cancer. Like who knew that? Right. Right. That’s crazy. So it’s coming. What’s lagging? What’s lagging is actually, sadly, medical education is still not teaching menopause enough. Not teaching these statistics and not teaching to specialists, right?  You should learn how estrogen affects the joints and the bone, right? ’cause you operate on it. If you are a physical therapist, you should learn in school. The effects. So if a 55-year-old woman comes with a frozen shoulder, you go, ha, wait a minute, you should go also get on estrogen. We still aren’t there yet.  And too many orthopedic I you, I live in California, which is a shoulder hurts. Let’s operate.

Dr. Weitz: I live in California, which is a much maligned state and everybody loves to criticize it for all these things. But, in California, it’s actually mandated that medical doctors learn about menopause and treat it as a condition.  So I think that’s a good thing.

Dr. Sophocles: Yes. It’s actually one of the most progressive states for menopause health policy in the country. I know because I follow menopause policy all over the country very closely.  And I’m very grateful to the lawmakers of California who are recognizing this and the influencers and podcasters who are sort of spreading this gospel.  Because if medicine is lagging behind, we need people like you to say hey let’s catch up. [00:16:00] And right. And I think you and I can, if we can reach even, you know, a hundred people today, we’ve done something good. So right.

Dr. Weitz:  Now what about the timing hypothesis?  I think I talked to some doctors who say, well, it’s okay to do hormones as long as you start ’em right away.  And if you wait, then it’s really bad. And, I have, I wonder if that’s really true. I think that you might not get, my take is, you might not get some of the benefits, like you were talking about the extreme loss of bone that happens in the first five years. You may have an increase in atherosclerotic plaque during the first five or 10 years.  So you may not get all the benefit, but I think there’s still reasons why it may be beneficial to prescribe hormones for women over 60.

Dr. Sophocles: Yes. That’s a really controversial topic. And the theory still,

Dr. Weitz:  I understand. That’s why I brought it up out.

No, but we’re gonna talk about it. Yeah, we should talk [00:17:00] about it.  And the medical community is sort of divided on both good and bad evidence. So clearly we need more studies and more money for bigger, better done studies. But here’s the skinny. What we know is that. The party line right now is that the most benefit happens in that age 50 to 60 window. Remember I said that’s when the biggest drop in bone density?

Dr. Weitz: Yes. Yep.  Absolutely.

Dr. Sophocles: And probably same for plaque formation. If we can keep those arteries clean until 60, we’ve really delayed the onset of atherosclerosis, and probably it’s the same in the brain because we know that women on HRT have delayed. Development of dementia and Alzheimer’s, so. One would think, why don’t I just keep delaying it?  Why don’t I just stay on it until I’m in the casket? And to be honest, personally, that’s what I will probably [00:18:00] do is stay on it forever because I have heart disease in my family, so I want my coronary arteries to get that estrogen forever. But there are, but I don’t want to neglect the reality that there are some studies and one just was published this week saying.  In women who started HRT after 65, the theory, the thinking is there’s already plaques and problems and the brain’s already deteriorating or whatever. And then if you add it, because estrogen can promote clot formation, it could actually lead to problems. 

Dr. Weitz:  Now wait a minute, isn’t that basically oral estrogen?

Dr. Sophocles: Oral. That’s right. Right. You’re so smart. I’m glad you’ve done your homework. And what we need are more studies looking at transdermal, which is all we use now.

Dr. Weitz:  A hundred percent. Yeah.

Dr. Sophocles:  We don’t do oral anymore. Yeah, so, so believe me, in the next five to 10 years, we’re going to have much more data so that if you and I talk again, and I hope we will.  We’re gonna say, Hey, great, we got these great big studies looking at women over 65. They might be mixed. It might say The bone was a no brainer, and if you have osteoporosis in your family or you have it yourself, you should stay on it. But maybe there’ll be some negative or questionable benefit in the Alzheimer’s world.  So it may not as crystal clear slam dunk as it is from 50 to 60, and you have to individualize it. That’s why. Sure. Absolutely. You have to talk about you as a patient and your risks with your doctor,

Dr. Weitz:  And the best medicine is individualized, personalized care.

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Dr. Sophocles: Question was about nutrition supplements, and I was saying that when estrogen drops the way your body stores fat changes, so we’re more likely to put fat on our abdomen.  That’s because estrogen drops more than testosterone, and testosterone kind of guides fat deposition to the abdomen rather than the legs or the butt. This is why men who. Gain weight, usually gain it in the abdomen, but after menopause, women gain in the abdomen. Well, so you, so what does that have to do with supplements?  It just means you have more fat around your belly. You have to look at what you’re eating and find ways that your body’s going to burn that fat. And [00:22:00] usually that’s. From my standpoint with building strength training, because muscle requires more calories, I hope you agree

Dr. Weitz: a hundred percent.  Absolutely. And the fat around the middle. The reason why it’s so significant is we refer to it as, you know, I don’t ask me that all the time. So one of the reasons why fat around the middle is so significant is it’s referred to as visceral adipose tissue, and that visceral adipose tissue is much more di directly related to cardiovascular disease and some of the other conditions.  So we really want to limit that fat around the middle.

Dr. Sophocles: Exactly. Exactly. And that’s where you come in, I’m sure. And you have about a million things you can do to help your clients do that.

Dr. Weitz: So, yeah. One of, one of the interesting concepts around this musculoskeletal syndrome of menopause is that. And this is something I don’t think that [00:23:00] most laypersons and probably not even a lot of doctors are familiar with, is that estrogen is an anabolic hormone.  We think of testosterone as the main anabolic hormone, but estrogen is also an anabolic hormone. It stimulates muscle protein synthesis, muscle cell proliferation, contributes to muscle mass and strength. Can you talk about this a little bit?

Dr. Sophocles: Yeah, I mean it. First of all, you just did a fantastic job, so I’m going to bring you on my lecture tour with me.  You’re fantastic. But estrogen plays a crucial role in the development and the maturation and the aging of bone, connective tissue, and muscle. So it it can infl. This is so nerdy, so I don’t wanna lose everybody, but it can influence. 

Dr. Weitz:  No, I love nerding out on the podcast.

Dr. Sophocles: Well, all right. [00:24:00] I just, it can influence the sensitivity of the muscle to sort of anabolic signaling, so it contributes both to the composition of the muscle and the performance of the muscle.  Which guess what? I never learned that in medical school. I didn’t learn that until I became a menopause expert. And all my menopausal women said, I’m working out and I just can’t gain anything. And then we put them on, estrogen for night sweats, not even for their muscle.  We put ’em on for hot flashes and they’d go, you know, I’m at the gym. I’m finally seeing something. And I thought, I would think to myself, I don’t get it. I thought they needed testosterone, but it turns out that estrogen is playing a role also. That doesn’t mean testosterone doesn’t, of course they need, women need testosterone too, and we do not have FDA approved testosterone yet. But my hope is we’ll get that right.

Dr. Weitz:  And I think some people listening to this are skeptics of what we just said about estrogen being anabolic might say, well, you’re seeing estrogen drops, but it’s really the drop in the testosterone that’s responsible for the loss of muscle.

Dr. Sophocles: Well, it is both, so let’s, I don’t think we should make it one or the other. I think the mic drop moment is that you also need estrogen for muscle strength and production, but that’s not to take away from the obvious, which is you need to, women need both estrogen and testosterone, but because societally testosterone’s always called the male hormone and estrogen the female hormone. Right? The powers that be have invented estrogen replacement therapy and left testosterone hanging out to dry. So absolutely, I really hope that in this next,..

Dr. Weitz: And by the by the way, the, by 10

Dr. Sophocles: years we could get on that safe.

Dr. Weitz: And by the way, the male researchers who decided that, hormone replacement for women should include estrogen and progesterone. Also thought it was a good idea to have the estrogen come from horses

Dr. Sophocles: here. The estro chemical structure as what our ovaries have made our whole life, it’s called estradiol, is so if someone tells you I want bioidentical hormones. That doesn’t mean you get a shot or a, you go to a fancy pharmacy. It doesn’t mean anything. It doesn’t have to be expensive. It means it should say estradiol on the package. That’s all. That’s all bioidentical means.

Dr. Weitz: Yeah, it needs to be the exact hormone structure that exists in women.  

Dr. Sophocles:  Can you hear me, Ben?

Dr. Weitz:  You’ve been going in and out the whole time. So, I don’t know. I’m not sure what’s gonna happen, but I’ll ask my editor to try to put it all together and see what happens and hope.

Dr. Sophocles: Yeah, we’ll see. And I don’t mind redoing, you know, I don’t mind redoing. Okay. So there’s so much good stuff here.  Yeah, there’s so much good stuff here.

Dr. Weitz: So, I wanted to get into the idea of the types of tendon and ligament injuries that happen. And I think this is an really interesting topic and we’ve known for some time that. There’s potential issues for women. For example, it’s been known that women athletes in particular are more likely to tear an ACL in their knee if it’s certain time of the month when estrogen say is lower.  And we know that after menopause there’s a significant increase in ACL tears, in rotator cuff tears, and. I looked at some of the literature and it’s not quite clear if the reason is because estrogen makes ligaments intended stiffer or it makes them laxer or less strong. It’s, it there’s some changes, but it’s I’ve sort of saw some literature that said opposite things.  What’s your take on that? Does

Dr. Sophocles: as and I, again, I’m not an orthopedic surgeon. Okay. I’m not, yeah, okay. It’s hard. I don’t know the answer to that. Okay. I do know. Okay. But we do know that there’s an increase in tendinopathy, right. Rotator cuff. Right. Yeah. Yeah. Okay. The reason I don’t know is because I just don’t know if it’s an increased laxity that’s, or if it’s that decrease in fluidity of the synovial fluid.   But I know the Achilles tendinopathy, rotator cuff tendinopathy, hamstring tendinopathy, and gluteal tendinopathy are common Also, there’s. It’s a Tino synovitis, an inflammation of the synovial fluid in something called DeQuervain’s tenosynovitis. It deco veins, tenino synovitis. Right. I know [00:29:00] those are common in postmenopausal women, but the mechanism is a little over my head.  Okay. You’re giving me way more credit than I deserve.

Dr. Weitz: So what else can we do for sarcopenia or this loss of muscle? We can take estrogen. Yeah, we can add testosterone. Are there some other reasonable steps?

Dr. Sophocles: Yes, we wanna begin to have women consider strength training as a very regular part, not a once in a blue moon.  Part of working out most of the baby boomers and Gen Xers grew up in an era of Jane Fonda and aerobics and gym fix and running, and heart health and aerobic activity. And we really need to scrap that or alter that. It doesn’t mean aerobic activity isn’t great, it’s wonderful for your health, but because we’re losing muscle mass and bone strength, you must have very regular strength training.  And that strength training should include a component of axial loading, meaning weight on the spine to stimulate the spine to make new bone cells, which then. And we’ll also transmit down into the hips and the femur. Remember, we’re thinking about how to keep you healthy, strong, and balanced from age 50 to 90.  Because women are living longer and we’re gonna have this huge explosion of geriatric men and women. When we have that, we’re gonna, if we don’t get them strong and balanced and flexible, we’re gonna have an enormous disaster of falls and hospitalizations and nursing home patients, and it’s gonna cost our healthcare system a fortune and it’s gonna contribute to a poor quality of life.  So for all the 50 year olds out there, I need you to look forward for the next 30 to 35 or 40 years and say What do I need to do so that I optimize my health span so I’m healthy as long as possible? And that must include being lean and strong. You don’t have to be skinny. In fact, you shouldn’t be skinny.  But if you can do weight training I say minimum three days a week, ideally five. And if you can lift heavy enough that you’re really seeing increases in your strength, you will put off the sarcopenia, which happens in older years. And I guess everyone knows who’s listening that sarcopenia is a medical term for a lack of muscle.  Sarco–lack of and muscle penia, lack of, and it’s a disaster, it geriatric populations. ’cause when people lose muscle mass, they can’t get out of a chair. And when they can’t get out of a chair, they sit and watch TV all day and get weaker and weaker. And then they become so debilitated that they fall. Right? And a hip [00:32:00] fracture in particular is, you know, you might as well just say, I got one year left to live.  ’cause once you have a hip fracture, it’s really downhill. So weight bearing on the spine, axial loading for women. Critical. 

Dr. Weitz:  Absolutely.  The take home message has to be that just using two pound dumbbells is not enough. That just walking with a couple of lightweights, that’s great, but that’s not gonna load your spine and your hips and cause increased mu bone density.  So listen to the podcast I did with Dr. Belinda Beck, who published the Lift-Mor trials, and she’s the only one to show that you can increase bone density with exercise.  And she has women do deadlifts, squats, overhead presses, five sets of five rep Maxs, and also ballistic loading as well. And that’s what you really need to do. You gotta lift heavy if you want to increase your bone density and [00:33:00] your muscle mass, right?  [High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial.]

Dr. Sophocles: That is brilliantly said and people should rewatch that. And also I found a nice program called Kari, K-A-A-R-I, Kari Prehab. It was initially developed for women who already have osteoporosis as a way to turn that ship around.  And then they realized, wait, why don’t we start doing this for women before they have it so we can increase the bone density and the muscle mass before? And I think. The key word there is prehab. You don’t wanna be in rehab at age 70 when you fall, you wanna be doing this Now. A lot of people hate the gym.  They hate the idea of going to the gym. Ben, I know you don’t. But for people who do. There’s so much out there, they can do this at home and it doesn’t cost a fortune. When I started the Kari Prehab program, I just went and bought some free Weitz some bands. It didn’t cost me a [00:34:00] lot and I could do it at home before I went to work, so I didn’t have to go to the gym ’cause I am not as motivated as you are. And so I wanna, I know people listening. Are probably already really wellness focused, but some of them lead very busy lives and they’re saying to themselves, how could I possibly make the time to do one more thing? And I would say perhaps it means doing something at home, or perhaps it means having a trainer once a week for accountability.  A lot of the at-home wellness programs have live sessions with a trainer, so don’t use the, I hate the gym thing as an excuse. Right. You can find your way to health and flexibility without that. Just another take home message, I think. ’cause I don’t want people to stop watching this and go forget it.  I don’t have the time,

Dr. Weitz: you know? Right. Absolutely. So, let’s touch on one more topic, which is that, [00:35:00] with the loss of estrogen in menopause, there’s an increase in cartilage cell damage, osteoarthritis, and this results in joint pain, loss of joint function, and may end up causing the need for a joint replacement.  Wouldn’t it be great if prescribing estrogen would decrease the number of joint replacements we’re gonna make? How much would that save our healthcare system?

Dr. Sophocles: I, well, I wish I had that number, but, and we will get that number because what we’re starting to do is actually attach dollars to the lack of estrogen prescriptions for the last 20 years.  So at the, I was at the FDA. In July where a number of us testified to in front of Marty McCarey, the head of the FDA, to help him see the massive health and suffering costs to the [00:36:00] lack of using HRT. And we’ve now linked just the lack of vaginal estrogen and the cost of UTIs. That happened because of that as between eight and $22 billion.  Wow. And that’s just little old urinary tract infections. You can imagine what the cost could be if we added all the fractured hips, the joint replacements, the new knees. I mean you can ima it many billions of dollars. So I know we are hoping, if nobody wants to. To pay for studies based on women caring about the health and suffering of women.  Maybe if it saves money, they’ll be excited, but it would be billions. Billions. You know, not to mention the loss of active lifetime ’cause you have a knee replacement. You’re out Right. For a few months. Yeah. Like, you’re not living your life. Absolutely. So, to me, I don’t know about you. I don’t wanna, I don’t wanna take a few months off, you know?

Dr. Weitz: No, absolutely. Yeah, it’s, I [00:37:00] know a bit about it. I won’t go into my own history, but I had a situation that I overcame. So, how can listeners and viewers contact you if they wanna make a consultation, find out about ordering your book? Your book is not out yet, right?

Dr. Sophocles: It comes out February 10th.  It’s called the bedroom gap, but it can be pre-ordered on Amazon. Okay. So if you just go on Amazon and write Maria Esophagus, the Bedroom Gap, you’ll, you can pre-order it. As far as contacting me, I have a virtual practice and I’m licensed in many states, including California, so that I can take care of women.  I, I care for women all over the world, but in the US I have licenses in many states. So Maria, so md.com is the easiest way to find my website, and there’s links on there to make. Ation and I’m happy to just md [00:38:00] It’s a mouthful. But

Dr. Weitz:  Thank you Maria and thank everybody out there for listening to this episode of the Rational Wellness Podcast With Dr. Maria Sophocles.  We explored the musculoskeletal syndrome of menopause. How hormonal changes can affect muscles, joints, and bones in ways that are often under recognized. Dr. Sophocles emphasized the importance of early recognition screening and the use of strategies including hormone replacement therapy and lifestyle approaches like strength training.  By raising awareness and providing women with better tools to protect their musculoskeletal health, we can help them maintain mobility, independence, and quality of life well into their menopausal years. If you enjoyed today’s episode, please subscribe to the Rational One List Podcast on your favorite platform.  Leave us a review and share it with someone who might benefit from this important discussion. Until next time, stay rational and stay well.

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Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star readings and review.  As you may know, I continue to accept a limited number of new patients per month for functional medicine.  If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.

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Craig Mullen discusses Root Cause Medicine 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

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Craig Mullen is a nurse practitioner and he is the founder and medical director of Remedy Functional Health Solutions, which is located in Salisbury, Maryland and his phone is 443-342-4141.

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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 Craig Mullen about the root cause revolution, which essentially means a functional medicine approach to health. Craig Mullen is a nurse practitioner who’s the founder of Remedy Functional Health Solutions.  Craig, thank you so much for joining us today.

Craig: Hey, thank you very much Dr. Weitz for having me on the show today. I am excited to be here and thrilled to have this opportunity to talk with you this morning. 

Dr. Weitz: So where are you located? What part of the country are you in? 

Craig: I am in Salisbury, Maryland which is a little portion of the state on the eastern side of the state that is adjacent to the coast.  We’re about 30 minutes away from the Atlantic Ocean, so it’s a nice spot to be. And you know, definitely is an exciting time for the area because we’ve got an influx of people coming to the eastern shore of the past decade. We’ve got a great university here in Salisbury that you know, has excellent exercise physiology and exercise science programs, as well as a pre pre-med program.  So, great time to be here on the eastern shore of Maryland.

Dr. Weitz: I’m speaking to you from about 20 minutes from the West coast, from the Pacific Coast, so awesome. The powers of technology. So what made you decide on your career path to become a nurse practitioner versus some of the other choices could have included being a physician’s assistant, an md, or some other kind of doctor.

Craig: Sure.  So my father was an oral surgeon for about 40 years. So I was pretty well acquainted with the healthcare system. By the time I was at the point where I needed to start looking into careers felt very comfortable with you know, health and science and whatnot. Actually went to school initially for a philosophy degree.

Dr. Weitz: Me too. I got a philosophy degree from UCLA.

Craig: Nice. Yeah it’s, you know, it’s a great field to be in. It really teaches you how to read it teaches you how to, you know, formulate how to ask good questions. Exactly. Ask, you know, the important questions, skeptical. Right, right. You write a lot of papers, get exposed to a lot of Yeah.

Dr. Weitz:  I was going to get a PhD in philosophy.

Craig: Yeah. Yeah. Excellent. So, I did that and then, you know, the natural sort of inclination for a lot of people who are in philosophy is either, you know, do that, which is go on and do graduate studies in philosophy or, you know, potentially become an attorney. [00:03:00] So I started prepping for the LSAT.  And then rapidly sort of did an about face and realized that this is not what I’m looking to do for the rest of my life. No, you know, shade to attorneys or anything, you know, with regard to practicing law, but, at that point in time you know, I was, I’ve always been very interested in science.  I’ve always had a deep fascination with wellness and health. And so, there was the option to pursue what’s called aa second degree or accelerated pathway to nursing to get your registered nurse your bachelor’s of nursing science. And so, I took part in that program. And but you know, going through that whole trajectory, I knew from the most early stages of taking the classes that I wanted to have the diagnostic and prescriptive authority and privilege.

And it really is a privilege. And so, you know, very early on [00:04:00] my sites were set on. The natural next step which is for a nurse to become either a nurse practitioner or you know, pursue a couple of other different avenues such as nurse anesthesia. You can be, you know, there’s a couple other pathways, but those are the main roles that nurses who seek advanced practice roles.  You know, usually pursue nurse anesthesia or nurse practitioner. And I knew that. Being a nurse practitioner would allow me the flexibility that I wouldn’t necessarily have as a nurse anesthetist to, you know, open my own practice and you know, see patients in different. Areas of you know, the discipline, whether it’s outpatient or inpatient.  And so ultimately got my family nurse practitioner degree from George Washington University. Worked in primary care for handful of years in the urgent care and am care settings especially [00:05:00] so during COVID or during the early years of COVID. And from there I actually went back to school.  I did some more training at Drexel University. To get what’s called an acute care certification, where you can practice in the hospital in critical care settings or in medical surgical settings.

Dr. Weitz: So your current practice, now you have your own practice and you also do some emergency or acute care.

Craig: Yes. Yep. So I still work on a part-time basis with local hospital. It’s Atlantic General Hospital. And I work with a hospitalist team there. I do like four shifts a month on average. Used to be, you know, 12 to 15. But since I’ve started my practice that this has become my real true passion and it really is.  It always has been health span optimization keeping people out of the hospital, keeping people off of. Prescription medications if we can. Really trying to [00:06:00] mitigate the risk for chronic disease. You know, not allowing it to set foot in people’s life, you know, to begin with. And if it is present, doing everything we can to halt it in its tracks and reverse that pathology so that we can help.  People live a more vital existence and add quality to their years, not just years to their life.

Dr. Weitz: And I think the need for this kind of care and the type of practice I have with functional medicine and many others do is. Ever more needed. It was just a report that the United States is doing poorer than most of the other advanced countries at reducing chronic diseases.  And in fact, hundred percent among Americans age 20 to 40, we’re seeing an increase in chronic diseases. So, we really desperately need a. Functional medicine approach that’s gonna look at diet and lifestyle and doing something about the root causes [00:07:00] of cardiovascular and these other chronic diseases, rather than just treating their symptoms when they, as they go downhill.

Craig: Right, exactly. You know, we’re just, as you were saying, we’re seeing an an increasing incidences of you know, terrible vascular events in younger people. I mean, we’re talking about myocardial infarction, heart attack as well as increased incidents of stroke among young people. So, very important that everybody start to address these issues.  Now we’re really having a. You know, it’s a struggle in America. Currently, our health system spends more money per capita compared to other industrialized, you know, first world nations. And we have one of the sickest populations despite that. 

Dr. Weitz:  So it’s about time we start preventing these chronic diseases and keeping them from getting worse rather than just treating the symptoms.  So I listened to a few of your other podcast [00:08:00] interviews and I think our approach to functional medicine analysis is fairly similar. I know you like, I like to do very detailed testing. Including a full thyroid panel, advanced lipids, hormones, nutrient status, as well as the basics. And doesn’t it drive you crazy when a patient shows up in your office and they say they went to their primary doctor and their lab showed they were in perfect health.

Craig: Yep. It really does. Yeah, because you know, patients are potentially being misguided in situations such as that. And you know, they also feel like they’re not being listened to because they feel as though something is amiss. Something is awry. They’re waking up, they don’t have the energy and the get up and go that they had in maybe their younger years or before a bad infection or a severe stressor that they experienced.  So, now they have some disruption in their life and they have brain fog, they have [00:09:00] fatigue. And they’re not sleeping well. They are having difficulty meeting the demands of their life, whether it’s kids, job you know, other things that they have going on. They’re just having more difficulty meeting those demands and, you know, it really does entail that we take a deeper look into what’s actually going on at the cellular level and looking at some of the biomechanics of, you know, how are these organs and whatnot actually functioning. Whether it’s the thyroid, which sets, you know, the metabolic rate for the body.  How are we detoxifying through the liver? You know, and how are we absorbing nutrients through the gut? And all of these things, you know, are critically important. 

Dr. Weitz:  And when these patients say they’ve had their labs done and they get the impression that every lab that would be beneficial was done what they don’t realize is that the only labs that they had run were what insurance wants to pay for.  Yes. Which essentially for [00:10:00] most patients is A CBC and a chem screen, maybe a basic lipid profile. If they get thyroid testing, it would probably just be a TSH. And so really of the thousands of potentially beneficial tests, they had five of ’em done and they think that’s all the labs that could be run.

Exactly. And

Craig: sometimes these, you know, are only being run once a year. You know, sometimes

Dr. Weitz: typically once a year. And by the way, the ranges that are looked at are what’s called the reference range, or essentially corresponds to what the average American’s levels are and. To me that is completely insane since we know the average American is metabolically unhealthy and unhealthy from any other perspectives and just looking at the range, comparing you to an average American is really doing a [00:11:00] disservice.  We need to be looking more at what we would call an optimal range.

Craig: Exactly. Yeah. I mean, something like a reference range for insulin that has an upper threshold of, you know, 24.7 is absolutely it’s mind numbing. How you know, concerning that is you know, insulin, as you well know should be a marker that’s, you know, six or below, you know, when we’re really looking.  To optimize you know, glucose metabolism and such. And so, you know, people are walking around with you know, a lot of metabolic insufficiency and they’re contributing to these chronic inflammatory patterns.

Dr. Weitz: And your average primary care doctor is only gonna flag, first of all, insulin is usually not run right.  But even if it was, they’re only going to flag it if it’s in the red and exactly. So they’re not really looking at that. And I recently had a patient who I looked at their labs and their liver enzymes were high, but they were still in a [00:12:00] reference range. So apparently during COVID and afterwards people were drinking so much and eating so much unhealthy food that liver enzymes went up.  So, UCLA raised their reference range for a ST from 40 to 70. So now a patient with 60 is considered normal, and that’s completely insane.

Craig: Yeah, that’s incredible. I haven’t seen that yet over here, but that is wild. I’m astonished.

Dr. Weitz: So patients need to know that the reference range is comparing you to the average American.

Craig:  Exactly, and we’ve seen how over time that’s changed with regard to other things as well. You know, if you look at a hormone panel for men, you know, 30, 50 years ago you know, the upper threshold of normal was not gonna be in the mid nine hundreds, and the lower threshold was not gonna be in the three hundreds.  It was closer to, you know, a range of 500 to 1200 you know, previously. 

Dr. Weitz:  So, as we I see some labs where the reference range is. One [00:13:00] 50 on the low end and a thousand, my gosh, on high end, which is like ridiculous.

Craig: Yeah. Crazy.

Dr. Weitz: So, let’s talk about some interesting cases where you did some detailed testing and figured out that the patients were off track and I thought maybe we could start with thyroid.

Sure.

Craig: So I see a number of thyroid Hashimoto’s patients in my practice. You know, it’s one by the way,

Dr. Weitz: for those who are not familiar, what is Hashimoto’s thyroiditis?

Craig: Hashimoto’s thyroiditis is the most common cause of hypothyroidism here in the United States and in the west. It’s associated with an elevation in autoantibodies or immune proteins that are.  Activated against our own tissue and ultimately contribute to the degenerative changes of our own tissues. And in the case of Hashimoto’s that is thyroid peroxidase. And thyroid globulin [00:14:00] antibodies are the two that are primarily most seen elevated. In conjunction with one another in Hashimoto’s.  And so, it’s, you know, one of the most common things that I see in my practice, it often coincides with people that are, you know, starting to notice some changes such as brain fog. They feel you know, that their energy is poor. They’re having you know, fatigue on a daily basis. They’re not sleeping well, they’re having constipation.  They have temperature intolerance, they have skin, hair, and nail issues. Hair is falling out. They are you know, not able to, you know, perform at the gym. They’re not able to perform at the job. And they’re also starting to experience undesirable changes in some other biomarkers, like, for example, thyroid hypothyroid states will often contribute over time to.

Abnormal and undesirable changes in lipid profiles. So, I see several hypothyroid patients in my practice. You know, it’s gotten [00:15:00] to the point now where I almost expect that people, when they come to me with certain symptoms, a lot of those symptoms that I just man mentioned I almost expect to see antibodies present and you know, I, no, no longer look at the thresholds for.  Antibodies and say, Hey, this is an autoimmune situation here. If they have antibodies present, I’m already starting to look at the path towards, you know, how do we reverse this? Why is this happening? And I’m not waiting for, you know, thyroid peroxidase to rise above 30 or anything like that. I’m saying, look, antibodies are present.  There’s a reason for this and we gotta, you know. Figure this out. And you know, that involves some multimodal, multifaceted approach. But it’s one of the most rewarding things to treat in my patients. And because you see over, you know, four to six months, these initial changes happening and patients start to feel better quite rapidly once you implement certain [00:16:00] interventions.

Dr. Weitz: Yeah, and you’ve probably seen patients where they’re taking thyroid, which is usually a synthetic T four, and yet their T three is still low, and nobody knew it because nobody measured their T three.

Craig: Exactly. Yep. And there’s a number of things that will contribute to low T three. I mean, there can be impaired conversion of T4 into T3 peripherally.  This is often attributable to certain nutrient deficiencies to, you know, other inflammatory insults. And so we, you know, have to really look at all those factors, take everything into account, what’s their vitamin D level? You know, are they getting you know, optimal diet exposure to things like selenium, zinc, copper you know, other factors that are gonna be involved in you know, conversion of of T4 into T3.

How’s their liver function? Liver and thyroid are very much interwoven with each other. So if there’s dysfunction in the liver, there’s oftentimes gonna be dysfunction in the [00:17:00] thyroid. Another thing that I see all the time is perimenopausal women and beyond into menopause and post who, you know, they’re obviously progesterone deficient.

Well, progesterone and thyroid also very interwoven with each other. And balancing progesterone is usually always one of or restoring progesterone really is one of the initial steps that I’ll take in women who are having significant hypothyroid issues. So interesting. Can you explain

Dr. Weitz: how progesterone affects thyroid?

Craig: Especially in the context of you know, in immune dysregulation. So, progesterone as a hormone is very immunomodulatory and it helps promote immune tolerance and will really down regulate processes in the body that contribute to immune hyperreactivity. So progesterone, you know, outside of Hashimoto’s.  It’s also been shown to be very beneficial for a number of other [00:18:00] autoimmune conditions, such as multiple sclerosis, ankylosing spondylitis rheumatoid arthritis, psoriatic arthritis. So, it’s, it has these very immunomodulatory and anti-inflammatory properties that really. You know, make it such a huge a powerhouse tool to employ and deploy in the treatment of autoimmunity.

Dr. Weitz: That’s really interesting. Do you ever use progesterone for men?

Craig: I do not often use progesterone for men, but there is, you know, it is necessary for men as well. And I have heard of practitioners who will recommend utilization of progesterone. Topically sometimes just applied, you know, along the inner thighs or to the scrotum for you know, the optimal benefit of progesterone.  It’s not something that I typically do. In my practice, I’m open to it. I’d have to read more into the science of it.

Dr. Weitz: Yeah I don’t know anybody who really [00:19:00] does it, but yet we get progesterone on the labs and I see that it’s sometimes low. I think the one context in which it is accepted to use it is in the context of traumatic brain injury.

Craig: Exactly. Yeah. And IV progesterone, right? So, that’s one of the things that I really picked up on. Dr. Lindsey Bergon was one of the ones who first introduced me to that idea. And you know, really profound. Absolutely.

Dr. Weitz: So let’s talk about looking at an advanced lipid profile. Why should most patients have an advanced lipid profile?  Why is the basic lipid profile so inadequate? And what are some of the important information we can glean from such a panel?

Craig: Yeah. So, I think, you know, it’s really important to also focus on cholesterol. What is cholesterol? What does it do in the body? Well, cholesterol is the precursor. It is the substrate from which our hormones are [00:20:00] ultimately generated and derived.  Not only that, cholesterol is a major component of. Cell membranes, right? So the delicate membranes that surround each and every one of our cells that provide some protection and support for their structure. So it’s essential as cell membranes are broken down, if we don’t have appropriate cholesterol to strengthen the cell membrane those cells are gonna be more prone to damage from oxidative stress and inflammation in the cellular environment.  And this will ultimately contribute to you know, changes in DNA structure and you know, proteins within the cell. So we, we need to have adequate cholesterol. Cholesterol is very important for overall cellular health’s critical for brain health. When we look at a lipid panel, if you go to your PCP and you get a standard lipid panel that shows total cholesterol, LDL cholesterol, HDL, triglycerides, v LDL.

You know, that’s really only part of the picture. And it’s an, [00:21:00] unfortunately, it’s a very archaic way of looking at lipids because we know that, you know, something like an LDL, for example can have various sizes and those sizes to the l sizes of the LDL correspond to. Various levels of risk.  For example, if somebody has a, what could be called a pattern, a LDL, which is a larger size lipid molecule, then this means that it skews towards being more of a buoyant beach ball esque lipid molecule that’s much less prone to contributing to atherogenesis. So the formation of plaque.  Inside the lumen of the blood vessel. So, this in comparison to somebody who has a higher count of small LDLs or their LDLs skew towards the smaller size, these are much more prone to invade the delicate endothelial tissue along inside the vascular bed. [00:22:00] Which you know, is going to be associated with the development of atherosclerosis and lesions that can contribute to coronary artery disease and cerebrovascular disease.

So. A lot of people will come into my practice and we run what’s called an NMR Lipo Profile. And you know, they get this wealth of information where we say, Hey, your lipids may be, your LDL count may be borderline high, but you skew towards this pattern A, the larger type of the LDL, and we can also see that your small LDL count is low.  And so those. Two things in conjunction with each other does provide a little bit of a buffer against you know, an LDL so, or an elevated LDL. So I think it’s very useful to look at it, you know, in that context it’s a much more comprehensive picture. And then we also look at things you know, for example, like lipoprotein little a, which has gained a lot of [00:23:00] attention over the past several years as being an independent risk factor.  For cardiovascular disease, lipoprotein little A is oftentimes construed as a non-modifiable risk factor, meaning no amount of diet, no amount of exercise is going to really change the number that we see there. On the lab. And so it’s very much genetically determined. If we look back at what lipoprotein little A does well, it’s an adhesive protein found on the outside of the cholesterol particle.

That probably dates back, you know. Hundreds of thousands of years in human evolution when we, you know, had no vascular intervention, we had no adequate medical care to heal an acute injury. And so this this particle or this, you know, this compound lipoprotein little a would be the type of thing that if there was vascular injury, if there was, you know, an acute issue [00:24:00] that needed to be dealt with. It, it is very sticky and it’ll adhere to the lining of the blood vessel and signal all these chemokines and cytokines or molecules you know, that will ultimately initiate and incite the repair process. But at the same time. It’s also going to result in more platelet adhesion and the adhesion of other repair factors that are found in the blood that can ultimately gunk up or clog up an artery.  So it is an independent risk factor. Generally, you know, I like to see that number you know, less than 90 in patients. The more we can drive that number down, I think is, you know, even better.

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Dr. Weitz:  I think you’re starting to hear more and more about lipoprotein a and the reason why is.  We’re getting set up for some drugs that will be on the market in the next few years to lower lipoprotein a. Right now there’s no drugs that are specifically targeting lipoprotein a. I think those drugs are gonna be big sellers. And the reason why most doctors are not testing for it is ’cause they don’t have a drug for it.  But aren’t there things we can do for lipoprotein little a?

Craig: Yeah, I think that, you know, at that point in time I’d be interested to look at those at the, you know, a new and emerging. Research on these medications ’cause I actually am not familiar with them. So that’s very fascinating to me.

Dr. Weitz:  Yeah. There’s like three or four that are in clinical studies now and will be on the market in the next couple of years, but that’s

Craig: fantastic.

Dr. Weitz: There are things we can do now to lower lipoprotein a, aren’t there?

Craig: So, yeah, what I always recommend to patients is that you know, the, we need to control some of the other factors, right?  So, you know, I try to push my patients away from statins and things of that nature. Not that statins don’t have their place, but there are other things that we can do to really sort of improve somebody’s. You know, cholesterol panel on a large scale. And so what we can do is implement things like Red Yeast, Rice, we can utilize citrus flavonoids like bergamot, gertin, no olein as well as vitamin E derivatives, such as tocotrienals and use those in combination with each other to have, you know, profound sometimes statin s.  Lowering of lipids and some of these agents even boost HDL. [00:28:00] You know, so we wanna focus on, on, on the potential benefits of that as well. And then yeah, you know, certainly looking at other, you know, dietary factors in conjunction with yeah, so

Dr. Weitz: niacin has been shown lower LP Lille by.

30 to 40% in a few patients, sure, as much as 70% a carnitine has some benefit, coq 10 has some benefit, flaxseeds have some benefit. So there’s a number of nutritional approaches that can help to lower lipoprotein a. Absolutely. Absolutely. And then minus polling had this whole concept of how we can use certain nutritional compounds to reduce the ability of lipoprotein a, to actually create this stickiness.

Craig: Oh, that’s fascinating. Yeah.

Dr. Weitz: Yeah. So you’ll have to check that out. So what are some of the other important parts of a lipid profile to look at? And also, do you have certain strategies for [00:29:00] reducing small dance LDL or increasing LDL particle size? How do we move that LDL advanced profile to a better health?

Craig: Yeah, absolutely. I think, you know, diet is where I really try to focus in those patients, you know, highlighting the importance of omega threes in supporting LDL, healthier LDL profiles, supporting HDLs you know, so this comes in the form of you know, again, flax, as you mentioned. Avocado oil you know, and other foods that are really dense in omega threes.

Dr. Weitz:  Do you measure Omega-3 levels?

Craig: I do sometimes I you know, as if somebody is really chronically inflamed you know, just to make sure that you know, they have appropriate activity there from an anti-inflammatory standpoint. And, you know, omega sixes as well can be very beneficial to, to look at.

But not in everybody, you know, everything is certainly. Sometimes cost [00:30:00] prohibitive and you know, it’s the type of thing that ideally if I could, I would but it’s not, you know, something that, that suits every, everybody, 

Dr. Weitz:  all my patients are getting Omega-3 levels measured. That’s all.  So what do you think about HDL? HDL is kind of this interesting molecule that we’ve thought of as protective, and there’ve been attempts to try to raise HDL with drugs and they’ve proven to be ineffective at lowering risk. And people have tried to look at HDL particle size and we know that HDL can be beneficial because it can do reverse cholesterol transport.  It can take exactly cholesterol from the artery and bring it back to the liver. But other than that it, there’s still some confusion as how do we know when HDL is higher? Is it even good or not? Because it’s also acknowledged that when HCL gets above a certain level, it’s not as functional.

Craig: Sure.  I think you know, I’d be interested in seeing continued research on that. I always try to shoot for HDL in you know, men and women definitely above 50 if we can on a standard lipid panel. Right. I think, you know, once we’re seeing HDL levels, you know, in the eighties, nineties you know, then we’re getting into the realm of, you know, how beneficial is this really?  You know, the size and the density of the HDL really does play a role in its ability to. Participate in that reverse cholesterol transport. So we do have to look at those factors as well when we look at something like you know, an lipid particle size and number. 

Dr. Weitz:  Yeah, I think we really need a better test for HDL functionality that’s widely available.

Sure. Absolutely.

Craig: Have you seen anything you know, coming about in down the pipeline with regard to that? Yeah,

Dr. Weitz: they’re definitely working on new tests. I know Cleveland has a test for HDL functionality, but not to [00:32:00] that have many people run it. And I think there’s more to understand about HDL and when HDL is beneficial and when it’s not.  So I think the HDL story is still to be flushed out and told completely, but in general, having a slightly higher HDL is good versus a lower HDL. I’ve certainly seen certain approaches where things drastically lower HDL, like for example bodybuilders who take anabolic steroids drastically lower HDL and that definitely is part of their having an increased cardiovascular.  Yeah, absolutely. So, let’s go into peptides. I know that I know that you utilize peptides frequently with patients, and why don’t we start with America’s favorite drugs, the GLP ones, which yes, make people, dance through the streets and sing. And why does every drug commercial have [00:33:00] people dancing and singing?

And you have no idea what the commercial’s even about. But so apparently these GLP ones now we’re hearing from recent studies reduce every chronic disease and are like the greatest drug since you know, mother’s milk. And I’ve even talked to patients who are taking them for longevity purposes, but.  I particular am very skeptical. Sure. To begin with, I’ve seen a number of patients who lost a bunch of weight. They lost 40, 50 pounds and then they gained 60 pounds back and now they have less muscle when they stop taking ’em. And I’ve seen a number of patients with side effects. They tend to lose muscle.  They get gut problems because it slows down gut motility. I’ve seen patients with vision problems, so I’m kind of skeptical. Why don’t you tell me about GLP ones and what’s your experience?

Craig: I think GLP ones can be very beneficial and I think that they have a lot of [00:34:00] potential

Dr. Weitz: By the way, for everybody who’s in know what we’re talking about.  We’re talking about drugs like Ozempic.

Craig: Yep, exactly. Ozempic, wegovy the, that’s the generic name for or I’m sorry. That’s the brand name for generic Semaglutide. On the Tirzepatide side of things we’re looking at Mounjaro Zep bound. And then some of the older medications Victoza, Saxenda, we’re talking about Liraglutide.  There’s also Dulaglutide or Trulicity. So you know, a whole class of medications that are basically classified as what we call Incretin mimetics. So, what they do is they promote a glucose dependent release of insulin from the pancreatic beta cell. Which helps with insulin sensi sensitivity in the body.  But they also work to slow the rate of gastric emptying. So the stomach empties into the duodenum. And the rate of emptying of food contents into the duodenum of the first portion of the small [00:35:00] intestine is slowed. So, what this does is it acts on stretch receptors at the, at the sphincter there, at the portion where the stomach enters into the small intestine which then sends messages to the hypothalamus and hunger centers in the brain, which can influence you know, satiety hormones and other signaling agents like leptin in the brain. And so, we’re… 

Dr. Weitz:  so patients eat less.

Craig: Exactly. Yeah. Or they have an earlier a sensation of fullness and they have a sensation of satiety and being satisfied by the meal that they’ve taken in. The other aspect is that they do work directly in the brain, in the hypothalamus in an area called the RQA nucleus. And this directly influences hunger and so cravings are reduced.  A lot of times there’s a reduction in food noise. Or what people consider, you know, food noise and that tendency to want to just, you know, graze and [00:36:00] snack and things of that nature. So. You know, multimodal approach with the GLP one medication to you know, reducing the amount of, ultimately reducing the amount of calories that people desire to take in.

Dr. Weitz:  And so how do we use these drugs more effectively than the traditional use?

Craig: Yeah. So the real problem comes in when people start, you know, just basically utilizing them as a tool for crash dieting, you know, so, yeah.

Dr. Weitz: They don’t change their diet, they don’t exercise. They’re not eating any healthier.  They’re just taking these drugs.

Craig: Right, exactly. They’re just taking the medication a lot times. 

Dr. Weitz:  They’re still eating junk food; they’re just eating less junk food.

Craig: Exactly. So, you know, once you get on that cycle say somebody is eating well below their basal metabolic rate, which is basically the rate at which your body is burning kilo calories throughout the day.  If you were to sit and do nothing but breathe all day on the couch, that’s your basal metabolic [00:37:00] rate. If you start dropping below that or start dropping.  Below your ki killer calorie needs for the day and your activity level ultimately you’re going to enter a state that is catabolic in nature. This is a state of breaking down tissues to supply energy for the body. And so people who are misusing GLP ones you know, maybe they are you know, not hitting their protein requirements, they’re not hitting their caloric requirements, they’re not hydrating and they’re certainly, you know, not exercising at that point.  They are going to have a net loss of muscle tissue. Muscle is the main metabolically active tissue in the body. And so as you lose muscle, you have significant declines in your basal metabolic rate. So look at these patients, you know, several months on you know, a year or so into their weight loss journey.  Yeah. They’ve lost 40, 50, 70 pounds. A lot of that if it has been muscle loss you know, has contributed to a [00:38:00] net decline in their basal metabolic rate. And then, you know, they say, okay, well I’ve reached my weight goal. I’m gonna come off the medication now. Long story short, all of the old habits come into play.  They start eating like they did previous, and they’re eating the same amount, right? They’re eating the caloric you know, they’re hitting the caloric thresholds that they were at previously and all of that excess calories as being stored again as fat. 

Dr. Weitz:  Oh, how do we utilize these drugs so that doesn’t happen?

Craig: Yeah, they’ve gotta be, you’ve gotta make sure that a, you are tracking people’s body composition. I don’t see how a GLP one prescriber can go through their practice, go, you know, continue to practice in a way where they’re not. Regularly mention measuring somebody’s body composition. And what I’m talking about in that regard is utilizing a device like InBody or volt something of that nature where you can [00:39:00] actually measure basal metabolic rate, where you can look at skeletal muscle mass for C to C.

Dr. Weitz:  Yeah, we use bio impedance in our office.

Craig: Yeah, it’s critical. I mean, you know, so you gotta measure for you know, fat reduction, you gotta measure for visceral fat reduction, which is a primary goal. In these metabolic, you wanna see

Dr. Weitz: when they’re losing weight, that they’re losing fat. You wanna make sure they’re not losing muscle and you’ve got understand that sometimes people lose water, which is not really fat loss.

Craig: Exactly. Yep. So that’s, you know, step number one. Doing the body composition analysis and routinely so, you know, the other major components are ensuring that they are hitting their protein requirements. Generally, I recommend. Anywhere from 1.2 to 1.6 grams per kilogram per day for an individual to prevent that sort of catabolic change where they’re losing muscle mass.  And then, you know, it’s also a major focus that they need to be [00:40:00] working on resistance training. And what that means is, at a minimum, using body weight, using re resistance bands, but really looking to also capitalize at you know, heavier lifting or utilizing weights. Utilizing machines in the gym to you know, basically precipitate muscle hypertrophy and growth or preservation at a minimum which also benefits bone density.  We see a lot of, you know, older patients who come to us and they’ve been on GLP once and they’ve become so catabolic that they’ve actually induced, you know, osteopenic and osteoporotic changes by way of having significant declines in. You know, muscle loss and you know, hydration as well.

Dr. Weitz: So what do you do about the fact that when people stop these drugs, they tend to lose, they gain their weight back?

Craig: I think that it’s really important to nail down those fundamental lifestyle aspects. Right. You know, so

Dr. Weitz: If they’re gonna continue to eat healthy and [00:41:00] exercise do you use a lower dosage so they’re less likely to have that kind of withdrawal effect?

Yes. If

Craig: somebody I try to stay as low as possible. Throughout the duration of treatment, if somebody, for example, on something like Semaglutide has you know, plenty of benefit from a 0.25 or 0.5 milligram dose weekly, that’s the level we stay at a provides. 

Dr. Weitz: So there is the standard protocols to just keep titrating a up till they get to a higher level, right?

Craig: I would say, you know, maybe standard in some practices, but definitely not mine, you know? Right. If we have efficacy and therapeutic benefit at those low doses keeping them there leaves more room to titrate up in the future if sensitization. Tolerance happens to the medication, it also minimizes the risk for side effects.  So in that way I think that, you know, small dosing or microdosing sometimes even breaking up a dose, you know, a low dose a few times a [00:42:00] week and doing a microdosing approach like that can be very beneficial. And the reason you have

Dr. Weitz: patients taking ’em for a long period of time.

Craig: Yeah. Including myself personally, I think that they’re very beneficial. And, you know, they have the potential to really support a lot of different metabolic, so, so

Dr. Weitz: you’re taking a GLP one.

Craig: Absolutely. I cycle back and forth between all three of them or, you know, I cycle back and forth between Semaglutide Tirzepatide and I’ve utilized Reddit, Tru Tide as well.

So I think that there’s, you know, significant benefit and personally subjectively I feel you know, substantial improvement in certain other things.

Dr. Weitz: Do you think there, outside of just what are some of the other things you think has benefited you?

Craig: So I have Tourette syndrome. And one of the things that I have as a result of that is some early degenerative osteoarthritic changes in my neck and my shoulders.  You know, which is, that’s like ultimately a [00:43:00] chronic inflammatory process. You know, they say osteoarthritis is not. An inflammatory disease, but you know, when you look at the cellular level, it really is, you know, I think we

Dr. Weitz: now recognize that there’s a big inflammatory component.

Craig: Exactly. Yeah. So, you know, utilizing semaglutide at low dose has a pronounced benefit in reducing some of the pain signals and the inflammation that I feel on a regular day-to-day basis.  And I’ve seen that sustained throughout the course of my utilization, which is, you know, well over. You know, a year and a half now, it’s probably bordering on two years that I’ve been utilizing these therapeutics. And you know, it also gives me, I think a little bit of a leg up when I have patients come to me and they’re looking to begin a journey with a GLP one peptide.  You know, I can explain to them what this feels like. I can explain you know, some of the potential side effects that they may encounter. And, you know, that gives them a little bit of confidence and understanding that they have somebody [00:44:00] that, you know, really can support them through that PO process.

Dr. Weitz: So what are some of your other favorite peptides? And I’m thinking about things like BPC 157 and Thyosin beta 4, et cetera.

Craig: BPC 157 is a must have tool in the shed for regenerative healthcare practices health span optimization practices,

Dr. Weitz:  Oral, injectable, or both?

Craig: Yeah. BPC 157. It’s a 15 amino acid sequence that is found naturally in human gastric juice.  Essentially when utilized orally, it can help to prevent and heal peptic ulcer disease. It’s shown some, you know, anecdotal improvements in healing mucosal injury in autoimmune conditions, such as, ulcerative colitis and in Crohn’s disease, which are both autoimmune inflammatory bowel diseases does help to modulate gaba serotonin and [00:45:00] dopamine pathways in the gastrointestinal tract as well.  So it can be an excellent option for balancing neurotransmitters and working with patients who have chronic anxiety and depressive symptoms from the standpoint of. You know, blood flow and improvements in tissue repair. It does promote an enhanced synthesis of nitric oxide and it supports nitric oxide pathways in the body.  So it’s very good at, you know, helping to support normal and healthy blood pressure. And it also upregulates VEGF or vascular endothelial growth factor, which is associated with. Capillary Genesis and the formation of new blood vessels. So, it can be very beneficial. Interesting.

Dr. Weitz: I never heard about the connection between BPC and and nitric oxide.

Craig: Yep. One of the, one of the major pathways that it definitely works on. And you know, that’s why PA patients a lot of times will have these improved recovery times. I [00:46:00] say patients, but a lot of times, you know, clients who are in. The bodybuilding or fitness or sports world will come to me and they’ve had an acute injury or they’re getting a little bit older and they’re just feeling as though their recovery time is a little bit prolonged you know, longer than what it used to be.  And they’re having to wait a few days before they really feel like they can give it their all in the gym again. And so, implementing a course of BPC 1 57. Is, you know, very much beneficial for improved blood flow tissue recovery. It basically helps to enhance collagen and elastin formation and synthesis and helps with collagen deposition that’s actually organized as opposed to, you know, disorganized collagen which can promote fibrosis and scarring.

Dr. Weitz:  And so what do you think about these guys from the gym that are buying these peptides like BPC online and administering ’em themselves?  Scary.

Craig: I don’t like it. I’m not a fan. I think that it’s [00:47:00] unregulated. It’s a commercial grade product for research use only or for animal use only.  And that, you know, there, there’s many reasons why that’s problematic. It could be adulterated. We never know the quality of the ingredients that are being utilized in those peptides. And the other aspect is that these are powerful agents. These are cell signaling agents. And so when you’re ordering something whether it’s a nutraceutical or a peptide online and you’re ordering commercial grade, you as the consumer have no recourse.  If something were to go awry, if you were to use. An injectable peptide and you have a negative or untoward response, you have no recourse. You have no, you know, ability to say, Hey I, you know, received this from my provider. And now I’m having, I. X issue. So there’s no consumer protection there, really.

Dr. Weitz: So utilize now in terms of the FDA and these peptides, [00:48:00] I know that the FDA has in the last couple years has been limiting the use of peptides. Where are we with that?

Craig: These are still categorized as you know, bulk substance, bi biologics, you know, a lot of the peptides that had formally been utilized, and that has limited the number of compound pharmacies that are willing to engage in the process of manufacturing and supplying these peptides to patients.  Now, fortunately, there have been several. I call them Bastions of hope because there are several compounding pharmacies out there that are still going full speed ahead with their compounding operations. And, you know, this is an area that I’ll let them and their legal teams, you know, wrangle with.  But for now, you know, that’s the only, those are the only places where I will source peptides for patients. You know, it’s gotta be a 5 0 3 a. Compounding pharmacy,

Dr. Weitz: so, so don’t buy peptides [00:49:00] online. You don’t know what you’re getting. And themselves. See a doctor practitioner like yourself. And get them from a compounding pharmacy.

Craig: Exactly. Get work with a clinician who’s trained in peptides. Ideally somebody who’s gone through some sort of rigorous training or certification program. There’s several programs out there for people who may be interested. So, you know, a four M has a Peptide therapy certification course, Dr. William Seeds with the SSRP or the Seeds Scientific and Research. Performance Institute has a phenomenal peptide therapy certification program. You wanna work with a provider who knows what they’re dealing with, who’s, you know, familiar with protocols, who’s familiar with the cellular mechanisms and the pathways that these peptides are really capitalizing on.  So, if you can avail yourself of a practitioner who is comfortable in, in that realm.

Dr. Weitz: Great. [00:50:00] So, let’s wrap up this interesting discussion. Any final thoughts and then tell us about your contact information.

Craig: Yeah, sure. Final thoughts? I’m gonna hit everybody with my favorite peptide right now.  SS 31, also known as Eptide. This is a powerhouse mitochondrial peptide in the wake of COVID-19. In the wake of, you know, all of these changes that we’re seeing in the American populace with regard to you know, immune dysregulation because of the cascade of inflammation that resulted from.  Metabolic syndrome you know, we need to have mitochondrial repair options. And so SS 31 works on the inner mitochondrial membrane. It stabilizes a molecule compound known as. Cardiolipin which basically is the scaffolding of the mitochondria on which all of our proteins that are associated with energy generation and energy metabolism are [00:51:00] situated.  So, that’s, you know, look up SS 31. It has FDA research for treatment of certain mitochondrial disorders.

Dr. Weitz: What dosage do you like for that?

Craig: Yeah, I usually start people on around four milligrams a day of SS 31. And then I titrate them up to around 10 milligrams a day. The four milligram to six milligram is more of like a.  You know, longevity, health span, optimizing approach. And then for the people who have a lot of mitochondrial dysfunction and, you know, they’re really having poor energy output. I utilize the higher doses anywhere from, you know, 12 to even upwards I’m sorry, 10 to upwards of 12 or 15 milligrams a day at times.  And so. That is it’s my favorite peptide. It’s a powerhouse peptide. It, you know, can really help with cognition and focus. It can help restore sleep patterns and circadian rhythms help with [00:52:00] glucose metabolism and energy optimization overall. So, you know, major. That’s

Dr. Weitz: great. A good clinical pearl for us.  I appreciate that. How can patients, of course and listening to this or watching this contact you.

Craig: So Remedy functional health.net is my website, www.remedyfunctionalhealth.net on Instagram. I am@remedy.functional.health. Post there all the time. And my practice. Is here in Salisbury, Maryland.  My number is 443-342-4141. And I do telehealth across the state of Maryland for people who are looking to revitalize and rejuvenate their life and work with patients very closely here, one-on-one locally. So, you know, reach out.

Dr. Weitz:  That sounds great. Thank you so much. Excellent.

Craig:  Hey, thank you, Dr. Weitz I really appreciate it. You have a great day.

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Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star ratings and review.  As you may know. I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and wanna promote longevity. Please call my Santa Monica Weitz Sports chiropractic and nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.