Dahlia Attia-King discusses Whole Exome Sequencing with Dr. Ben Weitz.
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Podcast Highlights
Join Dr. Ben Weitz in this episode of the Rational Wellness Podcast as he dives into the world of whole exome sequencing with Dahlia Atiyah King, founder and CEO of Panacea. Discover the latest advancements in DNA testing technology and how it can be a game-changer in the prevention of chronic diseases like cancer, heart disease, and neurodegenerative disorders. Learn about the differences between next-generation sequencing and commercial genetic tests like 23andMe, and how whole exome sequencing provides a more comprehensive analysis of your genetic makeup. Dahlia also shares her personal story of genetic testing and highlights the importance of accessibility and affordability in preventative health care. Tune in to gain valuable insights and explore how this cutting-edge genetic test can empower you to take control of your health future.
00:00 Introduction to Rational Wellness Podcast
00:30 Understanding Whole Exome Sequencing
01:26 Guest Introduction: Dahlia Atiyah King
02:44 Whole Exome Sequencing vs. Other Genetic Tests
08:10 Importance of Laboratory Standards
12:50 Personal Experience with Genetic Testing
24:17 Functional Medicine and Genetic Testing
27:44 Future of Genetic Testing
37:08 Addressing Patient Concerns and Final Thoughts
39:01 Conclusion and Special Offer
Dahlia Attia-King is the Founder and CEO of Panacea and she has a BS in Biology and Chemistry from the University of Miami. Panacea was founded with a mission to reduce barriers to access for clinical genetic testing so that people can get in control of their health and prevent disease. Panacea now offers residents of almost every state the ability to receive at-home clinical genetic testing called Whole Exome Sequencing and expert medical guidance in just a few clicks, empowering people to potentially save their own lives. The website is SeekPanacea.com.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: [00:00:00] 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 discussing something we’re probably not that familiar with, which is whole exome sequencing, which is a type of DNA testing. And this is another entry into the preventative field of trying to screen for chronic diseases like cancer and heart disease. We currently have a number of tests on the market for that. We have a full body MRI. We have a blood test for [00:01:00] circulating tumor cells known as the Galleri Early Cancer Detection Test. And, of course, we have all our biomarkers that we run as part of our normal functional medicine screens. But this new genetic test is another way to screen for possible cancer risk, given that up to 25 percent of cancers may have a genetic origin.
Today we’ll be speaking with Dahlia Attia King, who’s the founder and CEO of Panacea. She has a BS in biology and chemistry from the University of Miami. And her experience working for genetic labs exposed her to the reality that few patients were able to access Valuable Preventative Genetic Testing. She learned quickly that the lack of insurance coverage for genetic testing led to physician hesitancy to order testing. And these barriers [00:02:00] led her to develop her own company that could offer genetic testing at a more reasonable price that patients could order directly. So, her company, Panacea, offers whole exome sequencing, along with expert medical guidance. And this is another way to help us find out about risk for various chronic diseases, especially diseases like cancer, heart disease, and neurodegenerative diseases. So Dahlia, thank you for joining us.
Dahlia Attia-King: Thank you. Thank you for having me. It’s a pleasure to be here.
Dr. Weitz: So what is whole exome sequencing and why is it better than say 23andMe or Ancestry?
Dahlia Attia-King: Sure. So, before I get into the specific details about whole exome sequencing, let’s take just a step back and kind of understand the differences in general, among genetic testing. So that of course, you as providers can kind of know what you’re getting into when you’re talking about genetic testing. So there’s two major things that you have to consider when you’re sort of assessing a genetic test. Number one is what technology is being utilized in order to review the individual’s genes. And number two, What laboratories, what are the quality of the laboratories that are actually utilizing this technology and essentially delivering these results to you?
So when we talk about whole exome sequencing versus the type of genetic testing that we might get from 23andMe or Ancestry. We’re really talking about the comprehensiveness of the genetic review. And that is typically allowed by different [00:04:00] technologies. The technology that’s utilized by companies, by these commercial direct to consumer companies, is something called microarray. And what microarray tech does, it’s a very simple analogy, is a search and find mechanism, right? And if we’re writing a digital document, and we’re looking for specific words, word, maybe a word that we misspelled we would activate the search and find function and the document will automatically highlight where the misspelled word is, right? It’s kind of comparable to what microarray does. Microarray doesn’t actually read your gene. It doesn’t review your gene. It looks for a very specific variation in the gene. And if you don’t have that variation, then you kind of turn up. negative for that particular for that particular variation. The problem with that is you don’t always know. What you’re looking for, right, as the provider. Patients could [00:05:00] have all kinds of variations that are not very obvious, and if you don’t know what to look for, then you’re probably missing a ton of information. So microarray is really only useful when you’re very specifically looking for something.
Dr. Weitz: So in other words, what you’re saying is, my understanding, 23andMe picks out a set number of genetic SNPs that they’re looking for. Right. You know, maybe it’s 50, and that’s just what they’re looking for.
Dahlia Attia-King: Exactly. Exactly. I don’t know the number, so I don’t quote me on that, but that’s exactly right. There’s a predetermined list of things that they’re searching for. And they search for those things using that technology. And if those things are not present, then the patient is essentially negative for those things. It’s not completely useless. It’s actually wonderful. It’s a cost effective technology. It’s a quick technology, but it is not thorough. And so if you really want a [00:06:00] thorough analysis, of an individual genome. What you’re really going to want to utilize is a technology called next gen sequencing. Next gen sequencing is typically the technology that’s used in medicine, although microarray is also used in very specific cases. But in general, next gen sequencing is really the big daddy technology. What you, what next gen sequencing does is it literally reads. every letter of the genetic alphabet. It’s very comparable to me telling you, Doc, read me this book but don’t read me every word. Read me every letter. of every word in every sentence of every paragraph on every page. It is incredibly thorough and it’s very helpful when you’re not always sure what you’re looking for because it is a full detailed analysis.
So this type of technology, next gen sequencing, is really what allows for deep and thorough analysis [00:07:00] of an individual’s genes and their potential disease risk. Now taking it a step further, there’s different kinds of tests. That are utilized or utilize next gen sequencing. You could cherry pick and say, you know, you only want to sequence gene 1 and gene 2 and gene 3, right? That’s all you’re looking for. You could cherry pick a hundred genes and run next gen sequencing on a hundred genes, right? You can pick very specific genes that you’re reading each letter of the genetic alphabet for. But what whole exome sequencing does is it reviews all every gene, right? Your entire gene library from the first gene to the last gene. That’s 20 plus thousand genes. And the reason why that’s so valuable is because you’re not missing anything. You’re not leaving any stone unturned, right? And again, when you’re looking for a comprehensive review of an individual’s genome, you’re really wanting to do that full, [00:08:00] thorough search. Now, the other thing that’s really important to understand, which is kind of what I mentioned in the beginning, is the type of laboratory that’s utilizing this technology. Anyone can wake up tomorrow, buy sophisticated machinery that runs next gen sequencing, and call themselves a lab, and they sell whole exome sequencing to the public.
The difference, and the thing that’s really important that providers understand, is when you’re looking for true quality, reliable medical genetic testing, you really need to a laboratory that has TAP and CLIA certification. These certifications Basically ensure that the laboratory is operating at very high standards. These laboratories are the laboratories that are used by hospitals, by doctors and even the insurance reimbursements for laboratory testing typically have to come from CAP and CLIA certified labs. So again, when you’re looking for Quality, Medical, Genetic Testing, [00:09:00] What kind of technology are they using? Is it microarray? Is it next gen sequencing? And what kind of laboratory is being utilized? Is it a true CAP and CLIA certified medical laboratory? If you know those two things, then you can reliably order genetic testing from these laboratories or these institutions because you know they are truly using high quality tech and they are operating at the highest level standards when it comes to medical genetic testing.
Dr. Weitz: So what is an exome? So,
Dahlia Attia-King: Great question. I should have clarified that. So there’s two really like super comprehensive big tests. There’s whole genome sequencing and whole exome sequencing. Whole genome sequencing is, again, the reading of every single letter of your genetic alphabet. Every little thing. Whole exome sequencing is a little bit more specific. Your exome is [00:10:00] your full gene library. Now some people say, wait a minute, you just said whole genome, it sequences your whole genetic library, your whole genome, but whole exome does the same thing. Not quite. There’s actually genes in our genome, right? These are very specific information packets. They deliver instructions to the body. And then there is actually genetic information outside of those genes, outside of the gene packet. Those areas of genetic information don’t actually actually instruct the body to do something directly. So, it’s genetic material, it’s information, but it is not necessarily translated into useful information by the body, right?
So, genes are those packets that give it, give the body instruction, and then the genetic information outside of the genes really support the genes themselves and don’t actually, you know, give instruction to the body. So what we’re [00:11:00] focusing on with exome is just those gene packets, those genetic areas in your in your genome that instruct the body to do something.
And again, the reason why that’s so important is because most diseases are caused by variations in the gene packet, inside the gene packet, not in variations outside of the gene packet. So we only focus on sequencing the genes themselves, those information packets, and that is what whole exome sequencing is.
It’s more cost effective, it’s a lot more affordable than sequencing every little tidbit of genetic information, and it’s more juice for the squeeze, because again, you’re looking at the areas that are instructing the body to do something. And not any other areas.
Dr. Weitz: Is that additional genetic material that’s not part of the DNA? Isn’t that the epigenome?
Dahlia Attia-King: Not quite. Okay. Not quite. Yeah. The epigenome [00:12:00]
Dr. Weitz: is important, right? Those are the Switches that turn off and turn on our genes, right?
Dahlia Attia-King: Yes, and I so I’m not an expert in that area to be honest. I’m not a geneticist, so I don’t want to speak. But I think epigenome really mostly focuses on the the turning on and turning off like I think you mentioned of the genes themselves. And that can can be impacted by other things, right, the environment of the DNA and not the DNA itself.
Dr. Weitz: Okay, so, tell us about your experience when you ran this test on yourself, what you found, and then also if you can give us any detail on what steps you took afterwards.
Dahlia Attia-King: Yeah, absolutely. So I have a very ironic story with the founding of my company. Normally, I hear a lot of entrepreneurs they face a problem themselves and then they say, you know what, this is a problem I’m experiencing. I bet a lot of people are [00:13:00] experiencing this problem. Let me create this company or let me solve this problem. You know, and hopefully help a bunch of people.
I never considered. genetic testing as a problem for myself. I never even thought about genetic testing for myself, which is so insane. I worked for a group of laboratories, as you mentioned in the beginning, and I recognize how few people were able to access this potentially life changing, life saving test. And because of that problem that I observed, I decided to create a solution and make this testing a lot more accessible and affordable to people so that more people could get access to this information and potentially save their own lives. It wasn’t until I launched the company that I decided, hey, I could get genetic testing.
I’m the founder of this company. I would be a total fraud if I didn’t actually get this genetic test for myself. And so, I was patient number one, and I dragged my poor sister, my poor guinea pig sister into this as [00:14:00] patient number two. And ironically, we found out that we both have a genetic mutation that makes us nine times more likely to develop ovarian cancer than the average woman.
Mind you, my sister and I do not fit the traditional healthcare guidelines for genetic testing. We’ve even asked our physicians to If we needed to get genetic testing, and because we have no family history, we have no personal history of any related disease we really were sort of guided to not worry about it and not get genetic testing.
And so it wasn’t until we did it anyway, right, because again, we made this company to make this type of testing more accessible and affordable, that we realized that we both carry this, you know, kind of, hidden genetic mutation that makes us more at risk for this type of deadly disease. Now, what we’ve been able to do because we have this information is we’ve both been able to take it to our doctors and say, hey, listen, [00:15:00] we actually are at higher risk for developing this disease.
What can we do? And although ovarian cancer is one of those insidious types of cancers that really doesn’t any symptoms until very late stage there are a few things that can be done in order to hopefully catch the problem at early stages, or maybe even eliminate it completely. We get certain scans every year, of course, because, We have this risk that we wouldn’t have gotten otherwise.
In fact, this gene also increases your risk a little bit for a little bit more than the average woman for breast cancer as well. And so I get annual mammograms even though I’m under the age of the annual mammogram recommendation. I get mammograms, I get MRIs, and I get ultrasounds as well. So that we’re able to kind of monitor any, you know, any disease progression. And all of that is possible because of this genetic risk that I have. And that’s exactly what can be done for millions of other people that have these types of risks. This information [00:16:00] can empower you and allow you to identify any of these problems before they even become full blown problems so that you can hopefully save your own life.
Dr. Weitz: By the way, we talked off air about what is functional medicine, and so from a functional medicine perspective, apart from the scans to look for the beginnings of ovarian cancer, I would recommend that you look at your estrogen metabolism by taking a urinary estrogen test that looks at how you metabolize the estrogen, because depending upon whether you metabolize it along the four or the 16 hydroxyestrone pathway will determine to some extent whether you are at increased risk. And number two, you should be tested for environmental estrogens because there are many endocrine disrupting substances in the environment, like bisphenol [00:17:00] A, like pesticides, like phthalates, like, there’s a whole series of chemicals that. have an estrogenic effect and can also increase your risk of estrogen related cancers like breast cancer and ovarian cancer.
Dahlia Attia-King: That is great guidance and that is obviously your area of expertise and so I will leave all of that to you but that sounds phenomenal and even personally something I should probably look into so thank you for that.
Dr. Weitz: I do recommend that you look into that. So What are some of the diseases that patients, besides ovarian cancer might find on one of your tests? And and then it seems like the test is focused on cancer, heart disease, and neurodegenerative. Is that right? Or are those just the biggest most prevalent killers?
Dahlia Attia-King: Yeah, so genetic testing, medical genetic testing is really [00:18:00] as advanced as our scientific knowledge of genetics, right, and how our genes are playing a role in our disease. So the more we understand with scientific research the more these tests will be able to tell us. And so, to your point today, these tests really focus on those areas of knowledge that we sort of have a decent grasp on. And those areas are the areas of cancer, of cardiovascular diseases and conditions, and neurological disorders. There’s also a whole group of diseases that are sort of lumped into this group called rare diseases. There’s thousands of rare diseases, and they are just that. They’re quite rare. In aggregate they occur, I think, in, in 10 percent or more of the population but each individual rare disease is quite rare and could affect, you know, very few number of people. Those diseases can also be identified, I think, 80 percent of the time with with genetic testing. But the areas that I think will [00:19:00] concern the vast majority of people are those areas that are, you know, the big killers, right? The big problem problem makers. And so, scientific research is you know, sort of uncovering that one in eight cancers, is actually potentially linked to very specific identifiable genetic changes and in those areas, these tests are very helpful because those specific individuals will be able to understand where their risks are, again, before problems arise.
And they could reduce their risk and in a lot of cases even eliminate their risk completely. So yes, so cancer is definitely one of those spaces. And it tends to be one of the most attractive spaces because of how you know, our lifetime risk of developing cancer in the United States is almost one in two, right? So there’s basically a 50 percent chance in your lifetime that you will develop some sort of cancer. And so [00:20:00] having a risk assessment, Before you develop these problems, it’s incredibly, incredibly effective.
Dr. Weitz: What percentage of patients who get this test will have a negative result?
Dahlia Attia-King: That’s a phenomenal question. And actually the fantastic news is it is the majority of people. Most people will have a very boring test result and that’s what we want. We don’t want a riddled result, right? We want it to be as boring as possible. And the good news is that most people will actually be negative for the vast majority of mutations that science understands to increase your risk for disease. So it’s fantastic. And what we like to say is, you’re going to walk away with one of two things once you get this guy. You’re either going to walk away completely empowered because now you have information that will help you make smarter, more targeted decisions, and it will, you know, [00:21:00] potentially reduce your risk for developing any problems in the future. Or you will walk away with a tiny bit more relief, right? A little bit more comfort because you don’t have an increased risk. of developing any of these problems. So it is a win win situation with everybody you know, taking this test. But the good news is that the good majority of people will actually have very boring test results.
And no matter what your results are at Panacea, you get a one hour free post test session with a genetic counselor. And the reason why that’s so powerful is because genetic counselors are actually the experts. on genetic testing. In fact, they have more training on this than physicians do. And so, sitting down with a genetic counselor, no matter what your results are, is really helpful in helping you understand what your results mean and what your results don’t mean. And they also help you think about potentially beneficial next steps as well, and [00:22:00] what you should be talking about with your doctor. So, that’s something at Panacea that everybody gets, no matter what the results are.
Dr. Weitz: That’s great. I’ve really been enjoying this discussion, but I’d like to pause for a minute to let the listeners know that we have a special offer for those listening to this podcast. If they would like to order this genetic test through Panacea, they should go to the website seekpanacea. com and use the affiliate code Weitz15 and you will save 150 off your purchase. Now we’ll get back to the discussion.
Dr. Weitz: So, for practitioners who have their patients get this test, can they call in and talk to somebody from your staff to get some questions answered as to how they will work with their patients?
Dahlia Attia-King: Yeah, so, the genetic counselors that, that we work with are lovely and they will answer and [00:23:00] consult with the physician should the physician have any questions about any next steps or any, you know, they need any clarifying about the results themselves. Absolutely. So this is really a handholding experience, not only for the patient and the user, but also for the providers that, that might be helping the patients as well.
Dr. Weitz: Since a percentage of my listeners are functional medicine practitioners, how can this testing complement a functional medicine approach to patient care?
Dahlia Attia-King: Yeah, so again, I think what we’re all trying to do here is we’re all trying to reduce risk, and we’re all trying to do that by preventing Massive catastrophic problems from happening in the first place. I think disease prevention and as you mentioned to me offline Root cause based medicine, right, which is what functional medicine is is you know, a perfect pairing with this [00:24:00] type of preventative genetic testing. Our goal is to help individuals and providers really I understand where their risks are so that they can sort of continue a very targeted and personalize plan for for themselves and for their patients, because that truly is one of the best ways to identify an early problem.
And I mean, I hear it all the time, scientists and doctors talk about how you know, the real true problem with cancer is this, is when it’s discovered in very late stages, because that is when it really becomes a deadly issue. If you are able to discover cancer in very early stages, you really increase the risk, or increase the likelihood, excuse me, for you know, these types of problems to not be as deadly.
And so, what we’re hoping is to sort of put more people, into that early discovery category, or even the prevention category, where these problems don’t even happen in the [00:25:00] first place. And so with that mission of ours and the mission of functional medicine providers, I think we’re all really on the same boat here. We want to be able to utilize this technology to stop problems before they even start.
Dr. Weitz: Now, apart from these big diseases like cancer and heart disease, can your genetic testing also give us some guidance as to how patients metabolize their food, how they, you know, their propensity to gain or lose weight, or can it tell us anything about whether or not they’re more likely to do well with one type of diet over another or things like that.
Dahlia Attia-King: Yeah, so our testing specifically focuses on disease susceptibility at this time. We are obviously reviewing the entire genome and our laboratory partners. Obviously, they’re [00:26:00] Kaplan Clio, you know, certified laboratories. They certainly have the ability to run all kinds of genetic tests using all kinds of technologies. And in the future, we likely will be able to offer reporting on those specific things that you just mentioned. But to be clear, today, our whole exome sequencing is solely focused on inherited disease risk. That’s really the areas that we’re able to guide on. But stick around because we’re always adding different functions and different reports and are able to reveal all kinds of different information for our users and our providers.
Dr. Weitz: Now, what about for fetuses? Parents, you know, who are pregnant, are concerned about the propensity of their newborn to have certain genetic diseases. Can this test be done in that setting?
Dahlia Attia-King: So prenatal genetic testing is probably one of the biggest fields in genetics. And of [00:27:00] course, as parents, you know, we all want to do what is best for our child and our children. Today, prenatal testing focuses on very specific diseases. And whole exome and whole genome is not typically run or utilized in prenatal testing. I’m a little biased, obviously, but I believe, that’s exactly the direction or where the direction should be for prenatal testing. But believe it or not today, they only focus on very specific diseases.
We, we don’t do whole exome or whole genome in prenatal. But I think it’s certainly an excellent observation and an excellent question because it makes the most sense. And it also will set the child up for, you know, their health future, once they, you know, once you have an idea of what this child is at risk for, you can certainly start from very early stages and you know, help guide that child on a really healthy trajectory. It’s just not something that is being [00:28:00] done today. It’s wild to even think that we have this technology and we can use it in this way, and it’s actually not being utilized. So, hopefully we’ll explore that in the future.
Dr. Weitz: Are lifestyle interventions discussed by the genetic counselors with respect to some of these disease risks?
Dahlia Attia-King: In certain cases, yeah, absolutely. I mean, listen, in general, no matter what your genes are, I think the guidance still stands, right? Eat a healthy diet reduce your stress, be active, build muscle, right? All, all of these got these key guides or guidelines are important no matter what your genetic makeup is. But what’s interesting is if you actually Find that you have an increased risk for XYZ. That might be a really great boost into getting you, you know, into these lifestyle habits and patterns that you may have been flacking on or avoiding, right? And so sometimes it’s a great reminder that, you know, [00:29:00] in for us all to say, Hey, you know, we really do need to reduce our stress. We need to, you know, we need to sleep better. We need to do whatever. And so it could be a fantastic reminder. However, those things are important, no matter what your genes are. Right. And I don’t, I don’t think anybody would argue that. But yeah, that’s it.
Dr. Weitz: You know, the thing, unfortunately, is those of us who live in this world of diet and lifestyle and nutrition and what seems like a simple recommendation, you need to eat a healthy diet might seem a sort of a simple thing for maybe somebody who’s not in that world.
But once you get into that world, you realize that you have Ideas of what a healthy diet is. And you have people recommending eating meat only. You have other folks saying you should eat vegetables only. We have the ketogenic diet. We have the Mediterranean diet and they’re all [00:30:00] completely different. And, and so, we argue back and and forth and everybody has their opinion.
I have my opinion. And I try to use biomarkers to determine if people are doing well on a specific diet and if those biomarkers are not looking good on that diet. I use that as a basis for saying we need to try a different type of diet. But it would be nice if the genetics also could guide us as to, you’re the type of person you need who might do really well on a really low carb diet, even if it were, say, a ketogenic diet as opposed to somebody else who’s more likely to do really well on a, on a vegetarian lower fat diet.
Dahlia Attia-King: Right, absolutely. And we, we hear, we hear this all the time and I think That type of information could be very useful for people, obviously. And again, it’s something that, [00:31:00] that we can very easily sort of add on, right? We’re already looking at the genes very deeply. And there might be some different types of testing or, or technologies that might need to be utilized in order to drill down into those specifics that you’re, you’re referring to. And like I said, it’s very likely we’re going to do it. It’s funny because that area of genetics is not as. As, as studied, I should say in the scientific community, as much as the disease causing areas, right, of of genetics and so we sort of started out with the area that we have the best grasp on in, in, in science and our scientific understanding, but it’s certainly something we, we’re strongly considering and, and we could, you know, pretty easily add into our reporting abilities.
Dr. Weitz: Right. Okay. Can you give us any other examples of some patients who’ve run your test and discovered certain types of diseases so we have some concrete examples?
Dahlia Attia-King: Yeah, [00:32:00] so, clearly the, the, the areas of cancer are probably some of the, the, the most prevalent, I should say. We’ve had individuals that have an increased risk for colon cancer and that’s, that’s an interesting area because, Colon cancer is ideally one of the most preventable cancers because we have such good screening methods like colonoscopies. And the power of this type of testing is that it could alarm you to these risks before any of these recommended screening methods are actually recommended. There’s typically an age in which these screening methods are recommended. And if you have a genetic mutation. That puts you more at risk. You could start the screening methods earlier, again, to increase your risk or increase your likelihood of finding these problems or reducing your risk overall.
Dr. Weitz: And that would be especially important because recently we’ve heard about an increased risk of colon cancer in younger [00:33:00] people.
Dahlia Attia-King: Absolutely. And so, and colon cancer, your risk for colon cancer obviously, again, can be identified earlier in life, but it’s another really great area of where, you know, changing your diet, right, could help decrease your risk, even if you do have a genetic risk. A high fiber diet you know, They say try to avoid high fats and, and process, you know, meats, etc. Ideally, those things will reduce your risk for colon cancer, but especially if you have this genetic risk for colon cancer. But the best thing to do when you do have an increased risk for something like colon cancer is to start screening earlier, right? The colonoscopies. I think the recommended age for just got reduced from 50 to 45, for, for
Dr. Weitz: Yeah, but 45 is still pretty old when we’re having 25 year olds with it. So, if you got this test and it showed you had an increased risk, would that increase the likelihood of your insurance company to approve a [00:34:00] colonoscopy?
Dahlia Attia-King: Yes, so, yes, it does. And the good news is that there’s also a law called GINA and GINA is the Genetic Information Non Discrimination Act. And what that act does is it essentially requires the insurers to not drop you. as a member because of any of your genetic mutations that could be identifying these tests. And they also can’t hike up your premiums because of your genetic test results. And in most cases, yes, they do cover a lot of these services. Myself personally, my insurer does cover a lot of my screenings because of my genetic mutation. I wouldn’t have been able to get a breast MRI had I not had this.
genetic mutations. And my doctor obviously pushed for my insurer to cover these MRIs because of my genetic mutation. And I’m protected by Gina because now my insurer can’t drop me or change my premiums because of my, my genetic mutation. So that’s something luckily we, we don’t have to [00:35:00] worry about. And in, in most cases, or in, in some cases, maybe you will be able to, to get covered for these, these things.
Dr. Weitz: Now, I’ve heard you say that some of the patients don’t want to get these tests because they don’t want to get the negative results.
Dahlia Attia-King: Yeah, so one of the biggest hesitancies that we hear from people is they’re afraid. I don’t want to get this test because I don’t want to know. What, what if I do have an increased risk for colon cancer or breast cancer or, or whatever, I don’t want to know. And I understand that fear, of course, we, you know, it, it is always overwhelming to learn something about yourself that, that maybe is not that great, right?
But, the power of this test, and the whole reason it exists, is because it helps us change our trajectory. And it helps us get in control. of our past and our future. It would be [00:36:00] useless if these things were written in stone and you get this result and you literally have to sit there and wait to get sick, right?
It would be a useless task. Nobody would buy it. I would never endorse it. I wouldn’t buy it. I wouldn’t sell it. It would be just an absolute disaster. But that is not These tests give you an idea of where your red flags are, and because of that information, you can now be in control. You can now understand exactly how to target your healthcare with your provider and change the trajectory of your healthcare future because of this information.
And so again, this is, the purpose of this test is to empower you so that you can be better off with this information than without it. So fear is a very normal thing, but once you walk yourself through the reality and the logic of what this test can do for you, then it becomes a no brainer. Then everybody wants to do it because they realize how powerful it is.
Dr. Weitz: [00:37:00] That’s great. Okay, I think it’s time for us to wrap. If you have any final thoughts, otherwise tell us about how patients can find out about this testing.
Dahlia Attia-King: Yeah, so just as you said you can visit our site seekpanacea. com. That is where you can purchase a test within a few seconds.
Dr. Weitz: You want to spell that out exactly?
Dahlia Attia-King: Sure. Yep. So it’s seek, S E E K. Panacea, P A N A C E A, com, and that, like I said, that’s where you can purchase a test. We accept all major credit cards, and we also accept FSA and HSA, so if you have those insurance dollars that you need to spend, use them or lose them, you can certainly use them with our genetic testing. A lot of people do that, and they’re basically able to get this test for free, which is amazing. Thanks. And you also will be able to schedule your genetic counseling session once you purchase your test with us as well, but you can buy a [00:38:00] test within seconds online, and don’t forget to use Dr. Ben’s discount code, save you 150 on the test.
Dr. Weitz: Great. Thank you so much.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine. And I will talk to everybody next week.
Lara Zakaria discusses Hashimoto’s Thyroiditis 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
In this extensive and informative episode of the Rational Wellness Podcast, host Dr. Ben Weitz is joined by Lara Zakaria, the Foodie Pharmacist, to explore the complexities of thyroid health, focusing on autoimmune hypothyroidism, also known as Hashimoto’s thyroiditis. They delve into the prevalence and history of hypothyroidism in the U.S., the nuances of thyroid function, and the role of iodine. Key topics include the limitations of TSH levels for diagnosis, the importance of comprehensive thyroid testing, and the role of thyroid-binding globulin and sex hormone binding globulin. The discussion emphasizes a multifaceted approach to treatment, integrating gut health, stress management, adrenal health, and personalized medication strategies. Also covered are various thyroid medication options, dietary strategies for managing thyroid conditions, and the intricate relationship between iodine and thyroid health. Lara Zakaria shares insights on bio-individuality in functional medicine and introduces a one-month thyroid optimizer program. This episode offers a thorough understanding of thyroid health and individualized care protocols.
00:00 Introduction to the Rational Wellness Podcast
00:29 Understanding Hypothyroidism and Its Prevalence
02:11 History of Iodine Supplementation in the U.S.
03:30 Meet Lara Zakaria: The Foodie Pharmacist
04:09 The Role and Importance of the Thyroid Gland
06:01 Symptoms and Diagnosis of Hypothyroidism
07:23 Proper Testing for Thyroid Function
18:24 Autoimmune Thyroid Conditions and Their Management
26:02 Choosing the Right Thyroid Medication
26:55 Understanding Thyroid Medication Options
30:51 Addressing Medication Sensitivities
32:35 Impact of Biotin on Thyroid Testing
34:11 The Role of Iodine in Thyroid Health
41:32 Dietary Considerations for Hypothyroidism
46:15 The Goitrogen Debate
48:49 SIBO and Thyroid Health Connection
50:29 Conclusion and Contact Information
Lara Zakaria is an Integrative Pharmacist, Certified Nutrition Specialist and an IFM certified Practitioner. Combining her background in pharmacy and training in Personalized Nutrition, Functional Medicine, and herbalism, Lara designs personalized protocols that incorporate whole food, herbs, nutrigenomics/pharmacogenomics, medication history, and lifestyle modification to help patients achieve their health goals. Her website is LaraZakaria.com.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz. com. Thanks for joining me, and let’s jump into the podcast. Hello, Rational Wellness Podcasters.
Today we’ll be having a discussion with Lara Zakaria, the foodie pharmacist, about how to help patients with autoimmune hypothyroidism, also known as Hashimoto’s thyroiditis. Which is the most common autoimmune condition in the United States? I’m going to talk for a few minutes about the prevalence of hypothyroid, and I wanted to give you a little background about the history of iodine supplementation, [00:01:00] which kind of changed the landscape of thyroid conditions in the United States. So, the prevalence of hypothyroid in the U. S. has been increasing. From 2012 to 2019, the prevalence increased from 9.5 percent to 11.7%. The prevalence of untreated hypothyroid has increased from 11.8 percent to 14.4%. Greater than 78 percent of patients treatment consists only of T4, also known as Synthroid. In the body, T4 is then converted into T3, which is actually the active form of the hormone.
And hypothyroidism is nine times more likely in women than in men. Now, overt hypothyroidism is defined as elevated thyroid stimulating hormone. in combination with 3T4 below the reference range. Then there’s something [00:02:00] called subclinical hypothyroidism, and this is defined by elevated TSH, but normal 3T4.
So now I want to talk for a couple of minutes about the history of hypothyroidism in the U. S. So today, over 90 percent of those with hypothyroidism have Hashimoto’s, which means it’s an autoimmune condition not arising from an iodine deficiency. Prior to 1924, the main cause of hypothyroid in the US was iodine deficiency, especially across the northern part of this country and across Appalachia, where the soil was iodine deficient and this was known as the Gorder Belt. Iodine deficiency leads to enlargement of the thyroid known as goiter, and in extreme cases, this leads to [00:03:00] impaired neurological function, stunted growth, and physical deformities known as cretinism. But then, starting in 1924, a hundred years ago, we instituted iodized salt, and rates of goiter dropped to very low levels. Unfortunately, rates of Hashimoto soared. And in fact, this same pattern was repeated in other countries around the world. So that’s to set up the background a little bit.
Lara Zakaria, I hope I pronounced that properly, is an Integrative Pharmacist, Certified Nutrition Specialist, and an IFM Certified Practitioner. Combining her background in pharmacy and training in personalized nutrition, functional medicine, and herbalism, Lara designs personalized protocols that incorporate whole food herbs. Nutrigenomics, Medication History, and Lifestyle Modification to Help Patients Achieve [00:04:00] Their Health Goals. Welcome, Lara.
Lara Zakaria: Thank you so much for having me, Ben. There we go.
Dr. Weitz: So, what is the thyroid gland and why is it so important?
Lara Zakaria: Great place to start, right? Let’s set up the foundation. So the thyroid gland is a butterfly shaped gland that sits right at the base of the throat. So very often you’ll see imagery of butterflies. In fact, the blue butterfly has been adopted as the symbol for the thyroid gland. And it, its job is to produce the metabolic master hormone thyroid. And you know, not to sound melodramatic, but this is literally the hormone that is probably most responsible for activating or slowing down our metabolic process. It’s essential from every step of life, from conception to to gestation through childhood growth, making sure that everything, all, all the different cells and organs are growing healthfully. And as [00:05:00] we grow into adulthood, ensuring that we have a healthy metabolism, it’s lockstep with the way like our insulin hormones function, our other metabolic hormones function, and is responsible for, you know, the basic foundational stuff, heart rate, respiration rate, digestion, as well as some of the things that we consider superficial like hair growth, nail growth, skin texture, and quality. So very often we can easily assess that there’s something metabolically happening from some of the superficial function, and then when we start to see that metabolic decline, it starts to get more and more insidious and more and more serious. We start to see changes. in digestive function, in menstruation, in fertility, and then eventually we start to see things like outright primary hypothyroidism and outright conditions that really start to cause disruptions in metabolic function.
Dr. Weitz: So when they have outright hypothyroidism, what sorts of symptoms do you see then?
Lara Zakaria: So most people will present with fatigue, brain fog, energy issues. You’ll also see sometimes joint pain or difficulty recovering from workouts. That’s even if they can get themselves to do the workout. For a lot of people, it’s again, those superficial symptoms, changes in hair texture or hair quality, the rate at which their hair might be growing, their skin changes. It doesn’t have that. Luster to it as much. It might be drier or might even have to be so dry that it’s causing irritation or scratching changes in the nail bed quality, the length, the growth, and the strength of the nails, and a lot of these symptoms actually very closely mimic it, anemia, or iron deficiency. And so for some folks, that first step is often distinguishing whether they have an iron deficiency that might be causing some of these disruptions, because that’s a very important mineral, of course, or if this is caused by metabolic issues from [00:07:00] the hormonal dysfunction. The other piece of it is that we actually need iron as part of our process to make Thyroid. So the two are intertwined. So just because they have iron deficiency doesn’t mean it’s not impacting their thyroid and vice versa.
Dr. Weitz: Great. So let’s go into the proper testing for thyroid. Which tests should be run? Which tests do you like to run? And what do they tell us?
Lara Zakaria: Okay, so this is, this is a controversial topic because the guidelines recommend that we test the TSH. There are some recommendations to either get a T4, what’s called a reflex T4. In other words, a reflex T4 is if you test A TSH and it’s out of range, it’ll, the lab will automatically run a T4 or you outright ask for a T4, and most clinicians will recommend a free T4, meaning it’s unbound to protein,…
Dr. Weitz: And this is all to save an extra $10 for the insurance company.
Lara Zakaria: Well, to be fair, I’m going to run the list of the various [00:08:00] labs that I would recommend, but I would say that this is an okay starting point if we add the T4 at least, right? That’s an okay starting point. The problem with TSH on its own, one, the reference ranges on most labs are so wide, it’s very easy to miss an outlier that might cause that TSH to look like it’s normal, number one. Number two if you have a normal TSH, we’re not directly measuring the thyroid activity. We’re measuring the activity of the hormone that stimulates thyroid production. If there’s no issue with that part of the process but the issue is further down the line, we might potentially miss that. So if the issue is from converting T4 to T3 and we never measured a T3, Or even better yet, a reverse T3, then we’re missing the potential conversion issue, which is all, a couple of steps down from TSH production, right? So when you think about it, there, let’s, let’s back up a little bit, and let’s just do a quick refresher of the, the biology of thyroid production, right?
Dr. Weitz: Accepted range in conventional medicine for the TSH. Is it 0.5 to 4.5 or so?
Lara Zakaria: It depends on the lab. It can vary from lab to lab. The average that I see is usually somewhere between 0.5, maybe 1.5 on the low end up to 4 or 4.5 on the high end. That’s, that’s what I typically see on most standard lab testing. Some labs are going to vary because what they’re doing is they’re taking a population average. And sometimes they’re doing that local population. So if they’re doing it in New York or they’re doing it in California, there might be a variation on what that average looks like. So that’s why you’ll see slight variations on that. That said, that that recommended range is based on what a quote, healthy population could potentially fluctuate in their TSH. And that’s fair, but you’re taking an average, right? You’re not necessarily honing in on what’s optimal and you’re not necessarily honing in on all the various factors that can impact that average. Age, Gender, Inflammation, Nutritional Status. All these factors can [00:10:00] impact where that TSH might land. And then there’s bio individual differences of where somebody’s TSH might be.
Dr. Weitz: And we could argue that the average American is far from being healthy, so.
Lara Zakaria: That’s a very good point. What is defined as healthy, right? Right. Just because somebody doesn’t have TSH, maybe a diagnosis of hypothyroidism. They could call that healthy but they might have another physiological or metabolic condition that might alter again that TSH level and that function. So I think that’s, that’s a basic problem. So if we’re just relying on one marker in order to diagnose Transcripts What essentially could be multiple conditions, right, because there’s hypothyroidism, hyperthyroidism, autoimmune, there’s Graves, there’s Hashimoto’s, there’s subclinical. So there’s multiple things that could be happening, multiple reasons why those could be happening, but we’re only looking at one marker to try to identify. I think we’re putting a lot of pressure on TSH, frankly. I’m not saying throw it out. I’m just saying maybe that’s not enough and one good [00:11:00] basic step might be to add that T4 maybe I, I don’t know. I kind of like a total T4 with a free T4 as a basic starting point. ’cause then I know how much of that binding globulin might be holding onto T4 and how much of it is actually bioavailable. That gives me a clue as to what might be happening physiologically to the rest of the hormones, let alone to the T3 and everything else down the line. Now that said, we got to now convert T3 to T4, excuse me, to the active T3. That takes its own step. Then we’ve got to take that T3 and we’ve got to shuttle it over to the rest of the cells and they’ve got to engage with the cell receptors, fit that lock and key, so that we can then activate those cells and turn the metabolic process on.
A couple of things could go wrong there. We could potentially not have. Primarily enough T4 being produced. And we would catch that with a, with a T4 or free T4 measure. We could be [00:12:00] converting T4 to reverse T3 instead of to active T3. And again, if we’re not measuring reverse T3, T3 and free T3, then we’re not potentially catching that. We might have a lot of binding globulin. We talk about sex hormone binding globulin when it comes to testosterone and estrogen levels and how that could potentially impact hormones. But those same. Binding globulin, I call them Ubers. They’re like the Ubers of our hormones. Our hormones can’t just walk down the street on their own. They’ve gotta take, they can, they need a ride, right? Right. So they call the Uber. That’s the binding globulin. Thyroid has its own binding globulin, and very often the amount of binding globulin for thyroid MI mimics that of the sex hormones. So if there’s something that’s activating, increased. There’s more Ubers on the road.
For example, if somebody’s on estrogen therapy, that could increase their sex hormone binding globulin. That could also potentially increase their thyroid binding. So you’d have more bound thyroid than free thyroid. So again, measuring the bound [00:13:00] versus the free can be really helpful in identifying Is it a problem of too many thyroid’s not getting out of the car, or is it the problem somewhere in the conversion? Or, if I measure reverse T3, I can now see if stress might be, or inflammation might be, activating that conversion from an active T4 to a reverse T3.
Dr. Weitz: And for that reason, is it good to measure the thyroid globulin as well?
Lara Zakaria: You can, it’s a little bit harder to get. And so kind of, I’ll come back to this point about kind of choosing, choosing your own adventure based on the access, the lab that you’re using and the cost. But if you can, you, you sure can, but I think you can actually get enough information from just getting the bound and the free, but if it’s available and you, you want the extra data to confirm your findings, I think that’s. That’s reasonable. And then kind of going back to go down the line, you have now that T3, it gets in its uber, it goes to the cell site, it gets to the receptor, that key does not open the lock. Again, we talk about insulin resistance and we talk about [00:14:00] insulin resistance being an issue with the receptor activation and the acceptance of that insulin into the cell. Thyroid has a similar activity it has to go through. So if there’s an issue with the cell receptor sensitivity to the thyroid hormone, that’s also going to create another barrier for activating metabolism.
So when we can kind of get that full picture, when we can understand just from a hormonal perspective. TSH plus free total T four, free T four total, T three, free T three, reverse T three in my opinion. That would be foundational. And then from there we can start to get a little bit fancier. We can start to assess some of the nutrients that are involved in those steps. We can start to understand some of the we can look at autoimmune factors from there, if we wanna assess to see if there’s an autoimmune process that’s that’s creating the thyroid dysfunction. And then we can start looking at things like stool testing, hormonal testing, et cetera, to see if there’s these other factors that might impact a thyroid function.
Dr. Weitz: Well, given the fact that most [00:15:00] cases of thyroid problems are autoimmune, shouldn’t we automatically be measuring the TPO, the TGB, and perhaps the TSI?
Lara Zakaria: I think so. I think if you have a family history of autoimmune disease autoimmune diseases tend to run in clusters. So if we see them particularly on the maternal side, because they do, they are more prominent on in women than men. If you particularly see a history of it, I think it’s a good idea to at least, you know, annually, if not every couple of years, to run that autoimmune panel, especially if you already have either symptoms of hypothyroidism or hyperthyroidism for that matter. Or if you have a diagnosis of hypothyroidism. I have seen it over and over and over again, where somebody gets that diagnosis of hypothyroidism, they get, medicated or it’s either, you know, it’s either a borderline. And so they’re not medicated yet, or they get started on HRT for thyroid, but they never go back and recheck that [00:16:00] autoimmunity, right. They, they checked it the first time it was within range. But at some point, it pops up. So it’s a little, it’s a little deceptive. If it’s not triggered, and if you’re not in an auto, in an immune flare, you may not catch that autoimmunity. And so it’s really important, in my opinion, especially if you have a history of hypothyroidism, if, especially if your hypothyroid systems are not fully resolved with hormonal replacement therapy, to periodically check for autoimmune disease. Because as you said, Ben, it is the Hashimoto’s is the number one cause of hypothyroidism.
Dr. Weitz: Good, so that’s a good clinical pearl. You have a patient, they test negative for thyroid antibodies, so you decide they don’t have autoimmune thyroid, check it again at some point in the future because they may actually have it and those markers just may not have been elevated at that time.
Lara Zakaria: Absolutely, absolutely. And I would do all of the thyroid antibodies. I think we often stop at antithyroplobulin, but I think doing all of [00:17:00] them comprehensively is a good idea because that really gives us a better perspective because the way that that autoimmune presentation shows up, might be a little, again, it might be a little insidious and it might I’ve seen cases, Hashimoto’s is notorious for flipping between hyper thyroid symptoms and hypo thyroid symptoms. And I think that’s that presence of the variation in the way those antibodies are showing up. So I think it’s a good idea to sort of throw a wide blanket on it until you get a good sense of what their triggers are, what that process looks like for them. And that really can be so validating for patients that keep saying like, I don’t feel good.
Like I’ve been taking my medications. I’m so meticulous about taking and taking away from food. I still don’t feel good. That could be really validating to say, Hey, it’s actually not your thyroid. It’s actually your immune system. That’s causing some of that issue. Let’s address the immune dysfunction and let’s treat that root cause. And that usually really helps to keep them stable and they feel so much better. And those symptoms start to resolve.
Dr. Weitz: I’ll tell you what, why don’t we go into that first and then we’ll get into directly treating the thyroiditis. How do we address the autoimmune condition?
Lara Zakaria: Okay, so we’re going to zoom out now, right? Autoimmune disease, right? Autoimmune disease versus thyroid disease, right? So number one, I think conventionally we have, a lot of us have been trained that autoimmune disease is like a subset, the Hashimoto’s is a subset of thyroid disease. And I actually don’t look at it that way. I look at it as a different disease altogether. It’s a disease that impacts the immune system that happens to target the thyroid. Similar to how Crohn’s is an autoimmune disease, it’s an immune disease dysfunction that happens to target the thyroid. The colon, right? So I think that’s a really important distinction. It means that we still need to treat the thyroid.
We need to address the hypothyroidism, but we actually also have a responsibility to look a little bit more upstream and actually balance the immune system. And I’m seeing [00:19:00] the approach change significantly. I used to hear a lot from my patients saying, like, Well, my doctor said it is Hashimoto’s, but there’s nothing they could do about that. So I just keep taking my levothyroxine and call it a day. And I’m like, whoa, whoa, whoa, pump the brakes. There’s actually so much we can do. Number one, balancing the immune system with nutrition, making sure that you have all the basics when it comes to reducing oxidative stress. balancing the immune system, optimizing your vitamin D levels, your beta carotene and vitamin A levels, making sure your vitamin C is optimized. We can use things like quercetin, and we can really like focus in on that nutritional aspect. Antioxidants, things like EGCG and resveratrol all have been proven to to sort of balance that immune response. Selenium is really interesting. Actually, selenium and zinc, they’re kind of buddies, are really interesting because both have direct antioxidant activity. And that’s why they’re so central in both primary hypothyroidism and autoimmune hypothyroidism because not only are they part of the physiological process of making thyroid, they’re also involved in [00:20:00] the conversion and activation of thyroid and they have antioxidant activity as well. So they directly kind of impact that intersection between the autoimmune and the primary hormonal dysfunction.
And then other factors are gut health. That’s probably foundational. I would say that’s probably foundational for primary hypothyroidism too, but it’s especially important when it comes to autoimmune conditions, ensuring that we balance out any microbiome disruptions, any dysbiosis is addressed, any overgrowth is addressed, we’re addressing any intestinal permeability, and that we’re making sure that folks are balancing their make, they’re pooping every day, that they’re getting their, their stuff out on a daily, regular basis. They’re having healthy, robust formed stool every day is really, really important. Again, this is, sits at the intersection of both primary hypothyroidism as well as autoimmune, but really kind of like a foundational piece in my [00:21:00] opinion and for anybody who’s managing autoimmune patients. Another factor we kind of.
Glossed over is the adrenal piece and the stress piece. I always tell my patients, your adrenal glands and your thyroid glands are buddies. If your adrenal glands, we’re not keeping your adrenal glands happy. Your thyroid gland is going to tell us about it. They are two peas in a pod. So when we have thyroid disruption, we often see issues with catecholamine production and cortisol production and vice versa. If you are stressed and you’re not dealing with the stress primarily, you’re not going to see the benefits on your thyroid as effectively. So I think that’s a really important factor. So addressing stress, you know, foundational stuff, finding ways to manage our stress. We can’t completely avoid it right away from it, but finding ways to manage that and making sure that we are also accounting for cortisol dysfunction, high or low.
I very often find folks with thyroid issues tend to actually run on the low side and that their circadian rhythm sort of disrupts the [00:22:00] amount of cortisol that they produce and they’re sort of sluggish and dragging and don’t like have that energy in the morning. So if they’re telling me that, I definitely want to support their adrenal in one way to help to actually improve their adaptive response. If they’re super high stress, wired, having trouble sleeping, you’ve seen that elevation of the cortisol later in the day, then we want to neutralize and bring that cortisol down and then addressing sort of that catecholamine, the, the, the, the excess caffeine use because they’re trying to take advantage of that energy surge because they’re exhausted.
We want to make sure that we are addressing any low dopamine issues because they’re taking all that dopamine and they’re making epinephrine and norepinephrine instead. So they’re turning over those stress hormones very quickly and then doing all and then addressing how that’s impacting their gut function and, and all the other factors in terms of hormone balance.
Dr. Weitz: Right. And so let’s go into how do we treat the [00:23:00] Hashimoto’s? And why don’t we, would you rather start with diet and supplements? Or would you rather start with drugs? How would you like to handle it?
Lara Zakaria: Let’s start with the medication. Let’s start with the way it’s usually addressed. And then let’s use it with some of the, you know, all the good stuff that we can do more.
Dr. Weitz: Right. Okay. So we just give the patient Synthroid, end of the story, right?
Lara Zakaria: Yeah. That’s it. Call it a day. End of podcast. Right. So I will never, I, there’s a lot of also kind of chatter about, Oh, Synthroid is bad. Levothyroxine is bad. It’s synthetic. It’s, it’s fine. It, so many people do so well on Synthroid and there’s arguably some Hashimoto’s folks actually do better on Synthroid. And it just has to do with the way their body utilizes it and how it can convert it. So. If level, if you’re on levothyroxine, that does not mean that we have to discontinue levothyroxine. However, to the point you made earlier in the introduction, that’s only a T4. So if we’re not addressing conversion from T4 to T3, or there’s [00:24:00] additional dysfunctions that are slowing down that conversion, then we either have to optimize that conversion through nutrition and lifestyle factors. Or we need to then go in and add a T3. So it is possible, you know, we could do that as well through medication. You can do bioidentical hormones. That’s totally fine. You can also do it through traditional prescriptions. And I think it’s important to note that because for some people, the availability cost wise.
Some people can’t afford to do, you know, their insurance doesn’t cover it. They need to go with what their insurance covers. Number two, there are supply issues sometimes with some of these medications, but specifically the bioidentical hormones and the sort of older grandfathered bioidentical hormones that are available on the shelf, like R morthyroid, et cetera. And so that could be a challenge. Also, thyroid is a very narrow therapeutic index. The great thing about levothyroxine is it comes in a quarter microgram increment. So you really can hyper personalize a dose. And for people with Hashimoto’s, they might change [00:25:00] their dose on a day to day basis. They’re feeling a little bit too high, they might cut the dose down. So having that ability to adjust the dose by that fraction of a, of a microgram can really help them to, really empower them to make those changes very quickly. On the other hand, your armor thyroids, etc. Those don’t have a very wide dosing range. And so again, you might not feel good on them simply because it’s, you just can’t get that right. You know, like you put on a shoe and the half size up is too big and the half size down is, it’s kind of like that but more serious because you feel like. Crud, right? So, it’s, it’s I think important to kind of know that we need to choose the medication that’s going to work best for the patient and then work on it from there, right?
Whether we need to add a T3, that’s one option, or we can really focus on those factors that are going to improve conversion from T4 to T3. So, from, from a, from a conversion perspective, Stress and inflammation play a huge role. So if you’re managing somebody that’s on a [00:26:00] levothyroxine and you’re not addressing foundational aspects of stress management and you’re not addressing any other of the root causes of inflammation, that’s going to impact how well they can make that T3 and potentially might increase the reverse T3 that they’re making. In addition to that, Nutrients, Selenium and Zinc. I told you those guys are buddies and those are the star of the show when it comes to thyroid, but also vitamin A, vitamin E, and I would say antioxidants in general can be really helpful for that conversion piece.
Dr. Weitz: So just to clarify for people who are listening out there who are not really familiar with thyroid medication we’re talking about straight synthetic T4, which is known as Synthroid or Levothyroxine, as compared to what you’re referring to as bioidentical, which is thyroid from ground up pig’s glands, essentially, that contains T4, but also contains some T3 and even some T2 and T1. And so having a [00:27:00] balance of some T3 with the T4 is more of a natural type of sub of medication and may make it easier for the person to feel better because some of the T4 is already in the active T3 form. Or another option is you can add a synthetic T3 to their T4 if the person’s having trouble converting the T4 to T3 perhaps, right?
Lara Zakaria: Yes and no. What, what I’m saying is that, that different people will respond to different formulations, right? Because for example, in the the, I, the, in the versions, for example, like Armor Thyroid, or those are porcine derived to your point, there’s a combination of all the potential, it’s a glandular formula. And so there is a combination of T4, T3, and yes, even T2, which is less bioactive. And we don’t really talk about it as much as sort of the by product of T3 breakdown. However, we can’t always, [00:28:00] you’re not going to have consistency in the amount of T4 and T3 that are in those formulas. For some people who are hypersensitive, that variation from batch to batch or the wideness of that dosing parameter, the way that it comes in a capsule or tablet, it’s going to miss them. It’s either going to be too high, too low. We’re not going to get the Goldilocks out of it. We’re not going to get the just right dosage. In those cases, they actually, those folks might actually do better either on a customized bioidentical formula, a compounded formula that’s very exact and precise. Some people do better on synthetic and they don’t do as well on bioidentical.
And by the way, bioidentical in this case is not accurate. If it’s porcine derived, that’s not bioidentical, that’s porcine derived, right? Synthetic is actually closer to bioidentical because it actually looks exactly like the one that humans make. And then there’s the compounded that could be either porcine derived. They could also be derived from cattle instead of porcine. So if there is a [00:29:00] kosher or halal consideration, that’s also sometimes an option. And then there’s obviously synthetic instead. So there’s the, the, it really honestly depends. And what I, I too, there’s two myths I want to bust when it comes to medication and HRT when it comes to thyroid.
Number one, that the goal is always getting off of the thyroid HRT. I don’t think that’s necessary. I think some people have a reduced capacity to produce the hormones, and we need to supplement it, and if they feel good on it, that’s great. Like, that goal should be that they feel awesome, right? What we want to do is optimize it, and if they don’t need it, yeah, reduce the dose or eliminate it.
If it’s unnecessary, go ahead and de prescribe it. Myth number two is that bioidentical or animal derived is always superior to synthetic, and that’s not necessarily always the case. And true individualized and personalized medicine should actually respect what actually works best for the patient, and, and we should be kind of using [00:30:00] all of those options in our toolkit to make it fit for them, not only to make them feel great, but also, you know, what they feel is best for them, what their their own beliefs are in terms of what’s appropriate for their therapy.
Dr. Weitz: Yep. And then another issue that a lot of times we might want to deal with is prescription medications are typically have added additional ingredients like food dyes and coloring agents and a bunch of stuff that perhaps gluten even that we don’t necessarily want or that the person may be sensitive to.
Lara Zakaria: Absolutely. I think that’s a great layer to add to that. The bottles that we’re pulling off the shelf in a pharmacy if they’re coming from a standard manufacturer, are not going to have that layer. They’re not paying attention to gluten and they are using dyes. On one hand, it’s a safety concern, right one hand. The binders that they’re using are safe. They, we know that they’re not interfering with the [00:31:00] bioavailability of the thyroid hormone. Those colors aren’t interfering with the bioavailability of the tho thyroid hormone and arguably. really help us identify giving the right dose. So when we’re sitting there dispensing as pharmacists, the color usually cues us. Most pharmacists that work in community pharmacy could probably tell you what color goes with what dose because it’s so ingrained in our head because we dispense so much of it. And that could be a really helpful like seeing the color and go, Oh, that’s not the right color. Oh, I grabbed the wrong bottle.
On the other hand, if you have a patient who is sensitive to those, and I’ve seen it where patients will say, I don’t feel good when I take this brand, I feel okay. When I take this one, I don’t feel as good. And I’ve seen where pharmacies will dismiss those concerns. So on the other end of that spectrum is we need to also be really open minded as clinicians and hear out our patients and hear out their feedback and try to work with them to really find. Again, that ideal formulation that’s going to work for them.
Dr. Weitz: That’s great. I wanted to mention one issue that sometimes is not, is ignored [00:32:00] concerning thyroid testing, which is that depending upon the lab, if the person is consuming biotin, especially in higher levels. That can affect the way the test comes out. And how do you address that?
Lara Zakaria: Well, usually we just have folks discontinue their biotin supplements or B complex as sometimes we’ll contain a biotin. We’ll usually have folks discontinue. I usually recommend if it’s not something that you have to be on, like, if it’s not something like, if I don’t take this, I can’t function today. Go ahead and discontinue it before testing at least a couple days before. My general rule of thumb for my patients is if it’s water soluble, I’ll tell them two or three days is usually enough to flush it out. If it’s fat soluble, I usually kind of make the judgment call because it’ll take weeks for some fat soluble vitamins to really adjust. So from there, I’ll say, let’s say I really want to get an accurate vitamin D level. I rarely tell my patients to get off vitamins before I test it, but I might say, you know what, let’s take a break from the vitamin D for two or three weeks [00:33:00] and let’s just see what happens when we get your blood work done. Again, there might be very unique individual cases where that’s necessary, but to your point, very often those nutrients might interact with the way that the lab runs a test. And that’s really the reason we might recommend that we get off. It’s not so much the level, but the interaction with the testing method.
Dr. Weitz: Right. The biotin is water soluble. So two, three days.
Lara Zakaria: Yeah, exactly.
Dr. Weitz: Okay. So, let’s go into iodine. I mentioned a bit about the iodine. Some people advocate iodine supplementation. There’s a lot of thyroid supplements that contain iodine. Most multivitamins contain a modest amount of iodine. And then there are some clinicians advocating really high dosages of iodine.
Lara Zakaria: Yeah, I, I’ve seen cases where there was one clinician that had a patient go very high on the iodine, and at the same time, she has an MTHFR mutation, so they had them go [00:34:00] very high dose on methylated folate, and my suspicion is, is that is what triggered her severe Hashimoto’s. She had Hashimoto’s, that was very difficult to put into remission. So I think that’s a great warning that excessive amounts of iodine can be dangerous, that’s for sure. However, I’ve also seen cases where you have a Hashimoto’s or even a Graves disease and they do great on iodine. I think at the end of the day, there’s a couple of factors. One are they deficient in iodine? If they’re not deficient in iodine and you add more iodine, You’re at best going to have a net neutral reaction. At most, you could be triggering autoimmunity, and we’ve seen this in Hashimoto’s. Number two Iodine is a halide. Halides, like fluoride, chloride, and bromide, have a very unique chemical property that makes them want to attach to each other.
It’s actually kind of the magic between, with iodine and how we make thyroid has to do with this chemical property. It wants to attach and it is facilitated by the [00:35:00] presence of cofactors and enzymes. If you have excess amounts of other halides, like you’ve got exposure to chlorine from water, you’ve got exposure to bromide from formidated flour, you’ve got exposure to fluoride from fluorinated multivitamins or something like that, that could potentially knock out an iodine and create sort of like a wonky thyroid.
And in that case, that thyroid looks like a thyroid, but does not exactly behave like a thyroid. And in those cases, because it looks a little bit different, that could also potentially kind of confuse the immune system. So there’s also part of the, the theory is that the fact that these halogens are so much more available, so much more found so much environmentally more that they can actually knock out the iodine, outcompete the iodine.
So in some cases, adding more iodine can help it compete to create a better iodine better thyroid compound. That said, [00:36:00] I, I think that we have to be careful. Number one, the safest way if you want to add more iodine to somebody’s diet is, is to add it through food rather than add it through supplementation because the body will naturally then absorb the iodine it needs.
It’s going to compete with other nutrients in the food and it’ll sort of taper off. You’re not going to get the super high surge. Whereas if you supplement directly with iodine, it’s going to absorb more directly and that could potentially be excessive. That’s number one. Number two I considered actually topical application of iodine.
I’ve seen that really work well for folks, particularly if we, we need a little bit more iodine. We’re worried about overabsorption. Topical application can be really helpful. The trick is you don’t want the clear iodine, you want the one that has got a color. You stick it on the skin, a visible area, and if it absorbs, usually that means that person’s iodine deficient, and if it doesn’t absorb, that usually means they’re replete.
Again, it’s not like 100%, but it’s a very useful way to, to, to decide whether or not you need to be a little bit [00:37:00] more aggressive with your iodine therapy. You can do lab testing. Probably the best way to do it is looking at urine analysis. It’s a little bit of a pain in the butt to do, so it’s not my favorite and it’s, there, there’s not great information about what the targets should be.
So that’s not my favorite way, but if you can, by all means, especially if you could get multiple assessments every few months or something like that, that’s available, then that would be probably the ideal way to make sure that we’re not targeting too high on iodine, we’re not excessively supplementing, and at the same time, we’re not missing any opportunity to optimize iodine.
Dr. Weitz: Yeah, my experience is, iodine typically makes Hashimoto’s patients worse, but it is the case that a lot of drinking water is purified with chlorine, I know in L. A. we have chlorine in the water, they also add glycine. They, they also add fluorine to the water.
Lara Zakaria: Yep.
Dr. Weitz: So, and then a lot of people are no longer [00:38:00] consuming iodized salt, but are consuming Redmond sea salt or Himalayan pink salt, it’s the sea salt, etc.
Lara Zakaria: Not eating fish and not eating seaweed. And so they’re really, those are really the only two options when it comes to getting your iodine levels up. Yeah.
Dr. Weitz: Right. I know for myself, cause I, I have Hashimoto’s and I’m not on thyroid medication and I’ve been able to manage it nutritionally for the most part. But I tried the high dose 12 and a half milligrams of iodine and my TSH shot up to like 25. So yeah, it did not like it. It was very clear. Did not like it.
Lara Zakaria: Yeah. I, I usually so I’m very careful. I usually will give folks formulations that are like thyroid specific and I sort of choose. depending on the situation. My out the gate for a Hashimoto’s condition, I don’t, I’ll choose one that’s iodine free. However, I usually will add that on if we’re noticing either they don’t, they’re to your point, not eating enough sources of [00:39:00] iodine. Because at the end of the day, it’s not about like, they can’t have iodine, it’s not like an allergy to iodine, right? It’s excess amounts of iodine that will trigger that response. So, that totally makes sense.
Dr. Weitz: I know for me, increasing selenium and adding a lot more zinc and, and not consuming iodine made a huge difference.
Lara Zakaria: Absolutely. Actually, studies actually also show that selenium, selenium on its own, there’s studies that show selenium on its own can actually naturalize auto antibodies for Hashimoto’s. Combining selenium and zinc has also been shown. So again, specifically, I should say, especially if there’s a zinc deficiency, I think that combination is a magical combination. Right, yeah,
Dr. Weitz: I did the NutraEval and I was super low in zinc, despite the fact that I was consuming zinc. What about myoinositol? That’s kind of an interesting nutritional compound hypothyroid.
Lara Zakaria: Yeah, I, I wonder sometimes if it’s so much of a direct benefit or because myonocytal also has sort of a neurological [00:40:00] benefit to it. And so that might be part of the cat that again, that relationship between stress and adrenal function and thyroid production. But yeah, definitely another interesting option. I don’t necessarily always use it immediately, but it’s one of those things that is in the arsenal in specific populations. If there’s hormonal dysfunction. History, particularly in my women that might have a history of PCOS, or you know, if, if somebody, you know, kind of strikes me as that more nervous constitution, that’s usually a great add on.
Dr. Weitz: What about diet for patients with hypothyroid?
Lara Zakaria: So if there was going to be one diet, which I don’t believe that there’s really one diet for everybody. So let me, let me start off by saying that there is not one thing that works for everybody. But if there’s one thing that I could say that we have some evidence for is that eliminating gluten is generally favorable for folks, particularly with Hashimoto’s, possibly with people with primary hypothyroidism. There’s a theory that there is a molecular mimicry between [00:41:00] gluten and thyroid and that that might have been what instigated that autoimmune response. I don’t know that that has really borne out to be accurate, to be true. However, I think there’s a lot that could be said that comes with gluten containing diets that might be triggers for both the autoimmune piece and the hormonal dysregulation.
One would be gut function. You know, the microbiome we know that gluten itself can trigger intestinal permeability it’s for some people more than others, but even more so, so much of our gluten containing products, particularly wheat, have glyphosate with them. So, it’s hard for us to distinguish, is it the glyphosate, is it the gluten, you avoid the gluten, you tend to also avoid the glyphosate. And in that case, we know very significantly, can impact not only the gut piece, the microbiome, the intestinal permeability, the inflammation, but also directly impacts thyroid function. So I think from that, [00:42:00] from, from that perspective, if we’re struggling to sort of get it under control, you got a recent diagnosis, you, again, you’re, you’re medicated, but not feeling great.
I think it’s a great starting point to do a gluten elimination and see how that works. I’ve not seen any other evidence, either clinically or in the research, that sort of says, Oh, going on dairy free or removing eggs or that, you know, going keto or anything like that is directly beneficial for Hashimoto’s, but that’s going to be different for different people. If a person has a dairy reaction, then obviously removing the dairy makes sense for that person. So it might, in my practice, I might start with a basic elimination diet. At least those, the three big ones to me are going to be well I should say four. Gluten, Dairy, Soy, and Egg would be my top ones. And then I do that for at least four to six weeks, and then we do a reintroduction, a challenge of those foods, because I think it’s really important to challenge so [00:43:00] that we understand whether or not those foods were actually triggers or not. So I do a careful challenge. We identify if anything is still a trigger and or anything is questionable, and then we might continue to eliminate them if they turn out to be a problem, and then I come back in six months to a year, and we try to challenge again, just to make sure, because very often some of those sensitivities, they’re not true, they’re not true allergies, could actually clear up on their own when you do the gut work, you improve the microbiome, you address the intestinal permeability, you balance the immune system, very often they can reintroduce those foods back.
If not moderately, they can bring them back, you know, in a, in a healthy balanced way. Other than that, I really focus on those foundation, foundational nutrients, get their macros balanced, make sure they’re getting enough fiber in, and they’re getting tons of protein, right? So making sure we’re emphasizing that as a foundation.
Sometimes we go keto. If there’s a lot, there’s some evidence that keto can be really great as an anti inflammatory intervention. So if there’s a lot of inflammation, there’s other metabolic issues happening, keto could be a good way to [00:44:00] sort of clean some of that up, but that’s not appropriate for everybody.
So again, case by case basis. Once you get those macros in order, I’m really focusing in on bringing tons of fruits and vegetables in and bringing in all the specific nutrients, those antioxidants getting a lot of color. I talk to them about eating the rainbow and getting a variety of all those phytonutrients and polyphenols in because of the benefits that those are all going to have on the immune balance and on the gut microbiome.
I’m a big fan of the WALS protocol actually, so I, I do talk to them a lot about the WALS protocol and although she used it more for MS. I found it to be beneficial in my Hashimoto’s patients. So I sort of dial it up and down depending on what their specific needs are. And, and I think to your point, Ben, some people show up with Hashimoto’s and they’re very much a thyroid case. Like their symptoms are very much like hypothyroidism fatigue, you know, they’ve gone showing all those symptoms, but some people show up and all that stuff looks good on paper, but their autoimmune symptoms, their gut health, their adrenal function, they don’t. Hormone Health [00:45:00] is all, is all a struggle. And so we sort of positioned the diet depending on what we need to most directly support.
Dr. Weitz: When it comes to diet, do you think the concept of some vegetables as being goitrogens is something that we should pay attention to?
Lara Zakaria: I love this question.
Dr. Weitz: Is broccoli going to make my thyroid worse?
Lara Zakaria: Okay, goitrogens, when they’re cooked, go away. We don’t have to worry about them. So that said, there is something to be said about raw goitrogenic foods like broccoli that could be triggers for some. However, goitrogens typically are called goitrogens because they increase goiter. They are hyper, they create high amounts of thyroid production. So in an autoimmune case like Hashimoto’s, where you’re fluctuating between high and low, and if we still don’t have that under control and it’s triggering, just avoid the raw ones. Get it under control and you should be able to [00:46:00] tolerate cooked versions. But this is one of my pet peeves because those goitrogens tend to be those sulfa rich vegetables, right, your cruciferous vegetables, which are a powerhouse. They’re such a powerful food as antioxidants. They help us make glutathione. They reduce inflammation. They help with detoxification. They balance hormones. They are such a powerhouse. So this idea that we have to completely remove them from the diet is, misinformation. Cooks them to be safe. That’s probably easier on your digestion anyway. It eases some of that the, the, makes the fibers a little bit easier to digest as well. In fact, it improves the bioavailability of some of those phytonutrient compounds. When you see that broccoli start to steam up and it like gets super bright green, that’s when you know you’ve optimized those phytonutrients so they’re even more bioavailable. So that’s my suggestion. To be safe, cook them. If you’re in remission, if you are well controlled, then you should be fine, even if you have them raw.
Dr. Weitz: I, I, I’ve heard this one story on several podcasts where some woman [00:47:00] consumed like two pounds of raw bok choy for an extended period of time and died herself.
Lara Zakaria: Yeah, don’t do that. I, I don’t, I can’t imagine why you would do that, but don’t do that. Bok choy is delicious, but so much more delicious cooked with some garlic and some soy sauce, gluten free soy sauce.
Dr. Weitz: And, and, and poor broccoli is kind of a maligned vegetable because it’s a high FODMAP food. It’s a goitrogen….
Lara Zakaria: Poor broccoli.
Lara Zakaria: Don’t get me started on the high FODMAP thing too. Oh. Actually, that does remind me though you know, kind of going back to the making those connections and digestion, folks with Hashimoto’s and folks with primary hyperthyroidism are more prone to SIBO and digestive, I know, right? It just wants to, it wants to be part of the show, but folks with Hashimoto’s are at higher risk for developing SIBO and [00:48:00] IBS. And so to your point, so many of these things kind of, you know, they show up like, Oh, I’m going to avoid broccoli because broccoli is you know, is a goitrogen. Oh, I feel so much better off of it. Well, do you feel better because it was triggering your SIBO and we need to address your SIBO actually and get that microbiome in check and get your motility going? Because when you have low thyroid, your motility is going to be too slow. Slow motility increases your risk for SIBO. And that’s really the connection there.
Dr. Weitz: So there’s also an autoimmune connection too, because the latest research shows that SIBO has an autoimmune component.
Lara Zakaria: Yes, correct. And it has to do with the autonomic nervous system. And again, that connection back to the brain. And yes, absolutely. So I think, again, these kind of simplistic, just take this out, take out this food, and that’ll solve the condition. We need to start thinking a little bit more upstream, right? We need to start thinking about what is actually the foundational role. What’s the physiology that’s happening there? Where’s it going wrong and how do we address it? And we have to identify those bio-individual variances in people. Why one person might be more prone to one aspect versus somebody else that shows up a little bit differently. There’s definitely not one size fits all. Everybody needs their own bio individual approach. And we need to start thinking a little bit more with nuance when we approach it.
Dr. Weitz: That’s great. It’s been a great discussion. Tell everybody how they can get in touch with you and find out about what you have to offer.
Lara Zakaria: Amazing. Thank you, Ben. It’s been a pleasure being here. If you want to keep this conversation going, I spend a lot of time on Instagram and LinkedIn, so feel free to find me there. You could search my name or look for Foodie Pharmacist. That’s 2F, so Foodie, F O O D I E, Pharmacist. F, A, R, M, A, C, I, S, T. You can also come to my website, larazaccaria. com. And I do have a screening guide and a guide that talks about better assessment available on my website, as well as a collaboration with the Better Nutrition Program on a coached a one month thyroid optimizer [00:50:00] program that’s useful whether you have primary hypothyroidism or autoimmune hypothyroidism. It’s a great starting point. If you’re not sure where to start, you’re trying to identify what might be the area that you need to focus on on more, that’s what we built it for. And you get the four week program. It’s easy to follow in the app. Plus you get the added benefit of working with a coach as well.
Dr. Weitz: That’s great. Thank you, Lara.
Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help. overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111. And we can set you up for a consultation for functional medicine. And I will talk to everybody next week.
Dr. Tom O’Bryan discusses Demystifying LPS with moderator Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on September 24, 2024.
[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
00:00 Introduction and Podcast Overview
00:27 Welcome to the Functional Medicine Discussion Group
00:45 Sponsor Highlights: Integrative Therapeutics and Vibrant America
02:34 Introduction to Dr. Tom O’Bryan
02:55 Challenges in Gluten Sensitivity Testing
46:06 The Importance of LPS in Inflammation
46:23 LPS and Its Role in Alzheimer’s Disease
47:24 Bacterial Translocation and Immune Activation
48:12 Personal Anecdote and Research Insights
48:46 LPS and Neuroinflammation
49:23 The Overlooked Impact of LPS
51:46 LPS and Sepsis: A Hidden Danger
52:38 Leaky Gut in Monkeys: A Comparative Study
54:59 Chronic Inflammation and Its Consequences
01:04:08 The Path to Sepsis and Organ Dysfunction
01:05:17 The New Model of Sepsis Treatment
01:09:06 Sources and Detection of LPS
01:13:45 The Role of Lipoproteins in Inactivating LPS
Dr. Tom O’Bryan is a recognized world expert on gluten and its impact on health. He is an internationally recognized and sought after speaker and workshop leader specializing in the complications of Non-Celiac Gluten Sensitivity, Celiac Disease, and the development of Autoimmune Diseases, as they occur inside and outside of the intestines. His website is TheDr.com. Please register for his award-winning docuseries, TheInflammationEquation.com.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Ben Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me. And let’s jump into the podcast.
Welcome everybody. I’m Dr. Ben Weitz, and this is another Functional Medicine Discussion Group meeting. Please tell all your friends about these meetings. We have great speakers and it’s a great opportunity to network and learn and usually get some free food.
So our sponsors for this evening are Integrative Therapeutics. The rep from Integrative is not here so, I just wanted to tell you about a few Integrative Therapeutics products. It’s one of the few professional lines of supplements that we use in our office and since the topic is gastrointestinal related a couple of their products that we use that are really great is the Motility Activator, which is a great way to reset the gut motility naturally.
And they also have the elemental diet dextrose free version. So, for patients who are stuck, that you’re not making progress with SIBO, with IBS, consider two weeks of the elemental diet to let the gut really rest and and that can be really beneficial. So I want to thank our other sponsor for this evening, which is Vibrant America.
The rep from Vibrant America is also not here. He’s on his way. But Vibrant America is a one stop shop for Functional Medicine testing. We use a lot of Vibrant America testing. They offer great panels. You can use it to replace all your standard panels as well as all the specialty panels, the special Food Sensitivity Panels, The Gut Zoomer. They have a whole series of those. They have great toxin testing. We use the Total Tox Burden, which is this urine panel that you get environmental toxins, you get mycotoxins, you get heavy metals, and they have great Lyme testing. They have great testing for chronic viruses, so, it can pretty much be a one stop shop for Functional Medicine testing.
Dr. Ben Weitz: And so we’re so happy to have Dr. Tom O’Bryan joining us this evening, he flew in just to speak at our meeting. Tom is, doesn’t need any introduction. He’s an incredible speaker. Thank you so much, Tom. Thank you.
Dr. Tom O’Bryan: Thank you. Hello. Before I get started, about Vibrant,… So, how many of you have [00:03:00] tested for gluten sensitivity comes back negative, but the patient feels better when they go off of wheat? Is that common? It’s the test. It’s the test you’re using. So, I’ve known this for many, many years, that sometimes you get false negatives with the testing that’s available. Whether it’s gliadin antibodies, transglutaminase, endomycem, they come back negative, but the patient reacts to wheat. It’s the test. So, I started really questioning the tests. And what I did was, when I draw a tube of blood, I took a second tube, out of the same venipuncture. I labeled it Joe Smith and sent it to the lab with the patient’s blood, ordering the same test. And when the results come back, three out of ten times, three out of ten times, you didn’t know which [00:04:00] one to talk to the patient about, the one that was normal or the one that really had a problem. That’s how frequently you will see how inaccurate your testing is, and if you don’t look, you don’t know. So we live in la la land with the tests that we’re using, thinking they’re accurate. They’re not accurate. It’s the technology. ELISA tests were developed in 1986. Is that 50 years now? Not quite, 50 years ago. They’re really helpful. And I’ve known this for many, many years, and so what do you do? As you may know, I cut my teeth in the world of gluten and wheat related disorders and celiac. I did 26 8 hour days in 2008, unlocking the mysteries of gluten sensitivity. 8 hours with me, 300 studies, Metagenics sponsored it. Anyone in the room back there? With [00:05:00] me back then, yeah, yeah. And in 2009, I did 28 8 hour days on autoimmunity. I’ve been, I’ve been doing this for a while. And when you do the double blinds, the second tube of blood, and you do it enough times, you go, oh my god. You’re,… it’s like the carpet gets pulled out. You don’t know what to say to people. You just go for symptom relief and hope for the best, right?
So in the world of celiac disease, there’s who I call the four horsemen. They’re the greats in the field. Alessio Fasano at Harvard, Stefano Guadalini, University of Chicago, Peter Green at Columbia, and Joe Murray at Mayo. They’ve written more papers that are easy to read and relevant to clinicians than anyone I know. And Joe Murray. He’s the one, he’s got leather patches on the back of his elbows for his sport coats. Bowties, that he ties, not clipons, bowties, horn rimmed glasses. He’s the geek of geeks. And his papers are so enjoyable to read because they’re clinician friendly, right? If you can read papers by Mayo, by Joe Murray from Mayo, you’ll appreciate him. Well, in January of 2016, Murray wrote a paper and said there is a new era in laboratory medicine. A new era. This is from Murray at Mayo, and it’s called Silicon Chip Technology. They can look at 6,000 antigens in one blood draw. What? With 97 to 99 percent sensitivity, 98 to 100 percent specificity, right on the money, every time. So, in 1990, 1995, if I were to tell you, in about 20 years or so, I’m going to carry this little black thing the size of my [00:07:00] wallet in my hand, and if I just push on it a little bit and run my thumb one way, or I, do it another way. And I push on a button. I can tell you within five seconds that the air particulate matter in Santa Monica right now is 38. It’s a good day to exercise outside. It’s not too toxic. Chicago’s 22. Costa Rica is 38. Alessandria, where I live, is 80. Don’t exercise outside today. I can tell you anything you want to know in the world because I’ve got the encyclopedia in my hand and I can access it in 5 seconds. If I told you that in 1990, you would have thought I was watching too much Star Trek. Right? It wasn’t in our paradigm. We couldn’t believe that’s possible. It’s possible. That’s silicone chip technology. Wake up.
The tests that you’re doing you have to check, because who’s getting screwed? [00:08:00] It’s the patients. Because you’re believing what you see in the results and you apply your protocols based on that and so many times…three out of ten…in my practice, 3 out of 10. So, that’s my plug for Vibrant. Because it was Vibrant that Joe Murray was talking about. That’s the technology. Silicone chip technology. It’s a game changer. There’s nothing like it. I’ve never seen anything like it. So, they’re sponsoring me here tonight. So that’s my plug for Vibrant, before I get started. It’ll change your practice when you do this and you do like, do five patients, it’ll cost you, you have to pay for the test yourself. You can’t bill the patient for it, but you’ll find out. Wow, one out of five of my patients gave me completely wrong information, or two out of five, completely wrong information. It’s like, holy [00:09:00] cow. Okay, let’s go. See if I can.
I’m really excited to talk to you tonight about this topic. I’m really excited. It’s a, it’s the talk that I’m giving on Saturday morning in San Jose at the Vibrant Longevity Conference. And I think I’m going to rock a few boats here and I’m looking forward to that. So many thanks to Ben for the invitation, you know, for being able to come here tonight.
This is my boss. I think the only way we’re going to change the direction the planet is going in is to raise a generation of children that think outside the box. They have to think differently because we think we’re saving the planet, but we’re driving SUVs, right? We think a certain way. So we need children that think outside the box. And the topic of this talk is really important for that. So that’s my son. And he’s almost four now. So I’m going to give you 12 premises tonight, 12 concepts, and I hope you’ll write them down maybe in your phone or a couple of notes to take so that you can think about them some more. This presentation is designed as a paradigm expanding, thought provoking engagement. I suspect there will be a few new concepts here for some. Allow ideas to percolate from these facts and write down your thoughts and questions.
In my career, when I found a paper that really captured me, I was like, what? I taped the front page of the paper to the ceiling in my bedroom. I did. And when I go to sleep at night, I go, oh, oh yeah, oh yeah. And sometimes I’d have thoughts about it during the night. I’d wake up, I’d set myself up, I gave myself permission [00:11:00] to think outside the box. You know, to just have it in my awareness. And then I would, oh yeah, and then I’d write little notes down. I got this little pad with a pen. You pull the pen out and a very soft light shines down on the 3×5 card. So you don’t have to turn the lights on in the room. You don’t get blinded. Right. And then in the morning I say, Oh, that’s right. Oh yeah. I groomed myself in topics that I didn’t, I wasn’t familiar with. If I read a paper and it is like, what? I groomed myself to think about that topic. I encourage you. to consider doing that with something that really grabs you. Put it on your refrigerator. It doesn’t have to go on the ceiling. Put it on the refrigerator. A graph from one of the papers, right? Because most clinicians don’t have time to read research. You don’t have time to do that unless you’re a geek and just love it. Like I do. It’s in all, three bathrooms in the house. There’s research papers and highlighters in all the bathrooms, right? [00:12:00] So when you find something that captures you, you dive in. You really dive into it. You learn more about it. And the result is, within a few months, you’re pretty competent in that topic. Much more competent than your peers, because you’ve read three or four papers on that topic now. because you read one and you look at the references in the back and then you order the papers or you download them off the internet and you’ve read two, three, four of those papers, you’ve got that, doesn’t matter what the concept is. If it grabs your interest and you allow yourself, you set yourself up to think outside the box, the result is you expand your consciousness, you expand your awareness on that topic that you’re interested in. Allocate one hour a week. For six months, just one hour a week to the topic. And in six months, you’ve got this. You’ve really got this down.
This is a [00:13:00] paper that everyone should read. All disease begins in the, quote, leaky gut. The role of zonulin mediated gut permeability in the pathogenesis of chronic inflammatory diseases. This is Fasano at Harvard, Professor of Medicine at Harvard, Professor of Nutrition, Harvard School of Public Health, the chief Pediatric Gastroenterology at Harvard, the Director of the Celiac Research Center at Harvard, the Director of Mucosal Immunology at Harvard. This guy has five titles. Any one title is a lifelong dream for someone at the top of their game. He’s got five. We think he’s going to win the Nobel Prize because it’s him and his team that identified the mechanism of zonulin in the production of Leaky Gut back in 1997. And they’ve written 400 papers now on that in the last 25 years. He’s always really careful of what he says, always, so that he’s not misquoted. You’ll [00:14:00] see a paper, and there’s eight authors on the paper, and the last one, Alessio Fasano, the stamp of approval from the boss, right? This paper, he wrote himself. I give you that history because The significance of the message from this great in the field. He’s a great in the field. All disease begins in the leaky gut.
This is a paper that needs to go on your refrigerator or on your ceiling and you digest this paper. He talks about the perfect storm in the development of chronic inflammatory diseases. He lays it out sequentially, you go, wow, well, what about, wow, wait, what about, Wow! And you follow his line of thinking and you get it. All disease begins in the leaky gut.
So, this is so very true, isn’t it? Now, what [00:15:00] does he mean? Well, if you haven’t read this book, this is from the 1950s, and it’s such a critically important book to read. It’s all about the adrenal glands and the impact of stress, and if you don’t know, you probably know, but a young man that unfortunately dies of trauma, a healthy young man, his adrenal glands are the size of a walnut. A young man who unfortunately dies of disease, his adrenal glands are the size of a peanut. So you think giving some nutrients for a few months or changing a diet is going to change that? How do you rebuild adrenal glands? One cell at a time. It takes years to rebuild an adrenal gland, but do you have any biomarkers of what you’re doing and the goals of what you’re trying to produce? You read Selye’s book and you start to get this big picture. Now I put the book here because of the quote in the book. I just love the quote.[00:16:00]
You’re all advanced clinicians here. You’re all advanced, but you’ve not done double blinds on blood tests yet. Right? Nor so naive to believe you could do so without intellectual effort. We trust our labs. We trust what we’ve been told. Wake up. So this paper tells us of why we have every autoimmune disease is going up four to nine percent a year, every single one of them.
Why? Well, the population has gone from, in the 1950s, we were at about 2 billion. Now, we’re at over 6 billion in 50 years, in 70 years, but look at the ratio of these. Look at how many of them, oops, let me back that up, sorry. There we go. The blue line are those over 70, the percentage of the population over [00:17:00] 70, compared to The percentage of the population under 70. We’ve got billions of more elders now. That’s a primary contributor that every autoimmune disease is going up 4 9 percent a year because there’s more people living longer who’ve had a lifetime of toxic exposures and their bodies are breaking down, right?
Societal triumph of longevity is plagued with debilitating morbidity accentuated towards the end of life. There’s a recognized gap between lifespan, the total life lived, and healthspan, the period free from disease. That’s my personal goal, is to extend the healthy lifespan closer to the total lifespan. I don’t know about extending life, I don’t know, I can try, you know, I hope so, I hope so. But, that quality of life, [00:18:00] healthy lifespan is, and when I say that to a patient, they all, oh yeah, yeah that’s what I want, well this is what you have to do. You have to figure out how you’re throwing gasoline on the fire and stop throwing gasoline on the fire.
They get that, and they have a goal that they understand what they’re trying to accomplish. Male life expectancy is almost 79, but the average healthy male life expectancy is 62. So for men, the last 16 years of their life are spent with disabilities. That’s the average. That’s the average. For women, they live five years longer. And their average is 20 years of disability. They’ve lost healthy lifespan. Do you get how profound this is? When you show this to a patient, They don’t want to be with disabilities. They want to extend total, healthy lifespan. And when you frame it this way, [00:19:00] when you get, you know, a couple of these studies and you just read them and you start thinking about it, you put the ceiling of your bedroom, you start thinking about it, you start applying those principles to your life and to your family. You start understanding some of the mechanisms that have to be looked at. One fifth of an individual’s life will be lived with morbidity. That’s a gruesome thought, but that’s the average. Yeah, right now. That’s the average. So, whoa, whoa. So now we address a tool in reversing this devastating direction, right? That’s our goal.
When do these eventually disabling diseases begin? Most of you will remember this paradigm shifting study that came out in New England Journal of Medicine in 2003. Melissa Arbuckle at the VA, she looked for people with lupus in her VA center. There were 132 [00:20:00] people diagnosed with lupus. Now, if you’re in a VA center, you’re a vet. If you’re a vet, you were in the Armed Forces. If you were in the Armed Forces, you had your blood drawn many times over the years when you were healthy in the Marines or the Navy. What most people don’t know, government’s been saving and freezing all of that blood since 1978. They’ve got tens of millions of samples of our service people’s blood. Well, Arbuckle knew that, and she asked for permission to look at the blood, the frozen blood of the currently diagnosed veterans when they were healthy in the Marines or in the Navy. She got permission and what did she find? She found that antibodies are present years before a diagnosis. Elevated antibodies. There are seven antibodies to lupus. Every single one of them was elevated five years before there was ever a symptom. So here’s the symptom. The zero line is normal and anything above is elevated. And all of the antibodies of lupus are elevated and there’s a predictable course of increase in symptoms.
Antibodies, increased antibodies. Why? Because they’re still living the lifestyle that’s causing the problem. They don’t know it’s their lifestyle causing the problem. Until they hit a threshold. Now they get symptoms, and within six months to two years, they get the diagnosis of lupus. And this is the summary of those seven questions. different antibodies and how they climb. And she put this together and she made it up. She said, well, you’ve got normal level of antibodies to your thyroid or to your liver, whatever your brain, whatever antibodies you’re looking at. There’s a normal level. And why do we have antibodies to our thyroid? Why is there a normal level of antibodies to cerebellum? Because the antibodies are part of the [00:22:00] process of autophagy. Getting rid of the old and damaged cells, making room for new cells. But elevated antibodies means you’re killing off more cells than you’re making. That’s just a basic 101 concept. Elevated antibodies are never normal. Well, let’s just wait and see. What are you waiting for? You know, there’s a problem. There’s some type of imbalance. There’s a problem. But first you have normal immunity. Then you have benign autoimmune. That’s what she called it. That’s elevated antibodies and no symptoms. Now you get symptoms. And then you get a diagnosis.
To increase healthy lifespan, we must address the imbalances when in the prodromal period. What does that mean? Well, the prodromal period is before clinical illness, before a diagnosis of a disease. That’s when you’ve got to address this stuff. That’s when it’s [00:23:00] the easiest to address. And as Fassano says, arrest and reverse the development of autoimmune diseases. You can arrest them, but you have to learn how to do that before diagnosis. That’s like, whoa, okay, okay. And you think about that, you get a couple of those studies because they’re paradigm shifting in your brain. When you understand the mechanisms that are going on, you start thinking differently. Focus on addressing the presenting symptoms successfully, and you are still likely to exasperate the comorbidities.
How do we address the mechanisms triggering comorbidities? That’s the key to expanding healthy lifespan. And how do we accomplish this during the prodromal period? Well, in God we trust, in all others require data. That’s Andrew Campbell, and [00:24:00] that’s a very good sentence. I like that sentence a lot.
So here’s what I did back in 2008, the full day seminars on gluten. And I talked about, back then, the serology. Identifying celiac disease or gluten sensitivity is ineffective in detecting those with silent or subclinical celiac disease. The sensitivity of endomycium, for example, is 100 percent if patients have total villous atrophy. But when they have partial villous atrophy, it’s 31%, meaning it’s wrong 710 times with a false negative. Wait, what? So you’re testing for celiac disease? If they don’t have total villus atrophy, you miss it seven out of ten times if you’re doing endomycium or transglutaminase. You miss it seven out of ten times.
And I taught that back in 2008. But still, so many are still using [00:25:00] Transglutaminase or Gliadin antibodies as the marker people have a problem with wheat. It’s wrong 10 times if you don’t have total bilis atrophy. If you have total bilis atrophy, it’s right on the money. And fecal antibodies, some docs are doing fecal antibodies against these antigens. Well, the sensitivity of Transglutaminase is 10%. The specificity is 98, but that it accurately identifies it, it’s wrong 9 out of 10 times. And for Gliaden, it’s 6 percent wrong, 9. 4 out of 10 times. Well, I do the stool test. Um, can I suggest you read a study on that? And I give them this link. It’s like, wait, what?
You know, what? So, here’s Vibrant. This is a paper that Joe Murray’s team put out [00:26:00] in January of 2016 that changed my life. Now we had tools that I could tell clinicians about that are 97 to 99 percent sensitive and 98 to 100 percent specific. Right on the money every single time. The only exception is is if they have low total immunoglobulins.
Then you can’t test immunoglobulins because they’re low, or if they’re on steroids. You can’t test immunoglobulins if they’re on steroids. A combination of lithography and biochemistry for peptide synthesis has opened the door to a new era in the identification of novel biomarkers of disease. This is Murray.
This is one of the godfathers of celiac, and he doesn’t work for Vibrant. He was as excited as everybody else to see this technology. The relative non invasiveness, broad availability, and versatility of the high throughput [00:27:00] peptide microarrays makes this technology well suited for incorporation into routine healthcare and provide a promising new tool for biomarkers.
And this is the Wheat Zoomer test because you zoom in on the problems. This is page one of the test report, and this is the part where they look at leaky gut. These are the biomarkers of leaky gut, and that was a brilliant business move on their part. I wish I had stock in Auburn, but there’s no stock available, but I wish it was.
I did. Because this is brilliant. They took the most comprehensive test. ever produced so far that I know of to identify leaky gut, and they put it in the wheat zoomer, and they made it affordable. It’s like 350 bucks or 400 dollars. Very reasonable. But now you have not only the antibodies to zonulin, actin, and LPS, but you also get zonulin levels. which [00:28:00] is just excellent. So where do we begin in educating our patients? Is there a root cause in the development of chronic inflammatory diseases? You know, I’m the kind of guy that doesn’t hold back. So if you’re talking about, well, this is the root cause of your disease, this genetics, it’s the root cause.
No, it’s not. There are many causes to disease, but there’s one root mechanism. There’s one. I suggest there’s not a root cause. There are many causes and we must refrain from using this type of language as it confuses patients and deflates their receptivity. When a root cause is addressed, and they still have symptoms, they lose faith in you when you do language like that. Right? There is a one root mechanism in the development of chronic inflammatory diseases, and speaking to this paradigm will guide and empower your patients to use more of your services. They hop on board with you when they understand. [00:29:00] I call it the Prime Directive. What’s the Prime Directive? Well, the Center for Disease Control tells us that 14 of the 15 top causes of death are chronic inflammatory diseases. Everything except unintentional injury is a chronic inflammatory disease. It’s always inflammation, without exception. Why are we not making this primary in our therapeutics for every patient?
This is the mechanism of This is a patient you pull in a chain and breaks at the weakest link. It’s at one end, the middle, the other end. It’s your heart, your brain, your liver, your kidneys, wherever your weak link is. And that’s determined by your genetics and your antecedents. How you live your life. You eat mercury twi or you eat tuna fish twice a week.
You got mercury toxicity. Right, because all, most of the tuna now has mercury, high levels of mercury, right? That’s an antecedent. So it’s your genetics and how you live your life that [00:30:00] determines where the weak link is, but it’s inflammation that’s the pull on the chain. That’s what’s pulling on the chain.
You have a BRCA1 or BRCA2, it doesn’t mean you’re getting breast cancer. It means if you pull on the chain too hard, That’s where it may manifest. If you have an ApoE4, it doesn’t mean you’re getting Alzheimer’s. But if you pull on the chain, and Dale Bredesen has given us so much information on that. Stop pulling on the chain. There’s 36 holes in the roof. Fix the holes in the roof. That’s Dr. Bredesen’s approach. Right on the money. But it’s to stop pulling on the chain. And when you talk to your patients like this, they get it. It’s not geeky science to them. You’re pulling on the chain too hard. You got mold in your house. I tested you.
You got mold. We have to get the mold out because it’s pulling on the chain. And that’s your daughter’s attention deficit or whatever the symptoms are. They’re presenting with every chronic, Disease is a [00:31:00] Chronic Inflammatory Disease. Every one of them. We were never taught to think like this. Get a couple of these papers, and just chew on them a bit.
And you’ll get as passionate in your own way about it as I am. I’m half Italian I’m a little vocal about it. Chronic Inflammatory Diseases have been recognized as the most significant cause of death in the world today. When your immune system gets activated, why is it getting activated, it’s got, it gets activated producing inflammation because it got this message.
We’re under attack, fight and defend. That’s why you get inflammation. So the question is, what is it your immune system is trying to protect you from? It’s that basic. It really is that basic. And then it’s all the sophistication of what tests do you do and how do you interpret the tests? What do you do when you find the results? of where the inflammation is coming from, what are [00:32:00] the environmental triggers. That’s the art of medicine, the art of healthcare, right? But the concept is just so basic. I don’t mean to insult anyone here, but we should all be living in that world of basics with our patients. This is precisely why I spent the last year putting together the free docuseries, The Inflammation Equation.
I went to seven countries, interviewed 64 experts on inflammation. Did anyone in here see The Inflammation Equation? No, oh my, oh, a couple people? Thank you. Yeah. It’s TheInflammationEquation.com. Please register, it’s free, and watch the first day. Just watch, watch the first ten minutes. And if you’re not hooked, turn it off and say, alright, whatever. Right? Just watch the first ten minutes. Terry Walls started crying when, when she saw it. She started crying. She said, Tom, this is right on the money. I’m doing a docuseries. And she [00:33:00] just finished her docuseries. She said, I’m going to do a docuseries. I interviewed her in the early days for this one and she decided to do hers on ms, and it just launched and is really great.
But in any event, please take a look at this because you’ll find that every single patient when they watch this, and I programmed this I language this. So that every day we say, now go back to the healthcare practitioner that recommended this event to you and ask them, where’s my inflammation coming from, or do I have mold sensitivities, doc, or, but we prep your patients to come back to you.
We’re not selling them anything here is to come back to you more educated. So you aren’t trying to convince them. to do a test. They get it. They understand that you have to identify the environmental triggers that are activating the immune system, trying to protect you, [00:34:00] causing the inflammation, pulling on your chain, and wherever the weak link is on your chain, that’s where the symptoms are manifesting. They get it. They understand that basic concept. Pull the chain and breaks at the weakest link. This drawing is so wonderful. When I saw this, I had to go interview that guy. And that’s David Furman at Stanford, also at the Buck Institute. He got the contract with NASA to figure out why are the astronauts aging so quickly in space? Because astronauts can never go to Mars. Never. The technologies They’re two and a half years and the spaceships are at Mars, but astronauts will die on the way. Now NASA doesn’t talk about that, but that’s what they found out. And what is it? It’s inflammation. Accelerated inflammation. So I talked to David about that.
I love this drawing because every patient understands this. Mrs. Patient, you’ve got a viral [00:35:00] infection and that activates your immune system, or physical inactivity, or obesity, or Dysbiosis, Diet, Chronic Stress Hormones, Not Regenerative Sleep, Xenobiotic Accumulation in your body. It turns the wheel, which turns the middle wheel, which gives you systemic chronic inflammation that manifests as Diabetes, Cardiovascular Disease, Cancer, Depression, Autoimmune Disease, Neurodegenerative Disease, Sarcopenia, Immunosuppression, it doesn’t matter what the symptoms are. This is the mechanism. This is what they’re teaching in Stanford Medical School right now. This is the mechanism. We all should be embracing this as a 101 primary as we’re working with our patients. You know, we first have to of course address their symptoms so they’re starting to feel better or at the same time, but to educate them. This is what we have to educate them on. [00:36:00] And we know that the nine well established hallmarks of aging are all linked to sustained chronic inflammation. Every single one of them, without exception. This also is from Berman at Stanford. How important is it to identify the triggers of inflammation?
If you want to extend healthy lifespan, this is how you do it. You stop the deterioration, deterioration, the antibodies, killing off cells, killing off cells, killing off cells, while they feel fine. They feel fine. They don’t know. No, I don’t feel bad when I eat wheat dock. I feel fine. But they don’t know that for every one person that gets gut symptoms, there are eight people that don’t, who test positive to weep. They get brain symptoms, or skin symptoms, or joint symptoms. They don’t get gut [00:37:00] symptoms, so they feel fine. They think they’re okay. From the blood immune of a thousand individuals, They looked at this and they, a deep learning method was based on patterns of systemic age related inflammation, and this is what they found out.
The resulting inflammatory clock of aging tracked with multi morbidity, immunosenescence, frailty, and cardiovascular aging, and is also associated with exceptional longevity in centenarians. The ones that live long have low markers of chronic inflammation. And here is an example. 79 centenarians, disease free, they’re all disease free, were compared to 178 people under 40 who had had a heart attack and 178 people under 40 who did not have a heart attack.
So they compared the three groups. All the [00:38:00] centenarians were free of major age related diseases. Disease free veterinarians had significantly lower levels of serum zonulin and LPS than young patients.
This is what it looked like. I’m going to talk about lipopolysaccharides for the rest of the night now. Look at the numbers. You want to live over 100? This is what it takes. This is, this is extended Healthy Lifespan. This is what it takes. Low LPS. Low Zonulin.
And that’s just the bar graphs that went along with the study for LPS and the bar graph for Zonulin. LPS levels were significantly lower in disease free centenarians than in acute myocardial infarction patients and [00:39:00] healthy young controls. Zonulin levels were significantly lower in centenarians. So when researchers, when geeks, say significantly, they’re, you know, that’s their word for, Holy cow, Batman, look at this!
You know, it’s just startling, the results. Permeability may cause endotoxemia, which in turn leads to inflammation and insulin resistance, atherosclerosis and hypercoagulation. Our data suggests serum levels of zonulin and LPS emerge as potential novel biomarkers of exceptional longevity. Extending healthy lifespans.
Now there are many factors to take in mind, and this is one of them, but this is a primary that I’m talking about for the rest of the night. You really need to get this one down, understand this one. Put it on the ceiling of your bedroom. What other biomarkers are you currently using to identify exceptional longevity?[00:40:00]
We’re not using them. So LPS is a biomarker of exceptional longevity. A very basic paradigm in functional medicine is test, don’t guess. You must monitor a patient to confirm successful redirection and or to identify roadblocks. And the summary of this study, I’ll let you read that, very powerful study. 79 centenarians. Everything should be made as simple as possible, but not simpler. The essential question is with inflammation, what is the immune system trying to protect you from? What’s it trying to protect you from? Here’s Tassano. Those are his titles. That’s the paper that everyone should read. All disease begins in the leaky gut. And just google it, it pops right up and you can [00:41:00] download it.
Can you go back? Go back? Yeah. This? Okay.
The activation of the zonulin pathway represents a defensive mechanism to flush out microorganisms, contributing to the innate immune response of the host against changes in microbiome ecosystem. Do you understand what he’s saying? Our ancestors, Mrs. Patient, you have the same body as your ancestor 10, 000 years ago, the same kidneys, the same immune system, everything functions the same. And before agriculture, our ancestors were nomads. They followed their herds for food. Food was the number one thing they needed. Top priority. Then shelter and safety. Right? But it was food. They’re walking around, they find something, they grab it, they sniff, they nibble, and they eat it. If there were bugs on that food, which there [00:42:00] often were, and hydrochloric acid didn’t kill it, and it comes into the proximal part of the small intestine, that’s where toll like receptor 4 is very abundant.
Why? Because it’s the sentry, standing guard. I think of the soldiers at Buckingham Palace, those big hats, you know, they’re just dormant as can be. But don’t mess with those guys. But they’re dormant. Toll like receptor 4 is dormant, until it’s scanning everything that’s coming out of the stomach. And when it sees a bug, what does it do?
Two things. Within five minutes, it activates increased production of zonulin, which opens the tight junctions. Water comes from the body into the gut to wash out the bug with the poop. That’s what leaky gut is for. It’s a life saving mechanism. It’s very cool. Excessive leaky gut is a problem, right? Two things. That was the first one. The second thing, It activates NF kappa B, the [00:43:00] major amplifier of inflammation in the body, within five minutes. All that happens within five minutes. I’ve got the videos. If we have time later, I’ll play the videos and you see what leaky gut is within five minutes. Wow! So, that’s the purpose of leaky gut.
Now, listen to Fasano. Among the several potential intestinal luminal stimuli that stimulates zonulin, Small Exposure, Large Amounts of Bacteria, and it’s Exhaust LPS, and Gluten are the two most powerful triggers. Most powerful. Not soy, not dairy, not lectins. Gluten. Why? Oh, wait a minute. Okay, so I didn’t put the slides in here as to why. Why? And it’s in that paper from Fasano. Gluten is misinterpreted. as a harmful component of a microorganism. [00:44:00] The protein structure of these peptides of wheat look like the outer shell of gram negative bacteria. That’s why every human gets leaky gut every time they eat wheat, whether they feel it or not.
Every human. Maureen Leonard at Harvard, famous gastroenterologist, did a literature review on that topic, and she published it in the Journal of the American Medical Association, and she said this occurs in every human, everyone, whether you feel it or not. Okay, LPS. It’s one of the main toxins responsible for inflammation from gram negative bacteria, which ranks among the most potent amino stimulants found in nature. How important is that? One of the most potent immune stimulators in nature. [00:45:00] LPS is the major molecular component of the outer membrane of gram negative bacteria. It’s the shell that protects the gram negative bacteria, serves as a physical barrier, uh, protection from its surroundings. This is LPS. That’s LPS. Drosado says it’s one of the two most potent triggers activating leaky gut. Leaky gut is the gateway to development of chronic inflammatory diseases. 14 of the 15 top causes of death are chronic inflammatory diseases. When you put this together, it’s like, holy cow, I never thought of it that way.
Critically important to address LPS. It’s an intrastructural component found in the external membrane of gram negative bacteria, as well as representing [00:46:00] one of the most powerful microbial inflammation indicators. Could they say it any differently to knock it into our heads how important this is? One of the most powerful, one of two that stimulates leaky gut.
Look at this, the title of this paper. Look at the title first. Microbiome derived lipopolysaccharide enriched in the perinuclear region of Alzheimer’s disease brain. LPS is recognized by Toll like receptor 4 as a marker for the detection of bacterial pathogen. and is responsible for the development of inflammatory response, is perhaps the most potent stimulator and trigger of inflammation known.
Could they say it any more clearly for us to pay attention to it? The most powerful trigger of inflammation known [00:47:00] causes a substantial increase in the production of cytokines, chemokines, and the synthesis of a broad group of lipid inflammatory meteors. So LPS is the outer shell, and in your body, it’s called endotoxemia, when you have elevated levels of LPS.
Because it’s endotoxin. We know that gram negative bacteria is in the passage of viable indigenous bacteria from the GI tract to extra intestinal sites such as the mesenteric lymph nodes, the liver, the spleen, the kidney, the peritoneal cavity, the brain, and bloodstream, under some stressful conditions.
Wait, wait, what? What? Did they just say bacteria from the GI tract goes to extra intestinal sites, such as the brain, the mesenteric lymph node, the liver, the spleen, the kidney, the peritoneal cavities and the bloodstream? Yes. And damage to the gut correlates with [00:48:00] how much the immune system gets activated.
Now this is, this paper, this paper, it came out in 2010. I called my friend Ari Vojtani. We were working together at the time and Tom, Tom, are you okay? I said, yeah, yeah. Tom, it’s 10 o’clock at night. Why are you calling? Ari, listen to the title of this paper. Compromised gastrointestinal integrity and pigtail mucocs is associated with increased microbial translocation, immune activation, and IL 17 production.
In the absence of infection, and we were talking for an hour or more about this, because I’ll show you why. In the brain, LPS causes inflammatory response, which results in the degeneration of neurons, synaptic loss, and finally, neuronal cell death. This process is mediated by [00:49:00] the production of inflammatory molecules.
Look at this sentence, amyloidogenesis caused by LPS is the most prominent phenomena in the cortical and hippocampal areas. Most prominent in the development of Alzheimer’s. Nobody’s checking for it. Nobody’s treating it. Most powerful bacterial activator of an immune response, creating the inflammation.
that pulls at the chain. Could they say it any clearer? Look at the title of this paper, Lipopolysaccharide Induced Model of Neuroinflammation, Mechanisms of Action, Research Application, Future Directions for Excuse. You put this one on your ceiling, and in a few months, you’ve got this. You’ve got it. But right now, it’s like, whoa, that’s all geeky stuff.
You know, for most people, it’s [00:50:00] like, well, but when you read it once, and then next week, you read it again. And then maybe the next week, you kind of look at it once more, what you’ve highlighted, you start to get it, and you get in the flow of what these people who spend their lives researching this are trying to tell us.
Because we’re the ones that are supposed to be taking their information and applying it to the patients. But we don’t even know about this. Did you know that LPS? is the cause of amyloidogenesis, the most powerful trigger. LPS can induce characteristics features of Parkinson’s by causing neuron loss.
There are papers reporting persistent changes in the brain and cognition upon single LPS administration, even 10 months after LPS injection. This is consistent with the very first report of neurotoxicity after LPS exposure. When a laboratory worker developed Parkinson like signs three [00:51:00] weeks after exposure to 10 micrograms of LPS from salmonella through an open wound.
And this just talks about all the different areas of the brain and how LPS affects different areas of the brain. Take a picture of this one if you want.
You’ve got five seconds, four, three, two, one. What’s the longer term body response to LPS migration into systemic circulation? Absolutely no one is talking about what I’m about to talk about. I’ve never heard anybody talk about this. LPS is the primary cause of sepsis. Wait, wait, what? The number one cause of death of elders in hospitals?
Sepsis? And LPS is the primary cause of it? [00:52:00] By an overwhelming systemic response to bacterial infection, sepsis is a life threatening multiple organ dysfunction resulting from a deregulated Host response to infection. What is a deregulated host response to infection? What does that mean? How and why is this primary cause of mortality for elders in the hospitals a multi organ condition? How does that happen? Damage to the gut epithelium results in systemic microbial translocation from the gut into the body that correlates with immune activation. So pigtail macaque monkeys, their guts are very much like human guts, and lots and lots of studies have been done over the years with using macaque monkeys, because they’re very similar.
Pigtail macaque monkeys always have leaky gut. They always do. Don’t know [00:53:00] why. The food they’re eating probably. Rhesus macaque monkeys rarely have leaky gut. So they looked at this and they found an average LPS accounted for 13 percent of the tissue of the gut in monkeys that have leaky gut. But in those that don’t have leaky gut, LPS was only 0.
274%. Meaning, if you have a healthy gut, you don’t get the migration and deposit. LPS into the tissue. 13 percent of the tissue is made up of LPS. Do you think the immune system ignores that? Absolutely not. We think, oh my gosh, lead toxicity, lead poisoning, oh my gosh, and it’s important, of course, to address that.
Well, the immune system’s [00:54:00] attacking lead, isn’t it, in there? Do you think it’s not attacking the LPS, the most powerful trigger of inflammation that we have? And this, this is the key, this one, when you understand what you’re looking at, you start drooling. This is stained for LPS. The dark brown is LPS. This is how much of the tissue in pigtail macaques with leaky gut.
The LPS is deposited in the tissue. This is when you don’t have leaky gut. So, what kind of a state of inflammation do you think this would be? As much as the immune system could possibly do. Because it’s constant, right? This is a constant assault of bacteria that is a primary trigger activating an immune response.
Right. But it’s constant. [00:55:00] Chronic low grade systemic inflammation. 14 of the 15 top causes of death are chronic inflammatory diseases. And this is the area of the colon that had LPS embedded in the tissue.
And they identified, they looked at these animals and they found LPS embedded in the peripheral blood mononuclear cells, embedded in the spleen, embedded in the axillary lymph nodes, in the inguinal lymph nodes, in the mesenteric lymph nodes, in the duodenum, in the jejunum, in the ileum, in the cecum, in the colon.
Do you start to get a sense of where sepsis comes from?
A lifetime of leaky gut? A lifetime of infiltration of LPS depositing in your tissue throughout your body? And then something takes them over the edge, [00:56:00] and that inflammatory cascade is out of control, the cytokine storm is out of control. But it’s all the OPS that’s been deposited in there over 50, 60, 70 years, that no one ever detoxed to get out, because they’ve never identified it, they’ve never thought about it. These data define the degree to which microbial translocation stimulates the immune system, locally and systemically. Did they just say immune activation in the absence of viral infection? Yes, they did. What does that mean? It means the endotoxin that’s already in your body is triggering that chronic systemic inflammation.
Does that mean what is already stored in the tissue activates a chronic systemic immune response without new exposures? Yes! So you clean up the diet, you heal the gut, but they’re still walking LPS storage tanks [00:57:00] from 50 years of this stuff. It doesn’t go away unless you take action to get it out of there.
Very recent studies have evaluated pro inflammatory potential of several different chemokines, cytokines, amyloid, beta peptides, LPS, either alone in combination. So they’re checking all different markers of inflammation there, have indicated that when compared, bacterial LPS exhibits the strongest induction of pro inflammatory signaling in human neuronal glial cells of any signal inducer.
It’s the most powerful, and every one of you are ignoring it. Excuse me? It’s time to wake up. Look at the title of the article again. Where do you think Alzheimer’s comes from? Not just LPS, of course, but this is fueling that inflammation so quickly.[00:58:00]
For example, exposure of LPS from the gram negative GI tract, abundant bacterioides fragilis, and we’ve all done stool tests and we get positives back on B. fragilis. It’s pretty common for me, maybe 10 15 percent of the patients will have this. It’s found to be an exceptionally powerful inducer of NF kappa B that triggers the expression of pathogenic pathways involved in neurodegenerative inflammation. So LPS, Bacterioides Fragilis, is an exceptionally powerful inducer of the major amplifier of inflammation. Puts a whole new perspective on They don’t have any gut symptoms, but they’ve got positive for Bacterioides Fragilis, but they’ve got depression.
Might not the inflammation that’s caused by this be contributing to their neurodegenerative inflammation, be contributing to their [00:59:00] depression? Absolutely! All disease begins in the gut. Remember the article by Pisano? All disease begins in the gut. And this is a primary mechanism to this. It’s fairly common to find Bacteria Fragilis on a stool analysis.
Now perhaps you’ll look with eyes that see a deeper potential significance to this finding. Perhaps test for inflammation in the brain, because B Fragilis is an exceptionally powerful inducer of NF kappa B that triggers the expression of pathogenic pathways involved in neurodegenerative inflammation.
Every patient I see gets a WeetZoomer and a NeuroZoomer Plus, minimum. I don’t care what they present with. And then I show them how inflamed they are. And then we talk about other tests, if necessary. The NeuroZoomer has anyone here done NeuroZoomer Plus? Yeah? A few people? Okay. It looks at 53 markers of inflammation in your brain.
53! [01:00:00] with 97 99 percent sensitivity, 98 100 percent specificity. It’s a new era in laboratory medicine. And I asked my friend Jill Carnahan, I said, Jill, how often, she was taking a drink of water at dinner, I said, how often do you get a negative back on a Zoomer Plus, Neural Zoomer Plus? She went, Never!
You never get a negative back on a first test. Until people understand, Yeah. What to do? Everybody’s brain is inflamed. Why? Because we all have this low grade chronic systemic inflammation that is the mechanism for 14 of 15 top causes of death and 20 percent of the blood in your body that’s full of inflammatory cytokines is in your brain at any one time.
So your brain is the organ that’s most affected by it, right? So you test the brain for inflammation. You do the NeuroZoomer Plus test and [01:01:00] you see how bad it is. Then you start protocols to turn it around. Mrs. Patient, this will take two years. This is what, what I think you have to do, but I wouldn’t redo the test for at least a year.
You can if you want after six months, definitely not before, but I wouldn’t spend the money until a year. It’s going to take a while to turn this around. You know, you, you just give it to them straight. And once you’ve educated them about pulling on the chain, it’s always inflammation, their mother died of dementia, and they’re scared to death, you say, okay, we have to stop the pull on the chain.
And this is how you do it.
Oh, we’ll just skip that. Endotoxin may trigger cellular biosynthesis, activate intracellular mechanisms of apoptosis, and induce strong activation inflammatory pathways with the consequent release of pro inflammatories. You can read it all. [01:02:00] But this is LPS. This is what LPS does.
Imagine for just a moment how inflamed a body must be with this low grade constant inflammation fighting LPS in so many tissues throughout the body. It’s stored in the tissue.
Does LPS in the tissue go away on its own? No! LPS deposits incrementally in the tissue over a lifetime, activating a continual low grade systemic inflammation. It is a primary mechanism in development of chronic inflammatory diseases. It doesn’t go away. You want to stop sepsis? My mother died of sepsis. I didn’t know this at the time. This is why I know this now.
This fact alone should change [01:03:00] the paradigm of how we address the topic of intestinal permeability and leaky gut. I encourage a much more comprehensive detoxification protocol of identify, remove, and treat. Refine, Restore, Recheck. Whatever your protocols are in those five categories, but you always recheck.
I don’t care how much better they feel and they don’t want to spend the money. You always recheck because you don’t want to hear three years from now, Oh, I went to see Dr. So and so and I felt a little better for a while, but you know, it didn’t last. You always recheck. What is the impact of LPS that passes through a leaky gut into systemic deflation?
Recheck. Oh, we did that already. There’s a marker that says, yeah, we did that. Okay, it looks like I’ve got that there twice. Let me see what happened here. Let me find out where we are here. [01:04:00] Oh, I see. I know where we are now. This is very cool. I’m going to talk to you about where sepsis comes from. Sepsis is a life threatening multiple organ dysfunction.
Resulting from a deregulated host response to infection. LPS is the primary cause of sepsis, an inflammatory syndrome characterized by overwhelming systemic response to bacterial infection. See, if I just told you these things, you would think I was a little fanatic, right? But it’s these guys that are telling, it’s all these studies that are telling you this.
And we don’t know this, but this is the number one cause of death of elders in hospitals. And we are treating for this. This estimate of the prevalence of sepsis is 31. 5 million patients per year, with 5. 3 million deaths. High income countries hospital mortality rates for general and severe sepsis are significantly elevated, 17 and [01:05:00] 26 percent respectively.
In the old model, sepsis was used as a unique clinical syndrome. Oh, what are we going to do about sepsis? Difficult to treat, but the obvious target for therapy. Well, obvious, they’ve got sepsis, you have to treat it. No, that’s the old model. In the new model, incorporates sepsis, but as a late stage syndrome on a continuum of endotoxin related diseases. The new map encompasses the entire inflammatory cascade, And it’s Clinical Manifestations. This is what it looks like. This is the new map. And it’s, I mean, this went on the ceiling for six months. Because there’s so much to this, that when you start to understand, it’s like, What? What will? Okay, that makes sense, I get it. Yeah, that makes sense. Okay. Yeah, I can see how that’s next. Oh, okay, I can see that. The systemic toxicity of gram negative sepsis is largely due to [01:06:00] endotoxin, an LPS component of the outer membrane of gram negative bacteria. And look at the date of these papers. This was 25 years ago, we knew this, but our sepsis experts don’t think like this, they still think the old way.
Well, let’s try a different antibiotic and see if that’s going to work. LPS causes a substantial increase in the production of cytokines, chemokines, and the synthesis of a broad group of lipid inflammatory mediators. The systemic inflammatory response syndrome triggered by the bacterial endotoxin LPS Affects many organs and may lead to death.
So that’s the systemic inflammatory response syndrome. We also call that co morbidities, right? Imagine LPS in your liver, LPS in your kidneys, LPS in your heart, and then [01:07:00] imagine why you get these co morbidities of functional problems, right? Because they’re loaded, they’re toxic, as toxic as can be.
Bacterial translocation often leads to a progressive and catastrophic condition known as Multiple Organ Dysfunction Syndrome. So that’s after you’ve got sepsis. So first you’re healthy, then you get leaky gut, now you’ve got LPS that’s come into circulation, and it starts to accumulate, you’ve got endotoxin, then you get Systemic Inflammatory Response Syndrome.
Low grade chronic systemic inflammation. Then you get sepsis within 20 years, 30 years, whatever it should be. Then you get multiple organ dysfunction syndrome. Then you die. The number one cause of death of elders in hospitals. And it’s a syndrome. [01:08:00] The appreciation that septic shock lies at the far end of a continuum of clinical manifestations of the inflammatory response to bacteria and endotoxin will direct attention to preventative measures to treat at risk patients.
It’s a continuum of exposure and accumulation. And if you address the excess serum LPS earlier in life, you can reduce the amount of LPS that accumulates over the years in tissue. throughout your body, including your brain, and thus reduce the constant inflammatory cascade at the base cause of practically all degenerative diseases.
Does that make sense to you?
Now, you know what these pictures mean. It’s like, oh my god Do you want to take a picture of a biopsy of your tissue [01:09:00] and see what it looks like? So, sources of LPS, where does it come from? Through the oral cavity, through the Excessive Pathogenic Intestinal Permeability, Lipid Wrapped Transcytosis, Dormant Bacteria in the Blood that Gets Activated, Organic Material and Particulate Matter, Air Pollution, Minimally Processed Vegetables, Peeled and Sliced and Threw in Open Wool. Those are the most common sources of LPS. Wait, what? Minimally Processed Vegetables? What does that mean? When you dice an onion, within four days the amount of LPS on the diced onion is equal to the amount of LPS on the diced onion. is toxic levels. Onions, carrots, because you peel off the protective coating and the bacteria in the air feeds on the food and it repopulates, repopulates. So all those little bags of [01:10:00] peeled carrots that you buy in the store, and sometimes they’re a little slimy. That’s all bacteria. It’s like, whoa. Yes. Oops.
Identifying LPS. Well, we know leaky gut, that there’s both paracellular and transcellular pathways getting into circulation, that LPS gets through both ways. We all know that. Based on the central of LPS and sepsis, recently several methods and numerous devices for its detection have been produced. At this moment, simple, speedy, extremely sensitive, specific test for endotoxin determination are established and commercially available. Well, I checked zonulin levels. But the lifespan of zonulin is 4 minutes to 4 hours. So, if it comes back positive, [01:11:00] good! You identified something. If it comes back negative, it’s very likely, could be a false negative. Because the lifespan is 4 minutes to 4 hours.
Um, at the end please. It’ll be easier. This fluctuation in blood levels was studied for a period of 6 days in ICU patients with sepsis, and values were varied by a factor of 2 to 10, day to day. They’re just all over the place, measuring zonulin, because the lifespan is 4 minutes to 4 hours. The half life of antibodies is about 21 days, so antibodies to zonulin are a much more confident marker that you can look at.
And depending on the laboratories you’re using, Whether it’s accurate or not is determined by the sensitivity and specificity. You ask your lab rep, tell me the sensitivity and specificity of this test. They usually don’t know. [01:12:00] Well, uh, uh, it’s a good test. Yeah, I know it’s a good test, but what’s the sensitivity and specificity?
Well, uh, uh, you don’t really know, do you? Well, no, I don’t know. All right. Can you call the lab director? Can you find out from the lab director and then get back to me within two days? Yeah, I’ll do that. Great. Here’s my card. And you’ll find they’ll give you gobbledygook. They won’t tell you. They won’t tell you.
They said, well, you know, compared to, no, no, no, don’t compare. Just tell me the sensitivity and specificity. They won’t tell you because it’s embarrassing. It’s in the 70 and 80 percentile range. Unless you ask Vibrant, 97 to 99 percent sensitivity, 98 to 100 percent specificity, published by Mayo Clinic in a number of papers.
It’s a new era in laboratory medicine. It really is a game changer. I mean, there’s nothing like it on the planet. I don’t know about the Far East, but I teach in Brazil. I teach in North America. I teach in Europe. [01:13:00] I always look at the labs at Braves. In seminars, no one’s got anything that compares to what Vibrant’s got. And that’s the test on the wheat zoomer for intestinal permeability. There it is. And we’ve all seen these before of how to interpret each marker when you’re looking at antibodies to LPS and gluten, zonulin, and Actomycin. This I put in because I felt that I couldn’t be here without telling you about this.
It’s not widely known that lipoproteins bind and inactivate microbes and their toxins, LPS, by complex formation. They grab on to them. And you know who gave me [01:14:00] this paper? Kilmer McCulley, the godfather of homocysteine. And this was Eight years ago, nine years ago, he gave me the paper that just caught my attention.
Complex formation between all lipoprotein subclasses, and both bacteria and viruses has been demonstrated by electron microscopy, enzyme linked immunoabsorptive assays, and column chromatography. High cholesterol and or high LDL. is protective against infection and atherosclerosis. This is like, wait, what?
What? LPS or endotoxin, the main pathogenic factor of gram negative bacteria, binds rapidly to lipoproteins, mainly LDL, and lipoprotein bound is unable to activate the secretion of various cytokines. This is backup for the immune system. It [01:15:00] grabs onto LPS. So that macrophages don’t produce cytokines and it escorts it out of the system.
This is, wait, wait, what? Staph aureus alpha toxin, a toxin produced by most pathogenic staph strains and causing damage to a wide variety of cells, is found and almost totally inactivated by human LDL. LPS that gains access to the bloodstream. From the gut, lumen is bound by various particles. The majority of LPS circulates bound to HDL, but also with lower affinity to other lipoproteins.
This paper was two, 2022, a couple years ago. Lipoproteins bind LPS and decrease LPS stimulated cytokine production. So to reduce the inflammatory cascade. Your liver makes more cholesterol to grab on to the LPS, to lock it up, so that the immune system doesn’t [01:16:00] have to produce more inflammation. Lp little a was as potent as low density lipoproteins in inhibiting LPS stimulated tumor necrosis factor.
This suggests that circulating Lp little a may be an important factor in determining the amplitude of response to LPS in humans. This is like, wait, what? What? I didn’t know this. I didn’t know this. It’s also been demonstrated that LDL inactivates up to 90 percent of Staph aureus alpha toxin and even a larger fraction of bacterial LPS.
Phagocytosis of LPS bound to lipoproteins also explains why LDL becomes oxidized. You ever wonder where oxidized LDL comes from? Well, it’s the immune system attacking the LDL. Why is it attacking the LDL? Because it’s bound to LPS. Since macrophages inactivate [01:17:00] phagocytosis pathogens by producing oxygen radical species promoting LDL oxidation.
LPS from chlamydia and also from several periodontal pathogens is able to convert macrophages to foam cells in the presence of LDL. Conversion of macrophages to foam cells by bacteria indicates that these pathogens contribute to the development of atherosclerosis. Oh, look at the title of the paper.
How Macrophages are Converted to Foam Cells. It’s a response to LPS, the most powerful inflammatory trigger in nature. Learn Think of all the quotes from the different authors that I showed you earlier about LPS. None of them say, well, it’s one of the things you should think about. It’s the most powerful. It’s the number one. It stimulates amyloidogenesis. It’s the primary stimulator [01:18:00] of amyloidogenesis. Now we see what it’s doing with cardiovascular. Compared with normal rats, hypocholesterolemic rats injected with LPS have markedly increased mortality, 8 fold, which can be ameliorated by injecting them with LDL. They don’t die. Compared with normal mice, hypercholesterolemic mice challenged with LPS, Or live bacteria have an 8 fold increase in lifespan.
Wait, what? What? This should be called the wait what talk. Wait, what? Could this mean that sometimes elevated cholesterol, total cholesterol, HDL, LDL, oxidized LDL, Lp, may be life saving attempts by the body? [01:19:00] Excess? Okay. Reducing exposures to the triggers of inflammation. Stop pulling on the trait on the chain so hard.
That’s the message to our patients, which then will reduce activation of the immune system, which then reduces the response of inflammation, which then reduces low grade tissue damage, which then reduces dysfunction symptoms and the development of disease. which gives us a higher quality of function, extending healthy lifespan.
That’s the test, the wheat zoomer, which includes the testing for LPS. That’s the LPS portion of that test, the most comprehensive test I’ve ever seen. Please consider watching this, at least the first episode. You know, it’s all free. And when you see how good it is, have your patients watch it because they’re going to come back with questions and [01:20:00] be more engaged with you.
That’s why I spent 13 months doing this. Was it so your patients will come back to you more engaged and you don’t have to try to convince them. to do a test to find out where’s the inflammation coming from. We’ve got to educate them to be partners with you in exploration to figure out where it’s coming from.
So if your desire is to address presenting inflammatory complaints wherever they are, Extend or create a higher quality of life. Read papers like this one of Fasano’s. We must address the gateway in the development of chronic inflammatory diseases. The gut and the accumulated endotoxin that’s developed over a lifetime.
And what happens when you start setting yourself up to think outside the box, you allocate one hour a week to this, you get it. You just get it. You say, wow, this [01:21:00] is really cool. So I hope you will dive in. To whatever part of this really grabs you, take care of yourselves. Make sure to tell those important to you how much you love them.
And thank you very much for your kind attention. Questions? Yes, please.
When you were talking about the 4 minute to 4 hour window testing, is that other tests other than Vibrant? Which has to be through vibrator. Some. So the concept of four minutes to four hours, is that with other tests or is that also vibrance? Oh, it’s vibrant. ’cause zonulin doesn’t last long.
It dissipates, it falls apart. So it’s, as far as I know, any lab that would be the case. How accurate or stool testing markers. [01:22:00] How accurate are stool testing markers for zonulin? I’ve not read the paper on that, I don’t know. But after seeing what the accuracy was for transglutaminase, and uh, uh, I’m not very confident, but I don’t know on that.
Question from the audience: How are you binding to the LPS out of the tissue? How are you binding the LPS out of the tissue?
You have to mobilize it. And then use some kind of binders. I use G. I. Detox from Biobotanical. Sorry, what? G. I. Detox from Biobotanical Research. Oh, by the way, I’m sorry, I forgot to tell you. Vibrant is giving you a 20 percent discount Tonight on any test that you wanna order and that’s 20% off wholesale.
So how, say again, how are you gonna do that? I think that’s the vibrant rep. Guys, I have coupons for everybody in the room and wants to order a [01:23:00] test for yourself for a left one. Come check you guys calling, get you signed up. Also, next week we have Longevity Summit. Well, Dr. Arkady is going to be there.
Everybody in this room has a free ticket if you want to go. You just have to make your way to San Jose, okay? Alright. Thanks, man. Sorry. Yes. Okay. Thank you. I’m so sorry. I’m just curious. I work with a lot of older women. You work with what? A lot of older women. Yeah. Okay. so much.
Oh, tremendously. Tremendously. They, they have a panel that’ll be coming out pretty soon, an autoimmune panel, as good as they’ll rock your boat. Wow. Uh, but yeah. Someone in Croatia who runs a health clinic there for upper end people. [01:24:00] found me, reached out to me and said, will you work with me? I said, yeah.
Okay. Okay. And I helped her with her problems. So she said, would you work with my clients? I have upper end clients, world famous athletes. I said, well, yeah, I don’t have time, but all right. But this is, they all have to do these seven tests. First, before I’ll talk to them. And then I’ll talk to them and interpret the tests and send them back to you.
I don’t want to do therapy. I don’t want to do that. So they all did seven tests from Vibrant. And it was startling. There were 26 people that I’ve done one on ones with. 19 or 20 of them have mold and didn’t know it. Mold metabolites that are sky high. Uh, every one of them. had organophosphates that were elevated. Many of them had heavy metals. Many, almost all of [01:25:00] them, have wheat sensitivity, almost all of them. Some had some dairy, some had lectins. But when you do the test, when you do the panel, and you’ve got all this information, you can say, boom, there it is. That’s the primary one. Right? And there’s secondaries, but there’s the primary. And then you educate them on how to reduce their exposure to whatever that is. Well, they’re going to continue to flourish.
You do 10 tests on patients, 10 patients with double blinds from Cyrex, and then you do 10 tests with double blinds from Vibrant, you decide. I only did three with Vibrant because [01:26:00] I knew already, but, and all three were right on the money–97 to 99%. So there’s a 2-3 percent variation, which is very acceptable in my book. But a 25 percent variation? It’s not acceptable. Yes?
What’s my protocol to decrease LPS? To decrease LPS, heal the gut. You have to heal the gut. And that’s about a 20 minute discussion in my book, right? There’s a really great article to read. The Italians put out an article three years ago, The Mediterranean Gluten Free Diet, and it’s got a pyramid. And I have every patient put that pyramid on their refrigerator. So that’s the basic guideline. And do you know what’s on the bottom? of the pyramid with the most water. Cause everyone’s dehydrated. This patient, pinch your skin. If it doesn’t go flat immediately, if you can see it go down, [01:27:00] you’re dehydrated, right? So is, and you don’t want to sit at the very top of the pyramid. Gluten free foods, whether it’s breads or muffins or don’t eat that stuff. It’s garbage. Right? So that’s a starting point.
For Liga, do I prescribe? No.
Identify the triggers of inflammation. Stop throwing gasoline on the fire. Identify the dysbiosis in the microbiome. Build a healthy, diverse microbiome. So you find out where the deficiencies are, you look at what foods increase those deficient beneficial bacteria. Most patients need an antibacterial protocol to clean out the pathogens, and then you teach them how to live a healthier [01:28:00] lifestyle with food selections.
No, no, I’ve never had to. When we retest six months or a year later, almost always they’re down in normal range. I use Biocidin for that. Biocidin. BioCyte. Yeah. Say again. Dose. Dose. Biocidin doesn’t like the way I do it. I’ve had lots of talks with Rachel, the president of the company, about this. Hey, this is how I’m going to do it. I give them the spray, and they go up their nose with the spray, and in their mouth. And it’s like, like that. Unless they’re recovering alcoholics, then I don’t use the spray. Because there’s a little alcohol in there, right? The drops, and the capsules. I give them all of them. Two [01:29:00] or three times a day. And, biocidin, yeah, biocidin capsules. The GI detox at night, Ben. Yeah. We have to get out of here. Yeah, unfortunately. Oh, the library closes today. I didn’t know that. All right.
Thank you for making it all the way through this episode of the rational wellness podcast. For those of you who enjoy listening to the rational wellness podcast, I would very much appreciate it. If you could go to Apple Podcasts or Spotify and give us a 5 star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help, overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310 395 3111. And we can set you up for a consultation for functional medicine. And I will talk to everybody next week.
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The Holistic Kids discuss Avoiding Ultraprocessed Foods 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
In this episode of the Rational Wellness Podcast, Dr. Ben Weitz converses with the Holistic Kids, young advocates for health and nutrition, co-hosts of the Holistic Kids Show Podcast, and co-authors of a best-selling children’s book series with their mom, Medea Saeed. The discussion highlights their personal journey towards a healthy lifestyle, influenced by overcoming health challenges like allergies and eczema through dietary changes. The Holistic Kids emphasize the impact of eliminating fast food, dairy, and gluten from their diet while advocating for eating diverse vegetables and whole foods. They address the dangers of ultra-processed foods, the role of food industry advertising in shaping unhealthy habits, and the benefits of eating colorful, nutritious foods. They aim to educate and empower kids to make informed choices about their health, countering mainstream influences with a holistic approach. The episode closes with insights into the boys’ future aspirations in nutrition and functional medicine.
00:00 Introduction to Rational Wellness Podcast
00:26 Meet the Holistic Kids
02:19 Holistic Kids’ Health Journey
03:21 Dietary Changes and Their Impact
05:33 Making Vegetables Fun for Kids
10:21 The Importance of Real Food
12:59 The Dangers of Ultra-Processed Foods
15:14 The Addictive Nature of Junk Food
18:54 Advertising and the Food Industry
21:48 Investigating Health Organizations’ Funding
22:36 The Breakfast Myth Exposed
23:15 Cereal for Dinner?
24:42 The Rise of Artificial Foods
26:06 Impact of Artificial Dyes on Health
28:34 Addiction to Ultra-Processed Foods
31:06 Avoiding Junk Food at Social Events
35:03 Future Aspirations and Advice for Kids
39:57 Promoting Health and Nutrition
The Holistic Kids, Abdullah, Zain, Emaad, and Qasim are the co-hosts of The Holistic Kids’ Show Podcast. They have co-authored four best-selling books with their mother Madiha Saeed, MD, Adam’s Healing Adventureschildren book series which have been featured as Dr Mark Hyman’s Top 5 Picks. Their book The Teen Health Revolution: Unlocking lifestyle secrets to Optimizing the Mind, Body and Soul will be releasing in 2025. Their YouTube page is HolisticMom, MD.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast. Hello, Rational Wellness Podcasters!
Today, we’re going to have a discussion with the Holistic Kids. Holistic Kids. Oh, who, which three Holistic Kids are with us today? And what are your names?
Abdullah: I’m Abdulla.
Zain: I’m Zain.
Emaad: And I’m Emaad.
Dr. Weitz: All right, great. And so they’re the co-hosts of the Holistic Kids show podcast, and they have co authored four best selling books with their mother, Medea Saeed, Adam’s Healing Adventures [00:01:00] Children’s Book Series. And these have been featured as, there’s, there’s one of them as Dr. Mark Hyman’s Top 5 Picks. Their new book, which will be out next year, is The Teen Health Revolution, Unlocking Lifestyle Secrets to Optimizing the Mind, Body, and Soul. They spoke at the annual Institute of Functional Medicine conference in 2024, which is where I met them. The Holistic Kids Show Podcast is a completely run, kid run podcast, kids empowering kids. It’s a one of a kind podcast that has featured over 160 different experts from New York Times bestsellers, top physicians, Harvard professors, actors, White House correspondents, TV personalities, and even Dr. Ben Weitz, educating and empowering [00:02:00] kids of all ages to control their health and lives. The Holistic Kids are also the co creator of the first health course for kids by kids called Real Healing for Real Life Kids course. So welcome Holistic Kids.
Dr. Weitz: That’s great. So how, why did you become so interested in health? Tell us about your story.
Abdullah: Well, as you know, we go to school and we see all of our classmates. We see all of our friends and our, like, even sometimes family. And we see them all suffering. You know, Zan as, as well had, what did you had? 80 H? No, what? What? Eczema. Eczema, yeah. eczema. He had allergies. Mom had allergies, right? You had allergies. Mom, you had sinus allergies. He had allergies. I had, um, you know, terrible headaches, really bad dizziness. And we, and our [00:03:00] mom had a lot of, um, diseases as well. And we noticed that changing our diet, would keep us off going on the conventional way with taking kinds of medications. And eventually we started to eat better foods and we started to change ourselves, right? We started to feel better, you know, we started
Dr. Weitz: What are some of the major changes you did in terms of changing your diet?
Abdullah: We started to cut out fast food. We started to cut out the dairy, gluten. We used to eat it like all the time. Now we like barely, we don’t eat it as much. It’s more of a treat.
Dr. Weitz: It’s hard not to eat dairy and gluten, right?
Abdullah: But basically we, once we realized how much of a difference and impact it made on us, we were like, why don’t, why doesn’t, why don’t people know this? Oh, I have, I have, um, uh, AD, I have allergies now, it’s normal. Don’t worry about it. Like back, like [00:04:00] having a peanut allergy is seen as normal. Right. And it’s so weird to us. We were like, why don’t these people know this? Like people are literally feeding themselves poison. And they’re killing their own bodies. And these are our friends and classmates and the people around us.
Dr. Weitz: But it’s okay because we have a drug that can treat the symptoms.
Abdullah: Exactly. We were like, this is terrible. We need to do something. We need to have a change. And we want to bring this to kids in a way that they’ll understand. Because obviously back then we were like health, come on, right? And kids in general, right? They don’t really care about health. Yeah. Like Iman, how many kids in your school actually care about health?
Emaad: Like everybody hates health class.
Zain: Exactly. No one actually wants to learn or they don’t really care about their body because they’re like, oh, we’re kids, we’re immune to everything, right?
Dr. Weitz: But they probably care when they get a rash.
Abdullah: Yeah, you know, and it’s so sad because even when they do get [00:05:00] the rash, they’re like, Oh, I’ll just take, you know, antibiotics. But like, what do you mean by antibiotics? There’s better ways to do this. You just have to eat your arch nemesis, uh, vegetables.
Dr. Weitz: Your arch nemesis vegetables. Yeah. We have to get to the root cause and not just treat symptoms.
Zain: And that’s where really our journey started. Right. Does anyone want to add on anything? Yeah. Um, actually what’s sad is one in every second child has a chronic health condition and you’re not expected to live longer than their parents.
Dr. Weitz: There you go. So you guys want to change that?
Zain: Yes.
Dr. Weitz: So how did you get yourselves to start eating vegetables?
Zain: So it was all by the step by step process. Okay.
Abdullah: Like what our mom would used to do is she used to make smoothies and she would like, Like, um, uh, secretly put in microgreens, she would secretly put in like 10 different vegetables, and she would mix it with all these other fruits, and she’d put like stevia and stuff, and we could never tell. [00:06:00] Right. And so that was one way. Also, vegetables are fun to eat if you prepare them like a certain way, if you prepare them right. Right? So we would make vegetables, eating vegetables fun. We wouldn’t just eat broccoli, right? We wouldn’t just eat boring broccoli and boring carrots. How do you make broccoli fun? We would, sometimes we would steam it, like steamed vegetables. It’s
Zain: good.
Abdullah: We used to also use spices sometimes. Our mom was like amazing at turning, making vegetables fun. We’d have like a diverse amount of vegetables, like vegetables we didn’t even hear, like no existed. Right, Zed?
Zain: Also like if we’re like celery. We have something called Ants on a Log, which basically we put celery with peanut butter and, uh, raisins. Yeah, raisins. And that tasted like, we
Abdullah: were like, how did, how can we, how did we make celery taste so good? And there’s just this negative stigma around vegetables that most kids, uh, they buy into because that’s what people tell them. That vegetables are boring, that [00:07:00] vegetables make your life not fun. If you eat vegetables, you live under a rock and you’re depressed. This is more like most kids think, and we wanted to change that. And once we started to eat real vegetables and diverse vegetables, we started to see how fun that we can make vegetables.
Dr. Weitz: That’s great. How many, how many vegetables do you eat a day, do you think on average?
Zain: Ooh. So then there first there’s breakfast, yeah. And then there’s lunch. Uh huh.
Dr. Weitz: Do you have vegetables with breakfast?
Zain: Yes. Yes, we have. Yes. My mom makes like the smoothies.
Abdullah: Um, what are the smoothies? We have smoothies. So that has a ton of vegetables. She, she used to call them Hulk smoothies because they’re green, but then she’s like, Oh no, no, they will become stronger. You know, drink this. And she put in maybe some like banana or apple or something like that. And we drink it and it tasted good. Right.
Dr. Weitz: Cool.
Zain: And then lunch, every single, like when we go to school, I always prepare the lunches a vegetable, a [00:08:00] protein, and a carbohydrate. So we always get some type of vegetable.
Dr. Weitz: That’s great. A lot of kids are just eating chicken nuggets and, you know, they’re not having any vegetables at all unless you consider maybe french fries a vegetable.
Abdullah: They used to say, they used to say pizza has vegetables on it because of the tomato sauce. Correct. They’re like, I’m having a full meal because of, you got the bread, you got the cheese, you have the tomato sauce, which is a vegetable, you know.
Dr. Weitz: Oh yeah, when Reagan was president, they said just the ketchup on the burger was considered a vegetable.
Abdullah: I know, they’re, people are changing the idea of food so that it makes them feel better basically. Exactly.
Emaad: Yeah, we used to like, we sometimes like, in the morning we’d have like, um, sauerkraut, whipped cream, um, graffiti, and that’s all fair frame.
Dr. Weitz: That’s great, sauerkraut, feed your [00:09:00] microbiome, it’s fermented.
Abdullah: Yeah, cause there’s so many other fermented foods. that we love to enjoy. Like before we thought there was only pickles and then we realized you have sauerkraut, you have kimchi, right? We, anytime, right Emaad? Uh, anytime we feel like sick or like some we have a problem with our stomach, we’ll go and just, we’ll go to the fridge. We’ll have some sauerkraut because we, we know how it feels. We, the, the difference it makes, right Zen? Yes.
Zain: And it makes a huge difference. And like also with the different colors. Like you have to eat the entire rainbow. You can’t just like.
Dr. Weitz: You go, you guys are way ahead of most of the other kids. I would doubt many kids even know if they’ve even tasted sauerkraut or kimchi or know about eating the rainbow. So that’s great. What about activities? Do you guys play sports? Are you active?
Abdullah: Yes, definitely.
Dr. Weitz: What sports do you play?
Abdullah: Emaad, do you want to start?
Zain: What sports do you play?
Emaad: I play soccer and football.
Dr. Weitz: Okay.
Zain: I run, so cross country, track.
Abdullah: I play, you know, basketball, soccer. Uh, I also run in my free time. Or, I like to run. Um, and just go out in nature as well.
Dr. Weitz: That’s great. So let’s talk about the difference between real food and Fake food.
Abdullah: Okay.
Zain: So let’s just start with ultra processed foods. So although, do you wanna talk about what a ultra processed food is? Well,
Dr. Weitz: we like to call. Yeah, I mean basically we were talking about junk food, right? Yeah. That’s term, ultra process is a new term for junk food.
Abdullah: Yeah, no, for the nickname we give ultra processed foods like fake food because they’re not actually foods. Right. And, um, because. Children’s brains and bodies are made of food. I think it’s important to, you know, choose the foods [00:11:00] that we eat, like, and be mindful of those. So for us, the way we see ultra processed foods and the way it really is, it is basically just a formation, formulation of like ingredients, um, industrially produced ingredients that are put together to seem like, to make it look like a food, to make it have the food like shapes and textures Basically, instead of food, it’s industrially ingredients that have been created through industrial techniques. And that’s where the ultra and ultra processed food came from. Right. Right. And the thing that really blew my mind is I heard someone say, you know, ultra processed food is a science experiment and like they’re experimenting on us. We are the lab rats.
Dr. Weitz: That is true. And that’s why you see 14 different ingredients.
Abdullah: Exactly.
Dr. Weitz: There’s something wrong with that.
Abdullah: Like, I wrote, McDonald’s French Fries, 14 ingredients in [00:12:00] McDonald’s French Fries is way too much.
Dr. Weitz: Yeah. Yeah, those are super unhealthy. Not only are they, they, they take the potatoes, they soak them in sugar, then they deep fry them, they stick them in the freezer, they take them out, they deep fry them again so they can absorb more fat, they put salt on them.
Abdullah: My God, it’s crazy, right, Zen?
Dr. Weitz: Yeah.
Abdullah: Like, yeah. Also, what’s interesting is that, um, ultra processed foods, They’re basically reconstructed from whole food that was then reduced to a molecular level and then Reconstructed to look like food. I like to think it’s like pre digested food It’s already been through the entire system of being crushed and being smashed and then they just put it back together So that it tastes good and it makes us feel good, right?
Dr. Weitz: [00:13:00] Um, so how do ultra processed foods affect kids behavior and the way their brain works?
Abdullah: Well, ultra processed foods, they, they basically alter how the brain works and how the, um, and they harm the body because of the, they’ve basically been made addictive by these companies because if they’re not addictive, they’re addictive. Then people aren’t going to buy
Zain: or get them again. Right, Zen? Yeah. And also when we put junk food in us, we only get like junk behaviors, a junk body, a junk brain. Bad and fake foods destroy the balance of our gut microbiome. And with this, it leads to inflammation, like chronic inflammation imbalances our hormones, threatens our, our prefrontal cortex and destroys our ability to function optimally. Yeah. So it just creates a bad. [00:14:00] Life in general, like you don’t want to live a life that’s like Messed up.
Dr. Weitz: And they’ve actually, the food scientists have studied how to get people to eat the maximal amount of ultra processed foods. And there’s actually a concept they’ve come up with called the bliss point. And the bliss point is you just have the perfect amount of fat, sugar, and salt. So the person will just want to crave more and more and more of that unhealthy food.
Abdullah: Yeah, and then, like you were saying, when you add all of that fat and salt, you’ve essentially created an irresistible food. At that point, you know, they even have in the ads, they said you can’t have just one. Right, absolutely. They literally put it in the ads, you can’t have just one, you have to keep eating and eating and eating and eating. Because that’s how they were created.
Dr. Weitz: Right.
Abdullah: If, if you didn’t keep eating them, then they would [00:15:00] go back and yell at the scientists. Why didn’t you create it the way we wanted?
Dr. Weitz: Absolutely. They don’t want you to feel full and they want you to be eating it quickly. So you don’t even know how much you’re eating.
Abdullah: Also, what’s interesting is when I was going into like, how did these foods become so addictive? Because I was interesting. How do you make a food? That’s like just it’s because I was thinking of food as food from nature. How do you make something edible that addictive? So I went to the research and I actually realized that the way that ultra processed foods were made is that they activate the brain reward system in a way that is similar to drugs. It’s similar to nicotine. It’s similar to heroin. And what happens is when people they use like drugs like nicotine and heroin and alcohol.
Then they keep, they make these foods as addictive as them. And [00:16:00] there’s actually something in the field of drugs and addiction called the rate of delivery. And that is when, how fast the food goes through your body and it’s digested. It’s how fast it’s going to hit your brain. And that’s how fast it’s going to affect your body.
And, uh, I realized that because of the way that ultra processed foods were created, like, you know, how I said, um, they’re pre digested, and they go through your body fast, and like you said, they, you can’t, you don’t feel full, right? And because they go so fast through your body. Right. And actually, the faster they go through your body is the more addictive it becomes.
So I was like, oh my god, ultra processed foods are drugs based in LA. They’ve created, like, they’ve created them just like people have created drugs. And the same way that drugs work, is drugs work, or how all [00:17:00] depressed foods work. And I went more into this, like how do they do the research? Did they put, how much research did they put into developing this? Maybe it’s a coincidence, I don’t know. And I realized that the people that, you know, created Kraft and Nabisco and General Foods, they were owned by a company called Phyllip Morris. Right. Um, I don’t know about the company, but you’re probably, you know, you’re a little, you know,
Dr. Weitz: Phillip Morris was the company that made cigarettes and cigarettes is another example where they got everybody addicted and, and, and they just kept consuming more and more of it. And then tried to tell us that it really wasn’t unhealthy when it was killing us.
Abdullah: Exactly. And I went into this and I was like, okay, who’s Philip Morris? I went to research that. And apparently after they were exposed because they were selling, they were telling people, Oh, you know, smoking is fine. It’s fine. After they were exposed and studies [00:18:00] came out, you know, debunking them, they decided, you know what, let’s put our resources and into something else. And so they then bought Kraft, they bought Nabisco and General Foods, like I said, and Actually, the same scientists then used those methods of studying addiction and they then implemented that and created these ultra processed foods or these artificial foods. So the same, the same like strategies and research that went into making cigarettes super addictive went into making ultra processed foods addictive.
Dr. Weitz: Right, absolutely. Um, so, what happens when people eat these ultra processed foods is they’re no longer really in control. They’re just being controlled by the food industry.
Abdullah: Exactly. Like, you know, you look at advertisements. Advertisements are now a way [00:19:00] for these companies to basically control what’s happening inside the home. Nowadays, it’s crazy to me that advertising an addictive substance is now appropriate to advertise it, uh, to three year olds using a monkey and a tiger. Now it’s, now it’s like, it seems as normal to use an addictive substance as an advertisement with monkeys and tigers and other animals to seem appealing to three year olds and little kids. Right. And now it seems, oh yeah, this is fine, you’re allowed to do that. Like if it was, uh, cigarettes or drugs, it’d be, oh no, no, you can’t do this.
But with ultra processed foods. They say, yep, that’s completely good. They give the green light on that, right? You see people, you see the ad, you’re like, I want to buy that. Ooh, that looks good. That cereal, the colors that they use, it tricks their brain into thinking, I want that, right? Is that like, if you see, you know, you know, those ads, [00:20:00] yes.
Like the Froot Loops ads and, um, uh, what other ads? Like McDonald’s, like the, uh, Burger King ads, they, they, Like, they make the ads so that we want to keep on buying it, so it’s an entire scheme, basically.
Dr. Weitz: So, the kid shows are all filled with these ads for ultra processed foods, so the kids get overweight. And then the adult shows are all filled with ads for medications to try to help you lose the weight that you gain from eating the ultra processed foods. So, now all you have to do is take Ozembic and forget about eating healthy.
Abdullah: And it’s funny, it’s funny, Zan, you know, when, remember we were watching that one ad and it said side effects are death, you know, this illness, that, and the cancer, it’s pretty small letters. They have like a whole list of symptoms that are even worse than the original symptoms.
Zain: And then you just see like people, like happy people, like walking or [00:21:00] like swimming or just happy playing.
Dr. Weitz: Of course.
Zain: I don’t know the background, but like the music and then
Dr. Weitz: yeah, they don’t, they don’t see when they’re, uh, suffering from these, uh, chronic diseases like diabetes and they’re getting, you know, and they’re having to go through, um, dialysis because their kidneys are failing or they’re having to get their, um, toes and feet cut off from, uh, neuropathy from diabetes. So all these chronic diseases are, are killing us.
Zain: So. Who do we trust? Think about this. American Academy of Pediatrics? They take money from companies like Matt Johnson and Abbott. I know, remember, you were researching this for the book actually, right?
Abdullah: Yes. Yeah, so Zan was researching for the book, like, where do the money that, that, for a lot of these heart diseases, uh, heart disease organizations and all [00:22:00] of these other organizations, where do they go to?
And what Zan actually found was really interesting.
Zain: So, who do we trust? The American Academy of Pediatrics? No, they take money from companies like Matt Johnson Abbott. What about the American Diabetes Association? Koch and Cadbury give them donations. These are the same people that are making our recommendations. And I was like, what?
Abdullah: Like, I was, I was going into all the tobacco stuff and then Zan brought this entirely different part of it that you wouldn’t think would even exist. Like all, that’s why, you know, um, uh, the people, you know, the, the people that said that breakfast, you have to have breakfast, like breakfast is the most important meal of the day. Right. Guess who that came from? Uh, the cereal
Abdullah: industry. Exactly. Yeah. We were like, you’re telling us, because we knew by school, like everyone was saying, our teachers, that breakfast is the most important meal of the day. [00:23:00] It was ingrained into our minds that you can’t miss breakfast. And then we realized when we were doing this research, where it actually came from. Right, Zen? Right, Ma, did you know that the teachers say that breakfast was the most important meal of the day? Yeah, they
Zain: do it
Abdullah: in
Zain: shows and stuff.
Dr. Weitz: And then during COVID, a lot of people were staying home and, uh, a lot of them didn’t want to cook because they were too lazy. So I saw the CEO from one of the cereal companies on TV talking about how great it is that people are eating cereal for dinner now.
Abdullah: Cereal for dinner? Imagine having cereal for dinner?
Dr. Weitz: It’s just totally processed, loaded with sugar, and no vegetables, no fruits, no natural foods. It’s like a bowl of poison. Exactly.
Abdullah: And now it’s weird because it’s being seen as like, Oh, [00:24:00] if I had like five bowls of cereals, that’s more things. Okay. That’s good. That’s good. It seems normal now, right? If you don’t have, if you have anything like natural in the morning, you’re seen as like, what I can have, you know, I, I remember some person said, Oh yeah, I have toe. I have like toasted avocado on it. Avocado Toast, and I was like, what? We just eat cereal every single day. You’re having something that, like, exotic?
Dr. Weitz: Because Yeah, you go through the grocery store and there is a huge aisle with all these boxes of cereals. And you look at how much sugar is in them. It’s just horrendous.
Abdullah: Yeah, and the kids are now brainwashed. It’s become the new norm for people to eat these foods. Artificial foods. is now seen as food. I mean, if you thought about artificial food back in like the 1940s or something like that, you [00:25:00] would think of this as like some crazy invention, and now it’s become our daily diet. Everybody’s supposed to eat this. And, you know, several studies have actually been concluded that there’s an association between artificial food dyes and neurobehavioral symptoms in sensitive children, including hyperactivity, attentiveness, and restlessness.
And then people go say, Oh, you know, artificial foods are not that bad. I mean, come on, they’re not doing anything to our body. I’ve been eating it for 10, you know, 15 years. And people don’t realize that it’s affecting the future. Absolutely. And that’s why we really want to educate people because we are, you know, we are technically the future.
Dr. Weitz: And, and the, the group that makes out the US dietary guidelines recently said that there’s no proof that ultra processed foods are really harmful.
Abdullah: Wow, when we saw that we were like, [00:26:00] what, what are these people saying to me?
Dr. Weitz: Because they’re getting funding from Big Food.
Abdullah: Yeah, and also another thing that was really interesting is, you know, artificial dyes. Most people think, oh, they’re just like dyes, you know, you put in sprinkles and stuff like that. But artificial dyes can directly trigger something called gut dysbiosis. Correct. 95 percent of our neurotransmitters are made in the gut. That’s why we like to say that our gut is the second brain. And so, when artificial, um, dyes affect the gut, they then affect the neurotransmitters that are being made, which then affects our brains.
So, Nowadays, like, even in our schools, right, kids are becoming more crazy and crazy and crazy, right? Like, Raizan, in your high school, in my, like, uh, in middle school, yeah, in middle school, like, kids are crazy, right? Oh, yeah. And, like, kids, they’re so addicted to sugar and, like, [00:27:00] ultra processed foods. And
Zain: additives, you know, basically, the, the teachers bribe the, uh, the students with sugar, basically.
Emaad: And Jolly Ranch. If
Zain: they, if you, if you do this, you’ll get some candy. If you win, you’ll get some candy. If you get this bingo, you’ll get some candy and it’s always, they’re pushing kids to do it for candy and kids will do anything for candy. So,
Abdullah: yeah, that’s crazy. Kids will not like, I remember when I was in middle school, kids would have entire lockers full of candy because they needed, for some kids, they need candy to survive. It’s become from a want to a need, yeah?
Dr. Weitz: So, in our society, chronic diseases are the major cause of sickness and death, and over 70 percent of the population is overweight. [00:28:00] Why are we not doing anything about artificial ingredients and ultra processed foods that are contributing to this?
Abdullah: Does anyone want to answer that?
Dr. Weitz: Well, it’s all money.
Abdullah: You know, food additives make ultra processed foods taste better,
Dr. Weitz: right?
Abdullah: You know, they make them smell better, look better, be more addictive, and they last more on the shelves. Ultra processed foods, they’re addicted by design. And it’s, it’s, it’s worked. They, all of the money that they put in, all the research that they put, obviously, they’ve made something that is an addictive substance that people can’t resist anymore. And because of that, the global food items market It used to be worth, I think around 30, 38 billion in 2021, [00:29:00] but by 2026, the value of the global food additives industry is projected to be 56 billion.
Wow. 56 billion is now, it’s like, that’s the market for food additives. And one interesting thing I heard is if kids around the world would, uh, or kids in America missed, missed even one meal of ultra processed foods, then the food companies, uh, sales would plummet by 7%. If they just missed one meal, then their sales would go down by 7%.
So it’s all money. People think so, if, if it was so bad for us, why wouldn’t they tell us? If, um, uh, Smoking was bad for you. You think that Phil Morris was going to tell you, Oh, it’s bad for us. Bad for you. Don’t buy our product. They promoted it. They said, [00:30:00] no, all this research is bad. And these scientists, you know, they’re not trusted.
And the same thing is happening now. If, uh, right now they’re not, nobody’s going to stop the food industry because they’re making so much money. I mean, there’s, who’s going to stop them. Basically people have tried to loss, have to sue them. People have tried to talk, uh, tackle them and put them down and make them change the foods, but they’re not going to do anything because for them, we are money for them. We’re there. They’re probably, they are, we are the product basically.
Dr. Weitz: Right. And, and we’re sitting around arguing over whether we should eat a vegan diet or a Mediterranean diet. And meanwhile, uh, you can have, eat a vegan diet that’s all filled with junk fruit. So we should really be focused on the quality of the diet [00:31:00] and, and not just on the specific macronutrient content. So how do you guys stay away from ultra processed foods when, when you say go to another kid’s birthday party?
Zain: So we like to bring our own things ’cause um Oh, okay. We’re not going to eat their junk most of the time. You
Dr. Weitz: just whip out a bag with some cut up carrots or what? .
Zain: So basically, let’s say if they’re having cake, right? We will bring our own muffins or Oh, okay. Our own brownies. Okay. Like the real deal. You have the real deal or some cookies. And that really, we don’t really want that anymore because it doesn’t really look as appetizing as it did maybe 10 years ago. It makes us kind of even like nauseous and feel
Abdullah: sick when you see that food, right? Yeah. What do you do when you go to a party and that’s all they have? They just have pizza [00:32:00] and, you know, all this junk food.
Abdullah: Because we know, right, Emaad? We know that they’re basically just chemicals, right? Yeah. I mean, we just see, you know, a product, a substance, that people are eating and eating and eating. For us, it doesn’t seem appetizing anymore. Okay.
Zain: If they offer it to us, we say no. And we like to bring our own things, so we’ll have that.
Dr. Weitz: Oh, you guys got great willpower.
Abdullah: And that’s why we love to keep researching, because this information, right, it gives us power. And because we don’t want to be tricked into doing something we know is not good for us. At school, everyone is eating pizza, and yes, it still smells appetizing to us. It’s To us, it’s still actually disgusting. We don’t crave it anymore, we don’t want it. Uh, I know you might think that we’re lying, and it seems impossible. Because kids nowadays are seeing that they’re addicted to all of these kinds of foods. But, honestly, we can’t even stand the sight of it. Right? You know, when I was like 10 years old, I remember, Emaad, I think, [00:33:00] you brought like a Gingerbread house, oh
Emaad: yeah,
Zain: into the house, when he was in Kindergarten, they were decorating the gingerbread house, and luck could not stand it, so he like, completely like, threw it away.
Abdullah: I didn’t want this, you know, it’s like, it’s for me, I see them as drugs, you wouldn’t want drugs just like staying on, you wouldn’t want an addictive substance that’s dangerous for you. That we know destroys our body, that we know what it does to our brains. We know how it makes us feel. We don’t want that to, uh, I, I, it just didn’t feel right with me.
Dr. Weitz: So what do you guys do on Halloween?
Zain: Halloween, we just get, there are better alternatives to that candy. So
Emaad: it’s a brand that we like specifically use called Yummer. Do you
Dr. Weitz: guys go around and collect candy from other houses?
Zain: So it might be easier for us because we don’t actually celebrate Halloween. Oh,
Dr. Weitz: you don’t celebrate Halloween?
Zain: Yeah, we don’t celebrate Halloween.
Dr. Weitz: Oh, okay.
Zain: So it would be easier. We just like give it out.
Dr. Weitz: That’s one of our favorite pagan holidays.
Abdullah: No, but we still love anytime it’s Halloween. We’re like, Mom, um, everybody else is having candy. So we can, we have like our candy. Yeah. So we take, we get our organic, organic, natural, real. There you go.
Dr. Weitz: Cool.
Abdullah: And for us, that tastes even better than the other stuff. Because nobody likes to, nobody likes to know that they’re being tricked into doing something or that what they’re doing has been, you know, um, been advertised to them and basically like people don’t want to know that what they’re doing is being funded and their people are researching to trick them and make them do what they want to do. Right. So that’s why, you know, we also, we look through the ingredients and we see, okay, what does this do? What does that do? And then we make mindful choices because [00:35:00] we know their tricks. Right.
Dr. Weitz: So what do you guys see yourselves doing in the future?
Zain: So I have an interest in nutrition, so I’m thinking to become a, some type of doctor ish. Not like normal doctor. Right.
Dr. Weitz: And how about yourself?
Abdullah: Oh yeah, no, so I was thinking of going also into medicine and learning more about this and becoming in like, you know, educating more people basically.
Dr. Weitz: Right.
Abdullah: So you can
Dr. Weitz: become a functional medicine doctor, a naturopathic doctor.
Abdullah: I’m still thinking about it, which one I want to go into, but I know I want to work with functional medicine and the holistic way. Right. And how
Dr. Weitz: about yourself?
Emaad: I have no idea.
Dr. Weitz: How old are you?
Emaad: I’m 11.
Dr. Weitz: Okay. And how old are you? [00:36:00] 13. And you? I’m 16. Okay. There you go. So you’re, you’re almost applying to college soon.
Abdullah: Soon.
Dr. Weitz: Yeah. All right, great. So advice for other kids?
Zain: So we need to be more mindful about the food we eat. We have to use food as medicine to thrive, basically. So make sure it’s nutritious, helps our gut microbiome. It’s nutrient dense. Yeah, nutritious, nutrient dense. Yeah. Um, it helps your, like you said, gut microbiome, gut microbiome, insulin. Balance is insulin. Insulin and Balances blood sugar levels, all of this, and it’d be what we’re looking in, in foods. And it’s good for your body in general, basically.
Abdullah: And that’s all we want. We, we think this entire problem could become much better if kids actually read what they’re [00:37:00] eating, because the problem is not that kids know that it’s harmful for them and they continue to, Oh, I want to put these chemicals into my body. Oh, these chemicals that taste so good. No, they just don’t even, they don’t know what these foods are. So we just want kids, you know, to read ingredients because that’s what we used to do, right? Yes. When we started to do this, we wanted, we started to read ingredients. Um, uh, we started to think of food as like a molecular information that dictates our day to day, um, and long term function as natural
Zain: food because it has 5, 000 known biochemicals inside them. Like, that’s insane. That can really help us.
Abdullah: We think of food as like medicine, food as our fuel,
Zain: food as like dictates everything that we do in our life basically. Cause like food is like the single most powerful tool that impacts our brain, body, and our behaviors.
Zain: That’s great. It’s really important to look at food and especially like the good food and like eat it.
Abdullah: That’s why, you [00:38:00] know, that’s why we are so passionate about this because we know that we, that this food makes change, um, it can make a change to our bodies. We feel it, right? So we have more, we can even have more endurance than a lot of the people around us. Like I don’t play, I don’t, um, run track or cross country, but I already have a lot more endurance when I do run against other people. I’m like, Oh my God, they’re like exhausted. Like, how do you do this? I was like, I don’t know. This is, we just eat nutrient dense, uh, food. And the rainbow. Oh yes, we love to eat the rainbow.
Emaad: Speaking of rainbow, red foods contain lycopene that protects against cancer and heart disease. Orange foods help with hormonal health. Yellow foods is great to sustain nitrate, fiber, and great for the digestion. Green foods indicates biochemicals such as raffinate and sulfurophane, which raises the with um, boosts the circulation and lowers cancer. I love seaweed.
Abdullah: He loves seaweed. Like loves, loves seaweed.
Emaad: Loves.
Abdullah: That’s great.
Emaad: Iodine strengthens the immune system [00:39:00] and then blue and purple foods help the brain. Wow, that’s some very intense, uh, scientific information for us. Thank you. He
Abdullah: even compares it. He’s like, okay, this one has glucoraphanin and this one has iodine, iodine, which, which one we need. Compares, okay, I had seaweed before, I already got my iodine, so now let me get some sulforaphane.
Dr. Weitz: That’s great. I wonder how many 16 year olds would have any idea what glucoraphanin is.
Abdullah: Especially in my, in my, uh, 6th graders. Yeah. Well, you guys are way ahead of the curve and I applaud you for being knowledgeable and promoting health and that’s what this country needs. Tell people how they can find out about your podcasts, your books, and your course.
Abdullah: So, um, [00:40:00] Our subconscious world governs about 90 percent of our thoughts and actions. Training us to be positive is key. Especially as a teenager, I know negativity is basically our entire thing. But that is why we have to train our subconscious to be more positive. Because our subconscious is just neural pathways that need to be rerouted to become more positive. So we can look to see all the blessings in life, be grateful, be grateful, be grateful, be grateful. Know what we’re, uh, know that we’re not missing out, you know, see the things that we do have instead of the things that we don’t. With hundreds and thousands of edible foods on the planet, we need to look at the foods that we can eat instead of the foods that we can’t eat.
Zain: And our podcast is on, actually we interviewed you on our podcast, it’s on iTunes, Spotify, Apple Music, um, YouTube, like basically all the ones that you usually do. That’s great, and your books you can get [00:41:00] from, uh, Amazon, Barnes Noble, wherever they sell books. . Yeah. And then what about your course? It’s on your website?
Zain: Yes, it on website.
So, and the website is you definitely
Abdullah: check that out. The website is holistic kids.com.
Dr. Weitz: Well, thank you so much, guys, for joining me today and spreading the word about health and nutrition. Well, it’s our pleasure.
Zain: It’s our
Emaad: pleasure.
Zain: We need to empower kids. This is our mission. We need to empower the next generation. This is our purpose. Our purpose.
Dr. Weitz: That’s great that you guys already know what your purpose is. I, you guys are way ahead of the curve. Well, thank you. Thank you. It’s our pleasure. 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 [00:43:00] set you up for a consultation for functional medicine. And I will talk to everybody next week.
Dr. Yousef Elyaman discusses Fatty Liver disease with Dr. Ben Weitz.
[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.]
Podcast Highlights
Dr. Ben Weitz hosts a discussion with Dr. Yousef Elyaman on the recent rebranding and significance of non-alcoholic fatty liver disease, now known as Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD). They explore its emergence as a leading cause of liver failure, affecting millions globally due to poor metabolic health. The discussion delves into causes such as insulin resistance, uric acid dysregulation, and oxidative stress. They assess diagnostic methods, including FibroScan technology and various laboratory tests. Dr. Elyaman highlights functional medicine approaches, focusing on dietary changes, exercise, and targeted nutraceuticals like berberine, curcumin, and omega-3s.
The episode underscores the importance of understanding and addressing systemic imbalances to combat this epidemic, offering both professional insights and pragmatic medical advancements.
04:17 The Evolution of Fatty Liver Disease Terminology
07:17 Causes and Mechanisms of Fatty Liver Disease
17:07 Testing and Analyzing Fatty Liver
21:46 Advanced Testing and Treatment Plans
32:47 The Role of Semaglutide and Ozempic in Weight Management
33:33 Modified Mediterranean Food Plan for Fatty Liver
34:41 Exercise and Its Impact on Fatty Liver
36:50 Nutraceuticals for Insulin Resistance and Gut Health
37:55 Understanding Liver Enzymes and Oxidative Stress
40:52 Supplements for Fatty Liver and Overall Health
42:36 Functional Medicine Approach to Fatty Liver
50:31 Final Thoughts and Course Information
Dr. Yousef Elyaman is a board certified Internist with a speciality in Functional Medicine. Dr. Elyaman is the founder and Medical Director of Absolute Health, a primary care functional medicine practice in Ocala, Florida. Dr. Elyaman also serves as the Medical Director for HumanN, a leading nutraceutical company, and as a consultant for Quest Diagnostics Laboratory’s Wellness Division. He’s teaching faculty for the Institute for Functional Medicine, specializing in their Cardiometabolic module. His website is AbsoluteHealthOcala.com. Dr. Elyaman offers a detailed course on Fatty Liver for practioners, The Functional Medicine Practitioner Essentials course on Fatty Liver.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: [00:00:00] Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello, Rational Wellness Podcasters. Today, we’ll be having a discussion about a very important condition which had been known as non alcoholic fatty liver, but is now known as metabolic associated liver disease, I think. Is that correct?
Dr. Elyaman: Metabolic, yep, metabolic dysfunction associated fatty liver disease.
Dr. Weitz: Okay.
Dr. Elyaman: Actually, metabolic, now it’s Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD).
Dr. Weitz: But it’s a very important condition and everybody needs to know about it because this is going to be the leading cause of liver failure for millions of people around the world and we’re already in the midst of an epidemic of this condition as a result of our metabolic health, and we already know from recent research that over 70 percent of Americans are metabolically unhealthy.
Dr. Elyaman: Correct.
Dr. Weitz: So we have Dr. Yousef Elyaman here with us. So Dr. Elyaman, can you tell us about yourself, about your background a little bit and what you’ve been up to?
Dr. Elyaman: Yeah, I’m an internist, I’m a pediatrician. I belonged to the first graduating class of the Institute for Functional Medicine. I have my own practice here in Ocala, Florida. We have over seven providers, we have a insurance based functional medicine practice. We have health coaches. We have actually over 60 employees. I also am a faculty, teaching faculty for the Institute for Functional Medicine, so I do various talks across the world, actually, on functional medicine, on getting to the root cause. I live on a horse and cattle ranch in Ocala, Florida. Happily married, got seven kids. The oldest of 15. So, that’s about it.
Dr. Weitz: Yeah, that, that ought to keep anybody busy.
Dr. Elyaman: Oh yeah.
Dr. Weitz: So, tell us why fatty liver disease is so important. I teased the audience a little bit already.
Dr. Elyaman: Yeah, so you already kind of mentioned it, but But if you look at statistics, between 25 and 30 percent of people have fatty liver disease already. And that, I mean, you think about that means one in every four people have it. It is, not only can fatty liver lead to liver cirrhosis, meaning failure, and liver cancer, but the liver is the center of metabolism. All the stuff, in functional medicine, we’re learning about, like, Methylation issues, elevation of Homocysteine, inflammation, oxidative stress. Most of those things are happening at the level of the liver. So when the liver, when there’s a problem with the liver then the, and the liver isn’t functioning properly, it causes other issues. So, many, so when they have fatty liver disease, they have a high chance of dying from a stroke or a heart attack. They have a high chance of having high blood pressure just because of what the liver does. So it’s I think because it covers most of our or at least a quarter of our population, plus it leads to all kinds of other issues, we really do want to know about it.
Dr. Weitz: Absolutely. So, how do we know if we have fatty liver? How do we know if a patient has fatty liver? I’ll give you an example. I just talked to a patient and she had a CT scan of her abdomen and it showed [00:04:00] some fatty infiltration of her liver. Now, is that technically fatty liver or we need additional testing to really nail that down?
Dr. Elyaman: Yeah, we may need to do some additional testing. So now it’s called MASLD. So the S is with a is kind of pronounced with a Z. Right.
Dr. Weitz: So the condition had been called Non-Alcoholic Fatty Liver and now…
Dr. Elyaman: Yes. Now it’s called MASLD and actually it does sound a little bit cooler. I was very upset when the name changed and then it changed again because like I created a course on fatty liver. I have over 10 hours of teaching practitioners how to deal with fatty liver and it wasn’t called mazzled. I actually had to change the name of my course and kind of throw in fatty liver and mazzled but we can I know you, you were, you asked a follow up question but just…
Dr. Weitz: Yeah, let’s talk about the name and why it’s changed.
Dr. Elyaman:Yeah so the reason was, is that when you call something by what it’s not, like non [00:05:00] alcoholic, that it kind of doesn’t make sense to call it what it’s not. It turns out, it just, it didn’t. When the liver gets inflamed, one of the things that can happen is it can turn to fat. So what, that’s what they’ll see when they do a biopsy and under a microscope, they’ll see that the liver is turning to fat. So it was one of the most common causes back then of the liver turning to fat was alcoholism when or not even alcoholism when certain people, when they drink alcohol, different people have a different threshold, but that some people, it might be one drink a day, it would start turning that liver to fat. So they just called it by what it wasn’t, the most common cause at the time. Oh, non alcoholic. And then so naming it by what it’s not, kind of didn’t make sense. So now what it is. Metabolic Dysfunction Associated, because like you mentioned, metabolic disease, it’s associated with [00:06:00] metabolic disease, and metabolic disease is like driving this. And then the other part of it is steatotic, so metabolic dysfunction associated, steatotic is Latin for fat, and what people were saying is that. We were being stigmatized, or patients that had this were being stigmatized. Calling somebody fat or saying that, hey, this is fatty, is, was a little bit of a shaming thing. And also, even though they called it non alcoholic, people would go home, tell their family, and their family think, oh, you’re drinking too much. Even hough it’s non alcoholic, they’re like, oh yeah, it is alcoholic. So that’s where non alcoholic metabolic dysfunction associated, steatotic is the Latin word, and then liver disease. So that’s where the name came in. And then back to your case, you were talking about, you did, was it a CAT scan you mentioned?
Dr. Weitz: Yes.
Dr. Elyaman: Alright, so there’s a CAT scan, and the CAT scan shows that somebody has fat in the liver. Well, we know that they have liver, that they have fatty liver infiltrate, but various conditions can cause the liver to turn to fat. And that’s why, in order to make that diagnosis, you do have to rule out other conditions.
Dr. Weitz: Now, is there a difference between alcoholic fatty liver and metabolic associated liver? Is there a different mechanism of what’s happening? Because my understanding in metabolic associated liver disease is that as a result of having too much glucose in the system, that glucose is converted into triglycerides and then stored in the liver.
Dr. Elyaman: Yeah. So it’s interesting. There are about what, like digging in the research, about ten really common causes that of fatty liver disease. And because alcohol can cause the liver to start turning to fat, that’s just one of [00:08:00] the, one of the reasons for it, and because drinking alcohol is pretty common, they now, there’s actually a there’s a version of MASLD called AC, meaning alcoholic associated as well. So alcohol is a toxin and that toxin is causing the liver to start turning to fat. Now alcohol also,…yeah, alcohol will cause your homocysteine, which is that met, that level in the blood when that’s high, that means that you’re not doing what we call methylation properly. And methylation is kind of one of the ways that we break down different hormones and we detoxify. So that homocysteine can also go up, which can cause that liver to start getting inflamed and turn to fat. But like you were saying that, one of the primary causes in MASLD, take away the alcohol piece to it, is insulin resistance. But here’s what’s interesting about the insulin resistance. Insulin resistance. When you start taking lots of sugar and lots of carbohydrates, then the pancreas has to make up for it. It has to do something about it because we don’t want our blood levels to be filled with sugar. So the pancreas creates insulin, and that insulin is going to drive your glucose or your sugar into the cells. Now, what happens is that whenever our body gets too much of a hormone, like it’s just oversaturated, whether it’s testosterone and people are roiding up too much, whether it’s estrogen, what happens is those, the body just can’t handle, or the cells can’t handle it. So they start to get resistant to where you need more and more insulin for those receptors to work.
So now let’s go back to MASLD. People will have lots of sugar, and then they keep getting this, these spikes of insulin, and then they start getting resistant. And that, what would happen is now the insulin is not working, and they’re needing more and more insulin. That insulin resistance will cause an enzyme called hormone sensitive lipase, found in our fat cells to be overactive. And what that does it starts tearing up fat in the fat cell and start sending it to the liver. So now the liver gets overwhelmed not only with what they are eating, but also with all of these fatty acids that are like overwhelming the liver. So then the liver starts like trying to make, try, trying to repackage it. And it repackages it in something called VLDL and triglycerides. Now VLDL is what becomes LDL, which they usually call bad cholesterol, but we know in Functional Medicine that it’s not always bad. You actually need to have LDL, but it makes the [00:11:00] really tiny bad cholesterol. And the really bad, tiny bad cholesterol is what ends up causing clogging of the blood vessels or heart disease and a lot of the issues that we see. So from that mechanism, one of the primary mechanisms of MASLD is going to be that insulin resistance. Now you add toxins to the liver, you’re kind of pouring more fuel on it, and then that can make, can happen, that can add a little bit more. But what’s interesting is, those are just parts, there are so many other causes of mazzled, and if we just, we can’t just look at people that have fatty liver and are MASLD, and we’ve ruled out, and we can at some point, talk about how to rule out other causes to make sure you actually have the diagnosis, because I think that’s important. But there’s many other things that may be causing MASLD for our patients that, that we’re not picking up on. And we’re just saying, Oh, just lose weight. Like that’s not the answer.
Dr. Weitz: Or what are so many other causes?
Dr. Elyaman: Okay. So one of the other causes is an elevation of uric acid. So uric acid. Yeah, uric acid is a particle that’s found in the blood and it is usually associated with gout. So, really high amounts of uric acid in some people, because some people it doesn’t really cause that. They’ll get gout attacks where they get inflamed, painful joints. But that uric acid, if it’s elevated, it can actually cause other things. For example, it can cause fatty liver and it can cause the body to start storing fat. Now, the question is that why do we have this elevation of uric acid? And the answer is, so we think that it has so traditionally,
Dr. Weitz: So high uric acid is actually a metabolic issue, right?
Dr. Elyaman: Exactly. So it’s because of, so when we consume large amounts of fructose…
Dr. Weitz: Correct.
Dr. Elyaman: which is found in high fructose corn syrup. When it’s found, it’s also found in [00:13:00] in fruit juices. Then, and actually, you can get high uric acid from drinking alcohol, but what happens is that now the body, when it gets too much fructose at one time. Then the body has to use ATP to break it down or to process it. And that ATP, the A and the A in ATP gets broken down into and it increases uric acid. And then uric acid makes us start building more fat. It makes the liver not able to break fat down and it makes our body store more fat.
Dr. Weitz: So it’s not a coincidence. That fructose, which has a low glycemic index because it has to go through this circular route through the liver to finally get metabolized. And the exact same pathway is needed to break down alcohol.
Dr. Elyaman: Are you reading my mind or something here? No, not at all. I thought I was the only one that knew this stuff. No, it is not. It is not a coincidence. Yeah, no, it is not. It is not a coincidence. It is. It is. And what’s happening is this. If you look at the way we would eat, consume fructose in nature, it was kind of with you. There was fiber with it. There were other things, other. The different colors in the fruits and vegetables or phytonutrients had different healing properties. But in reality, if you look at our Stone Age ancestors, we had a mechanism to build or to acquire fat. So what would happen is that in springtime, we would get access to fruits. We would eat a whole bunch of fruits, because you never know, you don’t know how long that’s going to last. And then those fruits, one of the things that would happen, they would have sugar in them and sugar can increase insulin and make us gain fat. But then on the other side, the [00:15:00] fruits were caught, can cause uric acid to go up. And then the uric acid to go up would, would also then push us to store fat. And then what would happen is that winter would come. And when winter would come, then, unfortunately, a lot of vegans would change their minds really quickly, and then not, I mean, hey, we’re not in the Stone Ages, so you can, you can definitely be vegan and survive. But back then, what would you have access to? Nuts and seeds, and meats. And then, the nuts and seeds and meats, would then push our body into muscle storage and fat burning, to make us, kind to kind of change our body composition until spring would come again.
Dr. Weitz: Now why don’t bears die from fatty liver?
Dr. Elyaman: Oh. Because they’re too busy sleeping, man, not moving around. Bears are so that, that’s right. Bears eat. Bears.
Dr. Weitz: Bears eat the fruit.
Dr. Elyaman: Yes.
Dr. Weitz: To store fat to last through their hibernation. Right?
Dr. Elyaman: No, [00:16:00] absolutely. So actually this is just a theoretical thing or so. I’m sure the audience knows this is for entertainment purposes only, and don’t use this and whatever. But so if you think about it, human beings, we’re not supposed to…
Dr. Weitz: Make sure you check your bear for fatty liver.
Dr. Elyaman: Definitely check the bear for fatty liver. So humans, we are not supposed to store fat in our liver…
Dr. Weitz: Do you think Bobby Kennedy checked the bear in the back of his car for fatty liver?
Dr. Elyaman: I don’t think he, nope.
Dr. Weitz: Just kidding.
Dr. Elyaman: But I don’t think it happens in bears. I think it’s more of a human thing because we kind of overdo it a little. Like I, we didn’t really
Dr. Weitz: Human beings overdo things?
Dr. Elyaman: I know it’s shocking, but yes. Sometimes, some humans, not me. I don’t know what, I don’t, I would never ever overdo things, but some humans would overdo things, yes.
Dr. Weitz: Okay, I’m sorry for messing up your train of thought. I
Dr. Elyaman: did not at all. This is this. I love [00:17:00] this. This is how science can be fun. See, science is fun.
Dr. Weitz: I agree. I love science. So how do we test for fatty liver? How do we analyze people? What are the labs we want to look at? What are the tests we want to run?
Dr. Elyaman: Absolutely. So first of all, we’ve got to rule out other causes, right? So how do we rule out other causes? Well, we’re gonna we’re gonna get, one of the things we look at is a CBC or a blood count. And when you look at that CBC or blood count, you can look at what’s called the mean corpuscular volume or MCV. And if MCV is high, if the number is high, then that means your red blood cells are large. And what can cause your red blood cells to be large? B12 Deficiency, Folic Acid Deficiency, and also, in some people that drink alcohol can cause that to happen as well. Because it poisons the system, and makes your red blood cells larger. So, that would be a clue that there’s an issue with alcohol. With, that there’s an alcohol component to it, and that’s something you would talk to patients about and see, is this alcoholic fatty liver, or is it MASLD or is it a combination of both? The other thing that you can see when you’re looking at the blood count, is you can look at platelets. And your platelets are, if you’re and there is a test that you can do called a FIB4, and it’s really not a test, but what it is a calculation where they look at liver enzymes, your AST, your ALT, your age, and your platelets. And if your platelets are low compared to the, to, to what they should be based on what your liver enzymes are, then that can tell you that there is some fibrosis happening, meaning that there’s a hardening of the liver. Why? Because the liver is one of the, its functions is it makes a hormone called thrombopoietin. And thrombopoietin’s job is to go to the bone, to your bone marrow, [00:19:00] to tell your bone marrow to make platelets to help the blood clot. But if your liver is damaged, it can’t make it as well, and then those platelets are going to be lower. The other thing though, is that it could be a clue to alcohol as well. Because alcohol will poison your bone marrow and not allow it to make those platelets. So those are kind of some of those initial clues. So definitely a good history, find out if they’re drinking alcohol. You can do a viral Hepatitis Panel. And a viral hepatitis panel is to see if they have these chronic viruses that can infect the liver, like Hepatitis C, Hepatitis B, those are the common ones. You also can do something called an autoimmune hepatitis panel. And an autoimmune hepatitis panel is looking to see if you have an issue with autoimmune hepatitis. Autoimmune hepatitis is where the body is attacking the liver, it’s attacking itself. You can also get, and this is just kind of the initial, we have more of a functional medicine approach, of course we will look more. But this is just the initial test. So you check that Autoimmune Hepatitis panel and you can also check something called Alpha 1 Antitrypsin. And it’s a genetic condition and what happens is they can get problems with their liver and problems with their lung. You can also check an iron panel with ferritin because if you have iron overload, that can cause the liver to turn to fat. So that’s another thing that we would look at. And then you can also check copper levels. And if your copper is and it’s a little confusing, but if your copper is low, it could mean you have high copper, high free copper. So then you would follow up by getting a ceruloplasmin level, which is the carrier molecule for copper and a 24 hour urine copper. But bottom line, if you have too much free copper, that also can turn your liver to fat. And that’s the workup you do to rule out other causes. And then in the regular CMP, you’re going to look at something called an [00:21:00] alkaline phosphatase and a bilirubin. And if the alkaline phosphatase is high, then that’s kind of a clue that you have another liver issue…you need, you probably get to get them to a subspecialist…it’s not just the typical fatty liver or now called MASLD.
Dr. Weitz: What does it mean if the alkaline phosphatase is low?
Dr. Elyaman: It means that you have a problem with, you have a problem with kind of the bile flow. We call it cholestasis, so the bile ducts are kind of clogging up and the bile is not flowing properly.
Dr. Weitz: Ah, interesting. Okay. So, we’re gonna do those tests, and then what’s the next step if we’re suspecting that there might be fatty liver?
Dr. Elyaman: Yeah, so I, nowadays, we have readily available this amazing technology called FibroScan technology. And a FibroScan is an ultrasound technology, [00:22:00] but it’s specified. And what it can do is it can tell me two things. It gives me what’s called a CAP score and a fibrosis score. The CAP score is telling me how much fat is in the liver. And you’re supposed to have less than five percent fat in your liver. The fibrosis score tells me how much hardening is happening in the liver. And I can take those numbers without a biopsy because before you had to do a biopsy to know this. That’s the exciting piece. With non invasive tests, no biopsy, and based on that, I can actually tell the patient your liver is supposed to be less than 5 percent fat, you’re at a 37 percent fat, we need to get this down, we need to work on your liver. And I’ll tell you something, I have not seen people as motivated to make changes with, in their life, or in their lifestyle, in their habits as, I haven’t seen anything as powerful to make them, have, see them, have them make changes, as when you show them that there’s something going on with their liver.
It’s interesting, you’re like, oh yeah, your arteries are clogged up. Okay, we’ll try to make some changes. You tell ’em the liver and for some reason, they pay attention. But the FibroScan is a definite must that and the fibro, if you can. And the FibroScan also gives you a fibrosis, a hardening number. ’cause we want to see. Is the liver hardened? There’s another blood test. It’s kind of a newer test, but it’s part of the guidelines that you can look at called an ELF test. ELF. And the ELF test, when that’s high, that also can indicate that you have fibrosis or hardening of the liver. Why is that important? Because if you have hardening of the liver, that then step after that. So you go from fatty, you start getting hardening of the liver, to liver cirrhosis, and cirrhosis goes to liver failure. And that’s why to be able to pick up on that, and to be able to give them a number, and to be able to give them some things to do and see that improve, is a game changer.
Dr. Weitz: Now, it’s interesting that you get fat infiltration that leads to fibrosis. Why is that, how does that result from fatty infiltration?
Dr. Elyaman: Yeah because the liver gets all jammed up with fat, you can’t, and because of the mechanism behind it, because that insulin resistance can also cause some inflammation coming from fat cells, you can get something called oxidative stress, so you can get, you can get glycation, where, caramelization is happening in the liver, in the body. You get oxidative stress, so that’s where rusting is happening in the body. So, you have those things, you have that process happening, and you have the liver, man, you back that sucker up enough, and then you start getting inflammation, so it gets inflamed, and you start backing that thing up enough, it’ll start getting harder, and it’ll start getting that fibrosis.
Dr. Weitz: And a similar process happens in the vascular system, in the [00:25:00] arteries, in the heart, where you get oxidation and inflammation, and then you get hardening of the arteries, and you get fibrosis of the heart. And interestingly, you can have fatty infiltration of other organs besides the liver, right?
Dr. Elyaman: Right, and I’ll tell you what’s interesting. So I remember when I first started learning about functional medicine. First I was a skeptic, then I was a fan in awe, right? And I remember hearing people mentioning these pathways, and I’m like, how do they know so much? But it turns out that they’re the body is pretty similar, and there’s only a certain amount of ways that the body can go bad, which is why, you mention, just mentioning the process of fibrosis, you as a functional medicine practitioner can say, yep, that actually happens over here and over here. But that’s but yes, to your point, to your point the body has a finite amount of ways that it can go bad. And depending on where it’s, that process is happening, that’s [00:26:00] the disease condition that they’ll end up naming it or calling it.
Dr. Weitz: Right. Dr. Mark Houston is fond of saying there’s only three finite responses, oxidation, inflammation, and immune dysfunction that can result from an infinite number of causes.
Dr. Elyaman: Right. And you can call it three or you can call it 10, right? It depends on how you want to break it down and look at it. But yes, and Mark Houston is very famous for that. For mentioning, focus on these three things, right? Yeah.
Dr. Weitz: And so a lot of patients probably with fatty liver may have fatty pancreas, or fatty other organs.
Dr. Elyaman: Right, right.
Dr. Weitz: So what do we do when we discover that a patient we’re working with has fatty liver?
Dr. Elyaman: Right. So I’m going to want to, I’m going to want to now to take a deeper dive of their chemistry, right? So I’m going to, I’m going to want to get a something called the insulin resistance panel, where not only am I looking at those insulin levels, but I’m [00:27:00] also looking at I can get a score, an insulin resistance score, and I can see if, and based on that test, I can see if they, how much insulin resistance they have. I’ll tell you, there’s many…
Dr. Weitz: And is it, you usually get that from Cleveland Heart Lab?
Dr. Elyaman: Cleveland Heart, you can get it from CardioIQ. I actually, I’m a independent contractor with Cleveland Heart and CardioIQ. I actually work with them. I just I, it’s not released yet, but I gave them a talk on fatty liver recently. And so that’ll be coming out soon. But yeah, you can get it from them. There’s many specialty labs that you can get an insulin resistance score from. You can also you, another test, speaking of Cleveland Heart and CardioIQ, There’s a there’s a test called Small Density LDL.
Dr. Weitz: Yeah, we run that all the time, of course, yeah.
Dr. Elyaman: Right, now when you look at it from this aspect, insulin resistance causes in the fat cell the hormone sensitive [00:28:00] Lipase, to be overactive. Now you start to get, you start to get those fatty acids that are released into the bloodstream. Fatty acids going into the bloodstream go into the liver. In the liver has to do something about it, so it repackages it. But it, it repackages it into VLDL. VLDL can be Triglyceride rich or Triglyceride poor? Triglyceride rich VLDL is from that process that’s happening. Because there’s all these, all of these fatty acids. So you get Triglyceride rich VLDL. And this is why it’s important. As the VLDL starts turning into LDL, IDL and LDL, and releasing the Triglycerides. If it’s Triglyceride rich, you get lots of small density LDL, the one we look at as a risk factor for cardiovascular disease. Why is that important? For various reasons, and we can go into it later, but [00:29:00] various reasons, your triglycerides could look normal even though you have fatty liver disease, but one of the biggest markers of your fatty liver disease. So if you have fatty liver disease, if you look at this test, if this number goes down, your fatty liver disease is getting better. And that’s small density LDL. So I’m going to want to get a small density LDL. I’m going to want to get a uric acid. And I’m not going to go by the lab’s definition of high uric acid. The lab basically is looking for what is a risk factor for gout. I’m worried about metabolic disease.
Dr. Weitz: So 5.5?
Dr. Elyaman: 5.5 or less. You did it. You did it again. Stop reading my mind. Absolutely. I go 5. 5 in younger people. We actually want younger women. We’re thinking 4.5. So I’ll look at, I’ll, I look, I check a uric acid every time I do a lipid panel.
Dr. Weitz: It’s just part of my panel right? Yeah. If you do an advanced lipid [00:30:00] profile, which we always do, we always include uric acid.
Dr. Elyaman: Perfect. Yeah. We do the same at our office. So then I look at it. And I’m, I see the uric acid and I’m like, Hey you’re taking, this is too much fructose. You’re taking in too much sugar. So we do these tests, we check the iron, we check, so we check these things. And then we like checking a homocysteine because if it’s high, then they might need some methyl B vitamins. And then based on that, we will put them on some sort of a treatment plan. So you’re so let’s start with nutrition.
Dr. Weitz: By the way, I recently had a conversation with Mark Houston who informed me that your risk of coronary artery disease goes up with a homocysteine level of above 5.
Dr. Elyaman: Wow, well, I shoot for 7 or less because of that.
Dr. Weitz: Right, I do too.
Dr. Elyaman: Yeah, we’re in America, man. If I can get you to seven, man, I’m a winner.
Dr. Weitz: Exactly. It’s like trying to get everybody’s blood pressure to 110 over 70. You’re not likely to do it.
Dr. Elyaman: Yeah. That homocysteine can [00:31:00] be an ugly little thing. Like it causes atherosclerosis in the Bredesen protocol for those people. Like we do the Bredesen protocol in our office when it comes to dementia. Right. You want that less than seven. So that homocysteine is a important piece.
Dr. Weitz: Yeah, okay, go ahead.
Dr. Elyaman: So back to, yes, weight loss, in the beginning, weight loss should end up lowering fatty liver. Why? Because now your body’s metabolizing fat, right? It’s breaking it down. But you gotta be careful, because if somebody loses weight, and then they maintain that weight by eating garbage, eventually what happens is the liver will let go of a lot of its fat. And it will, the fatty liver will start, will reverse, and then they maintain the weight, but they’re doing all of the junk stuff that they really don’t want to be doing. Guess what? The liver can refill with fat again at that weight. [00:32:00] So that’s the thing, they’re just like, oh, just lose weight and you’re fine. No. So we got to look a little bit deeper than that.
Dr. Weitz: So what you’re trying to tell us is if you just eat less junk because you’re taking Ozembic. Yes. That’s not really a good solution.
Dr. Elyaman: Right. So, so less junk because you’re taking Semaglutide.
Dr. Weitz: Right. In other words, a person who doesn’t change their diet.
Dr. Elyaman: Ozembic probably has a lot of money to come after me, but I didn’t say it.
Dr. Weitz: Okay. Okay. So let’s just say somebody who loses weight by taking a GLP 1 agonist without a change in their exercise or eating healthier or doing any of those things.
Dr. Elyaman: Why don’t you just say Ozempic? So absolutely, that’s one of the biggest issues. So do we put people on semaglutide? Do we put people on Ozempic? We do, but we’re not going to just say, Take this shot and see you later. We’re saying if I’m putting you on this [00:33:00] as a tool, I’m putting them on it as a tool, already planning for when I’m taking you off of it. Because yes, you just eat less junk, then the body will release fat, and when the body starts to release fat, then the bo then the liver will release fat, and then you stabilize, you could potentially then refill that liver up again because of the nine or ten potential causes of MASLD. So what is, what was I getting to? What we want is not to just say lose weight and that’s it. We want to say, well, what type of a food plan, and I like calling diets food plan because it’s, this is kind of the, what you eat, right?
So what kind of a food plan will cause weight loss? I’m sorry a decrease in fatty liver, independent of weight loss. And what I mean by that is, is that they can stay exactly the same on a scale. but their fatty liver starts to go down. And that’s the [00:34:00] Modified Mediterranean Food Plan. And that’s in IFM, we call it the Cardiometabolic Food Plan. We have kind of our own version of that.
Dr. Weitz: Right. Yeah. By modified, it’s basically a lower glycemic version, correct?
Dr. Elyaman: Correct. So that’s eating, and that’s the thing, they’re having, they’re eating healthy fats, they’re eating they’re consuming olive oil they’re getting all the different vegetables in, they’re nuts and seeds. So things that certain conventional literature may not be endorsing, but they’re, nuts and seeds are high in fat, well you know what, they can be healthy if you’re not, if they’re not roasted and not salted. Right? So, but a modified Mediterranean food plan is really nourishing the body, and you can start to see that. The other thing is that if you can get people to exercise, you can actually decrease fat in the liver independent of weight loss. So if I can just get someone to stay exactly the same weight, But do some sort of exercise. Cardio does some [00:35:00] things and resistance training does others. Because what happens, you tell people lose weight or you’re toast, and then they’ll start to lose weight and then they’ll get hungry and they’ll gain a little weight and then they’ll start to feel like depressed.
So then they’re going to eat more, right? And their fatty liver gets worse. And no. So this is not, we meet people where that we’re at. Everybody’s on their own journey, everybody has their own things, but why don’t we try to increase more of these foods? And why don’t we add a little bit of a wok to your Doritos? And why don’t we, and why don’t, and why don’t we also get some resistance training in there? So nutrition is gonna be key, because we’re looking for not to lose the fat in it and then the fat pops back. We’re looking for a long term. And hopefully they will lose fat as well, and their body composition will change.
Dr. Weitz: Resistance training, I think, is crucial for increasing metabolic rate.
Dr. Elyaman: It’s huge. Yep.
Dr. Weitz: and not to mention preventing loss of muscle and loss of bone as we get older.
Dr. Elyaman: [00:36:00] Right. Resistance training is every, you know, every one of our patients should have some sort of a cardio plan, even if it’s just walking 20 or 30 minutes a day, how many patients have I taken off so many different medicines, just because they go, I can get them to go for a 30 minute walk a day. Then the resistance training, Something to something about stretch, maybe some sort of like stretch and body. I mean, listen you’re a chiropractor, so you won’t know about this stuff, but let me help you. So I’m like preaching to the guy. I read your mind, didn’t I? It was my turn.
Dr. Weitz: What else can we do to treat these patients? What about you mentioned diet, you mentioned exercise, what are some of the other lifestyle factors? And let’s go into nutraceuticals.
Dr. Elyaman: All right, so let’s talk about nutraceuticals. Of course, nutraceuticals are not FDA approved to treat any disease and we’re looking at imbalances, right? So from an imbalance [00:37:00] point of view, insulin resistance, there’s some go to nutraceuticals. One of them would be berberine. Berberine can help with insulin resistance. Berberine can help kill bad bacteria in the gut. And one of the things that causes fatty liver that we didn’t talk about is something called SIBO, Small Intestinal Bacterial Overgrowth. And that, what happens is that those lipopolysaccharides that are in the gram negative bacteria that overwhelm the gut can get absorbed and they can cause inflammation in the liver. So, berberine is a go to because it helps with that. Now, one of the tests that we look at is something called GGT.
Dr. Weitz: By the way, I just saw a paper, berberine has been shown to reduce kidney damage from high Uric Acid.
Dr. Elyaman: Amazing. Amazing.
Dr. Weitz: Berberine is amazing.
Dr. Elyaman: It is. It is. It is great stuff. It is. It is definitely the go to. So, the GGT is a marker. [00:38:00] We check it, usually, what practitioners usually look at GGT for is, if it’s high, it means that it’s your liver enzymes that are elevated are coming from your liver and not from, not from other tissue, or not from or your alkaline phosphatase, if it’s high, it’s coming from the liver, it’s not coming from the bone. But the reality is, is that if we really look at what GGT is looking at, it is looking, it’s a byproduct of glutathione, our body’s most powerful antioxidant, or rust buster. And when you see that GGT high, you know there’s oxidative stress happening.
Dr. Weitz: By the way, what number do you like to see for GGT and why don’t you throw in ALT and AST as well? Because depending upon the lab, the normal range changes. And I’m always trying to explain to patients, forget about the normal range because that’s just reflecting the average American.
Dr. Elyaman: [00:39:00] The secret to the optimal numbers they can get if they read my book. I’m just kidding. I don’t even have a book. All right. So if I have a book one day, no, you make a good point. There were population studies. So let’s look at AST and ALT. AST and ALT are, Those are those are the traditionally what we call the liver enzymes for women, you want your ALT to be 25 or less men 35 or less not what the lab says for a GGT I want to see it less than 35 better than less than 30.
So if my GGT so if my if someone’s GGT is in that higher end of normal or high, then I’m gonna think they have oxidative stress. So what are our go-to you? And that if they have insulin resistance and o oxidative stress, alpha lipoic acid may be helpful, right? Because it helps with glucose and it helps with that.
If they have high GGT, you can think about N acetylcysteine or NAC because that increases glutathione, but that’s not [00:40:00] fixing the problem, the underlying problem. But I’ll tell you there, there’s a study that was showing. that CoQ10, and I like the ubiquinol form, also can help when you have that elevation in GGT.
Dr. Weitz: Interesting.
Dr. Elyaman: Probably curcumin as well. Curcumin. Man, curcumin, like, everything you look at curcumin helps with.
Dr. Weitz: Absolutely. Curcumin.
Dr. Elyaman: As a matter of fact, probably this podcast is doing so well because you take a lot of curcumin.
Dr. Weitz: Absolutely.
No wonder I’m orange. No I don’t know. Sometimes no matter how I set up the lighting, my, I look a little orange or a little pink or something like that. And you never quite figure it out. But
Dr. Elyaman: it’s the curcumin. You’re probably having a lot of carrot juice too.
Dr. Weitz: No carrot juice. No, gave up the juice. So what other nutraceuticals are beneficial?
Dr. Elyaman: Yeah. So that just, you kind of, you take a look, you [00:41:00] see what the imbalance is. If you’re, so we talked about insulin resistance, we talked about oxidative stress and elevation in uric acid. So things like I actually work on the medical director for a company called Human N. They’re the ones that make Neo40 Professional and whatnot. And we actually designed a a capsule that has four ingredients in it that have been found to lower uric acid. One is, one is is Cherry, Tart Cherry Extract, which may help lower it.
Dr. Weitz: The other
Dr. Elyaman: one is Vitamin C, because Vitamin C may lower it.
The other one is going to be a, like a Green Tea Extract. The fourth one tart cherry, vitamin C. The fourth one is a surprise . ’cause I can’t remember. Or
Dr. Weitz: a 10 maybe .
Dr. Elyaman: No. It was yeah. Yeah. It’s a surprise. This is a, that’s okay. This is homework for the audience to look at. Okay. Uric acid balance.
Dr. Weitz: Yeah. We’ve been using either Uric X from Designs for [00:42:00] Health or a few other Nice. Other professional companies have uric acid products.
Dr. Elyaman: So low, so that’s kind of for the uric acid.
Dr. Weitz: Okay.
Dr. Elyaman: Oh, I’m sorry. The fourth ingredient was quercetin, because quercetin can lower it as well.
Dr. Weitz: Correct.
Dr. Elyaman: And quercetin can help with people that have allergies and people that have, so it can help, it’s a mast cell stabilizer. And actually, and people that have issues with kind of like fibro, a lot of times it’s a mast cell issue, so it can help with that. So the only reason I’m mentioning these other conditions is because in functional, you can’t, you can only take so many pills. So what we’re looking for is, What other associated conditions do they have? Let’s try to find that one supplement that will help with all of those things. So we talked about high homocysteine. So definitely with homocysteine, you’re going to look at your methylation, your B vitamins. Certain B vitamins need to be activated to what’s called the methylated form. So your B6 to P5P, your B12 to methyl B12, your folate to [00:43:00] methylfolate, your 5 phosphate you also, so all those four things, if you can get them in the already activated methylated form, then they may actually help lower homocysteine, and then, or with homocysteine balance, and then the, then there’s something called trimethylglycine, or betaine, and that also can lower it so sometimes we’ll do that.
Sometimes we’ll give taurine. Taurine is a cool one because taurine may help with work on GABA receptors to help people relax a little bit. And taurine may help with with regulate heart rhythm as well. And taurine is needed to conjugate bile acids. And one of the imbalances that cause fatty liver MASLD is you can have you can have this abnormal bile acid. That, that’s the cool thing about it. It’s not just there’s one imbalance. Most people, even functional medicine practitioners, they think, Oh yeah, fatty liver. It’s just like insulin resistance. No, dude, there is like so many different things. That, which is why, which is why, I don’t know why the [00:44:00] first course I made on my own was fatty liver. I think I started going down that rabbit hole, and then I’m like, no, this is so freaking important. I don’t care if the world doesn’t know it. I know it.
Dr. Weitz: Probably herbal bitters would be good for bioflow. Which one? Bitters. Oh yeah. Bitters is part of it.
Dr. Elyaman: Yeah. Bitters could be part, can, can help with bile flow. Cleaning out the gut because because what happens is if you have a lot of bad bacteria, you get these secondary bile acids that worsen fatty liver. Things to kind of help the composition. So phosphatidylcholine. I’ve seen amazing improvements in liver, in fatty liver content from putting people on phosphatidylcholine and there’s research to, there’s, there’s research to support that, not as robust as we’d like, but there’s research to support it and part of what it could do is it’s changing the composition and helping bile acids have less cholesterol in it.
Dr. Weitz: Right. That’s why when I have a patient with fatty liver I usually use a curcumin that’s bound [00:45:00] up with phosphatidylcholine.
Dr. Elyaman: Two for
Dr. Weitz: one. Two for one.
Dr. Elyaman: Yep. Yep. And sometimes we’ll give, we’ll end up, we’ll end up giving about 1800 milligrams of phosphatidylcholine divided twice a day. And we see great results.
Also the vitamin E Everybody’s different, but one of the things that happens in fatty liver is that people will start to deplete their vitamin E. They’ll also deplete glutathione. And the challenge with vitamin E is that the type of vitamin E that they usually get over the counter is D alpha tocopherol.
Yes. You see, there’s studies that show that taking, yes, exactly, right down. throw it down the drain, don’t even give it to your animals. Because what happens is that, that you look at the literature and what you see is that vitamin E may be amazing, but it also may cause all kinds of problems.
And one of the things we think is that because it depends on what the type of vitamin E, your vitamin E, there’s an alpha, beta, delta, gamma, [00:46:00] tocopherol, alpha, beta, delta, and a gamma tocotrienol, eight forms. And if you start taking that one form, you could block the other seven from getting in. Yes. Yeah,
Dr. Weitz: I’m big on the tocotrienols.
Dr. Elyaman: Since you’ve been reading my mind so much, I need to get you on my podcast, brother. I really need you. Yeah, very good. Yeah, so, so I think those are, there, there is a, there’s another supplement that I’ve been a fan of as well, and it’s called Tudka. And Tudka is, yeah, it’s the taurine bound ursodiol. Ursodiol is also, could be a supplement, but it also is a it also is a prescription that you can get, and there’s data that shows it may help with fatty liver. But Tudka is 1 C. step further. And what it really is like doing is it’s like, if you think of your bile as the oil of your car, it’s that treatment to the oil. So it helps improve [00:47:00] the quality of the oil. And it may also help. So for my challenging patients, they’re going to have, I like Tudco. I like Phosphatidylcholine. I like mixed tocopherols and tocotrienols. These are those challenging patients, but I don’t, I don’t think we should throw all of these supplements at people at once. Find out what’s the problem, work on nutrition, work on exercise, follow the tests, follow, and then maybe add a little something here and something there. You got to keep it interesting.
Dr. Weitz: You got it. Yeah, it’s easy to get excited and overwhelm them with too many supplements at one time. Right, right. Now, me, myself, I take about 30 twice a day.
Dr. Elyaman: That’s it. That’s the problem.
Dr. Weitz: I’m hedging my bets.
Dr. Elyaman: You read about it and you’re like, man, this is so amazing. I need this. And then you look at it. Yeah, we should probably just show a picture of our supplement cabinet. I have my own supplement cabinet. That’s [00:48:00] mine. And then I have the family supplement kit. I’m like, it’s nuts. Every once in a while I go into their supplement cabinet. But I try to, I, for patients, I, you, between three to five. And then you kind of give them the options. Never give, I never give more than three supplements at once, or I try not to. Oh, I missed one supplement. So actually, especially one supplement that that I like using to rebalance is going to be the Omega 3s. So we’ll check Omega 3 levels. And we try to optimize omega 3s as well.
Dr. Weitz: Yeah I think a multi, omegas, vitamin D with K, probably a probiotic. That’s baseline. That’s not even going into supplementation. That’s just essential.
Dr. Elyaman: That’s just replacing what we normally would have gotten if we lived in Stone Age times, right? We would have gotten our vit We would have gotten a bunch of greens, right? [00:49:00] And when in the spring, we would have gotten our Omega 3 composition would have been much better. We would have been getting sunlight, so our D would be, do it, we’d get the vitamin D. The greens we would get our vitamin K from. So yeah it’s the processing that’s happening. I agree with you. Those are my bare bone baseline as well. Just, this is like just normal. This is just replacing what normally is missing in everybody in our food.
Dr. Weitz: Right. If we were eating fruits and vegetables that were organic, that weren’t grown in soil, that was depleted of nutrients, and wasn’t over farmed, the same you know, foods grown over and over again, stored in frozen containers, shipped long distances to get to the supermarket, and Yeah.
Dr. Elyaman: And it’s not that hard. And you’d need a time machine, because even with all that, it could still be garbage. So, you go back in time, and then you harvest, and then you get back in the time machine, and I mean, that’s, that’s what we’re working towards, but till then, take those supplements. [00:50:00]
Dr. Weitz: Yeah, I got my time machine in the back.
I’m working on it. I got,
Dr. Elyaman: I have a little, a couple
Dr. Weitz: tweaks
Dr. Elyaman: to make, but I’m not there yet. I’m not there yet. I’m not there yet.
Dr. Weitz: Yeah, what’s happened in the experiment so far? You meet a few of your friends?
Dr. Elyaman: Listen, I can’t talk about it. I can’t talk about what happens in my backyard, okay? You want to come over? Come to Ocala.
Dr. Weitz: All right. So final thoughts about MASLD?
Dr. Elyaman: Yeah. Final thoughts. You know, now that we have, for those functional medicine practitioners, look up, look up the FibroScan and and figure out where you can get one. A lot of times you can get it for free at a research center because they’re researching different drugs for for fatty liver disease. There is a new drug that was the first FDA approved drug [00:51:00] Four fatty liver and the and it’s for, they have to have fibrosis, F two and F three. And it’s called ResMed, huh? It’s what’s, what we call, it’s a thyroid beta agonist. So if you look, I can see something about that. Yeah. It’s o only $4,000 a month . So if you are. Here’s the thing, so the thyroid hormone is, there’s different receptors throughout the body for the thyroid hormone. You have alpha and you have beta. The alpha is found in the heart, the beta is found in the liver, and then throughout the body it’s different, right?
So what this is it’s specific for beta, so it doesn’t increase the heart rate. So basically what you’re doing is trying to give people thyroid hormone without increasing the heart rate. Now, as functional medicine practitioners, we are checking advanced thyroid panels, and we are optimizing thyroid. We know, like if you look at the research, low T3 is a risk [00:52:00] factor for having fatty liver disease. Which is one of the other imbalances that cause fatty liver. Which is why I twitch a little when people say, oh yeah, that’s just insulin resistance. No bud, it could be toxicity and it could be thyroid dysfunction.
Dr. Weitz: You know what, real quick, could you just go through the 10 different causes of fatty liver? Because we hit some of them, but I don’t know if we hit all of them.
Dr. Elyaman: Let me try from the top of my head. Okay.
Dr. Weitz: Okay.
Dr. Elyaman: We did plan for this, right? , I think they need to know our planning. Did I think they need to know how much we planned for this. I texted you this morning. We both had like, work to do and then we just jumped on, right? So, exactly. So insulin resistance uric acid dysregulation iron overload is, it can be a cause. A discordance between your omega 3s and your omega 6s can be a cause methylation disorders and hyperhomocystinemia. Now this, these are parts of the process or [00:53:00] causes, but you can also have the Inflammation, Oxidative Stress can cause it as well. Small Intestinal Bacterial Overgrowth or Dysbiosis can be a cause of it. And also Bile Dysregulation. And also certain food intolerances. So like people, Some people, their fatty liver is caused because by celiac disease, like a subclinical celiac, then their problem is gluten. I think those are the major ones.
Toxicity, so toxicity can be a component, and there’s actually a condition called Taffled, or maybe it’ll be called Tazzled now with a new name change, and that’s basically, they are exposed to some sort of toxin. These are the people that don’t have the typical like metabolic syndrome factors and, but they have fatty liver and that would be tasseled as well.
So I think those are the main causes and those are the main things that we’re going to want to look at. And then based on your patient’s individual imbalance, [00:54:00] that’s what you’re going to go after. And that’s what you’re going to follow up on.
Dr. Weitz: That’s great. For fibrotic Liver, do you, are there any things that you use? I’ve used Modified Citrus Pectin.
Dr. Elyaman: Right, so, and Modified Citrus Pectin is helpful probably in all stages because a subclinical cholestasis is part of is part of the issue and it can help with growing good bacteria. So yes, but I’d say when they have that fibrosis, I’m going to number one, get their iron levels optimized. Their ferritin, I need less than 150. I’m going to make sure that they don’t have, I’m going to say absolutely no alcohol. I’m going to make sure that I’m going to look at like the, get homocysteine and all that stuff down. But I’m also, but I’m, I like Tudca. I like mixed Tocopherols and Tocotrienols 800 and Phosphotidylcholine, and that’s when we start hitting it really hard.
Dr. Weitz: What [00:55:00] about milk thistle? Glutathione. NAC. Oh yeah. You can mention NAC.
Dr. Elyaman: Yeah. Yeah. We can use some NAC I’ll tell you. So. If they have elevated liver enzymes based on the numbers that we mentioned, not based on what the lab says, then I usually am going to put them on a mix with Milk Thistle and NAC and just different things that are going it’s all put together in the same supplement and that’s just kind of a base.
Dr. Weitz: Like a liver support formula. Yeah,
Dr. Elyaman: just a baseline liver support. Right. And then you start hitting it hard with the one supplement prescriptions. Yeah.
Dr. Weitz: Cool. Great. So that was incredible. We covered a lot of information in an hour, Doc.
Dr. Elyaman: Nice. Yeah, I know. And I had a lot of fun with it. So that’s excellent. That’s excellent.
Dr. Weitz: So tell us about your course that you offer.
Dr. Elyaman: Yeah, so we have, so it’s still fairly new. We have the FMP Essentials, Functional Medicine [00:56:00] Practitioner Essentials. com, and the first course we launched was the Mazeld course, the Reversal of Mazeld course. It’s over 10 hours, taking a deeper dive in all of these different imbalances and kind of what we just went over, but the kind of, more of a systematic, all right, do these labs.
This is why I recommend these things. It kind of goes more in detail and elaborates more on what we talked about. And how do you and the beautiful thing about it is that once you’ve went through the course, you not only learned how to deal with fatty liver, but you also learned how to deal with diabetes and coronary artery disease and some of the because that’s the secondary benefit you’re going to get.
is how to deal with these functional medicine balances. So yeah, we would love to have it’s one of the things I’m very proud of, would love to, to have you there. If you guys want to keep in contact with me social media wise so across social media, I’m still learning the social media thing to be honest. I’m not like one day [00:57:00] I’m going to be more, better at it, but across the platforms.
Dr. Weitz: And one day you’re going to be Mark Hyman.
Dr. Elyaman: Yes. Well, I’m not there yet, but I’m coming for you, Mark. So at, I’m going to still stay in his shadow, right? Dr. Eman for myself at Dr. Eman. And then at FMP Essentials HQ for the, for our functional medicine practitioner essentials. And we’re right about to launch a mastermind for functional Medicine practitioners. We’re, it’s gonna, there’s gonna be a free mastermind that everybody can jump in and we’ll have our own kind of our own platform, social media platform. And then there’ll be kind of like paid tiers. So.
Dr. Weitz: That’s very cool.
So how about patients who want to have you help
Dr. Elyaman: them? Patients that want to have me help them? Currently, I’m not seeing new patients. Oh, okay. Yeah, so they might, if they live in Ocala, if they live in Florida, they can come check out the practice and see one of our providers and [00:58:00] that’s absolute health. Do they need to go to remote
Dr. Weitz: care?
Dr. Elyaman: We’re not doing remote care. No, we, there’s licensing. You got to get the license throughout.
Dr. Weitz: Okay.
Dr. Elyaman: So
Dr. Weitz: cool.
Dr. Elyaman: So you stay in California. I will stay in Florida and take care of the people here. The other 48 States covered and we’ll be good.
Dr. Weitz: Okay. Sounds good, doc. Thank you so much.
Dr. Elyaman: You’re welcome. My pleasure. Thank you for having me.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would help [00:59:00] 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.
Dr. Steven Sandberg-Lewis discusses Reflux with Dr. Ben Weitz.
[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.]
Podcast Highlights
Understanding Reflux: Expert Insights with Dr. Steven Sandberg-Lewis
In this episode of the Rational Wellness Podcast, Dr. Ben Weitz discusses various aspects of reflux with expert Dr. Steven Sandberg-Lewis. They explore the symptoms and types of reflux, including GERD, silent reflux, and bile reflux, and clarify terminologies like GER without D. Factors contributing to reflux, such as gastrointestinal motility issues, structural abnormalities like hiatal hernia, and lifestyle factors, are examined. They also discuss treatment options, ranging from medications like PPIs and histamine blockers to natural treatments including dietary adjustments, herbs, and supplements. The importance of diagnosing and managing Barrett’s esophagus to prevent esophageal cancer is highlighted. Other topics covered include the use of melatonin, vagal tone exercises, and addressing H. pylori infections. The discussion underscores the significance of a holistic and individualized approach to managing reflux and related gastrointestinal conditions.
00:00 Introduction to Rational Wellness Podcast
00:27 Understanding Reflux and Its Symptoms
01:34 Types of Reflux and Their Differences
03:44 Mechanisms Behind Reflux
07:28 Heartburn vs. Reflux
13:52 Medications and Reflux
18:23 Bile Reflux Explained
33:28 Hiatal Hernia and Reflux
37:54 GLP-1 Agonists and Reflux
39:31 Hormone Imbalance and Menopause
42:05 Proton Pump Inhibitors and Reflux Management
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz. com. Thanks for joining me and let’s jump into the podcast. Hello, Rational Wellness Podcasters. Today, I’m very excited that we’ll be speaking with Dr. Steven Sandberg Lewis about reflux, which is an extremely common gastrointestinal disorder. Heartburn is the main symptom in reflux and is often described as a discomfort or a burning pain felt in the chest or throat. It occurs at least once a week in about 30 percent of most Americans. And in [00:01:00] up to two thirds of those with IBS, which is, I think, the most common GI condition. Heartburn can be caused by a reflux of the intestinal content up into the throat or esophagus, or it can occur without reflux. Other symptoms of reflux include regurgitation, chronic cough, sore throat, vomiting, hoarseness, chronic throat clearing.
Reflux is often used interchangeably with gastroesophageal reflux disorder, GERD, but this is not correct because there are other forms of reflux, including bile reflux. And silent reflux, which is also known as laryngopharyngeal reflux. The NIH website has now introduced a new term, GER which is gastroesophageal reflux, but not disorder. Anyway, if you’re confused, I’m confused. And we’re going to try to sort this out a little bit with Dr. Steven Sandberg Lewis.
Dr. Sandberg Lewis is one of the smartest integrative physicians I’ve ever spoken to. He’s a practicing naturopathic physician for 46 years. He teaches gastroenterology at the National University of Natural Medicine, lectures around the world. He has an awesome medical textbook called Functional Gastroenterology, which is now in its second edition. And his newest book is called Let’s Be Real About Reflux, Getting to the Heart of Heartburn. and Dr. Sandberg Lewis Practices in Portland, Oregon at Hive Mind Medicine. Dr. SSL, thank you so much for joining us.
Dr. Sandberg-Lewis: Yeah, my pleasure. Always good to talk with you.
Dr. Weitz: You know, one of the coolest things about your book is the limericks. Every chapter has a limerick.
Dr. Sandberg-Lewis: Yeah, we wanted to be a little lighthearted about it too.
Dr. Weitz: I want to read the limerick for the introduction. If a hammer is all that you see, then now every problem will be. So reject a poor hammer and think in a manner that allows things to be seen clearly. So let’s see if we can see clearly about reflux.
Dr. Sandberg-Lewis: Yeah, well, you know what you said, Ben, about GER, Gastroesophageal Reflux, without the D on it.
Dr. Weitz: Yeah,
Dr. Sandberg-Lewis: We add the D when there are symptoms or destruction, you know, of tissue. But GER, just having reflux itself, is considered a normal phenomenon that occurs perhaps about three times after each meal. But it’s so minimal, and if all the protective mechanisms are in place that move it back down before it does any damage or causes any symptoms, then people don’t even know they have it. And, you know, we talk about this as like, babies actually have regurgitation as a normal thing. Most babies spit up in the first year of life and that’s not considered a problem unless they have failure to thrive or start to have other kinds of problems or sleep problems or pain or other signs of distress. Yeah these reversals in flow of the upper GI tract are normal as long as all the protective mechanisms are in place.
Dr. Weitz: So essentially everything in the GI tract is supposed to go from north to south and anything that moves the opposite direction is what we call reflux.
Dr. Sandberg-Lewis: Yeah.
Dr. Weitz: But why should there be a normal amount when you eat if we have all these contraction of these muscles and this motility mechanism that pushes everything down?
Dr. Sandberg-Lewis: Well, again, There’s so many different mechanisms and that’s why I have a chapter in there on all the mechanisms of this. But if you think about probably the simplest one or the most direct one to discuss is transient lower esophageal sphincter relaxations, right? So TLES for lower esophageal sphincter and relaxations. So this is a normal mechanism that allows gas and pressure to vent from the stomach out as a belch. And it involves [00:06:00] the lower esophageal sphincter opening much longer than a normal swallow. So normally when someone swallows, something the peristaltic wave moves down, muscularly moves the food or liquid down, and then the lower esophageal sphincter just opens just for a couple of seconds to allow the material to move through, and then it closes tight if it’s working properly. And that’s its normal state is to be closed and contracted. With TLESRs they’re opening the lower esophageal sphincter and then eventually the upper esophageal sphincter to allow gas to vent from the stomach so people don’t have horrible pain. Some people can’t belch properly and they have a lot of pain. I see a lot of those people. So this lower esophageal sphincter relaxation, this transit type, it’s not that transit. It’s sometimes up to 20 seconds long, and that’s just way longer than it’s supposed to stay open. [00:07:00] So people who eat in a way that creates more gas in their stomach or small intestine and need to vent it, they can have a lot more reflux. That’s thought to be a major mechanism.
Dr. Weitz: Or people have SIBO who have more gas being produced, right?
Dr. Sandberg-Lewis: Right. Small intestine moving up into the stomach and then venting, you know, can vent either way. It could go down or up, but up is closer.
Dr. Weitz: So what’s the difference between, explain more about what exactly is heartburn as compared to reflux?
Dr. Sandberg-Lewis: So heartburn is that, as you said, subjective sensation of burning or pressure usually in the lower sternal area sometimes slightly lower, but usually right around there, substernal, and it’s not necessarily only caused by reflux of [00:08:00] stomach contents into the esophagus. That’s one cause, but it can also be caused by just pressure differentials. So there’s this thing called Functional heartburn, where there’s actually no reflux at all. If you do all the tests to see if there’s actually reflux, there isn’t, but people have the same symptoms and there’s all kinds of creative ways to explain that nobody really has pinned down the exact mechanism of why people have burning pain, substernal, without having any reflux of stomach contents. But, it’s fun to make up mechanisms, but, yeah, you don’t have to have reflux of stomach contents into the esophagus to have the same symptoms. An interesting thing, I mention a study in the book where they just found that pressure from, say, more [00:09:00] gas or anything that distends the esophagus, pressure in the esophagus can either trigger burning pain or it can trigger chest pain. People feel like they’re having a heart attack. And that’s why reflux is, sometimes they say it can mimic a heart attack or angina, because it’s a very similar sensation. And it doesn’t have to be from reflux. It could just be from pressure within the esophagus.
Dr. Weitz: Now it’s generally thought in the medical community that reflux has to do with too much hydrochloric acid, which is why medications are often prescribed that reduce acid. Like PPIs.
Dr. Sandberg-Lewis: Right. But that’s why I wrote the book. Cause that’s not the whole story.
Dr. Weitz: Of course. And in fact more people have low acid than high acid. [00:10:00]
Dr. Sandberg-Lewis: Yeah. So again, just having pressure of fluid in the esophagus can cause heartburn or chest pain. So it doesn’t have to be acid. Also and that’s called either weakly acid reflux or non acid reflux. And it’s probably 40 percent of cases of people with heartburn that are tested. But also, Remember this. First of all, there are a number of really good studies that purport that the symptoms of reflux are actually due to inflammation and not burning. It’s like, oh, it’s not actually burning the tissue, it’s causing inflammation in the tissue. So that’s one thing. And of course, chronic inflammation can lead to Barrett’s esophagus and even cancer of the esophagus, so that’s a big deal. But also, if you think about it, what’s the actual cause? enzyme that digests [00:11:00] protein. The first one is pepsin, right? And pepsin is the active hormone that can digest tissue such as the lining of the lower esophagus or the stomach if it’s not protected properly. But it’s actually secreted as pepsinogen, a zymogen that doesn’t have that ability. And it’s the acid in the stomach. The pH of the stomach cleaves it and turns it into, from pepsinogen into pepsin. So, again, you don’t actually have to have fluid refluxing. You may just have kind of a mist, you know? You can have, and we think that’s why, reflux can really aggravate asthma because you’re inhaling pepsin and stomach acid and [00:12:00] possibly slightly not completely digested food in little droplets and inhaling that into your lungs. Wow. Irritant. There are other mechanisms for that as well, but just think about it. You don’t have to have fluid coming up. You don’t have to have food coming up. It could just be a mist of pepsin and or acid. And the pepsin alone is enough to cause a lot of irritation.
Dr. Weitz: How do we know about this mist? Has that been something that’s been confirmed by some sort of testing?
Dr. Sandberg-Lewis: The The standard tests that are used for reflux don’t actually show that, but there is a test where you can check pepsin levels in the saliva. And you know, if you’ve got significant amounts of pepsin, like 40 units or more in a saliva specimen, you know for sure that what was in the stomach is now in the throat. [00:13:00] And so it’s especially used to help to diagnose LPR, that laryngopharyngeal reflux that you mentioned. Where people don’t necessarily have heartburn symptoms in the lower sternum, but instead have all these voice and throat symptoms that you mentioned, like clearing and coughing and sore throat and changes in their voice and hoarseness, et cetera.
Dr. Weitz: So for physicians listening, right?
Dr. Sandberg-Lewis: Your patient doesn’t even need you to order the test. They can go to, I think it’s pepsincheck. com, I think is the website. And they can order a pepsin test. They get three vials to take samples of saliva three different times in the day, and they’ll measure it for pepsin, and then they can share those results with you.
Dr. Weitz: Interesting. For the average patient with reflux, since most people don’t have too much [00:14:00] acid, is there a real rationale for using PPIs, proton pump inhibitors?
Dr. Sandberg-Lewis: Well, of course, there’s proton pump inhibitors and there’s histamine blockers.
Dr. Weitz: Okay. And so like Pepin is an H2 histamine blocker.
Dr. Sandberg-Lewis: Pepcid AC is a brand name for famotidine the generic, which is a H2 receptor antagonist. Yeah. And I like, I just had a new patient who was having severe, severe cutting pain and he, we know based on his upper endoscopy that he has duodenal ulcers, multiple ones, not just a single solitary one. And he was having so much pain and taking a proton pump inhibitor didn’t do anything for his pain. He got some relief from sucralfate, which is, it’s kind of like [00:15:00] a I call it allopathic, DGL ’cause it kind sos it kind of coats the tissue and relieves it.
Dr. Weitz: What is it called?
Dr. Sandberg-Lewis: Suc fate. Suc. Suc crawl fate. It’s S-U-C-R-A-L-F-A-T-E. Huh. Anyway, he got some relief from that, but then he started to have side effects, so he’s now taking famotidine and that has. because it’s an H2 receptor blocker has completely taken his pain away so far. Totally different mechanism. So again, this is a guy, he’s a guy who tends towards asthma and other allergic tendencies, and so it, it makes a lot of sense if he actually wants to block his acid to, to use this kind of histamine mechanism, rather than try to just shut off the whole proton pump, and a lot of people don’t tolerate that.
Also, like you said when I do Heidelberg testing in my [00:16:00] office to actually measure pH, I used to say, about 25 to 30 percent of people actually are hypersecretors of acid and the other probably 50% underproducing and the rest were normal producers of acid. But what I’m seeing now more and more, I’d say it’s about 50:50. So about maybe 50 or 40 percent of people are hypersecretors of acid. But this is one thing I think is really important and I think what’s happening is people who have been taking a proton pump inhibitor, when they go in for testing, you know, any kind of testing to see if they have reflux, they have them stop the proton pump inhibitor for seven days. And then they do the test, and I think that clearly, during that time, they are hypersecreting because [00:17:00] their proton pump inhibitor is not there, so all of that histamine and gastrin, we know gastrin levels go sky high in the blood when you’re taking a proton pump inhibitor, because gastrin is the stomach hormone locally produced that’s trying to trigger you to make more acid, but you can’t because you’ve taken the proton pump inhibitor. You take that drug away and now you’ve got these really high levels of gastrin and now you’re going to produce huge amounts of acid. So people that get tested for reflux after they’ve already been on a trial of proton pump inhibitors, often look like they produce huge amounts of acid. So I don’t blame anybody for being confused about that and thinking, oh, it’s all about too much acid. Well, it is once you’ve been taking a proton pump inhibitor for three or four weeks or three or four years, or some of my patients 20 years. I think that, unfortunately, those very good tests, [00:18:00] like the Bravo test and the pH impedance test, they’re, unfortunately, they’re measuring, most of their patients are people that were already put on a proton pump inhibitor, took it away for a week, did the test, and they just look like they create huge amounts of acid, even though that might not be where they started. Interesting. So what is bile reflux? So bile reflux is when you move down one valve and if the pyloric valve instead of the lower esophageal sphincter is not functioning properly and staying closed.
Dr. Weitz: So this is a valve between the stomach and the small intestine?
Dr. Sandberg-Lewis: Right, and when that valve is hypotonic, or not as functional as it should be, that can allow reflux of small intestine contents into [00:19:00] the stomach, and that alone can then cause a lot of irritation because bile, okay, let’s talk about, so what’s coming up through the pyloric valve. It’s bile, it’s bacteria and fungus, it’s Brush border enzymes that are produced on the small intestine lining. It’s undigested food, you know, not incompletely digested food. And it’s also pancreatic enzymes, which can also digest fat, protein, and carbohydrate. You know, there are proteases in there really strongly. So, now you’ve got this soup, and then you might mix it with stomach acid in the stomach, and pepsin, and now it’s a much more complex soup. irritant. And then of course if people have reflux into their esophagus, all of that goes up into the esophagus. But some people it just really irritates their [00:20:00] stomach and that’s called bile gastritis or reactive gastritis. But if it refluxes into the lower esophagus it can cause the worst kind of reflux heartburn. esophageal irritation. And we think actually is a more potent stimulator of Barrett’s esophagus over time than just regular reflux.
Dr. Weitz: Yeah. I spoke with Dr. Rahbar and he said when he does his endoscopies, patients with SIBO have an increased risk of that bile reflux. And he feels that potentially indicates fungal overgrowth. I forgot why though.
Dr. Sandberg-Lewis: Well, you know, he I liked, I really liked the way he does his upper endoscopies. First of all, when he’s checking for parasites, often he’ll take a sample of the bile, actual bile from one of the ducts, or if it collects in the duodenum, and he’ll test [00:21:00] that instead of just stool for parasites because we know parasites like to live in the gallbladder. But also he and Dr. Satish Rao can also culture the duodenal contents for fungus as well as bacteria and see the exact, what’s actually overgrown instead of just the breath test that doesn’t tell you, just shows you how much gas they produce. So yeah he’s very progressive. I love what he does.
Dr. Weitz: One of the fears of reflux is that if it burns the esophagus, it can set up the risk of Barrett’s esophagus and eventually esophageal cancer. So, how do we protect against that? Obviously, we have to reverse the reflux, and part of it’s about the protective factors in the esophagus.
Dr. Sandberg-Lewis: Yeah, so first of all I [00:22:00] mean the best thing you can do is to actually diagnose Barrett’s early, and the, it’s kind of a joke in terms of how few people actually get tested for Barrett’s because if you, if you consider the top four risk factors, being Caucasian, being male, being over 50, and then there’s a whole other list. So basically, all white guys over 50 should be screened because they have the highest risk. If you add type 2 diabetes any smoking history, and then also having a waist circumference that puts you in the visceral adiposity obesity range. Those are all big risk factors. So, you know, there’s just, there’s a lot of people that should be screened.
And that’s why I wish that the ESOGuard test [00:23:00] had been picked up and used by more doctors, because that’s a non, kind of a non invasive way to take a sample, like you would take a pap smear. You take some tissue from the cervix and the vagina and you can check it microscopically. In this case, they take some scrapings brushings from the lower esophagus by putting a tube down through the nose and down into the lower esophagus expanding this little bulb on the bottom, pulling it up through the lower esophagus, and then deflating it again and taking it out. It takes like five minutes. And then they can check it for DNA adducts that are common for Barrett’s esophagus. Or esophageal cancer. So it’s just a great little screening tool. Unfortunately, it didn’t catch on and I hope that over time it will. I talk about it in the chat. Is that a test that you do? It is. It, you [00:24:00] know, it’s not available everywhere, but we do have it available here in Portland. There’s a hospital that where you can send patients where they do it. ESOGuard test, but anyway in terms of besides early diagnosis once you know that the patient has it.
There’s so many things you can do. So first of all you can use green tea extract, you can use vitamin A and C, excuse me, vitamin C and E, you can use of course diets that are higher in fruits and vegetables, and we often will use a, an extract of berries, like a frozen berry extract, so they can get a real good dose of anthocyanidins and beta carotene through that each day. And then folic acid, and also riboflavin those B vitamins have been shown to be really protective against further [00:25:00] development. And then you know, like you said, probably the most important thing is actually treat the cause behind the reflux if you can, so they don’t continue to have reflux and don’t have that chronic inflammation.
I mean, the good news is that, Even in men that have a higher risk of this, you know, if you know the patient has Barrett’s esophagus, you can periodically biopsy those areas and make sure there’s no dysplasia occurring, because mild, moderate, and severe dysplasia, just like with a pap smear, you know, looking for dysplasia, those are the precursors to esophageal cancer in this case. when you check in the lower esophagus. So you can prevent dysplasia and prevent the whole process from going forward to cancer with a lot of these factors. And of course, all the lifestyle factors that help to correct that need for transient lower esophageal sphincter [00:26:00] relaxations and gas and all those things that fuel reflux. We talk about that in the chapter on lifestyle issues too.
Dr. Weitz: What about using nutrients that would directly affect the esophagus. I’ve had some patients slowly sip on some slippery elm in water to try to soothe the esophagus and produce some healing.
Dr. Sandberg-Lewis: Yeah. Some of the, probably the more healing herbs that we use for that are the DGL, you know, the licorice without the glycyrrhiza, unless your patient’s also hypoadrenal, and then you might want to use some whole licorice as well. Slippery Elm Althea, which is marshmallow root Aloe Vera, all those things can really help allay irritation, chronic inflammation and often heal tissue. But melatonin is another [00:27:00] really important one, and that’s why there’s a whole chapter in the book on melatonin, because it’s It just really impresses me that there’s a study that shows that people with the lowest melatonin levels are people who have duodenal ulcers. People with the slightly better levels have erosive esophagitis, and people with the best levels of melatonin in their system are people that have NERD, which is non erosive reflux disease. They don’t have any damage. from reflux, even if they have reflux. So in all three cases, you’re talking about people.
Dr. Weitz: And what do we think would be a reasonable dosage of melatonin? Because people are all over the place on how much melatonin they use. When it comes to sleep. [00:28:00] Some people are advocating three. I’ve heard people recommend 3. There’s some herbal melatonin now that Deanna Minich is recommending at super low dosage. And yet on the cancer front, people are recommending two or three hundred milligrams per day. Yeah, they’re, yeah, I know when I read your book, you were talking about the levels in the gut as being like 400 times the levels in the bloodstream. So I’m wondering, would that lead to a recommendation of a higher dosage of melatonin to take for this purpose?
Dr. Sandberg-Lewis: Yeah, so, typically we use 3-6 mg.
Dr. Weitz: Which is to the sleep recommendation.
Dr. Sandberg-Lewis: Yeah, yeah. And, on the other hand, if you consider one of the risk factors for [00:29:00] Barrett’s esophagus is sleeping less than 6 hours.
Dr. Weitz: Oh, really?
Dr. Sandberg-Lewis: Yeah, it’s on that list with the other things I mentioned.
Dr. Weitz: Oh, okay. So,
Dr. Sandberg-Lewis: again, if you can improve someone’s sleep and if you can balance their melatonin, cortisol, and DHEA, You know, because there’s a big relationship there, right? When cortisol is highest in the morning and drops down to its lowest at night, that’s what allows melatonin to come up. And then melatonin drops as cortisol’s coming up in the morning. And so they take turns, you know, they’re in phases. And so, if you can improve sleep, if you can balance cortisol and other stress hormones so that people make more of their own melatonin, I think that’s probably the best. I probably don’t, I don’t have people take melatonin as a pill, as much as I try to really improve their sleep and their stress hormone balance.
Dr. Weitz: How do you help them improve their sleep?
Dr. Sandberg-Lewis: Oh, yeah. Well, first of [00:30:00] all if you find somebody who’s got high cortisol at night, instead of its lowest level, right. That’s really going to help them sleep. If you can help modulate it with adapted genic herbs especially ashwagandha. Okay.
Dr. Weitz: Phosphatidylserine.
Dr. Sandberg-Lewis: Phosphatidylserine is one that we think works through the ACTH, negative feedback loop. And then sometimes if they also, as well as having a high cortisol, they also have a low DHEA. Bringing up the DHEA will help modulate the cortisol down toward where you want it. So it’s a balancing act there. And then of course there’s sleep hygiene and, getting people off of their screens late into the night and all that kind of thing.
Dr. Weitz: Getting away from the blue light, et cetera.
Dr. Sandberg-Lewis: Yeah. Or neurofeedback and other forms of biofeedback that can help. The gut and the nervous system produce better [00:31:00] levels of these sleep hormones and protective, GI protective hormones. So again, yeah, it’s a, there are lots of ways to approach it, but if you can get their melatonin and its related hormones in balance, that’s probably even better. And, you know, get them sleeping closer to eight hours.
Dr. Weitz: Now there’s a number of categories of drugs that increase your risk of reflux. So we have drugs such as NSAIDs, corticosteroids, alcohol, bisphosphonates, which are the anti resortive drugs for osteoporosis that we know have esophageal issues benzodiazepines, which people often use for sleep or for stress, and calcium channel blockers. [00:32:00]
Dr. Sandberg-Lewis: Yeah, so things that disrupt the muscle function, smooth muscle function anticholinergics can be a problem there too. But you mentioned about the bisphosphonates, I think, so there’s two categories really, there are drugs that irritate the esophagus, and can make reflux worse, the symptoms worse, and bisphosphonates are in that group. You know, that’s why you have to be able to stand or sit for at least 30 minutes after you take it, so it won’t pool in your esophagus, because it’s so irritating, and NSAIDs are the same way. But then there’s the other group that affect the muscle tone or other factors that actually can cause reflux, and you mentioned those.
Dr. Weitz: And that whole thing about the position you’re in, that’s super important for managing reflux, meaning patients who you’re trying to help relieve their reflux, you want to recommend that they not eat a [00:33:00] meal and then put their feet up or recline that they sit upright. Maybe I often will suggest going for a walk just to push the food down and decrease the likelihood that things will come up.
Dr. Sandberg-Lewis: Yeah and that’s the reason why. finishing food by at least three hours before you lie down to go to sleep is a great idea. And some people do much more than that, more than three hours sometimes. But I think you might want to also consider people that have reflux symptoms that have a hiatal hernia, sliding hiatal hernia. And then those who don’t, you know, they have reflux, but don’t have a hiatal hernia. Really when you think about it, If you have a sliding hiatal hernia and it’s up, cause it can slide up and down.
Dr. Weitz: Right, so let’s explain to the public what we’re talking about. You’re talking about this opening in the diaphragm [00:34:00] and the stomach slides up through that opening, correct?
Dr. Sandberg-Lewis: Correct. Yeah, so, of course, the esophagus is in the chest with the heart and the lungs.
Dr. Weitz: Right.
Dr. Sandberg-Lewis: Then there’s the diaphragm muscle, and it separates everything that’s in the chest from what’s in the abdomen. The stomach’s in the abdomen, so it has to meet up with the esophagus, and they’re in two different parts of the body. So there’s an opening called the hiatus, which means window in Latin the hiatus of the diaphragm. That allows the esophagus to meet up with the stomach that’s underneath the diaphragm. And so a sliding hiatal hernia, let’s say this is the hiatus here in the diaphragm and here’s the stomach hiatal hernia is typically about two centimeters is an average small one. Two centimeters of the stomach has moved into the chest. Sometimes three centimeters. If they’re [00:35:00] really big, they’re larger than five centimeters. So even having this, basically a less than an inch of the stomach in the chest can cause all kinds of symptoms. And if you think about it, the diaphragm is a muscle.
It’s smooth muscle, just like the lower esophageal sphincter, which is part of the esophagus. The esophagus and the lower esophageal sphincter are running through that hiatus in the diaphragm, which is a muscle and actually has to what are called CRUX, C R U X, and it means like a cross, and these are like little extensions of the muscle of the diaphragm that hug the lower esophageal sphincter.
So the lower esophageal sphincter is a muscle. and it’s surrounded by the diaphragm muscle. You put those together and you have a [00:36:00] really good system. If you move the lower esophageal sphincter, which is right here at the top of the stomach, up two centimeters or three centimeters, now it doesn’t have its big brother around it, hugging it anymore. it’s going to be way weaker. So those transient lower esophageal sphincter relaxations and regular openings, all of that can be a lot weaker. So having a high sliding hiatal hernia just adds a whole new ball of wax to the whole reflux issue. That’s why it’s really important to deal with it if you can.
Dr. Weitz: What do you think about patients getting that surgery, the Nissen fundoplication?
Dr. Sandberg-Lewis: Yeah, Nissen fundoplication is, often a pretty effective treatment. There are visceral manipulation and exercise treatments that [00:37:00] can correct the smaller ones.
Dr. Weitz: Yeah. I often use the technique I learned from you.
Dr. Sandberg-Lewis: Yeah. But yeah, for persistent ones or the really large ones the ones that are greater than three centimeters that just won’t stay down, or if someone has hypermobility syndrome, like Ehlers Danlos Syndrome, where their tissues just don’t hold things in place as much, those people are really prone to lower esophageal sphincter laxity and hiatal hernia, sliding hiatal hernia, that you can put it back in place, but it won’t stay. So, there are definitely some good reasons to, to use Nissenfund application if it’s needed as a last resort.
Dr. Weitz: Now we’re talking about medications and we know that anything that alters esophageal or gastric motility, is going to increase the risk of reflux. And we now have this class of medications that is taking the [00:38:00] country by storm, that we’re now seeing millions of people use, and we’re probably going to see Tens of millions on soon. And these are the GLP 1 agonist drugs like Ozembic, which people are using for weight loss. And now they’re being touted for 20 other health benefits supposedly. And we know that they work partially by slowing gastric motility.
Dr. Sandberg-Lewis: Right, slowing down the absorption of carbohydrates. They, really, GLP and the other incretins that are normally produced in the small intestine, they are amazing. They’re really important. for treating diabetes and insulin resistance and helping people lose weight and normalize their blood sugar.
Dr. Weitz: But all these GI disorders that are related [00:39:00] to decreased motility are likely to be exacerbated.
Dr. Sandberg-Lewis: It’s very, yeah it’s a side effect that can definitely be an issue.
Dr. Weitz:I asked Dr. Pimentel and he said looking at breath tests and and microbiome of these patients, it’s totally messed up.
Dr. Sandberg-Lewis: Yeah, and I’m, I think that there’s another drug that has the GLP 1, but also has another in Cretin as well Terzapatide. Yeah. And I think that one’s gonna turn out to be a better choice because, again, when they started giving all women going through menopause estrogen back in the 1960s, It was a miracle. I mean, their hot flashes were better, they slept better, all kinds of things were better. Then they found out a lot of them are getting cancer of the uterus. Because you’re only [00:40:00] using one hormone. And what about the progesterone? They balance each other. They’re…
Dr. Weitz: Not to mention it was horse estrogen.
Dr. Sandberg-Lewis: Well, yeah, I mean, you can, you could argue about the ratios of E1, E2, and E3.
Dr. Weitz: Horse estrogen.
Dr. Sandberg-Lewis: The thing is,
Dr. Weitz: we gave women horse estrogen.
Dr. Sandberg-Lewis: The thing is that I think whenever you give a single hormone and you don’t give its sister or brother hormone, the other incretins in this case you’re looking for trouble. You’re gonna, because every, basically every or most of the endocrine organs in the body have these paired balancing hormones. And if you look, even look at the thyroid, We know that thyroxin demineralizes bone if you have too much of it. Thyrocalcitonin, also produced in the thyroid, builds [00:41:00] bone. So if you just give one hormone, you can really cause imbalances. You don’t get that fine tuning that we normally have. So that’s why I think we’re going to find that using the incretins as a group, instead of just semaglutide by itself, It’s probably going to be better. But of course, if you can get your patient to make more incretins, just like if you get your patient to make more melatonin, instead of having to give it to them, that’s even better. And there’s lots of good ways to do that.
Dr. Weitz: Right. But don’t you think we’re likely to see a big increase in reflux?
Dr. Sandberg-Lewis: If you consider that it’s, So common already. You mentioned 30 percent of the population has reflux at least once a week and maybe 20, 20 percent has it on a regular basis. More often than that, it’s already so common. Yeah, again, you can’t fool mother nature. You can’t mess [00:42:00] around and not use a balanced approach and not expect to do well.
Dr. Weitz: When you have patients who are taking proton pump inhibitors, how do you handle that? If you have ’em, stop them. How do you wean ’em off?
Dr. Sandberg-Lewis: So first of all, the newest recommendations from the American College of Gastroenterology for Barrett’s esophagus is for patients to be offered a proton pump inhibitor to take at least once a day. indefinitely. They have found that that does reduce the risk of dysplasia and conversion to esophageal cancer. So currently, its changed. Three years ago, they didn’t say that. They said it wasn’t beneficial. And now the research shows that it is. I let patients know that. I let them know that unless they have bad side effects or for some other reason, can’t take a proton pump inhibitor, taking one [00:43:00] once a day, if they have Barrett’s is the recommendation.
Dr. Weitz: And what if they don’t have Barrett’s and they’re worried about?
Dr. Sandberg-Lewis: If they don’t have Barrett’s and they just have heartburn and you think it’s reflux or you know, it’s reflux. Right. Certainly if they have erosive esophagitis. You know, there’s LA grade A through D esophagitis, and D is the worst, but if they have grade C or D reflux esophagitis, I recommend that they do take a proton pump inhibitor until it’s healed. And a lot of those people may need it long term unless you can treat the causes of their reflux. So there’s a place for it. And it really can heal. And it’s just, those are the people that they take a proton pump inhibitor and it’s like a miracle from the first dose. because all that incredible burning pain that they’re having all the time from a raw esophagus that’s eroded [00:44:00] is suddenly gone. It usually works really well for those people. So you use it until it’s healed and you work on the underlying causes while you’re doing that. If someone’s just taking a proton pump inhibitor because that’s all their doctor knew for their heartburn, a lot of times it’s not even working. 40 percent of the time it doesn’t work, and people still take it because, well, my doctor told me to.
Those are people that, you can definitely wean them off if it’s not helping anyway. And a lot of people that it is helping, you can wean them off too if you can treat the underlying causes. So I have a little step down approach to it where what we often do is we will Let’s say they’re taking a proton pump inhibitor when you first see them.
They’re taking it twice a day, maybe at high potency. We’ll cut it down to the lower potency twice a day. [00:45:00] And then if they’re doing just as well as they were before, then we’ll cut it down to once a day. If they start having reflux, that part of the day where they’re not taking their second dose, We’ll, you know, we’ll use these, either a natural medicine to help that, or we’ll use famotidine, that H2 receptor antagonist, which is, in my experience, a lot less prone to creating this rebound hypersecretion.
We keep doing that, you know, if it’s been, it could be two weeks, it could be a month, they’re realizing, okay, I’m doing fine now. Then, we take the other dose of the proton pump inhibitor out. And if they need it, we might use the famotidine. So they’re taking it once or twice a day on the days they’re not taking the proton pump inhibitor.
And now they’re taking maybe the proton pump inhibitor Monday, Wednesday, Friday, and Saturday. [00:46:00] And they’re just taking the famotidine on the other days. And if they’re doing just fine, we go even further and we have them just take it Monday, Thursday, and Sunday, you know, every third day. And it’s a very slow process.
When someone’s been on a proton pump inhibitor for decades sometimes, even just years, you really have to do it slowly. But if you do it slowly, you can normalize that rebound hypersecretion. There’s one study that states that rebound hypersecretion can, in some cases, can go as long as 8 months. Wow. So, yeah, you know, if someone’s been taking a proton pump inhibitor for a long time, take your time, have them take their time and say, Hey, look, if a year from now, you’re off of this drug that you don’t need, because we’ve assessed you don’t need it what’s the harm? You’ve been taking it for 5 [00:47:00] years already, right? If you just try to stop it quickly, you will fail. So let’s do it right.
Dr. Weitz:H. pylori infection. Now, the story about H. pylori infection, for people who don’t know, is that this is a bacteria that burrows itself into the wall of the, into the stomach, and that Dr. Marshall proved a number of years ago that this was the cause of ulcers. And he did it by drinking H. pylori solution, gave himself an ulcer, proved that he had it, and then used triple antibiotic therapy, two antibiotics along with the PPI and cured himself of ulcers. And so the thought was that these ulcers derive because the [00:48:00] stomach starts secreting more acid in response to the H. pylori. And a lot of doctors feel that H. pylori infection is one of the causative, possible causative factors of reflux. I know that you definitely disagree with that.
Dr. Sandberg-Lewis: It’s a, it’s just a misconception. All the, virtually all the research shows that H. pylori is protective against reflux, Barrett’s esophagus, and esophageal cancer. So to me it makes no sense to even test somebody for H. pylori if they already have reflux or Barretts. And then, if they have an upper endoscopy. They’re going to be tested because you, that’s part of an upper endoscopy, and they’re going to get treated if they have it. [00:49:00] Luckily, the research that I looked into says that if you treat the H. pylori once you already have Barrett’s, it doesn’t seem to make it all worse. It doesn’t make the reflux worse, but 100 percent of the world’s population, we think, had H. pylori in their stomachs for at least 60, 000 years until we started killing it in the 1990s. And yeah, it can cause duodenal ulcers, stomach ulcers. It can cause gastritis, inflammation of the stomach lining, and it can cause a really rare form of lymphoma that occurs in the stomach called maltoma. And there are some other conditions that it can aggravate. It can aggravate psoriasis and a number of other things, chronic hives. There are other things that it could be associated with in adults.
But in children, it’s [00:50:00] very important for maturing the immune system, especially in the gut where most of the immune system is. And so our concern and Dr. Blaser writes about this very eloquently, the concern is we’ve gone from 100 percent of the world’s population having this protective thing in the first few years of your life to mature your immune system to having less than five percent of children in the US have it now when they need it. And, it’s also, it reduces the risk of hay fever, food allergy, respiratory allergy, asthma, Crohn’s disease. Really good meta analysis showing, a bunch of studies that show that it really helps protect against Crohn’s disease.
Dr. Weitz: Is there any way that we know of to increase H. pylori?
Dr. Sandberg-Lewis: Well, yeah Blaser has a great solution. And he says, so he thinks once the FDA understands this process, which might be 30 years from now when babies are born, they will give them a multi strain probiotic of H. pylori, not just one strain, several strains seems to be better than one, and they’ll just give the, to the kids, and then they’ll have that protection. reduce risk of autoimmune diseases, allergic triad, and reflux and its complications. And then, if when they’re older, they develop ulcers, or they look like they might be at risk for stomach cancer, if there’s a family risk, then they’ll kill it with triple therapy, but they will give it to the newborns that need it. So, so much.
Dr. Weitz: Yeah. We do the GI map stool test quite a bit, and that includes H. pylori and the virulence factors.
Dr. Sandberg-Lewis: Yeah. Now, you know, I have a bug about that, and that is I have a slide in my lecture on H. pylori and it says, how natural doctors get it wrong. My feeling is if you’re going to do stool panels. Do a stool panel that doesn’t have H. pylori. I use, can I say names of labs?
Dr. Weitz: Yeah, sure.
Dr. Sandberg-Lewis: I use Doctor’s Data Origin, sometimes Genova, but mostly Doctor’s Data. They correctly on their panels, they’re checking for parasites and they’re checking for fungus and they’re checking for beneficial bacteria. They check for pathogens like Clostridium Difficile, but they don’t test for H. pylori unless you do a special order for it, because I don’t want to test my patients. that just have reflux. I [00:53:00] don’t want to test them for H. pylori and then have to kill their H. pylori, which has nothing to do with causing their reflux.
Dr. Weitz: Well, I don’t feel any compulsion to having to kill their H. pylori just because it comes up.
Dr. Sandberg-Lewis: Well, that’s the thing though, is a lot of doctors, when they see that it’s a positive, and for good reason, the dictum in H. pylori The world of H. pylori is test and treat, meaning if you test somebody, you’re supposed to treat them,
Dr. Weitz: right?
Dr. Sandberg-Lewis: So I don’t even want to test them unless I have a good reason to because they have a disease that’s associated with a more virulent form.
Dr. Weitz: Now, I’m pretty sure that you write in your book that if we use like the triple antibiotic therapy, which is the standard for killing H. pylori, that can increase the risk for GERD, right? Or [00:54:00] reflux?
Dr. Sandberg-Lewis: I think the mechanism there is I’ve seen people develop SIBO and IMO. Okay. Overgrowth after triple therapy, because it’s kind of a perfect way to get Overgrowth, right? You’ve taken two antibiotics that really affect the balance. And then you’re taking a proton pump inhibitor, which has more negative effects on the microbiome probably than the antibiotics, but you put all three together and you’re really, really likely to get overgrowth. So yeah, you can definitely get reflux when you didn’t have it before. I see that a lot, I don’t want to talk people out of. Treating H. pylori or saying they’re doctors wrong because it’s test and treat. I wonder what the
Dr. Weitz: effects are if we treat it with mastic gum and the other natural treatments.
Dr. Sandberg-Lewis: What you do that and then you retest them and you see if it worked.
Dr. Weitz: Sometimes, sometimes we just base on how they feel.
Dr. Sandberg-Lewis: Yeah, mastic is a wonderful demulsant, it just it can heal [00:55:00] ulcers. We know that it’s used For thousands of years for that purpose and gastritis. It’s really soothing and healing And there are some studies that show a little tendency for it to reduce H pylori But you know no single agent kills H. pylori. That’s why triple therapy and quadruple therapy are what they are, right? Right. So there’s no prescription or natural thing that’s going to work on its own. It’s going to have to be a combination. And really if you’re thinking the H. pylori really needs to be killed, then you need to retest.
And the thing about, one thing I’ll say about the GI map, their test, if I’m correct, when I look at it, their H. pylori test is DNA. It’s PCR DNA. Correct. And that is not a standard test [00:56:00] for H. pylori. It’s their own test that they made up. I think it’s great to be creative, but I’m not going to di I’m not going to diagnose H. pylori based on that because it’s not a standard test. So if it comes back positive, I run a standard test, which would be H. pylori IgG blood antibody, Or even better, H. pylori stool antigen, you know, which is a protein in the stool, or H. pylori breath test. Those are definitive tests, and the breath test, as well as the stool antigen, those are telling you that you have it right now. The blood antibody, if you got treated, it could still be positive, even if it’s gone. You can’t use that to retest. But the stool antigen or the breath test, they’re going to, they’re going to turn negative. Once you’ve treated it properly. So, I just say, if you’re going to do that and nothing wrong with the [00:57:00] GI map, double check it with a standard test. If you get a positive.
Dr. Weitz: Let’s go through some of the most important treatments that we want to think about. You’ve mentioned some of them already, but we were trying to find some of the underlying causes. So we want to see if they have. Structural issues like some of the ones you’ve talked about, like hiatal hernia problems with the lower esophageal sphincter whether they have issues with motility we want to see if they have SIBO, because SIBO can lead to gas and affect motility, and then correct those. We want to rule out food sensitivities, right? Do you regularly rule out food sensitivities or is that something you look at sometimes?
Dr. Sandberg-Lewis: You know, I tend to use diets that initially are restrictive of certain food groups, and [00:58:00] I tend to do that as more of an elimination diet rather than testing, but it’s an important thing. I know personally from my own health, and I never talk about my own case, but when it comes to reflux, If I want to have reflux, all I have to do is eat white potato. Really? If I eat white potato in any form, more than a couple teaspoons, I’m going to have reflux. Now, of course, I do a lot of things right in terms of my overall diet, but that’s the one thing I know will do it. And I have other patients that it could be that, it could be sugar, it could be one patient it’s kiwis and other citrus fruit. Some people it’s dairy. They cut out dairy products or lactose containing dairy products and their reflux completely goes away. Some patients, Especially celiac disease and non celiac gluten intolerance patients. They take the gluten out. They don’t have reflux anymore. So you’re [00:59:00] absolutely right. That’s a big deal. Not everybody’s designed to eat everything you can buy in a supermarket.
Dr. Weitz: Right. So, what are some of the other treatment approaches?
Dr. Sandberg-Lewis: Yeah. So again, the way I did it in my chapter on natural treatments is I did it by mechanism, right? Which I think is a good way to think about it. So if you know on somebody’s upper endoscopy it, the report says, the lower esophageal sphincter was gaping open. I’m going to do things to help with parasympathetic tone, diaphragmatic breathing exercises, getting good diaphragmatic tone, help to get the big brother to hug the little brother. You can use vagal toning exercises. You can use what I use a lot.
Dr. Weitz: What do you, what are your favorite vagal toning exercises?
Dr. Sandberg-Lewis: Well, actually my favorite is alternate nasal [01:00:00] breathing together with diaphragmatic breathing.
Dr. Weitz: Alternate nasal breathing. I never, yeah,
Dr. Sandberg-Lewis: it’s called a Pranayama in yoga. Okay. You breathe out of one nostril and I breathe out of the other one. It’s on my website, I have a description and you can, it’s just Pranayama explains it, but it’s a really good brain balancing, vagal balancing exercise along with toning of the diaphragm. But in addition, we know from the heart math research, right. Feeling a sense of gratefulness before meals can really improve vagal tone. So using, if people like using some kind of an app, they can use HeartMath. The HeartMath folks and other companies, they make a Biofeedback device that gives you heart rate [01:01:00] variability, biofeedback, and you can learn to improve your heart rate variability, which is a direct result of good vagal tone. And it’s very enjoyable kind of little games that you can play with your vagus nerve.
Dr. Weitz: What about vagal nerve stimulating devices?
Dr. Sandberg-Lewis: You know, there’s more and more versions of that now that are less scary than the ones they used to have, and I haven’t started using those, but I’m sure we’ll see more and more data about those as time goes on. It makes sense. It passes through here. One of the ways that I just test for vagus nerve tone is to look at the person’s rise in their palate when they say ah. And I want to see symmetrical rise and a brisk rise. So I do that as part of my physical exam, but yeah, other things that I do for the lower [01:02:00] esophageal sphincter tone is Huperzine A, right? Huperzine A, which is a anti cholinesterase. It’s a cholinesterase
Dr. Weitz: Often included in brain formulas.
Dr. Sandberg-Lewis: Yeah, because acetylcholine is such an important memory and cognitive brain neurotransmitter, but it’s also the main neurotransmitter. neurotransmitter for the vagus nerve and the lower esophageal sphincter. So use that. Sometimes we’ll use phosphatidylcholine or other sources of choline as precursors for acetylcholine as long as well as the huperzine. So again, depending on the mechanism, I use different treatments. But I usually have people start out with the lifestyle issues. The Reduce Carbs, Reduce Reflux mnemonic, C A R B S, that has all those things in it.
Dr. Weitz: Is that, [01:03:00] so what kind of diet are you typically putting these patients on?
Dr. Sandberg-Lewis: Again, it depends. If they have SIBO, it’s going to be a low fermentation diet, right? If it’s, and most of the, again, when I came up with that mnemonic, Reduce Carbs, Reduce Reflux. The C A R B S was just a way to remember everything, but it is true that high carbohydrate diets seem to be the most important causes of reflux, and so most of the diets we use are lower fermentable carbohydrates, like FODMAP diet, or even Cedars Sinai diet, or Oh, Dr.
Dr. Weitz: White Rice, White Bread Diet.
Dr. Sandberg-Lewis: Hey, you know, it’s it’s the least restrictive. And so if you have a patient that just says, you’ve had these patients, they come in and say, okay, let me just tell you right at the start here, I’m not changing my diet. I don’t want to change my diet. [01:04:00] Or maybe they have an eating disorder, history of an eating disorder and you can’t really mess with their diet because they already have so many issues with it that they work with their counselor on. So you want to, sometimes you use that as the least invasive as opposed to the biphasic diet by Dr. Jacobi, which is probably the most restrictive, but it works great and it’s great for vegetarians and vegans and low histamine also. Right. I have about five or six different diets I use depending on the situation, but I think the important thing is The meal spacing, going at least four hours between meals and 12 hours at least overnight and not eating at least for three or more hours before they go to bed. That can be very important.
Dr. Weitz: Do you like adding digestive enzymes or herbal bitters to increase the likelihood that they’ll break [01:05:00] down the food?
Dr. Sandberg-Lewis: I think bitters are great for anybody that responds well to them. Bitter herbs, the bitter receptors are in most of the tissues in the body, even blood vessel walls, I believe. We call them bitter taste receptors because that’s what we first discovered was they could taste bitters, but they do a whole lot of other really essential things. Yeah, bitters are great. Bitters are great. Digestive enzymes, I got a whole chapter on that because it’s pretty complicated, but certainly we treat people that don’t make enough pancreatic enzymes or don’t make enough brush border enzymes, but also, food based enzymes, raw food, sprouted food. and the kind of plant enzymes that you can buy, they’re a whole different category, because they’re actually starting to digest food when it’s in the stomach, whereas most pancreatic enzymes that you produce in your own body, or [01:06:00] take as a a medicine that’s made from pork those only work in the small intestine. So these plant enzymes are like food based enzymes that have a much wider range. Like I say, they start working in the stomach, they work in a very wide pH, instead of very narrow pH.
Dr. Weitz: So you like the plant based enzymes better?
Dr. Sandberg-Lewis: Well, they’re just a whole different animal. They’re not even an animal. They’re just, they’re so different. Are they good? They can be extremely helpful. Okay. Yeah, even just, even papaya enzyme can be really helpful. protein. Yeah, for some people’s reflux can be really helpful. And it’s a helpful thing also for gastroparesis, which we haven’t talked about, but we nudged up against it when we were talking about ozempic. But, you know, that’s another big one. If you have delayed gastric emptying, you have to treat that with a number of things that, besides prokinetic [01:07:00] herbs or drugs that help keep things moving through the stomach so they don’t back up into the esophagus.
Dr. Weitz: And delayed gastric emptying can be common in patients with diabetes and certain other conditions.
Dr. Sandberg-Lewis: Diabetes and celiac and other gluten intolerances I find are the biggest, biggest group that have that.
Dr. Weitz: So you use natural prokinetics or you use prescription prokinetics?
Dr. Sandberg-Lewis: Yeah, I’ll just mention too, traumatic brain injury is a major cause. Okay. Of delayed gastric emptying and gastroparesis as well, which is often ignored in medicine. But yeah, I’ll I often, the simplest is ginger, right? Ginger is just a wonderful prokinetic for the stomach, upper GI, prokinetic. And that’s what, I think one of the reasons why it helps with, Nausea [01:08:00] in many cases. It also is a serotonin receptor modulator, which can help with nausea, but it’s, yeah it’s the simplest and most elegant if people tolerate it well.
Dr. Weitz: I think that’s the questions I had prepared. Any, anything else you want to tell us?
Dr. Sandberg-Lewis: I will tell you that there’s a chapter in the book called Your Brain May Be Sabotaging Your Digestion.
Dr. Weitz: Okay. Here’s the book right here.
Dr. Sandberg-Lewis: It’s the only chapter I didn’t write.
Dr. Weitz: Oh, really?
Dr. Sandberg-Lewis: It’s chapter 11.
Dr. Weitz: Okay. Who wrote that?
Dr. Sandberg-Lewis: My brilliant wife.
Dr. Weitz: Oh, okay.
Dr. Sandberg-Lewis: Kayla Sandberg Lewis wrote it. She’s a wife. Oh, okay. biofeedback and stress management provider. And she, if you don’t read anything else in the book, I think that chapter really helps you get your lifestyle in gear, chewing, breathing,[01:09:00] your approach to Eating, breathing, drinking liquids that can really provide the strong underpinnings for proper digestion.
Dr. Weitz: Chewing your food, eating slowly,
Dr. Sandberg-Lewis: drinking water away from meals in adequate amounts for hydration, together with breathing by using your diaphragm, like some of the things we alluded to, to get the vagus nerve working properly. All these things are really important for vagal. function and just getting your body in the right neurologic phase for digestion.
Dr. Weitz: What about that heel drop exercise? I know we mentioned that last time we talked a year or so ago. That seems like a really cool exercise. Do you give that regularly to the patients?
Dr. Sandberg-Lewis: Yeah, I have a handout sheet [01:10:00] that we hiatal hernia too, but I have a little handout sheet when I do the visceral manipulation for hiatal hernia syndrome. I will give him that handout and it talks about avoiding breath holding during exertion and core muscle contraction. I teach people that before they get up off the table, I say, now take a nice full belly breath and breathe out as you sit up, as you contract your abdominal muscles.
So any exercises, core exercises they’re doing, anytime they’re lifting something heavy, or even more so, if they’re constipated, or even if they’re not constipated, if they bear down to have a bowel movement, and push it out, that’s okay, but take a full belly breath first and exhale slowly as you bear down, if you run out of air, stop bearing down, take another breath.
That way you’re reducing that [01:11:00] great increase in intra abdominal pressure that occurs when you hold your breath and do a Valsalva maneuver that greatly increases the intra abdominal pressure intends to push things upward. In addition, the heel drops exercise is just something you can do in the morning after a correction that we do in the office. Drink at least 12 ounces of water to fill the stomach and weigh it down like a water balloon a little bit, and then go up on the balls of your feet, drop on your heels 11 times, and that, that pendulous stomach pulls down. And it helps to keep that correction that we did in the office in place below the diaphragm.
Dr. Weitz: Great. So everybody pick up Dr. Sandberg Lewis’s book and they can get a hold of you through your website. What’s your [01:12:00] website?
Dr. Sandberg-Lewis: HMM, which is Hive Mind Medicine, PDX, which is the abbreviation for Portland, dot com. HMMPDX. com.
Dr. Weitz: And you have courses available, correct?
Dr. Sandberg-Lewis: I teach courses and we have some online courses that we’ve done through Shivan Sarna and Neurala
Dr. Weitz: Jacoby.
Dr. Sandberg-Lewis: They have those at their websites.
Dr. Weitz: Yeah. I took the course that Neurala has on the physical. Yeah. That’s a good one.
Dr. Sandberg-Lewis: They did a really good job on that. They did a really good job on that.
Dr. Weitz: Well, thank you so much, Stephen.
Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us [01:13:00] a five star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition, and want to prevent chronic problems, and want to promote longevity, Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine. And I will talk to everybody next week.
https://drweitz.com/wp-content/uploads/2024/08/rwp-378-website.jpg350785drweitzhttp://www.drweitz.com/wp-content/uploads/2017/06/drweitzdsamplelogo-withtext.pngdrweitz2024-09-24 06:00:572024-10-01 05:31:39Reflux with Dr. Steven Sandberg-Lewis: Rational Wellness Podcast 379
Dr. Susan Sklar discusses Burning Mouth Syndrome 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
00:00 Introduction to Rational Wellness Podcast
00:27 Understanding Burning Mouth Syndrome
01:33 Dr. Susan Sklar’s Background and Expertise
02:47 Personal Experiences with Burning Mouth Syndrome
05:04 Exploring Functional Medicine and Hormone Therapy
07:06 Challenges in Conventional Medical System
09:56 Hormone Restoration and Neurosteroids
16:44 Diagnosis and Treatment Approaches
32:57 Diet and Lifestyle Considerations
34:14 Final Thoughts and Resources
Dr. Susan Sklar is a Harvard-trained gynecologist who practiced medicine at her private practice in Southern California for 30 years, and now consults internationally through her official website SusanSklarMD.com. Dr. Sklar pursued training in sexual function solutions for men and women and completed the nationally recognized fellowship in Anti-Aging and Regenerative Medicine sponsored by the American Academy of Anti-Aging Medicine. She is certified in the Bredesen Protocol for slowing and reversing early-stage Alzheimer’s disease and its precursor, mild cognitive impairment. Dr. Sklar’s current professional specialty is the development of breakthrough treatments for Burning Mouth Syndrome, a chronic, neuropathic pain condition that affects primarily menopausal women. Hundreds of women have found relief in the hormone balancing protocols developed by Dr. Sklar in her practice.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz. com. Thanks for joining me and let’s jump into the podcast. Hello, Rational Wellness Podcasters. Today, we’ll be having a discussion with Dr. Susan Sklar about Burning Mouth Syndrome.
Burning Mouth Syndrome is a painful condition that causes a burning, scalding, or tingling sensation in the mouth. It can affect the tongue, lips, gums, inside of the cheeks, roof of the mouth or large areas of the whole mouth. The burning can be severe, as if the mouth has been injured by a hot drink. Other symptoms include dry mouth or an altered taste in the mouth. Burning Mouth Syndrome can occur every day or may come and go. The symptoms can last for months or years. The majority of patients appear to be post menopausal women. And while we don’t know what causes it, it may be related to hormones or to specific medications.
Dr. Susan Sklar is a Harvard trained gynecologist who practiced medicine at her private practice in Southern California. for 30 years. And now she consults internationally through her official website, SusanSklarMD.com. Dr. Sklar pursued training in sexual function solutions for men and women and [00:02:00] completed the nationally recognized fellowship in anti aging and regenerative medicine sponsored by A4M. She’s also certified in the Bredesen protocol for slowing and reversing Alzheimer’s disease. And Dr. Sklar’s current professional specialty is the development of breakthrough treatments for Burning Mouth Syndrome, a chronic neuropathic pain condition that affects primarily postmenopausal women, and hundreds of women have found relief And the Hormone Balancing Protocols developed by Dr. Sklar in her practice. So welcome, Dr. Sklar.
Dr. Sklar: Thank you. Yes, that’s all true.
Dr. Weitz: I realize I may have had some version of Burning Mouth Syndrome. I don’t know if this quite qualifies, but after the first time I had COVID I chewed some gum that had mint in it, and my tongue started burning, and every time I would eat anything that had mint or ginger, my tongue would burn.
Dr. Sklar: And then, did it resolve spontaneously?
Dr. Weitz: It lasted about two years, and then just went away.
Dr. Sklar: Whoa, so that’s very interesting. I’ve had people who I didn’t, but I’ve certainly run into people whose burning mouth, which they already had, got significantly worse with COVID. I also had one patient whose mouth pain went away when she got COVID because there’s a mechanism it’s with the mechanism, I don’t know if all of the iterations of COVID still have it, but the initial iteration of COVID, Remember, it could make people quite sick before they felt bad.
People would end up all of a sudden with their PO2s were, down in the [00:04:00] 70s and they had been feeling perfectly okay. So all the usual symptoms of discomfort, pain, air hunger, they didn’t have. And there is a particular mechanism that this woman’s immunologist thought came into play that actually had her burning mouth go away when she had COVID. And that was a couple of years ago. I have not been back in touch with her because she felt better and she, she didn’t need to see me anymore. But mostly the people I see, and it’s impressive that it lasted two years for you because that’s really a significantly long time. And the actual definition is oral discomfort that lasts for longer than three months and occurs on a daily basis.
Dr. Weitz: Now, it only occurred if I consumed something that had mint or if I ate ginger.
Dr. Sklar: That’s interesting. And mint is certainly an issue for people with burning mouth. Citrus is. It may be that you had a very mild version that only really [00:05:00] became noticeable when you had an irritant in your mouth.
Dr. Weitz: Yeah. Tell us about your personal health journey. And how you found your way to Functional Medicine and to Burning Mouth Syndrome?
Dr. Sklar: My personal health journey I, originally I was trained as an obstetrician gynecologist and then hence got into the whole field of men’s and women’s sexual medicine, which I did for a while. And then, I had problems, oh, actually starting In my 30s and early 40s, GI problems and was diagnosed with colitis and put on any number of medications, including steroids, which made me crazy, like I would be up all night and only sleep for two hours a night and, Found myself in my bathroom cleaning the brass handles of the, of this thing at 3 am and saying, What the heck are you doing up at 3 a. m. with the, the brass polish? And never really got better. And [00:06:00] then it was actually an article in a local newspaper that talked about gluten. And everybody knows about gluten elimination now, but this was like, 35 years ago. And I thought, okay that’s not a hard thing to do. I’ll just stop eating wheat and see what happens. And away went all of my colitis symptoms. And my GI doctor was like, because I had to go for regular colonoscopies and she, the nurses were surprised that I had a diagnosis of colitis and was not on any medication. And my GI doctor, I told her what I was doing and she said when I had my colonoscopy, so are you still doing that?
What diet was it you were doing? The thing with the gluten? And I said yeah. And that’s why I don’t have any symptoms or any lesions anymore. And so I could see the problem. And this is a, was a wonderful doctor, who was super caring. And I thought, Why wouldn’t somebody diagnosed, every time someone gets a [00:07:00] diagnosis of colitis or Crohn’s, why wouldn’t you give them a trial off of gluten and see what it does? And so I began to see, personally how the conventional medical system fails people.
Dr. Weitz: And yeah, I was amazed over the years that the fact that on average, many gastroenterologists don’t think it matters at all what you eat. How could the study of the tube that the food goes down not matter what food you were putting in?
Dr. Sklar: Yeah, exactly Anyhow when that all was going on was around the same time. I was getting Burned out on OBGYN, dealing with insurance companies, quite frankly, and seeing, oh, 25 to 30 patients a day trying to relate to people in a 15 minute appointment. And I just thought, I can’t do this anymore. I just, I’m [00:08:00] done. I can’t do it. And then I thought what else am I going to do? I’m not, like some doctors are like authors or there was this local dermatologist who made children’s clothes and she started a shop that carried children’s stuff. And I’m like, I’m not really equipped to do anything else. That’s been my passion my whole life. So what am I going to do? We actually have a foster son that we took in, one of my kids friends in high school, and he said, I’ve been designing furniture, and I’m designing furniture for somebody who I think you’ll be interested in what she’s doing. She doesn’t want to say much of anything to me about it.
She’s very private about it, but I’ll see what I can find out. And it was somebody who ultimately ended up becoming a very good friend of mine who had been a plastic surgeon and got into the, quote, field of anti aging medicine and working with hormones. And she took me under her wing and, told me what courses to go to, and where to [00:09:00] study, and how to market, and really got me set up.
And so it turns out and it fits in very well, and I let all my gynecology patients know that I have this new practice. So a number of former gynecology patients came into my new functional medicine anti aging practice. Early on, somebody who actually hadn’t been one of my GYN patients, came to see me and I put her on the usual array of hormones for restoration. Estrogen, Progesterone, Testosterone, DHEA, Pregnenolone, Melatonin, and Thyroid. And this woman happened to be a physical trainer. And she wrote a little testimonial that I put on my website. So this was in 2007. It was a rudimentary one page website. Nobody had blogs and stuff like that. It was a single page my son set up for me. And she wrote this little testimonial that she said was okay to put on the website. And she said, Since in the two months that I’ve been on a [00:10:00] hormone restoration program, my energy is better, my mood is better, my muscle definition is better, and my burning mouth is not nearly as bad, which I honestly, I hate to say it, I didn’t really pay much attention to it because I kind of didn’t know what it was.
And people started approaching me saying, Oh, you treat burning mouth syndrome? And I was like well, not really. And so I spent an incredible amount of time in the neuroendoimmunology literature. Which is like brain research reviews and other journals trying to figure out what would a hormone have to do with a nerve pain or pain? And it turns out, a lot. And in fact, these steroids are actually made in our nerves. They’re called Neurosteroids. When I saw the term Neurosteroids, I was like, Oh my goodness, I’ve hit the jackpot because this [00:11:00] explains what I’ve been seeing.
Dr. Weitz: And repeat that one more time, what you just said?
Dr. Sklar: There are steroid hormones like DHEA, pregnenolone and progesterone that are made in nerves and they are called neuro steroids. There are neuroactive steroids, which are steroids made in other places, like the ovaries and the testes, that have actions on the nerves, but there are actually steroids made in these nerves. And they have actions on how nerves function. They’re anti inflammatory, they help nerve to nerve transmission. And so the best I could figure out, because I didn’t know who to ask about this, was that, these hormones were somehow reducing inflammation and improving these people’s situation. It’s not a permanent fix, it doesn’t cure the situation, but it certainly gives people relief to the point where [00:12:00] They can, basically, it’s not ruling their lives and, you know, you’re a chiropractor, Ben.
You know what chronic pain does to people. For sure. It can destroy your life. It can destroy your relationships. Yes. And when it involves your mouth, it has to do with what you can or can’t eat. And so it ends up that people who have this isolate, don’t go out to dinner. A lot of our socializing is done over meals.
Right. Right. So that kind of goes by the wayside and a lot people’s gauge of how much better they are is what they can eat. Can they drink coffee now? Can they eat salads again? Can they socialize with friends like the one patient I mentioned who finally was able to go to Thanksgiving dinner with the rest of her family?
The other issue that comes up, am I still okay as far as freezing? Okay the other issue that comes up is, as you said, [00:13:00] A lot of the people that have this condition are perimenopausal and menopausal women. Our medical system really does not recognize a lot of what is going on with women as valid. Thinks women are being hysterical, still. Think women are making it up that it’s in their heads. There are actually articles in the literature That says, Bernie Mouse Syndrome is because women are watching too many upsetting soap operas on TV.
Dr. Weitz: I saw that in one of your articles. It kind of reminds me of IBS, which is another, the most common gastrointestinal condition, which is more common in women, and was often dismissed as a psychological disorder.
Dr. Sklar: Right, exactly. So, women have that discrimination going on, not being believed, and you know, you talked about my website, the people with Burning Mouth Syndrome, of all of the patients I’ve ever met, with all their variety of medical are on the internet more than any other group of patients that I’ve ever encountered. And it’s not unusual for somebody to tell me something like, yeah, I found you because I went to the Mayo Clinic, Oral Facial Pain Clinic, and they said, no, there’s nothing we can do for you. And I went home and I was crying all night and couldn’t sleep. So I got on my computer and I found you. And I hear that story over and over again. People with burning mouth are on the computer incessantly.
Dr. Weitz: I was, I was looking around for some of the conventional medical perspectives on things and it looks like one of the most common treatments is to prescribe what you, which is sort of the cure all for almost any pain or neurological condition that they don’t know what else to do, they prescribe [00:15:00] gabapentin.
Dr. Sklar: Right. Which seems to help a few people, and I, the problem with Gabapentin is side effects. So, people often feel zombie like on Gabapentin, too sedated to do anything. And so, I think there may be a place for it. By the time people come and see me, number one, if it was going to go away on its own, it already did. If Gabapentin was going to take care of it, they don’t come and see me. But I’ve had people on gabapentin with side effects like sedation, who we’ve put on a hormone program, they feel somewhat better, but not all the way better, maybe, or they get all the way better, and we say, well, let’s try to withdraw the gabapentin so you don’t have so much sedation and problems from it, and they notice that their pain increases.
So sometimes it’s hard to, for people to tell if something’s working or not until you try to withdraw it. Right. So we try to use a low enough dose and other things to support them, but you’re right. Gabapentin, [00:16:00] also pregabalin or Lyrica is frequently used. The other thing that’s big in the literature for oral facial pain and trigeminal neuralgia is duloxetine.
And I have a long list of possible medications that I’m certainly happy to try people on. The problem with those medications is often they have side effects and, you know, what we know about hormone restoration is usually there can be some side effects, but usually there are side benefits. So people like the patient that I mentioned in the very beginning, who was kind of my start in burning mouth syndrome, her energy was better. Her mood was better. So I see that people get those side benefits from being on hormones.
Dr. Weitz: So how do you diagnose patients with Burning Mouth Syndrome? Is this a purely clinical diagnosis, or are there some tests that can be done?
Dr. Sklar: It’s really clinical. It’s history. And like I said, by the time people see me, they’ve been [00:17:00] to multiple dentists, Ear, Nose, and Throat Doctors, Oral Facial Pain Clinic. So they’ve been examined and everything looks normal. Some of these people probably have small fiber neuropathy. And when I did a survey,
Dr. Weitz: what that is, Yeah,
Dr. Sklar: there are small nerve fibers that can degenerate and cause neuropathic pain. It could happen anywhere in the body and it can be you. And it has a number of causes. Lyme can cause it. Mold can cause it. Viral illnesses can cause it. It can be an autoimmune reaction. And so very small
Dr. Weitz: Why would it be small nerve fibers?
Dr. Sklar: I don’t know if I have a good answer to you, but it’s the unmyelinated smallest nerve fibers that get affected. That are sensory fibers. And you can make a diagnosis in a lot of cases by doing skin [00:18:00] biopsies because those small fibers penetrate the skin. And I suspect that in some people, of course, then you want to try to find the underlying cause because it doesn’t just go away on its own. If it’s Lyme, you want to treat the Lyme. If it’s viruses, you want to treat the viruses. But doing a survey of my patients, about a quarter to a third of them have neuropathy in other places besides their mouth. So they may have peripheral neuropathy in their lower extremities. The patient that I mentioned that was my very first one who got better on hormones had burning on the skin of her shoulders on her back. Some people feel burning up into their nasal passages, down into the trachea and into the lungs and skin anywhere on their bodies. So we’re, I’m starting to look at, and everybody doesn’t get better on a hormone restoration program. The other things that have been brought up as potential contributors are mast cell activation, [00:19:00] Some Dr. Lawrence Afrin, who a lot of, of functional medicine know about in terms of mast cell expertise has a couple of papers out about putting people on histamine blockers like Pepsid, which, you’re not crazy about putting people on something like Pepsid, which is a stomach acid blocker long term, but if you’re talking about somebody not being able to live their life because of severe chronic pain, it’s a trade off.
And I’m using something like Zizol or Claritin or Zyrtex to for H1 blocking. So there seems to be, for some people, a mast cell component. And the more I go along, the more complicated the patients I see tend to be. And so I have a number of patients who have clearly mast cell overactivity, who’s, who get urticaria, hives, whose faces turn red at the, at the drop of a hat. Who get itchy all over a couple of [00:20:00] people whose throat closes up and have to go to the ER as, a histamine reaction. So histamine and mast cells play a role for some people. The other thing that’s been posited as a possible cause is that this is a post viral, like post herpetic neuralgia.
And there’s a woman named Maria Nagel who’s in Colorado. She’s a neurologist, and she’s written a few papers on treating people with very high dose Valtrex or Valcyclovir. Right, so getting better on Valcyclovir, and it’s high dose for a prolonged period of time, like three to six months. Some people, it seems like, need to be on a maintenance dose long term. But that has helped some people with burning mouth syndrome get better.
Dr. Weitz: Okay I also saw something about this condition called oral lichen sclerosis as being a cause, and it’s not [00:21:00] clear exactly what this condition is, and have you seen this condition as a factor?
Dr. Sklar: I haven’t I’ve seen more oral lichen planus and which is kind of flat, round lesions that occur in the mouth. Okay. The lichen sclerosis not so clear about in the oral cavity.
Dr. Weitz: Maybe it was planus. Yeah, I’m not sure.
Dr. Sklar: I’m very familiar with lichen sclerosis on the vulva having been an OBGYN, but yeah, I’ve certainly lichen planus in the mouth. That does not, I don’t see that very often. Okay.
Dr. Weitz: So are there labs that you run when you get these patients?
Dr. Sklar: Yes, there are labs I run. They don’t make a diagnosis of Burning Mouth Syndrome, but they help me rule things in and out. I do viral panels for varicella and herpes. It seems like a lot of these people have reactivated Epstein Barr virus, and I’m not [00:22:00] sure what role that plays in chronic pain.
Dr. Weitz: Right.
Dr. Sklar: There are a number of papers in the literature about micronutrient deficiencies and Burning Mouth syndrome.
Dr. Weitz:What’s your favorite, what’s your favorite viral panel that you like to run for clinicians out there?
Dr. Sklar: Usually I start with what people’s insurance will cover, so I will do Varicella, IgG, and IgM.
Dr. Weitz: Okay.
Dr. Sklar: Herpes type 1 and 2 IgG, Quest is no longer doing the IgM. I checked for Epstein Barr early antigen, as well as Epstein Barr VCA and eBNA. Those are probably the main ones.
Dr. Weitz: Okay.
Dr. Sklar: Yeah. And I know there are some, good labs that do viral like Cyrix and or immunosciences, but
Dr. Weitz: Yeah. And Vibrain also has a viral panel.
Dr. Sklar: Right? Yeah. I haven’t used those. I mainly use Quest and LabCorp.
Dr. Weitz: Okay. [00:23:00]
Dr. Sklar: And then I check for micronutrient deficiencies.
Okay. So magnesium.
Dr. Weitz: How do you check for that? Do you run one of the micronutrient panels?
Dr. Sklar: No, again, I just use Quest and LabCorp, yeah, our Red Blood Cell Magnesium Copper and Zinc. CoQ10 levels
Dr. Weitz: Vitamin D, Omega 3.
Dr. Sklar: Oh, definitely Vitamin D. I’ve had some people who got better, we did their labs, they were going to get their hormones. Prescriptions and that sort of thing, but they went ahead and started on vitamin D because their vitamin D’s were incredibly low and their pain significantly improved. So definitely vitamin D is really important. I actually Probably an
Dr. Weitz: iron panel as well, right?
Dr. Sklar: We do iron, yep, ferritin. And then the other thing that can be helpful if this is central pain syndrome is low dose naltrexone. So not so much in the talking more about treatment than lab testing.
Dr. Weitz: Tell us about low dose naltrexone for patients [00:24:00] and practitioners who are listening who are not familiar with it.
Dr. Sklar: So, low dose naltrexone, I was first introduced to for treatment of autoimmunity because it’s anti inflammatory.
Dr. Weitz: Right.
Dr. Sklar: And and it’s, and people, patients get freaked out. You have to explain to them what naltrexone is. And it doesn’t mean that they aren’t. Opioid addict but it is low dose of naltrexone and naltrexone for opiate addiction and reversal is treated at like 50 milligrams a pill. Low dose naltrexone is anywhere from 1.5 up to, I use a maximum of 9 milligrams. Some people use ultra low dose naltrexone, but I have less experience with that. And it’s been found to help central pain syndromes. Pain can live in your mouth, and if it’s a nerve in your mouth, if you inject local anesthesia into that nerve, It should relieve your pain [00:25:00] and numb your tongue.
The many of the, most of the people I see with burning mouth syndrome, if you do that, they would still have their pain because their pain now lives in the brain, not only in their tongue. And so for those central pain syndromes, low dose naltrexone helps the release of our natural. opioids that our body can produce.
So our natural endorphins and opioids and help with reducing pain. So I usually start people on a hormone restoration program. We see how it goes for a month or so. If things start getting better, great. If not, we add low dose naltrexone, and also at the same time I’m correcting iron deficiency or magnesium co Q10, all the micronutrients and vitamin D at the same time.
Dr. Weitz: So tell us about your hormone restoration program. Do you, how do you test the hormones? How do you prescribe and [00:26:00] how much in general are typical treatment protocols for you?
Dr. Sklar: Again, I use the regular commercial labs and test estradiol, progesterone, testosterone free and total thyroid 3T3, 3T4, and thyroid stimulating hormone and DHEA and pregnenolone. And I try to have treatment levels, after treatment. in the range of a young adult. So I try to have estrogen levels between 60 and 80, maybe not as high as the young menstruating women, but I don’t want it in the hundreds for postmenopausal women. Progesterone between 10 and 20, which is the luteal phase optimal level at ovulation, or rather 14, like five to seven days after ovulation. DHEA, I try to put pretty high a lot of us in functional medicine use pretty high [00:27:00] amounts of DHEA and don’t feel like there’s really an upper limit. In terms
Dr. Weitz: Give us an idea of what Of dosing. Level of dosing of supplements and then what level on the blood do you like to see?
Dr. Sklar: Right. So for estrogen, I usually have people use an estradiol patch. Okay. And they use anywhere from 0. 025 to usually 0. 5 is, 0. 05 is enough in a bi weekly patch progesterone people are on 100 to 200 milligrams of micronized oral estrogen, which I like to use because one of the things that oral estrogen does is get metabolized to something called allopregnanolone. And allopregnolone is a really potent, calming, anti inflammatory, neurosteroid, neuroactive steroid.
Dr. Weitz: Oral progesterone, right?
Dr. Sklar: Oral, so topical progesterone does not go through that conversion. Into allopregnolone. So I intentionally will use oral progesterone. [00:28:00] And there’s debates about all of this in the, I think
Dr. Weitz: it’s pretty typical for a lot in the functional medicine community to use a topical estrogen and an oral progesterone.
Dr. Sklar: Okay. Yeah. I was just listening to a talk by an expert who said don’t use oral progesterone. It goes through bad metabolism in the liver. And I was like, I don’t agree with that. We use DHEA and usually for women, it’s anywhere from 25 to 50 milligrams a day. For men 50 maybe to 100 Pregnenolone, and I see some people with like incredible low DHEA and Pregnenolone levels anywhere from 50 to 100 milligrams of Pregnenolone in a day.
Okay. Thyroid, I like to have people’s T3 in the upper quartile of normal, so if your reference range is 2. 3 to 4. 2, have it [00:29:00] somewhere 3. 5 to 4. 2. And testosterone for women to see, again, at the upper end of the normal range. For women, it’s somewhere around 35 to 45. For total testosterone. And so the dose of testosterone I’ll use is somewhere anywhere from, oh, one to up to five milligrams a day, mostly around 2. 5 milligrams a day in a topical cream.
Dr. Weitz: Are there some women that you will not recommend hormones for?
Dr. Sklar: Yes. I had one patient who has I’m trying to remember, it wasn’t factor V Leiden, but she had a blood clotting diathesis and her hematologist said no hormones whatsoever. And we did everything else, put her on low dose naltrexone, corrected all the micronutrients. He did let her be on vitamin D and her pain improved significantly. Women who have had breast [00:30:00] cancer, I have them check with their oncologist. Some oncologists are okay with women using not estrogen necessarily, but DHEA and pregnenolone, they’re not so worried about the downstream effects. So I would say those are the two main classes of people in whom I would not use hormones and of course men who have had prostate cancer.
Dr. Weitz: I guess there’s certain medications that can trigger burning mouth as well.
Dr. Sklar: There are. There are certain anti hypertense drugs. Antihypertensive, like the angiotensin receptor blockers. I’m always trying to have people do a trial off of those. I haven’t really found that to be a big contributor, I must say. That, that hasn’t panned out to provide people with a whole lot of relief. Quite honestly. Okay,
Dr. Weitz: so even though maybe they triggered it, they take him off, it doesn’t make it go away.
Dr. Sklar: It doesn’t seem like it, no.
Dr. Weitz: Okay, so [00:31:00] what percentage of the patients that you’re treating for Bernie Mouth get a fair amount of relief?
Dr. Sklar: Yeah, so somewhere around probably 60 to 65% which may not sound real high, but you’ve got to realize these are people that have been everywhere to all the major pain clinics and then I realized there were people that would not be able to come and actually become a patient, and so I developed a supplement called BMS Advanced Support Burning Mouth Syndrome. We abbreviate BMS and I put DHEA and pregnenolone in it. Oh, B12, I forgot to mention, but certainly B12 is really important for nerve function. So it has methylfolate in it. And And Lipoic Acid because there’s some literature that shows that Lipoic Acid helps neuropathic pain. And I put it together in a supplement and it turns out it’s not effective for everybody, but about 25 or 30 percent of people get [00:32:00] really dramatic relief of their burning mouth and have just ordered it for years. If you’re one of those people, it ends up really good for you. So that is available for people who are not going to actually become patients of mine.
Dr. Weitz: What’s your guess how many people out there are suffering with this condition?
Dr. Sklar: So there are really wide estimates, but probably millions. I hear from people all over the world. I have a course for patients, takes people through, takes the public through the different kinds of things that might be, it might be a virus, it might be this, it might be that, what the conventional system, how it evaluates you, how to find a practitioner that might know something about hormone restoration. And we had people from Australia and a whole variety of places. I hear from people in Europe fairly often about wanting to order a supplement. I do hear from people all over the place.
Dr. Weitz: Does diet play a [00:33:00] role?
Dr. Sklar: For some people it does. I encourage people to do a gluten free diet and a sugar elimination. And that has made a dramatic difference for some people.
Dr. Weitz: So sugar elimination, you mean like gradually eliminating sugar or just stop?
Dr. Sklar: If you can just stop it, sugar is really inflammatory. Absolutely. Yeah, so I try to get people just to stop cold turkey. Yeah, I
Dr. Weitz: have a lot of patients. Gluten, Dairy, Sugar, just take it out right away.
Dr. Sklar: So one of the problems with these patients is their nutrition, because a lot of times they end up all they can eat is like rice and oatmeal. And so they become very nutritionally deprived. And so I try not to, I’m not sure how much dairy plays a role. So if they can eat yogurt because it’s smooth and it’s cool. I try not to eliminate that, but gluten certainly seems to be a big one. And then people will [00:34:00] naturally, like I said, not eat oranges and grapefruit and spicy foods because it’s just too painful.
Dr. Weitz: That’s great. Those are the questions that I had prepared. Anything else you want to tell us about this condition and to help give some hope to people out there who are dealing with it?
Dr. Sklar: Yeah, absolutely. And I really appreciate this opportunity, Ben. So often people are made to feel like it’s in their head and it’s not in your head. If you feel pain, You need to pursue it until you find somebody who can help you and take you seriously, because that’s the most heartbreaking part of it. I’ve had patients who were admitted to mental institutions because their doctors thought they were that crazy. And yeah, it’s, it can get really extreme. You really need to pursue care until you find somebody who [00:35:00] believes you, and at least can start. looking into treatment and help for you.
Dr. Weitz: How can those listening or viewing get a hold of you and find out how you can help them?
Dr. Sklar: Yeah. I have a new website called www. susansklarmd. com. Okay. I recently sold my functional medicine practice. So there is still a Sklar Center website. But that’s no longer the Burning Mouth website.
Dr. Weitz: Interesting.
Dr. Sklar: Yes. So my new website is called Dr. Susan Sklar’s Hope for Burning Mouth. Okay. And so www. SusanSklarMD. com will take you to the website. I also have a Hope for Burning Mouth YouTube channel that has a ton of videos and a lot of information.
Dr. Weitz: And you mentioned you have a training program as well.[00:36:00]
Dr. Sklar: I have on my website, people can sign up for an educational program. It’s got 12 modules. It’s very detailed and has references and can help direct people to try to figure out how they can get help. And I’m working on a course.
Dr. Weitz: patients or practitioners?
Dr. Sklar: I’m sorry, what did you say?
Dr. Weitz: Oh is that for patients or practitioners?
Dr. Sklar: So that’s for patients. Okay. And I have a partially done course for practitioners. Oh. Yeah, so all the detailed research and papers I just filed away because someday there’s going to be a practitioner’s course.
Dr. Weitz: Okay. That’s great. Thank you so much, Susan.
Dr. Sklar: You’re so welcome. Thank you for having me.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would 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.
https://drweitz.com/wp-content/uploads/2024/08/rwp-376-website.jpg350785drweitzhttp://www.drweitz.com/wp-content/uploads/2017/06/drweitzdsamplelogo-withtext.pngdrweitz2024-09-17 06:00:272024-09-24 12:00:29Burning Mouth Syndrome with Dr. Susan Sklar: Rational Wellness Podcast 378
Dr. Ben Weitz discusses Coronary Artery Disease at the Functional Medicine Discussion Group meeting on August 22, 2024. This was the first annual Dr. Howard Elkin Memorial Integrative Cardiology Lecture.
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Podcast Highlights
4:32The goals of this presentation are:
1. To help you understand more about what coronary artery disease is, how plaque forms, and what happens when you have a myocardial infarction, or heart attack.
2. Is to understand advanced lipid testing and direct testing of the arteries, including the CT Angiogram with Artificial Intelligence.
3. To understand how to treat coronary artery disease, with an emphasis on diet and nutritional supplements.
5:22Heart disease continues to be the Number One killer in the US and coronary artery disease continues to be the number one form of heart disease. Over 800,000 people in the US suffer a heart attack every year. Coronary artery disease refers to disease in the arteries that supply the heart. The most important artery is the Left Anterior Descending Artery, which supplies over half of the heart muscle with blood and oxygen. The LAD is also known as the “Widow Maker”, because if this artery becomes clogged by a heart attack, you will most likely die.
6:36 Plaque and Plaque rupture. What happens in coronary artery disease is that the arteries become lined with plaque and this plaque is composed of oxidized plaque, as well as inflammatory and white blood cells. The inside of the arteries is called the endothelium and this is a crucial surface. If the endothelium is not functioning properly, we refer to this as endothelial dysfunction, and this can result in decreased production of nitric oxide production. Lining the surface of the endothelium are the finger like projections known as the glycocalyx, which is composed of glycoproteins and proteoglycans. What usually leads to a heart attack is not that the arteries become more and more closed up, but most of the time what happens is that the plaque ruptures, forming a clot, which occludes the coronary artery. By the way, plaque that is calcified is usually more stable and less likely to rupture. In order for plaque to form, you need to not only have cholesterol, but also oxidation or inflammation, so on labs you want to look at measures of oxidation and inflammation.
14:50Other Risk Factors. One risk factor for CAD is uric acid, which is not just a marker for gout but is a marker of metabolic disease, which Dr. David Perlmutter has pointed out to us. Over 5.5 is considered elevated for metabolic disease. Fibrinogen is a marker for clotting. Elevated iron and ferritin increases the risk for clotting. Lack of sleep, lack of exercise, and stress also increase risk. Elevated Homocysteine is an inflammatory marker in the blood stream separate from cholesterol that increases your risk of heart attack and stroke. According to Dr. Houston, the risk starts when homocysteine if above 5 and really increases exponentially when it is above 12. The way to lower homocysteine is with methylated B vitamins and trimethylglycine. Low and high thyroid both increase the risk for heart disease. Micronutrient deficiencies.
23:11 The Advanced Lipid Profile. There are a number of specialty labs that offer Advanced Lipid Profiles, including Boston Heart and Cleveland Heart, both of which Dr. Elkin often ran. The advanced lipid profile looks at not just LDL but also LDL particle number and particle size. It’s the small, dense LDL that puts you at the biggest risk. Another marker that has recently become more popular is ApoB, which is Dr. Peter Attia’s favorite marker. I will show you an example of a patient who had normal ApoB but many other risk factors, such as small, dense LDL and inflammatory markers. I am arguing that there is not one best marker for Coronary Artery Disease but rather we need to look at the full picture that includes a number of markers. Other tests that you want to look at are Oxidized LDL, Lp-PLAC, and MPO, all of which are markers for inflammation in the arteries. This profile should also include Lp(a), which is a particularly atherogenic LDL particle, often described as sticky. Other markers that are often included are Vitamin D, Omega 3, CoQ10, ADMA, and TMAO.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Thank you everybody for attending a Functional Medicine Discussion Group of Santa Monica. And our next month we have Dr. Tom O’Brien who will be speaking on Tuesday the 24th, so that should be really exciting. He’s a great speaker he’s spoken with us before, he has a new presentation he wants to talk about so definitely put that on your calendar.
Integrative Therapeutics is our sponsor for this evening. So I want to thank them for sponsoring another one of our meetings. And if you’re not familiar with their products, they’re one of the few professional lines of supplements that we carry in our office. And they have a number of great products for every condition, including cardiovascular. We use their berberine regularly. They have several highly advanced forms of curcumin, Their latest one is Curalieve and it’s super highly absorbable. So that’s a great product at one capsule twice a day is easy to take. It’s super effective. Lowering inflammation.
I want to say tonight there’s some good news and there’s some bad news. So the good news has to do with me. I don’t know if everybody’s aware, but I fell and fractured my femur on Halloween night and had surgery the next day. And unfortunately it wasn’t healing because there was a gap between the bones after the surgery. And so it was diagnosed as a non union, but I can now say that it has healed. The mic’s not working? Okay. I’ve got to keep my mic on. Keep it close to my mouth. Okay. Thank you, Bernie. I’ll just repeat the good news is that it’s about me. I fell and fractured my femur, and it wasn’t healing. I have a non union. And I was told I needed another surgery, but in the functional medicine world, we believe in the ability of the body to heal itself. And so I wasn’t going to accept that. So I came up with a plan. I scoured research showing that a drug called Forteo, which simulates new bone cells helps healing of non-union fractures. And I started taking injections of Forteo, I also used Human Growth Hormone two IUs a day, and I started using a bone stimulator, and I did that for four months, along with, of course, all the supplements, 10,000 IUs, Vitamin D, 45mg MK4, Boron, Calcium, Magnesium, Strontium, Collagen, Glucosamine and I can now say that my hip is healed. Yay! So, thank you. I’m really happy.
The bad news is that our friend and colleague, Dr. Howard Elkin unfortunately passed away on August 1st. He used to come to our meetings regularly, he worked at my office one day a week for about a year. He was a great integrative cardiologist. He also did prescribe bioidentical hormones and trying to find another cardiologist to send his patients. There was nobody like Howard. So very sad. So I’m dedicating this talk to Howard Elkin. So this is the first annual Howard, Dr. Howard Elkin Memorial Talk on Integrative Cardiology. So let’s get started here. This is Howard’s book.
And so the goals of the presentation are number one to get you to understand more about what is coronary artery disease, how does plaque form, and what happens when you have a myocardial infarction. Number two is to understand the testing and in particular, advanced lipid testing. And we’re also going to talk about some of the direct testing. We have somebody from Cleerly Health to talk about the CT Angiogram with Artificial Intelligence, which is the latest test that allows you non-invasively to see exactly what’s happening inside the arteries. And then I’m going to focus on some of the approaches to treating coronary artery disease with an emphasis on diet and supplements.
So heart disease continues to be the number one killer in the United States and coronary artery disease is the number one cause of heart disease. Over 800,000 people in the U.S. suffer a heart attack every year. And heart disease is still the number one killer in women as well. It’s common for women to be fearful about breast cancer, but the number of women that die from breast cancer on average is a fraction of the number of women who die from cardiovascular disease. So, that should be the focus for preventative medicine.
Coronary artery disease has to do with disease in the arteries that supply the heart and these are four of the main arteries that supply the heart. And this artery right there is the Left Anterior Descending artery. And that artery supplies over half of the heart muscle. And if that artery becomes completely clogged by a heart attack, you’re most likely not going to make it. They call that the widow maker. Alright. So, what happens in coronary artery disease is that the arteries become lined with plaque and plaque is composed partially of oxidized cholesterol, as well as inflammatory cells, white blood cells, etc.
But what usually leads to a heart attack or a myocardial infarction is not that the arteries become more and more closed until they’re fully closed. 75 percent of the time what happens is that the plaque ruptures, it breaks open and forms a clot. And so the mere presence of cholesterol does not mean that you’re going to have plaque buildup. The most significant factor is that the plaque becomes oxidized and or inflamed. So looking at markers of oxidation and inflammation are super important.
So let’s see, the endothelial lining of the arteries. So the inside of the arteries is called the endothelium. And we think that is where a lot of the action happens. And there’s a lot of focus in the research on the health of the endothelium. And there’s several things. [Hey, Johnny.] There’s a number of things we can do to improve the health of the endothelium.
Okay, so here is a slide about the endothelium. So the endothelium is this one, [Hi Roxane], is this one cell lining of the inside of the arteries. And if the endothelium is not working properly, we call that endothelial dysfunction. And what that will mean is that typically you’ll get less nitric oxide production. Nitric Oxide is one of the key players in heart disease. Having good Nitric Oxide production reduces hypertension, improves the health of the arteries, and it’s super important. And here’s a finger-like lining of the endothelium, those little finger-like projections. That’s called the glycocalyx. The glycocalyx is composed of glycoproteins and proteoglycans. And the health of the glycocalyx is super important in understanding what’s going on.
So, here’s an example of plaque inside the arteries. And so on the left side we have you see the plaque and if the plaque rushes, it looks something like that, and this is where you have a calcium fibrous cap like a [00:09:00] plaque. And so, most people are concerned about having calcium in the arteries. It turns out that if you have plaque in your arteries, it’s bad. If that plaque is covered by calcium, it’s more likely to be stable, and stable plaque is less likely to lead to a myocardial infarction. So I have a short video here, just in case you don’t understand this. The heart pumps blood to the body through a complex network of arteries.
With the exception of the coronary arteries, which nourish the heart itself, most arteries transport oxygen rich blood away from the heart. Let’s see. 1, Cancer, 2, and 0. I’d be like, what’s happening to me? It’s a tragedy. Trouble? Wait a minute. What do you think the sound holds up to? The heart pumps blood to the body through a complex network of [00:10:00] arteries.
Let’s take a turn. Circulating in the blood are red blood cells, white blood cells, nutrients, and other life sustaining substances. Cholesterol and other fatty substances also circulate in the blood. Over time, these substances can be deposited in the artery walls, a condition called atherosclerosis. The deposited cholesterol, or plaque, can build up over time, causing hardening and narrowing of the otherwise smooth [00:11:00] artery walls.
When the walls of the artery become narrowed and hardened, blood flow is restricted. As the plaque accumulates, the buildup can become unstable and may break off or rupture. A condition called thrombosis results when blood starts to coagulate or clump together at the site of the rupture, similar to the way blood clots to stop bleeding from a pipe.
A blockage or thrombus can grow larger, further restricting the flow of blood. The thrombus is also in danger of breaking from the site and traveling through the arteries. The blockage caused by a thrombus can be life threatening. A blockage in the coronary arteries may cause a heart attack. While a blockage in a cerebral artery may cause a stroke.
Blockage in one of the major arteries of the body can prevent blood flow to an extremity or organ. Causing pain and tissue damage to the area.[00:12:00]
Great. That was pretty interesting. So, in order to control inflammation and oxidation, this is a list of supplements from Dr. Mark Houston’s book. By the way, this is one of the best books about coronary artery disease. I don’t know if you know Dr. Mark Houston, but I’ve studied a bunch with him, and he is one of the premier teachers of cardiovascular medicine. He teaches for A4M. This [book] is called The Truth About Heart Disease. But, yeah, this is all about coronary artery disease. There’s actually a lot of supplements, I probably take almost all of them, and here’s a list of the top anti oxidant foods I could go through all of those.
Okay, so Yeah. Okay, so the top list that I choose, these are the examples for someone familiar with Can you just hold that for a second? [00:13:00] Oh yeah, sure. There you go. And human stuff. Sorry. Annatto. Yeah, it’s interesting how beans are so high in antioxidant. Beans are really super healthy, even though Dr. Gundry says they’re not.
As long as they’re properly cooked, and if you undercook your beans, you’ll know it. So, high blood pressure, obviously it’s a super risk factor for coronary heart disease. Smoking, everybody knows about. Cholesterol, dyslipidemia, insulin resistance, diabetes. If you have diabetes, you have three times the risk of heart attack. I’m going to focus more and just talk about some of the other factors, but diabetes is super important. Insulin resistance, it’s in the stages of a heart attack. [00:14:00] Needs to be addressed. This is about inactivity and obesity.
Now, this is a list that not everybody thinks about, so I’m going to spend a little more time on this. So, uric acid is a very important marker. Significantly increases risk of coronary artery disease. It’s typically not measured by most doctors. We do it. I run a lot of panels to Vibrant America, and we always look at uric acid. Dr. David Perlmutter has really emphasized the importance of uric acid as a metabolic marker and not just as a marker for gout. We have fibrinogen, fibrinogen is an important marker to look at, increases risk of clotting, the blood gets thicker, that increases your risk. Elevated iron and ferritin. I did a podcast with a doctor from, wrote a book about Hemachromatosis, and 30% of population has at least one gene that makes them more likely to store iron. But guess what? We have no idea because iron doesn’t get measured on most patients. I had a patient who was being treated for anemia was because their, he, because their hematocrit and their hemoglobin were high [meant to say low]. And they put him on iron. Nobody ever measured the iron. He doesn’t need iron. He was having a problem. He’s a painter. He was having a problem with lead toxicity, which was blocking his iron. So giving him more iron was never going to fix it.
I had a couple of women, a mother and a daughter, they’re both vegan, they have high iron and ferritin but nobody measured it. They’re vegan, everybody assumed that they needed iron, but they’re storing iron, so start measuring iron, do a whole iron panel on all your patients, you’re going to find a number of patients that need to reduce their iron, and here’s some strategies for reducing the iron. For one thing, high dose curcumin, there’s a number of things you can do.
Sleep, is super important.
Homocysteine. How many industry measure homocysteine? Okay. Homocysteine is a inflammatory marker in blood, separate from cholesterol. It significantly increases your risk of heart disease. According to Dr. Houston, risk starts when homocysteine is above 5. Yes, most of the labs say it should be under 12. Now, after 12, it really shoots up. We usually try to get it below 8. Getting it down to 5 is hard, but it’s interesting. So, homocysteine is super important. The way you get it down is with specific B vitamins.
For Thyroid anything that causes inflammation, I put low hormones because we know that having proper good levels of hormones is super important for health. Anything that causes inflammation such as chronic infections, toxins mold, it turns out [00:17:00] that Dr. Elkin, the day he was moving out of his house because he had mold. Addisalice, so that could be an inflammatory trigger micronutrient deficiencies, gut health, Dr. Elkin regularly ran stool tests on his cardiovascular patients, everybody thought he was crazy, but it’s super important, we all know, especially in functional medicine, it all starts in the gut.
Alright, so the controversy about cholesterol, and we have Johnny Bowden in the back of the room who wrote The Great Cholesterol Myth. And so, it’s a question whether cholesterol itself is a factor. Most of the studies indicate that it’s only when cholesterol becomes oxidized or when there’s inflammation in the arteries that cholesterol really becomes a problem.
Cholesterol is essential for all these functions in the body. It’s essential for producing. Our sex hormones, it’s important for brain health there’s a whole series of nutrients that won’t get produced, you don’t have sufficient levels of cholesterol, it’s how our body makes vitamin D from the sun it’s no wonder patients in Southern California, I, we measure vitamin D all the time, it’s amazing how many people come in who get plenty of sun and they still have low vitamin D. And one of the reasons could be because everybody’s trying to get their cholesterol down so much.
So, oxidation, inflammation interestingly, just to throw something into controversy, and I’m not going to make any conclusions about it, but, we debate what should be the best level of LDL cholesterol, and we’re going to talk about my LDL is. itself, not necessarily the best marker, but there was a study done recently, University of Pittsburgh, and they found that the patients who are least likely to die of heart disease had LDL [00:19:00] cholesterol in a range of, while it was long term, it was 20 or more, not just heart disease. They had cut LDLC in the range of 100 to 189. So, there’s still things we probably don’t know about this whole situation. Yeah. Bernie . I was going into small . Yes, absolutely. Which is rich. Oh, the small particle is the one you have to worry about. I mean, is that Bridge point to C. Okay. So, we’re gonna talk about this, but the most doctors, most cardiologists run what’s called the Basic Lipid Profile.
And that means total cholesterol, estimated LDL, what they call LDL C. They just go, it’s about this much LDL. They don’t count the particles of HDL and triglycerides. And it’s wonderfully inadequate. [00:20:00] It’s really malpractice that they’re not running a advanced lipid profile, and that’s where we can come in as functional medicine practitioners.
And, in fact, if you start running the advanced lipid profiles, and we’ll talk about that soon, as well as some of the other advanced steps I have a good relationship with my primary care doctor, and sometimes we run these advanced lipids on his patients, and I share the information with him. I help the patients with the nutritional approach, but Sure. He can’t run those panels because the insurance companies come after him. And, I know it’s criminal. It’s crazy that we let insurance companies run our health care system. It’s really not good for us. So, you can run these advanced lipid panels and you’ll save the patients money. Because if they get sent on insurance to run an advanced lipid profile and it’s not covered, they’ll get charged thousands of dollars.[00:21:00]
Whereas we can get a really good advanced lipid profile for you. We use Vibrant America and so we can do advanced lipids, hormones, thyroid nutrients and get it done for four or five hundred dollars. Okay. So we just talked about the basic lipid profile and even cardiologists are not running it even though they should and the reason why is insurance coverage and time. So they just run the basic lipid profile.
Okay, so what is the Advanced Lipid Profile? Well, there’s a number of specialty labs that offer Advanced Lipid Profiles. Howard, Dr. Elkin, he often ran either Boston Heart or Cleveland Heart. And all of these labs have special parts of their tests that the other labs don’t have. They’ve developed a proprietary testing. I’ll [00:22:00] show you a few examples of Advanced Lipid Profiles so you can get a better idea of how to interpret some of these. All right. So the Advanced Lipid Profile typically will look at not just LDL, not just total cholesterol and estimated LDL, but it’s going to look at LDL particle number and particle size. So it’s the small dense LDL that puts you at biggest risk. Lately, a marker that has become more popular is ApoB. Peter Attia says it’s the only one you need to look at and it’ll determine your risk. I’m going to show you a slide later on, on somebody that Howard tested who had a Cleveland Heart Lab, had totally normal ApoB, but is at a lot of risk, because they had a lot of small dense LDL, and other inflammatory markers. So, I’m going to basically be arguing that there’s not one marker that’s best. We need to look at a number of markers. Other tests that you want to look at, Oxidized LDL, Lp-PLAC, and MPO. Those are all markers for inflammation inside the arteries. So inflammation is the key, as we know there’s so many different diseases, and it’s certainly the case with Coronary artery disease.
Lp(a). How many of you test for Lp(a)? Everybody should be getting testing for Lp, little a. I’ve had arguments with primary care doctors. No, it’s hereditary. You can test for it while they’re in the process of developing drugs for Lp(a). And once those drugs are out in a few years, everybody’s going to test for it. But now, they don’t want to test for it because they don’t know what they can do about it. But there are things that we could do, and we’ll talk about that. Vitamin D, Omega 3 is super important, Coenzyme Q10, ADMA is a marker for nitric oxide status. Not everybody [00:24:00] offers that. Unfortunately, Vibrant doesn’t offer it.
TMAO is a controversial marker. I don’t share anything about that. There’s this doctor at Cleveland Clinic, Stanley Hazen. It just seems like every six months he comes out with some other study, trying to tell us that everything we, we think is good is actually bad. And so, TMAO is this marker that’s supposedly correlated with heart disease. Do you know what the biggest source of TMAO is? Fish. We know how important fish is for health. TMAO is formed from either L carnitine or choline. So it recommends not eating foods that have choline or L carnitine. Do you know how important L carnitine is for the heart? Do you know how important choline is for the brain? So, I’m very skeptical of TMAO as a marker, but there’s something to it.
Okay genetics, I’m not really going to comment about this. This is a panel that Dr. Mark Houston developed with Vibrant America, and these are all, you can get this whole panel done from Vibrant. These are important markers, so you see ApoE, you’ve probably heard of ApoE3, ApoE4, that’s a risk for Alzheimer’s, but also for cardiovascular disease.
Alright, Lp little a. Lp little a is a particularly atherogenic, sticky LDL particles, It’s super important. It puts you at higher risk for heart disease. The trainer from The Biggest Loser, he had a massive heart attack and this was his only risk factor that they could find. So, if you have elevated levels of Lp(a) above 30, especially above 50, you definitely have to address it. So it’s important to know that. What can you do about Lp(a)? Statins actually raise Lp(a). This is more common in African Americans. PCSK9 inhibitors, these are injectable drugs that lower cholesterol, and they can lower Lp(a) 20-30%. Like niacin, it’s very effective at lowering Lp(a) 20-30%. So we use a controllable release of niacin and niacin has fallen out of favor from doctors because of some, quite frankly, bad studies, but niacin is very effective when used in proper dosages as part of a nutritional program and I’ve seen patients where their Lp(a) will drop 50 percent just with niacin. L-Carnitine, 10-20 percent reduction in Lp(a), CoEnzymeQ10 can help, Ground Flaxseeds. Then there’s this Linus Pauling strategy. We don’t know, I don’t think there’s any human studies, I think it comes from animal studies, but this Progeny of Dr. Pauling, somehow it came out of his research on vitamin C, the combination of vitamin C, Proline, and Lysine, and he had an Lp one way for binding to the artery walls where it don’t qualify. So that’s another strategy. Dr. Joel Kahn, I don’t know if you’re familiar with him, he’s an integrative cardiologist in Michigan. He wrote a whole book about Lp(a). I did an interview with him, so you can check out my interview with Dr. Kahn on my podcast, Rational Wellness. Oh, Dr. Joel Kahn, KAHN. He has a weekly podcast, truly good.
Homocysteine, you mentioned Homocysteine. There’s fundamentals of B vitamins, they exclude ethylated B vitamins and trimethylglycine can lower hopelessness in most patients by emptying. [00:28:00] You might have to use two or three capsules a day, but just keep experimenting. You can usually get it down. Sometimes adding extra TMG, Trimethylglycine, can be beneficial if it doesn’t come down to split the B vitamins. Oh, a lot of the companies have formulas specifically related to this. ApoB testing, so Peter Attia says this is all you need. There’s one ApoB particle for every LDL particle.
Wait, go back one sec. Yeah, sorry. Sorry. You know what, I’m happy to share my slides with everybody. Great. Yeah. Yeah. Absolutely. Uh, so, we talked about LDL particle number, that’s the LDLp, that’s where they actually count the number of LDL particles, as opposed to estimating it, [00:29:00] and it’s the small dense LDL particles that are more likely to penetrate through the wall of the artery and become part of a plaque.
Um, heart attack symptoms. Any sort of pain in the upper extremity can be a symptom of a heart attack. So for big patients, I’m thinking something else is going on. They’re having neck pain or shoulder pain. And 45 percent of all heart attacks are silent. Shortness of breath. Once again, I’m not a cardiologist as you all know, so I’m trying to focus on the things that We can make a difference with, which are, the traditional natural things. Uh, so, these are his forms of stress testing. I’ll go about the EKG treadmill test. And there’s a couple of other forms of stress testing.[00:30:00]
And and now we have direct artery testing. So, there’s something called coronary calcium scan. Are you familiar with that? So, it’s an easy test to send your patients with. A lot of them are guessing whether or not they have heart disease. According to your calcium scan, you can get it for two, three hundred bucks. It may not be covered by insurance, but a lot of the labs offer it. And it will give you an idea of how much calcified plaque you have in your arteries. Yeah calcium is bad, but what’s worse is soft plaque. So, soft plaque is more vulnerable to break off and lead to a myocardial infarction. Thank you. Now, traditionally, cardiologists have run what’s called cardiac catheterization, also known as an angiogram and this is where they run a catheter through the leg through the arteries of the heart, visualize it, and they, that’s been done for a number of years. One of the problems with that test is that they have the same patient get tested by different cardiologists. One of them says it’s a 30 percent block, one of them says it’s a 50 percent block. So we now have a more advanced test, which is the CT angiogram with artificial intelligence. And that’s who can we help. So we have a representative who who’s then come up to tell us a little bit about the Cleerly Health scan.
Edan: Awesome. This is fine. Perfect. This. Okay? Perfect. Can you guys all hear me without the mic? I’m a little loud. Yeah. Okay. Good evening, everyone. My name is Edan. I’m actually your point of contact here for All Things Cleerly. I live here in Venice Beach. Dr. Howard Elkin actually was a big user of ours. When I heard of his passing, it was actually pretty tough. I used to use the Martins Fair. Might be better. Yeah. When when I heard the news about Dr. Elkin, it was actually a pretty big blow to us. We do a case review for most of our patients for the providers, pretty much every single patient you send through. We do a case review with our medical team. We had an extra view with Dr. Elkin on Monday before I found out, so it was a tough blow for us, but I’m going to spend the next eight or so minutes just [00:33:00] talking to you guys about Cleerly and then if you guys have any questions after the fact, I’ve got my cars as well, so we can chat about it, but a little bit about the company, so our founder, his name is Dr. Min and he’s a cardiologist by trade. He focused on research for most of his career. And realized in finding his, in all of his findings that he had a chance to really, hopefully change the world. And so, he started the company with the intent to create a world without heart attacks, which as you guys all know is no small feat. But Dr. Min likes to say that if we’re successful in our endeavor, it’ll be a silent revolution, whereby the number one killer in the world simply drops to number two. Number 3, so on and so forth. So he’s very humble in his pursuit, and the individuals within the organization, we all strive to be the same. And in order to do so, we follow in the footsteps of cancer prevention. So if you can recall back in the day before there was an emphasis on the prevention of cancer, an individual, a patient, would walk into the doctor’s office with a sign or a symptom, and by then we’d know it’d be a little bit too late. Thus began the revolution for the prevention of cancer, and in [00:34:00] today’s day and age, If you combine all of the deaths associated with all of the cancers, they amount to less deaths than cardiovascular. Now the reason behind that is because the tools that we currently had simply didn’t shed enough light into what we needed to know. For example, if you ran an advanced lipid panel such as the one that Dr. Weitz was talking about, it’ll give you a lot of amazing information about your patient’s blood chemistry. Let’s say the patient had elevated lipids and you were to work on lowering those lipids through natural supplementation, lifestyle modifications, or pharmacological pursuits. And you were successful in lowering those lipids. The question becomes, okay, well, what’s going on within the coronary tree, right? We now hear all about these high ketogenic diets, right? So heavy lipids and their lipids are through the sky. But I can tell you so many cases of individuals that run their clear, these are clear, these are clean.
So it isn’t, like, to your point, it isn’t 100 percent about the cholesterol and about the magnesium as well. Similarly, if you were to run a calcium score, A calcium score will tell you [00:35:00] how much stable plaque there is, and to Dr. Weitz’s point it’s not necessarily just about the calcified plaque, it’s more so about the soft plaque.
So enter Cleerly, we’re the company that can talk to you all about the different types of plaque, where it is, and how much of it there is. Now we’ve come to understand that there are three different types of plaque. The first is your calcified plaque, which in our software would be denoted as aluminum, this is just your calcium, but you’d get out of a calcium score. The second is non calcified plaque, which in the software looks like it’s yellow plaque. This is slightly softer than the calcified plaque, slightly more at risk for rupture. And then the third type of plaque is called, it’s just a fancy term for the lowest type, lowest density or the softest plaque, that’s called low density, non calcified plaque. And so this stuff is the really, really dangerous stuff. We’re based in research and so we currently have unpublished data that suggests that just one cubic millimeter of this stuff increases your risk for an event threefold. [00:36:00] So consider a person that has a hundred cubic millimeters of total plaque, right?
All three plaque types. That’s considered a stage one patient, which we’ve talked to you about, which is pretty Low, but if they just have one cubic millimeter of that to be the low density stuff that increases your risks. That’s basically actually all I wanted to do on the slides Most of this talks a little bit more about the company and how to actually obtain the results But just know that from a resource perspective we focus on education first and foremost So we want you to understand when you get these reports you understand number one what they mean What to do about them from a medical therapy perspective all the options available and when to follow up So we’re not the type of organization that just kind of throws something at you and says, Hey, good luck, figure it out.
We literally walk you through and every single patient that you send our way, we actually set up a 30 minute Zoom session to talk to you about the results of those patients. So just know that you always feel supported. If that’s the gist do you have a couple of minutes maybe for questions? Yeah. Yeah.[00:37:00]
Any questions? Sure. So a doctor in Valley mentioned to me, Brad mentioned that I have Ibogaine, it can contaminate, literally, short of wells in my patients. And I said, Oh, there’s something called Heart Something. And I’m saying that to make you look at that list, but I’m sure you’re aware of the competitors and I’m just so curious what the difference is.
I love that you brought that up. So, what your doctor was referring to was HeartFlow? Yes. HeartFlow is a company that evaluates flow, otherwise known as FFR. FFR is used in order to determine what’s called ischemia. And so, from a, Prevention perspective, if a patient is already ischemic, the answer is the cath lab, right? But from a functional medicine and preventative perspective, we’re trying to get it, catch the disease before they need to get to the cath lab. And unfortunately over 52 percent of heart attacks are in asymptomatic patients. And so if we’re really going to work on stopping it or preventing it before we [00:38:00] even get to the Cath Lab. Plaque is what you look at first. Once you look at the plaque, if there’s a stenosis that’s greater than 40%, we call it the gray zone, between 40 and 90 percent stenosis, that’s called the gray zone. The question is, are those plaques that comprise of 40 to 90 percent stenosis in one of the vessels, are those ischemic? And does that patient then need to go to the Cath Lab? Now there’s more and more evidence that show that stenting lesions, depending on what type of lesion they are, don’t necessarily prove to actually improve anything other than symptoms. And so people are starting to move away from sending patients to the cath lab and intervening through stents and or CABG.
Because the fact of the matter is, it may just alleviate symptoms for patients that are experiencing symptoms, but it doesn’t actually improve things. The things that does improve is natural supplementation, pharmacological pursuits if needed, and then just lifestyle. Lifestyle is the biggest thing. The last thing I’ll add to that is it’s been 10 years since [00:39:00] FFRCT has come out and cardiovascular disease has not improved.
Hey, so when lifestyle is spot free, it may be reattacked, re approved. What’s the time exactly? It really will. Now, it’s interesting. I say this anecdotally. Because it’s difficult to put it in from a study perspective however, we can give you example after example of individuals that may be slightly overweight and, or simply aren’t exercising, or aren’t getting enough sleep, or aren’t, or are just too high stress, they’ll obtain it clearly, they’ll obtain it clearly a year later after losing 30 pounds, or whatever it might be, and the amount of Maybe not necessarily plaque transformation, more so maybe just the slowdown of actual plaque formation.
Is there anything else you should be aware of? I would assume so. I don’t know 100% the answer to that question 100%, but I would assume so. If you’re not getting good sleep, then it’s going to be affecting the [00:40:00] cardiovascular. Yes. So, what locations do this test? So, another, another great question. So, from a Southern California perspective, we’re very, very lucky. We’ve got a ton, from Santa Monica, to Beverly Hills, to Torrance, all the way down the coast into San Diego. So, again, that would be a great question. Just reach out to me, say, Hey, I have a patient in this location, where do I go? None of the out of hits, though, right? We do have, we have we have Northridge, Westlake Woodland Hills, got a lot of spots.
Yes. Can you talk to us about her background, too? Sure. And she told me that she cares about it. We’re close. We’re hoping. Yeah, we’re really, really close. We’re hoping by January 1st. Yeah. Lots of questions, but how much time do we have left? Maybe, maybe we’ll take the rest of the questions offline?
We’ll check. Let’s get started. Sounds good. Of course. Thank you. Let me get this up. I do. That much. Do you guys have this [00:41:00] list of evidence each who had plaque reversal? Yes, we have. I will tell you that amongst the blockbuster pharmacological pursuits that the doctor just spoke about anecdotally, PCSK9 inhibitors.
Okay. So your Repatha and then you’re new with Veo. The PCSK nine inhibitors are pretty much the only medications out there right now. that people are seeing actual regression in disease. Once you have the indices, currently with what we know, regression is not the goal. Transformation is the goal. It all starts off as soft black, or transform it into the calcite. Do you get regression? Do you get the start? Yes. That potential solution. Oh, thank you so much.
Dr. Weitz: Okay, great. So, there’s a couple of tests that some doctors like Dr. Mark Houston I mentioned him, he’s my mentor he uses a test called EndoPat to measure endothelial function. And there’s also one man using for his office called Pulse Weight Velocity. And then another test that’s often done is Carotid Ultrasound. And there’s actually two different tests. There’s the Carotid Artery Ultrasound, and there’s also the Carotid Intermedial Thickness. The ultrasound better predicts events but the Carotid Intermedial Thickness can better measure the thickness of the plaque but it’s measuring it’s measuring the the artery in the neck, not the artery in the heart.
So, anyway, so here is an advanced lipid profile, so we’re doing good on time. Really happy. I think, I hope I have been talking too fast. Okay, great. So, this is a Boston Heart. This is one of my patients. [00:43:00] So you can see here where there’s LDL-P, which is the particle number and small dense LDL. These are both somewhat elevated.
We still, there’s a lot of controversy as it relates to HDL. So HDL is a, so-called good cholesterol. And the reason why it’s called the good cholesterol is that ideally, HDL can do reverse cholesterol transport. So, once the cholesterol in the body is produced in the liver, and then some of it makes its way into the artery, the HDL can take the cholesterol from the artery, bring it back to the liver, which is reverse cholesterol transport. But, it’s, we’re still trying to figure out, how do we know that the HDL is doing what it’s supposed to do, and just having a higher HDL doesn’t necessarily mean that it’s going to happen. Having low HDL is not good. So, one way to look at it is to ook at HDL particle size. The latest data seems to show that all the different HDL particle sizes can be beneficial. So Cleveland has a test for HDL functionality, so that may be the direction we need to go. Boston Heart uniquely has this test that looks at whether or not you’re a cholesterol absorber or a cholesterol producer. So here we have a patient who’s a high cholesterol absorber. So this can help you with your strategy potentially. So, for example, on a natural front, you could use Berberine or you could use plant sterols, which help the block cholesterol. If the person’s a cholesterol producer, then you want to think more about red yeast rice, tocotrienols, and some other compounds on the drug front. If they’re a cholesterol producer, you should be thinking about Statins, PCSK9 inhibitors. If they’re a cholesterol absorber, you can think about Zetia.
So, some of these are other markers. This is 5 percent of markers for inflammation in your arteries. So we always want to look at HsCRP, this marker, LpPLA2, and MPO, myeloperoxidase. Interestingly, we had a number of patients with mild COVID. We found a lot of patients with elevated MPO.
And I think this is a marker of inflammation. That occurred as a result of inflammatory, so, obviously looking at glucose and insulin. I know a lot of doctors don’t look at insulin, but it’s so important. If you’re managing your glucose, but you’re having to use a lot of insulin, obviously you’re developing insulin insensitivity.
Here are a few genetic markers, so, this patient had a one copy of Apo E4, and that put him at risk. This is actually a guy who came into a really good chain, at 40 years old he was fortunately following I think what’s wrong, nutritional program for him, which was he was doing more of a Keto Paleo type of diet and he pulled a group of coffee, and he ended up having a heart attack at 40. Yeah, it wasn’t a severe heart attack, but, it was a wake up call. And so, ApoE4 probably is one of the risk factors. This is a test to see if you can tolerate satins or if they’ll be effective.
Omega 3s, everybody should be measuring Omega 3. We try to get the Omega 3 index above 10. I myself, I take 6 grams of DHA a day. I take it with tocotrienols to prevent the oxidation of the polyunsaturated fat. Let’s see.
And I have Q10, HOMO 6, HOMO 12. So this is a panel we run for Vibrant Health. It doesn’t have all the markers we want. They don’t have LDL P. They don’t have a few of the other things I would like to have. But, Vibrant Labs, Vibrant America Lab, I don’t feel familiar with them. Like, they’re a great lab for functional medicine practitioners because they’re kind of a one stop shop. There’s not much you can’t get from them. They have some great toxin tests, they have all the gluten sensitivity tests. I put together a panel, I have set up a male panel, a female panel, and then we modify it. And so, this is the advanced lipids. This is the inflammatory markers right there, so you can see this patient has [00:48:00] elevated homocysteine and IHS CRP, that should be below 1. Unfortunately, they don’t have Lp, but Lae, Lp, or a small Nth Lp out, so that’s good. Insulin resistance, you can see that here with insulin 16, they have hemoglobin, you can see 6.
2, full fiber, more hormones but I’m not going to talk about all this. Uric acid, we’re always looking at uric acid dispersing it to the Lp, uric acid. So, There are a bunch of natural supplements that can help lower uric acid. According to David Perlmutter, if you want to get your uric acid below 5. 5, So, technically over 7, it tends to increase significantly your risk of gout. That’s probably what you’ve heard your [00:49:00] cat say, mentioned before.
IGF 1, that’s an interesting part of SOFR 1. In Japanese, IGF 1 is agropoxy for growth hormone. So, you don’t want your IGF 1 to be too low. But we supported this model long ago. If your IGF 1 is too high, And that increases your risk of cancer. But, his view is not one I necessarily agree with all of it.
He also recommends a lower protein intake. But, he said, Zach, you want to keep the IGF 1 below 175. Make a trace. And so, this is a core area Janssen scan. This is something that’s a live plant. A live plant. We don’t make everything there.
This is one of Howard’s slides, I think so his patients, as you [00:50:00] can see, they have a lot of inflammation, HSCRP, they don’t have enough nitric oxide they have a lot of slow hits, LDL, low HDL, so this person really is at a lot of risk, so it’s looking at all these different factors, not just one thing, and when it comes to ApoB, They have a perfectly healthy able P of 59.
So if, we’re gonna follow Peter Attia’s recommendation for just focus on ApoB, but unfortunately it’s not enough. We need to look at more markers. So that’s one should be all want that very high homelessness needs. So this really has a lot of risk.
And this is part of by, in the heartland, we got people to translate these, [00:51:00] to get into the operative machine. Now you can see it even slower. But it was changing so much now. So that’s one H2, Camp, Spinetop, and Chinkosan. Okay, how do we reduce Cardiac Coronary Heart Disease? So, from a lifestyle perspective we’re obviously stop smoking, healthy diet, and we’ll talk about some of the ideas of what the most heart helping diet is. Exercise, everybody should be exercising, everybody should be doing some form of resistance training, everybody should be doing cardiovascular training, everybody should be doing stretching, everybody should be doing balance training.
You’ve got to reduce the [00:52:00] visceral adipose tissue around the heart and the organs, that’s most associated with cardiovascular disease. Sleep, super important. Gasting is beneficial. Hormones I’ve become a believer in that we should try to have optimal levels of hormones. And I do think that the research shows that when you take bioidentical hormones, you’re healthier.
Or as you can see, I am a specialist for cardiovascular risk it’s a reason why we can have a lower risk of heart disease a bit later on and increase the depth of that cause. What about testosterone? Well, there’s some controversy about it, but A lot of the data seems to show that testosterone, say as long as you carefully monitor, the thing that can happen with testosterone is you start producing too many red blood cells, hemoglobin, and that goes out.
If that happens, your blood gets thick and stickier. And that’s not a [00:53:00] good thing. So everybody takes testosterone monitors in. But I think for men if everything else is healthy, you can have a good testosterone level later into life. For example, I’m 66 and my testosterone level is 1000. So I never take testosterone.
Alright, so we have the modified Mediterranean diet. Mediterranean Diets. I think it has a lot of research to be done in why it’s a Mediterranean diet. Extra virgin olive oil, super beneficial for cardiovascular health. Of course you gotta get Duplain. Olive oil, and that’s a whole thing. I had a whole podcast about how to select the right olive oil.
It’s been penetrating diet, I have to say. It’s lots of vegetables, fruits, legumes, even though I’m not touching them, do you see it? No. Fish, is red wine beneficial for the [00:54:00] heart? Generally don’t think it is. But for a while, it was the French Herodotes, I think. Drink a lot of wine, have healthy hearts, and it gives the benefit that the Red Queen, Red Wine, can increase HDL levels.
So, right now, everybody seems to be down on Red and White Maybe, maybe there’s some benefits by consuming a lot of alcohol, I mean, the poor folio diet, there’s several studies using this particular diet as a way to reduce risk of cardiovascular disease, and it has specific components. that have been known to help have more favorable lipids, and those are specifically soy plants, cereals, nuts, and soluble fiber.
Soluble fiber was a big thing for a while when you had to eat oatmeal because of soluble fiber. I do think that fiber is super important. It’s [00:55:00] probably not because of the fiber, and by the way, this is coming directly from Dr. Musi, because the fiber belongs onto the cholesterol and T synaptic system, but rather the fiber has a beneficial effect on the microbiome.
that decreases our risk for heart disease. And we’re learning more and more about the importance of the microbiome. For example, the most popular drug for diabetes is Hormin. And how does that Hormin work? You can figure it out. And a lot of the data seems to be pointing out that Hormin has a positive effect on the microbiome.
And, by the way, Berberine is a natural version of that Hormin. And it works largely through the microbiome. Lower carb diet can be beneficial especially for patients with insulin resistance and diabetes. There’s some data on vegetarian diet and, a lot of people swear by vegetarian diet [00:56:00] and for some patients it’s going to be the best choice for them.
I’m trying not to get beat up by eating something when I get out of here. I’m just kidding. So, when it comes to overall dietary recommendations, we certainly want to avoid sugar and high glycemic carbohydrates. So those are carbohydrates that cause a huge spike in blood sugar, things like bread, cookies, etc. etc. Ultra processed foods. Somehow we came from junk foods, processed foods, now it’s ultra processed. Like, ultra processed foods are not good. Despite the fact that the U. S. Dietary Guidelines, the folks that made the U. S. Dietary Guidelines came out with something poor like several months ago saying, there’s no food, and ultra processed foods are not healthy. Okay formula of all health a number of foods that will help to manage [00:57:00] livings.
We know that nuts are super beneficial. There’s a few plants that I use. I have a whole bunch of different nuts. Almonds, pecans, walnuts. Walnuts also have some, magnesium in them. Nuts and seeds are super beneficial. I like to add flax seeds. Thanks. Buy the flaxseeds organic and store it in the fridge or freezer and grind it yourself.
Because flaxseed oil is very highly oxidizable, just like fish oil is, so you don’t want to buy random flaxseeds. And they’re most likely to be oxidized because it’s been stored for a while. But Flaxseeds are super beneficial for a lot of things. So, in, so, in the functional medicine world, there is some doctors that have written some books about sodium, say, There’s nothing to worry about with sodium salt, it’s not a risk factor, eat sodium, eat plenty [00:58:00] of sodium according to Dr. Houston, who I trust, salt is absolutely harmful to the vascular system, and generally speaking, we want to keep our sodium down, and we want to keep our potassium and our magnesium up, and it’s not just because it’s Increases blood pressure, but it damages the arteries, makes the arteries stiffer. This is coming from Dr. Houston. I’ve seen some data on him as well. I trust what he’s saying. So, we want to make sure you’re getting lots of potassium and magnesium. Potassium, shoot for at least 5 grams a day, and probably at least 1 gram a day of magnesium. Keep your blood pressure low.
What about eating fat? I can’t necessarily solve all these controversies, but Trans fats, for sure, we know are [00:59:00] not good. Don’t eat trans fats. Omega 3s, we know are good. Monounsaturated oils, like olive oil, we know are good. Everything in between, there’s a question that’s up. The data seems to show a modest amount of ants is healthy on a weekly basis.
What about coconut oil? I think a lot of us in the functional medicine world feel that coconut oil is a healthy oil. I know when I was cooking my vegetables with coconut oil, my small pants helped me out a lot. So I stopped, I switched to avocado oil and variety cooking, according to Dr. Houston, coconut oil is not good and the reason why is because it has long chain saturated fat.
So, what about saturated fat? That’s the big controversy. Saturated fat ban was being contributed to heart disease. Well, [01:00:00] it depends. Saturated fat actually is there’s a number of types of saturated fat. So here are saturated fats with 12 or more carbon chains that are known as long chains. Saturated fats. Those are more correlated with heart disease. Medium gene, 12 12 carbons or less, and extreme gene saturated fats are not associated with heart disease. So, what happens when you take patients and you say, Let’s remove the saturated fats and let’s substitute something else. So when you substitute polyunsaturated fats, the risk of heart disease seems to go down. When you substitute carbohydrates, especially refined carbohydrates, the risk tends to go up. There’s going to be meetings that are not going to be happening. Epidemical might be the way to [01:01:00] speak at them. I’m done. He has plenty of medications, it’s carb rich, and we have prescribed medications, but we need to be aware of them. Fibrates are drugs that were popular, they’re not that popular, my understanding is, among cardiologists but it’s a way to reduce cholesterol. Most of the cardiologists are going to be recommending statins to start with. There’s water soluble, fat soluble statins, That sodium or statins seem to be more effective and better tolerated, generally speaking. So, those are Suprastat, Crestor, and Propastat. Zetia is a drug, I mentioned it before, it helps block cholesterol absorption. It doesn’t have the side effects the potential side effects of statins.
So, Zetia is a drug that can either be added to a statin, or patients who are intolerant to a [01:02:00] statin, don’t want to take a statin, and still want to take a medication you can do a combination of Bempedoic Acid, which is the neurospinal neurostruts, that helps the lower lipids, and combine that with Xetia, and get a really good effect.
Problem with endodermal gassing is that it’s expected to be very nutritious and useful for recovery. Of course, aspirin. We know that clotting is a factor, so, I think thinner blood is probably good, like, which would be two things, so, taking an aspirin, which is recommended for everybody, like, some patients have bleeding, and so it’s not good for them, so, not an idea. From a natural perspective, if you take enough fish oil, I do prevent adrenals, uh, you blood is likely to be thinner, take a [01:03:00] lot of curing as well.
Uh, you can use that kinase, hydrokinase, natural blood thinners, uh, so everybody’s talking about GLP 1 agonists like Ozembic. And, uh, everybody’s thinking of the weight loss, as you saw Oprah last night, looks like a totally different person. Um, they, they really work for weight loss. What are the side effects going to be?
I think there’s going to be a huge number of side effects because of slow GI motility. That’s one of the ways that they, uh, help with weight loss because people don’t get hungry because it sits in their stomach. Uh, so. We’ve, I know in my practice, we’ve treated a lot of patients for gastrointestinal problems, like SIBO, reflux, and decreased motility is a big problem, [01:04:00] so, uh, Dr. Pimentel has said that testing patients for SIBO, or on these drugs, is just, uh, is horrible. The microbiome is all messed up. We used to do IV chelation. It’s still done in some clinics. It’s a way to naturally reduce your cholesterol levels. Um, but I don’t think it’s done that often anymore. Did you see, um, here at CNN’s most recent article, it was talking about, which surprised me, how he, and I guess it was supported by evidence, I don’t remember the exact quote, but that PCSK 9 inhibitors and statins.
He was supporting young. Oh, a hundred percent. I guess he did. Peter Dean says, uh, he said on what this podcast said, we, you get your, uh, your a OB above 40 or like your LVL below 30 will eliminate cardiovascular [01:05:00] disease and doing it, whatever means necessary, which means stat, PCSK nine inhibitors, et cetera.
So, I showed you a slide where a person had a good April 8th, but they had a lot of small events, they had a lot of information, so it’s, in my opinion, it’s the whole picture. It’s not just one market. It’s, it, it takes one, just one market. Alright, Stats, uh, um, so, uh, Stats, uh,
I think in a functional medicine world, we tend to think that statins are absolutely the worst thing in the world, and everybody has side effects. Um, I know a number of doctors will say that 20 percent of their patients are on statins and muscle pain. Uh, according to studies by the big pharma, [01:06:00] it’s like 1%.
It’s definitely 1 in 1%. Uh, I don’t know if it’s 20%, it depends. Uh, there are studies where they give people a placebo instead of a statin and they get muscle pain. Uh, so, it’s hard to say, but there are definitely a percentage of patients who are intolerant to statins. They usually can tolerate Red Yeast Rice and other agents.
Um, one of the things that is happening still is they actually stabilize plaques. They dry out some of their cholesterol, they tend to calcify them. So, as I mentioned, I think a lot of us see calcium and all my god, that’s the worst thing in the world. But, uh, a stable plaque gets better than a soft plaque.
So, That may be one of the mechanisms by which statins are beneficial. Uh, I, I actually heard the, [01:07:00] uh, with the doctor from your company, uh, Joel Kahn’s podcast, and he was saying you can’t reverse plaque, but that if you, uh, calcify it, it will look smaller, and, and that’s what’s really happening. According to Dr. Busey, you can’t reverse plaque, and there’s a number of studies that have shown it, and, and that’s what’s happening. Uh, I guess we’ll, we’ll keep working it and find out. Um, for sure, SACWIS inhibits quite a number of nutrients that won’t be produced along that pathway in that SACWIS blot. We all know about CoQ10, so everybody who’s on the SAC should be taking CoQ10, absolutely.
CoQ10 is super beneficial to the heart. And often in higher dosages, Joel Kahn on his podcast said that, on average, he is prescribing his patients 400 and sometimes 800 milligrams a day of OQ10. [01:08:00] Um, it also can be in sex, also can be in production by eating, maybe some fats, so Trinols, Carnitine, 5K, um, medical interventions.
Thank you. As we heard earlier, neither stents nor bypass surgery, if the patient is stable. So if the patient’s got a blockage in the midst of an event, they open up the artery with a stent, that’s different. But if the patient is stable, they get a stent, they get a coronary bypass surgery, it doesn’t reduce your risk of death.
Alright, here we go. This is good stuff. You wanna take a picture of this slide? I got several of some rice. It, the same pathway. It’s often [01:09:00] un under, uh, underused, uh, under dose. So I just had a patient in my office yesterday. Uh, he was intolerant to, uh, stat. His cardiologist put him on Reggie’s rice, but they put him on 1200 milligrams.
You’ve got to do at least 24 milligrams a day if you want it to be beneficial. Sometimes it’s 48, that’s taken at night. And that’s usually when they prescribe the sac as well. Tocotrienols, when taken with Red Yeast Rice or a statin actually improves the effect. Are you familiar with tocotrienols? Tocotrienols are a form of vitamin E and vitamin E is a family that includes tocopherols and tocotrienols. So tocotrienols have some unique properties. [01:10:00] So I’m a big believer in Toco tree. And why Statin at night? Um, because body tends to produce together, tends to produce cholesterol at night.
Um, Niacin, as I mentioned, Niacin is maize nutrient that has all these benefits for cardiovascular health. So, Niacin is one of the few ingredients, as I mentioned, you can lower Lp, but why? It can increase HDL. It’s one of the few things that can take LDL particle and make it bigger. We use modest doses, just like 500 milligrams, and at that level, you You know, there’s very few potential side effects.
It was common for Cardiologists to prescribe niacin. Typically, they would be using 2 grams, sometimes 3 grams. And at that [01:11:00] level, sometimes there are some side effects. Of course at any level you might get some flushing, but flushing is not harmful. Plant sterols are another good supplement that inhibits cholesterol absorption that will do one than three grams a day.
Berberine is an amazing supplement for cardiovascular health. One of the few things that has been shown to reverse plaque you, but studies, uh, and as I mentioned, , uh, natural metformin. It’s also a natural PCSK9 inhibitor. This study showed a 3.2 percent reversal of plaque in 4 months. Just think of Berkeley. Citrus Bergamot is another one to add.
If you have a patient on Red Yeast Rice and you’re not getting an amount of improvement, you want to add Citrus Bergamot, Omega 3 fish oils, [01:12:00] super important. Um, despite some of the studies that are coming out of the New England Journal of Medicine or the AMA Journal, ever notice that Um, there’s like a hundred studies that have come out over the last several years on the benefits of fish oil. But the two that show that fish oil is not beneficial or harmful, those are the ones published in the New England Journal of Medicine. So, I think there’s just overwhelming evidence that omega 3 fats are beneficial.
Question: What do you think of krill versus a combination of fish?
Dr. Weitz: So, my understanding is, is most of the data supports a sufficient amount of Omega 3. At least 2 grams a day. You wouldn’t have to take like 25 krill capsules to get 2 grams. So, unless you, unless you want to take that much, I say get a good quality, high dose of fish oil, 1, 000 milligrams, [01:13:00] tributyls, or more. Raman Sulfate or Fucoidan Sulfate, so those are seaweeds that are included in specific supplements that can help to support the glycocalyx of the endothelium. And so, one of them is called Arteriosil is a very popular one. EndoGel is pro regenerative. Regenovasc, these are, uh, supplements that specifically are going to reduce your risk of coronary artery disease, help significantly with blood pressure. You also want to include a nitric oxide stimulator. Those are super important for blood pressure as well. I mentioned the importance of the glycocalyx producing nitric oxide. Nitric oxide is a gas that’s produced for a short period of time. We can use things like L Citrulline, [01:14:00] beet root extract and some other things that stimulate nitric oxide. Glucosamine sulfate. Glucosamine sulfate and chondroitin sulfate. These are popular joint supplements that have been shown to support the glycocalyx. So I mentioned the glycocalyx as opposed to proteoglycans. And it turns out there’s three or four studies showing significant reduction in risk. Look at this: 39 percent reduction in all cause mortality, 65 percent reduction in cardiovascular mortality from taking glucosamine sulfate. It’s amazing. I don’t know why everybody’s not talking about this. When I saw this study coming out, now there’s another study, there’s another study that came out last year. I emailed Joel Kahn and said, wow, is this real? He goes, [01:15:00] yeah. He goes, there’s three or four other studies. So, put all of your patients on glucosamine sulfate. Aged garlic. It can reduce soft plaque, it can reduce blood pressure. And Nattokinas, which is a natural blood thinner.
CoQ10 also helps. It’s, as I mentioned, it helps to lower LDL in the brain, it supports the heart muscle, mitochondria, part of our program to rebuild the patient with heart failure. It includes CoQ10, D ribose, L carnitine, and Iodocybin. Methylated D vitamins to lower homeopathy. Lycopene. improves HDL functionality, Dr. Houston developed a supplement with 20 mg of Lycopene and several nutrients for one of the components. [01:16:00] Uh, we wouldn’t want to use specific nutritional strategies. The lower LDL, LDL A, I think I mentioned, most of these, uh, What do you, what do you do about oxidized Lp? Uh, Yesin helps, so does popocranate.
There’s some supplements on the market that contain popocranate and some other, uh, antioxidants, resveratrol, citric ergomide, zirconianols, curcumin. I don’t do HDL functionality, I just mentioned glycopene, omega 3, and again, it’s a B vitamin.
So, here are some books that I recommend. Dr. Houston’s book. This is Jonathan Bowden’s book. Johnny is right here in our audience. Johnny is a very prolific author. Uh, he’s written like 15 different books. [01:17:00] He wrote this with Dr. Sinatra. Yeah, about a year and a half ago, actually, Johnny, Dr. And Dr. Sinatra’s son and I, we all did a tribute to Dr. Sinatra when he died. We did a podcast together. Um, so here’s a book by Dr. Sinatra. Here’s another book by Dr. Mark Huston. This is Joel Kahn’s book about Lp and LDL. Mark Houston has some amazing articles where he writes. There’s all these different supplements, the Cali Chloroate, warm supplements, uh, Ectoide Pathways.
So, great resource. You can take a course with Dr. Houston, teach us how for you for him. You should definitely do it. Um, so, thank you. Please subscribe to my podcast. Tell your colleagues about these names. We’re very educational. We get great [01:18:00] speakers. Um, and it’s, it’s, Costs nothing. It’s a great way to use your network. Uh, let’s get back to networking. Time to get back in person and support Integrative therapeutics. Thank you.
Dr. Weitz: Yeah. Okay. We have to leave unfortunately. Thank you.
Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. Thank you. 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, [01:24:00] 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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Ryan Smith of TruDiagnostic discusses the Tru-Age Test of Biological Aging with Dr. Ben Weitz.
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Podcast Highlights
3:48 DNA Methylation is the best marker we have to understand biological aging. DNA methylation is an epigenetic modification, meaning that certain genes are turned on or turned off. And methylation is the main switch for turning on and off genes. Some genes we want turned off and some we want turned on. DNA methylation is now very repeatable and the most predictive of ways to measure biological aging.
6:28 The History of Biological Methylation Clocks. The key factor to understand is what is aging, which is difficult to define? One question is, is aging a disease? If we recognize it as a disease, then our regulatory framework will allow there to be drugs to treat it. There are first generation clocks like Horvath and Hannum, and second generation clocks like Grimm Age and Pheno Age, and now we’re into third generation clocks. First generation clocks like Horvath were really designed to predict chronological age and they were originally designed for forensics in crime scenes rather than for health. But then they noticed that those who were younger than their chronological age, were protected from negative health outcomes, which was very exciting. If aging is a disease, then it is the biggest risk factor for every chronic disease and death by a large margin. So aging is important for our health.
Ryan Smithis the CEO of TruDiagnostic, who offer the TruAge test, which is the best commercially available way to measure biological aging by measuring DNA methylation. Their website is TruDiagnostic.com.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.
Hello, Rational Wellness Podcasters! I’m very excited today to be discussing biological aging, which is one of the topics I’m very passionate about. We need to, it’s helpful to have ways to gauge our biological age as compared to our chronological age so we can find out how we’re doing in our longevity quest. Are we on the right path? Are we aging slower? biologically than we are chronologically, which of course is the goal. And one probably the best way to do that is with methylation, biological aging tests, looking at DNA methylation, And the best commercially available way to do this is through True Diagnostics who offer the True Age Test.
And today we have Ryan Smith, the CEO of True Diagnostics to discuss biological aging and the newest variations of their tests that’s available that can help us not only to understand how good a job we’re doing with our biological aging, but perhaps with the newest version, giving us some way to figure out what sorts of diet, lifestyle, supplement, other recommendations we can make, particularly to help us improve that biological aging. So [00:02:00] Ryan, thank you so much for joining us.
Ryan Smith: Yeah, thanks so much for having me. I know it’s been a while since we talked about the topic and a lot’s happened.
Dr. Weitz: Absolutely. So let’s start from the beginning. How did you start True Diagnostics and, how did you get involved in the field of DNA methylation, biological aging?
Ryan Smith: It’s a long and convoluted path. Biochemist as an undergrad, becoming a med school dropout, after finishing all the actual educational material, I got to the clinical portion of my third year and really hated it and decided to do something different. Ended up creating a compounding pharmacy that was dealing in this sort of cash pay, preventative, integrative wellness space. And prior to that I had no idea that this existed, but I loved that there was a community focusing on preventative medicine in a true way. It’s certainly something always easier to prevent than to treat. And and so got really excited about that. Our pharmacy grew really rapidly. We were the fourth fastest growing company in healthcare. And then, but we always knew that we wanted to to test a lot of our products to see how they were actually to see how they were actually affecting health span and lifespan. And that brought up this idea of these biological age clocks as surrogates to see if they were effective tools to measure this process. I got really excited about that and I got excited about the potential applications of this biomarker, DNA methylation even beyond aging. So we basically sold that company in 2020 to start TruDiagnostic. And now we have our four year anniversary this week and as a result we have built the largest DNA methylation database in the world and have created a lot of new algorithms to be able to read the information we find in your epigenetics.
Dr. Weitz: Right. Perhaps explain what is DNA methylation and why is it a better marker for biological aging compared to other biomarkers? I guess some people use GRIP tests. We have VO2 max. In the past, it was a telomere length test, which I guess is still available.
Ryan Smith: Yeah, definitely. The so yeah, DNA methylation generally is what we call an epigenetic modification. So these are modifications above the genome which control your gene expression. So how much is a gene turned on and turned off? And the reason that we need this is because obviously all of our cells in our body have the same DNA, right? Our heart or our skin, our brain, the same exact DNA sequence, but they behave very differently, right? You want your heart cells to behave like heart cells and your skin cells to behave like skin cells. And to do that, they have to express different genes. So as your cells are going for. polypotent stem cells, which can do anything to the cell type that they’re meant to be, they’re doing it by turning on and turning off genes. And one of the mechanisms for that is DNA methylation. And DNA methylation really is the off switch that we sort of think about for some genes.
And so, DNA methylation in and of itself is not good or bad. Some, there are some genes we want turned off. There’s some genes we want turned on and different I would say abilities for each cell. And so that’s really what we’re measuring though, is from whole blood at True Diagnostic, what we’re looking at is all of those patterns of gene regulation, what’s turned on, what’s turned off, and we’re interpreting that for an outcome. And DNA methylation is probably the most frequently used biological aging tool mainly because it’s the most predictive. I think you mentioned some really great tools like VO2 max and grip strength, physiological standards that we know deteriorate with age. But generally, they’re not as predictive as some of these other clocks. And that’s really how we judge if a clock is effective. Can it be very predictive of outcomes? So if we’re seeing, for instance, 10 year age accelerations, does that mean there were worse risks for everything in the future? Or if we’re seeing 10 years deceleration, are we seeing that risk decrease? And that’s really what these clocks specialize in, is they’re incredibly predictive of outcomes. And so, and, they’re very precise now. So we can, measure the same sample and get the same result. And then now they also change with therapy and that’s really what we’re documenting as well. So we can actually show that these are responding to the things we already know improve biological age. So for all those reasons, they’ve become I would say a leading method in biological age quantification, mainly because they’re highly predictive.
Dr. Weitz: Can you explain the history of biological methylation clocks? I understand we’ve had the first generation clocks like the Horvath and the Hannum clock and then the second generation clocks like Grimm age and Pheno age and now we’re into the third generation. So can you explain a little bit about what this evolution in Methylation Clocks is about?
Ryan Smith: Yeah, definitely. Then, at the end of the day, it comes back to one question, which is pretty hard to define, which is what is aging, right? There are a lot of definitions for it where other people say, is it a disease or is it not? In these biological age clocks, we first wanted to
Dr. Weitz: Officially right now, it’s not considered a disease. Yeah. Yeah correct. So there are people pushing for that so that perhaps there’ll be insurance coverage or something for somebody diagnosed or wanting to utilize therapies to promote longevity.
Ryan Smith: Yeah, definitely. And so we can have drugs approved to treat aging as a primary cause. We can’t do it right now because it doesn’t exist in the regulatory framework. And the World Health Organization does have an ICD 11 extension code for aging to say a disease is caused by aging, but we can’t actually say that. Aging itself is a disease. And so there’s a lot of of controversy in this definition because there’s so many things that happen as we age. There’s sort of, multiple hallmarks of aging that change across our body. But also, the things that we would even just see while looking at a person, right? They’re, the wrinkles, the gray hair, all these different things. And so aging is sort of hard to define, but in order to create a surrogate or to measure or predict the process, we really have to start with some definition. And those definitions started in 2013 with Dr. Steve Horvath at UCLA, where he was creating just predictors of chronological age. That’s what we call those first generation clocks. So can we, by taking the methylation patterns of a blood sample, predict how old your chronological age is? And at [00:08:00] first, that wasn’t used for health. It was used for, forensics, to date how old someone was, if they left their DNA at a crime scene, or to date refugees, to see if they were adults or minors, and therefore eligible for asylum. But then they started to notice a really big pattern, which is that those people who with this testing were younger than their chronological age, were protected from health, negative health outcomes. And vice versa, those people who were older with this testing were at more increased risk for negative health outcomes. And so even though it was meant to be a chronological age predictor, it was sort of measuring some biological function that was predictive of outcomes. And that’s why it was so exciting.
It’s for the first time, We might’ve been able to measure the aging process molecularly that could then, tell us about outcomes. And the reason that this is important is aging is the biggest risk factor for every chronic disease and death. If you can think of a disease, aging is the biggest risk and not by a small margin. We’re talking about 90 percent of the risk of Alzheimer’s is related to age. Right. You can, and even things like, smoking and obesity, which we know are bad for us, pale in comparison to the relative risk that age is for most of these diseases. So age, we know this dysfunction, which happens with age, no matter how you define it is incredibly important to our health.
And so, whenever they started to see this molecular signature in 2013, it got people really excited. But ultimately it’s a little bit flawed, that definition, because we really don’t care about your chronological age, right? We know people in their eighties, who look 50 and we know people in their fifties who look 80. That’s sort of the process we want to measure, right? We want to be able to predict what negative outcomes are going to happen. So you can maintain the most optimal function. And so the second generation clocks, instead of being trained to predict the chronological age of an individual, we’re trained to predict biological features. So things like blood based biomarkers or in the case of probably grim age, one of the most popular algorithms it was trained to predict time until death. And time until death is a good surrogate for longevity because it’s a clearly defined outcome and, but it doesn’t take into a lot of other things.
Dr. Weitz: By the way, just stop for one second. Explain [00:10:00] what you mean when it was trained to predict time to death. We’re talking about using artificial intelligence. Is that how we’re training it? What do we mean by training it?
Ryan Smith: Yeah. So all of these algorithms have to be trained. And so generally what we’re doing is we’re taking methylation data and we’re telling an artificial intelligence system to take in this information and create a tool that can predict X that could be chronological age. It could be how much you’ve smoked across an entire lifetime. It could be, do you have COPD or not have COPD? It could be, a wide majority. of things, but we’re training using artificial intelligence to read these patterns to predict an output. And and so that, that output again, originally was chronological age, but the, in second generation clocks, it became biological function.
So whenever these things are trained to bring time until death, what they’re really doing is looking at a group of samples that have been taken over the last 40 years and where we know where that person has passed away and then seeing if it can [00:11:00] predict. how long until a sample passes away. And and even our newest clock, Omic age that we just developed with Harvard is about 92 percent accurate within a 10 year time period of predicting death. So we can predict death within a 10 year time period with really good accuracy, even over 75 percent within a four year time period. And so, we can get quite accurate at predicting that as an outcome. There’s been a lot of criticism of methylation clocks that they don’t really help us predict it very accurately.
Dr. Weitz: They don’t really add much to it. There’s been a number of articles criticizing it. And you hear some of the prominent people in the health world saying there’s really no benefit. But But I think as these clocks are developing, they’re overcoming, I think, a lot of these initial criticisms.
Ryan Smith: Oh, exactly. And I think that we do not shy away from the criticisms. I think that they’re valid. And in fact, I think [00:12:00] that we like to point them out because some of the, knowledge that we’ve gained from those clocks are no longer relevant and we need to sort of advance. And so, there, there are quite a few issues that have happened with the clocks previously. The most I would say the biggest issue has been precision of these clocks, as I think you mentioned. If you take the same sample and then retake that same sample and perform an analysis, how close are those results? And even with the Horvath clock originally, it had a mean absolute error of right around 3.
9 years which is. Not helpful a lot of times, right? Because if you’re doing within a period of four years are you sure that’s technical measurement change or just because of your biological change? And ultimately we, we don’t want something that changes with the wind. We want something that is really good at predicting outcomes based on your own independent biology.
And so, so that’s been one issue that’s certainly been fixed. One other big issue is. do they respond to interventions we already know are beneficial for aging? So for instance caloric restriction is probably the most well validated therapy across animals and humans [00:13:00] to improve health span and lifespan.
But whenever we do this analysis with the epigenetic clocks, we see those first generation clocks we talked about, trained at chronological age, actually go up, which doesn’t make a lot of sense, right? And so these newer generation clocks do respond to what we would expect, But some of that first generation clock, again, is giving us bad data.
And it’s not just caloric restriction. It’s also things like senolytics, like disatinib and quercetin go up with first generation, but go down with the newer clocks. And so, that’s also been an issue. And again, you don’t want to put a tool in someone’s hands that gives you the wrong data. Otherwise you’re acting against your own self interest.
So those should have certainly been there. And then probably the last of those big issues is this idea of what do you do about it? And that’s ultimately. Yeah, the important part, right? Yeah.
Yeah. I’ve run the test a few times in the past and that was one of the big questions is, okay, so I see this rate of aging, it’s either good or bad. And then, there’s no in, from the initial part, it’s a version of the test is really, was no way to say, [00:14:00] okay, here are some of the things you need to focus on to improve that biological aging in this particular person.
Ryan Smith: Exactly. And, that the question is, if we’re going to recommend caloric restriction to everyone, regardless of how they score, do we even need to test in the first place? Right. It might make people more motivated, right. If you have a bad score, they might say, Hey, I need to really do these, it’s a, to have a lot of effort into this, but ultimately that’s been a huge limitation in the past as well is, you and I might be aging much differently, right. We might have someone who smokes who has, their lungs are aging, their cardiovascular system is at risk, whereas we have someone else who maybe is a little bit overweight, doesn’t exercise, they might have more musculoskeletal aging or metabolic aging, and so this is different in every single person, and being able to identify the why we might be accelerated in aging or decelerated in aging is important because then it helps us to Set A Proper Protocol To Improve Our Health.
And previous to really I would say September of last year we didn’t have any tools which could provide that resolution. Now [00:15:00] with some of the newer clocks particularly the Omic H clock I referenced earlier as that death predictor that we developed with Harvard and then now the Symfony AH clock that we developed with Yale, those are able to provide some actual individual resolution to then tell you maybe what would be the best recommendations for treatment time.
Dr. Weitz: You mentioned senolytics and that’s one of the 12 hallmarks of aging. How well does your test correlate with those 12 hallmarks of aging?
Ryan Smith: Some of those hallmarks are hard to define as well, right? We might, some of those, for instance, like nutrient dysregulation, sensing dysregulation, or proteomic dysregulation. Those are hard to define. And and even to have that data in match cohorts can be difficult. If we look at some of the ones that are easier, like telomere attrition, for instance, or senescence burden it can be a little bit easier. And so for instance, we see that really, although telomere length is extensively validated it’s got, over 20,000 studies on being a feature of aging, it’s really not that predictive.
It, it really only explains in a study in [00:16:00] Generation Scholarland, 2. 8 percent of the variance in aging whereas those methylation clocks are now over 60%. So as we’re comparing them, there’s some biomarkers that we would prioritize to be more important, and that would be certainly the methylation clocks over things like telomeres.
In the case of senescence is a wormhole to go down into because we’re about to publish this article with Yale that, that actually shows that even Senolytics. don’t actually change the epigenetic methylation signature of cells after they’ve received similitics. And we’ve tried to create some surrogate predictors of that process.
Dr. Weitz: What is, what does that mean?
Ryan Smith: Yeah, we don’t know. But but generally we don’t think we can act with DNA methylation alone adequately capture I would say senescence signature is very well, at least at the moment. That doesn’t mean that senescence is not impacting the methylation clocks or correlated with those clocks. They certainly are. That’s why we saw this additive inquisitin improve the epigenetic clocks, but it’s probably through a different mechanism, such as reducing the inflammation that’s oftentimes associated with senescence. So DNA methylation I think it’s still good at predicting [00:17:00] outcomes of aging, maybe not directly good at predicting those individual features like senescence, for instance.
Dr. Weitz: Or, maybe those hallmarks of aging aren’t maybe the exact right hallmarks of aging.
Ryan Smith: Yeah, that that’s one thing too, and and with all of these things, one of the big issues is we don’t know what’s causative or correlative, right? So we can pick up these signals that are associated with aging, but we don’t know which of those signals are causing, dysregulation versus a result of it. And so that’s something else that will be elucidated in these further years to make these clocks even more accurate and more usable.
Dr. Weitz: So now tell us about the Omic age clock that you’re using now.
Ryan Smith: Yeah. So we really have, I would say three clocks in our testing that we think are the best clocks to use. That would be the Omic age clock. As I mentioned, that one is one we developed with Harvard. And we did this with the idea that the clocks get better when you feed them more biological data. So we’ve started with, Morgan Levine’s, first second generation clock used nine blood [00:18:00] based biomarkers. And now as the clocks have started to improve the idea is that the more information you can feed this model, the more it can pick out what’s relevant. And whenever we first started, there were nine hallmarks of aging. Now there’s probably 15 to 19, depending on who you ask. And so one of the things we wanted to do with this cohort was measure everything. So we did, we measured in about 5,000 patients. We measured full genome. We measured the epigenomics. We did some RNA and transcriptomics. We measured, over 25, 000 proteins.
We measured over 7, 000 metabolites. And then we had all of their clinical data as well. And we put all of this together in one big model to predict time until death. And so that’s what the Ohmic Age Clock is. It’s probably the clock that’s been trained on the most biological data. And and trained to predict death as an outcome.
And it’s quite good at that. It is up there with grim age as being the most predictive clocks of mortality. So if you’re really interested in mortality, specifically in living longer, this is a great clock for you. But we include some features in it, which are able even to predict your blood based biomarkers. So we can tell you about your C reactive [00:19:00] protein or, your HbA1c or your fasting glucose, which can give us more of that resolution on what to do about it.
Dr. Weitz: So we see that you’re talking about predicting the C reactive protein without directly measuring the C reactive protein.
Ryan Smith: Exactly. Yeah. We call those epigenetic biomarker proxies. And in the case of C reactive protein, our predictor is actually even just a better biomarker than C reactive protein across the board. We have better hazard ratios to every disease and more significance which means
Dr. Weitz: Really? This is fascinating. So what are you seeing is you took patients, measured their C reactive protein, measured and looked at their and then found specific patterns of methylation that correlated with those biomarkers.
Ryan Smith: Absolutely happens. Okay. Yeah, definitely. And and so this is sort of how I, for anyone who’s not watching and it is listening, you can refer to the YouTube for some of these images I’ll show really quickly, but yeah, we measured all of [00:20:00] these proteins metabolites and clinical values.
And we said, Hey, can we predict these with DNA methylation? And in the case of CRP, we certainly see this. This is data from a lithiathin birth cohort where we don’t see a trend of aging with regular CRP, but we do see a trend with aging with our DNA methylation predictor of CRP. In addition to that, we see that our predictor is more precise, meaning it’s more repeatable.
In measurements, we see associations with cognitive function we don’t see with regular CRP. We see here is brain MRIs, where we look at DNA methylation CRP versus regular CRP, and we see that our DNA methylation version is 6. 4 times more predictive of brain outcomes than regular CRP. And here you can see that sort of the effect size and significance is higher in all of these different outcomes of CRP, BMI, cardiovascular disease, diabetes, all better than even regular CRP.
So we see that and we can actually see what genes are affected in this process. So the high highest weighted gene in our algorithm comes from the SOC three gene, which is a suppressor of cytokine signaling which makes sense, right? A [00:21:00] as this gene is affected, our levels of cytokines and inflammation, it’s gonna be affected.
And so with DNA methylation, we can actually predict these other biomarkers, all with just a simple finger stick blood measurement. And we incorporate those into our models. They can tell us why we’re aging faster or why we’re aging shorter.
Dr. Weitz: Fascinating. So if I was working with a patient who has signs of cognitive dysfunction, how could I use your test and then make changes to that patient’s diet, lifestyle, et cetera, and then use that test again to see if we’re, Improving that brain function.
Ryan Smith: Yeah. I think that’s an important thing to mention is that if you have a patient who already has a disease, we know that aging is going to accelerate that disease process, but sometimes it’s not the most important thing, right? If we have someone who’s diagnosed with diabetes, we’re generally going to say, Hey, fix your HbA1c in your fasting glucose, don’t fix your aging. Right. So a lot of times, once we [00:22:00] get to disease, this is a secondary consideration manage the disease, but for people who are looking to prevent. disease. So let’s just say someone has Alzheimer’s or a history of neurodegenerative disease in their family. We know that 90 percent of Alzheimer’s risk is age. So this is absolutely something someone should focus on.
Dr. Weitz: Yeah, let’s say they have one or two copies of the APOE4 gene.
Ryan Smith: Yeah, exactly. And so the idea would be that the lower that you can get your biological age, the lower your risk of developing early onset Alzheimer’s or any type of dementia. And we know that from multiple association studies. These DNA methylation clocks, there’s now been over 2000 studies published on these DNA methylation clocks and outcomes. And generally you can find ’em connected to all outcomes. And so the idea would be that we’ll test, see where you’re at, and then make recommendations on how to improve that.
So for instance, let’s just say that you see someone come in, we give them a omic age, we tell ’em that their age is two years older than their chronological age. So they might be. 47 biologically while being 45 chronologically. They’re accelerated aging and we [00:23:00] would want to fix that. So we might recommend things to try and get that down.
Some of those things are pretty intuitive and the things that we know already work for optimal health, right? Exercise, proper diet, nutrition, reducing stress, getting the right amount of sleep, right? Those things are not. Terribly innovative, but they also work, right? And when they work, we see it reflected in reduced ages.
And then so we have that, but we can also make even, I would say, more exotic recommendations based on some of the studies we’re doing. Where hyperbaric oxygen will work, or young plasma would work, or senolytics would work, for instance and starting to make some of those recommendations as well. So, first you get a baseline, then we will try and implement protocols to reverse that process. And then hopefully as we measure it, we see you continue to reduce that gap and become younger versus your chronological age.
Dr. Weitz: Now, what about personal, personalized recommendations? So with all these things we have some guidelines, but there’s a lot of controversy. Which is the best diet for each person? Maybe one person’s going to optimize their [00:24:00] biological aging with a vegetarian diet, and the next person’s going to optimize it with any Mediterranean diet. And maybe, is there a way that we can use this testing to say, okay, for you, the vegetarian diet’s helping you to age better?
Ryan Smith:So, yeah so absolutely. And that’s where these newer algorithms come in. Those epigenetic biomarker proxies from omic age, for instance. So for instance, we might see someone who has really low carotenoid levels, right? Beta carotene levels. We know that beta carotene is associated with better aging across the board. All of these epigenetic clocks. And even just in regular meta analysis studies, we can say, Hey, someone has really low beta carotene. We need to encourage their consumption of beta carotene. Leafy green vegetables and carrots, right? To increase that metabolite, which we know is going to be, reducing their biological age, reducing inflammatory markers.
So we can absolutely make some specific recommendations like that. Some that are directly related to supplements, right? So, we have, even a metabolite called uridine, which can be supplemented and sold at places like Life [00:25:00] Extension to improve those markers. And so we can certainly make those individual recommendations based on Where you’re elevated and we know that elevation should be low, right?
So if we see your HgA1C is high, or your fasting glucose is high, we know that’s not good for aging. We want to get that lower. We’ll make specific recommendations for you. The other report that we just launched last week was Symphony Age. Symphony age is one we developed with Yale. And although we don’t report on individual biomarkers like hba one C or CRP, we report on aging of different organ systems.
And that’s so that we can actually, again, make more precise recommendations to say that your overall aging might look great, but. Your brain is aging really quickly. We want to try and improve that. So let’s pay attention to the tried and true methods we know to improve brain aging. And so one of the next publications we’ll come out with that same group from Yale, and because I keep mentioning them so much, I want to give them a direct shout out, which is Albert Higgins Chan and I would say his lab, which he took over from Morgan Levine.
Many people might know Morgan Levine. As a famous aging researcher, she’s amazing as well. They’ve created a great culture in that lab and are doing some amazing research. But one of the research [00:26:00] things I also wanted to give a shout out to a PhD student, Raghav Sehgal, as well. He is also doing some work here, but we’re about to publish a paper on 50 plus longitudinal interventional trials with all of the clocks analyzed.
And we’re really excited to do it because it’s a toolkit for both patients as well as physicians on how to best improve these clocks. And so we have some really exciting data coming out there. I’ll just give you a brief picture to show you some of this analysis. But here you can see some of the different analysis that we’re doing, everything from rapamycin to, vegan or healthy vegetarian guidelines. And we can show what clocks respond and in what direction to give you a cheat sheet. But the one thing we find out is the three best clocks.
Dr. Weitz: And of course, I see you, you got Ozembic in there. You got semiglutide….
Ryan Smith: Yeah, definitely. And some of these come with caveats. We’re about to publish a huge semiagglutide study as well. But but yeah the idea being is that we’ll be able to, use the same measuring sticks across trials to then tell you what is the biggest [00:27:00] potential to change your biological age in a positive way versus a negative way. And we’re really excited about that. That’s very cool.
Dr. Weitz: So, the symphony age is now available as part of your program, right?
Ryan Smith: It is, and it is. And so you’ll get with our testing now, a big report. I can just even show you really quickly what that would look like as I sort of talk to you. I know, again, most people are going to be listening so we don’t have to spend a ton of time on it. But we can give you for instance, Your omic age, that’ll tell you your age versus the population. We’ll track those changes over time. We can even then tell you how your aging is affecting your disease risk. So are accelerated aging leading to increased disease risk of each of these outcomes? We can then tell you what to do about it. So where are you out of range and what would we want to correct?
And then what are those things that most typically correct these different biomarkers? We also give that symphony age again with the age of each organ system and track that longitudinally as well. We give the rate of aging. This is the last of those aging algorithms that I mentioned. It’s the only third generation clock trained [00:28:00] longitudinally over time.
And it’s by far the most responsive to change. So in all of the, those 50 different interventional trials, it was the one that changed the most in measuring Effective change. So we’ll do that. We’ll do your immune cell subset percentages. We’ll do, your telomere length. We’ll tell you how much you’ve smoked and drank across lifetime as well as a few other different reports. So you get quite a bit of information. Aging is certainly what most people are using this for now, but in the future we see this actually morphing to a diagnostic that can help with all areas of health. Interesting.
Dr. Weitz: What are, so from the interventions that have been done so far you mentioned caloric restriction. What other things do we know that seem to impact biological aging?
Ryan Smith: Yeah, I would say again a lot of the data that’s out there tells us what we already know, which is not a bad thing. I think that people might say, hey, I see that, Mediterranean diets are super helpful for aging. That doesn’t, that’s not a huge surprise to most people, right? But the fact that we’re seeing consistency with these measurements to what we already know is actually a [00:29:00] good thing because it shows that we’re on the right track. And so a lot of the things that we know are, Avoiding bad behaviors, right? Off the bat. And most of you know what those bad behaviors are, right? They’re going to be the smoking and drinking, the processed foods, the lack of exercise, the lack of social connection and relationships, even workplace stress. Even people who work over 40 hours a week are on average 1.5 years older with some of these algorithms than those who are not. So service off stop bad behaviors. And then replace them obviously with good behaviors, getting the right amount of sleep, right? Making sure that. You’re not eating a lot of processed foods or fatty foods.
Making sure that you’re doing all the right things from a diet and nutrition perspective. When we get into the more exotic things, like the protocols, the procedures, the medications the supplements we start to see some different things that are a little bit more exciting. For instance, we’re seeing you know, good improvements with things like hyperbaric oxygen which again is probably not a surprise to a lot of people, but good to be replicated.
We’re seeing the satinib and quercetin again, similitics actually improve the biological aging over time. We’re seeing I, I would say [00:30:00] though, that the thing that jumps out to me time and time again is probably the most reliable therapy are things that inhibit mTOR. So things like caloric restriction, mTOR, this mammalian target of rapamycin is a sort of a master regulator of some of the processes in our cell.
And things that inhibit it generally have better outcomes. And so, Wrapamycin is another example of that. It specifically inhibits this enzyme and has been shown to increase lifespan in dogs by 33 percent in animal trials. recently in a rhesus monkey trial, 15%. And so I would say that, methionine restriction, caloric restriction, rapamycin derivatives, those are all play a big impact in, or one of, I think the most effective solutions we have now.
Dr. Weitz: Now you mentioned mTOR and mTOR has to do with growth and there’s kind of been two trends in longevity, Therapeutics. And one is an older trend and one is a newer trend. And the older trend was to focus on making sure that we [00:31:00] continue to regenerate our tissues. Because we know as we get older that things break down. The cells break down, things don’t work as well, you lose muscle, you lose bone, we have sarcopenia, osteopenia etc. Brain doesn’t function as well. So We want to use things that stimulate growth and regeneration and we saw a lot of clinics using growth hormone and other hormones, testosterone other therapies that promote regeneration because as you get older, you fall you break a hip, etc. And that’s a major cause of mortality. And in the last 10, 15 years. We’ve seen more of a trend of people talking about reducing mTOR. Let’s not have too much growth. Let’s make sure we in fact people have pointed to [00:32:00] there’s certain populations like the Laron dwarfs in Ecuador that don’t produce growth hormone. So having less growth hormone is good. And so we have these two opposite trends, promote growth, regeneration, not lose our strength, not lose our bones, not lose our, or no, we have to reduce growth because growth is associated with cancer and we need to use things that suppress it. And I’m sure at some point we’ll find out there’s a balance, what’s your sense of those two trends right now?
Ryan Smith: Yeah, I think there certainly is a balance, but I would say that time and time again, I think that we are more on the stop the proliferation than to encourage it. So more of the mTOR inhibition versus the growth pathways, IGF 1 and now in multiple studies, the higher the levels, generally the shorter the lifespan of the first ever animal veterinary pathway for drug approval for longevity is actually an IGF 1 blocker. In canines. And so [00:33:00] I think that the more the data is coming I think that trying to limit proliferation or growth is generally where the data is pointing. Whereas and so things like rapamycin and mTOR inhibitors are a good way to do that.
Dr. Weitz: On, on the other hand, the first study that showed reversal of biological aging, the Fahy trial used growth hormone and DHEA as two of its major interventions.
Ryan Smith: Yeah, but it was only in nine patients, all men and and, generally, one of the big problems with that is we know the growth hormone actually does have an effect at regenerating the thymus that immune organ that, that’s
Dr. Weitz: Which that’s a major factor with aging. That’s why so many older people die from severe infections is because they have Thymic involution, shrinking of the thymus gland, your immune system gets weaker.
Ryan Smith: Yeah, definitely. And, I think that metformin even if you looked at some of that interventional data, we were talking about in that trial with Yale it looks [00:34:00] good at reversing it. So it’s hard to say which one is the main leader there, but with nine patients, it’s probably too small of a sample size to even to, to speculate. But with that being said, I think that yeah, I would go probably the mTOR inhibition over AMP kinase and some of those other activation pathways, but but I,
Dr. Weitz: it’s interesting, even some of the top researchers have said, well, yes, reduce IGF1 until you hit age 65, then it’s okay to promote more IGF1. And this also relates to our recommendations for diet. So for example, Cool. Protein has been associated with promoting, potentially promoting, I don’t know if it’s necessarily as correlated as some people claim, but that it promotes IGF 1. And so therefore you want to have a lower protein intake, more of a vegetarian diet until you hit 65. Then you want to have more protein because you don’t want the person to fall and break their hip and then they go [00:35:00] downhill from there.
Ryan Smith: Exactly. Frailty is one of the best surrogates we have from an FDA or governmental perspective for aging. And we know that is absolutely impacted by some things like IGF 1.
Dr. Weitz: And it’s also one of the reasons why weight training is so beneficial for aging. Because, that loss of muscle. There are people in nursing homes that can’t get out of bed simply because they’re too weak.
Ryan Smith: Exactly. Yeah. And so there are certainly, I think that’s why instead of looking for individual biomarkers, we really have to look at effective tools, right? Tools that predict outcomes effectively. And that’s I think what we’re hoping to develop. Otherwise, you can get lost a little bit in every single biomarker that is associated with aging. That’s again, why these hallmarks of aging keep expanding. But we still are, I would say, still, So far away from having an FDA approved drug to treat that process. And I, by the way, before we get away from this topic, the hyper function theory of aging by Mikkel Blagoslony is one that incorporates both models. I think. Oh, really? Tell me about that. Yeah, this idea that we’re optimized as evolutionarily [00:36:00] for reproduction.
But we never really turn off those developmental pathways. So we keep proliferating, we keep, sort of, growing, but the idea is that with mTOR inhibitors, you can stop or slow that process. And by slowing that process, we will lose function at a much later date. And that’s, so there’s a lot of good data to suggest this.
So for instance, rapamycin, Started earlier in life, generally has better effects than started late in life. So we’re preventing some of that degradation and signal loss versus I would say, trying to treat it once it’s already happened like we would lytics, for instance.
And so I’m a big fan of the hyper function theory of aging as well as this epigenetic information loss theory of aging. Where the instructions to ourselves on how to perform just get a little dysregulated over time whether a result or cause of disease. But yeah, I think that, those, how we manage it clinically is the end of the goal, right?
Are we using growth hormone? Are we doing nine months on mTOR inhibition and three months on, proliferative growth with, trying to improve, growth hormone levels or hormone levels or our NAD levels or whatever it might be. And so we’re trying to come to that, but through a [00:37:00] unified framework and that really means creating tools that we can use as surrogates to gauge this process.
Dr. Weitz: I suspect, even though the trend now is to reduce mTOR, that in the future we’re going to find out that this is a J shaped curve like we see with a lot of things, and having low levels of vitamin D is bad. Having, super high levels of vitamin D is probably not optimal either, and so there’s a J shaped curve where if your your promotion of growth and regeneration is too low, that’s going to be bad, and if it’s too high, that’s going to be bad too.
Ryan Smith: Yeah, definitely. And yeah, and I think we’re just now trying to answer those questions with again, something that’s reliable and reproducible. And I think that yeah we’ll get to some of that. I think in terms of where the best are, but I also want to bring up this idea of, in the future, I think probably the most exciting intervention of them all is this idea of cellular reprogramming. It is incredibly exciting. And I think will really shift how we think about both disease as well as aging. [00:38:00] So what do we mean by cellular reprogramming? Yeah, so in, in 2012 a scientist named Yamanaka won the Nobel Prize. Oh yes. Yeah, and this is this idea that he was using proteins to take any cell and revert it back into a pluripotent stem cell.
So a cell that was a, for instance, a skin cell could go back and become anything now with that same genetic information. And in doing so, in further research, we’ve also seen that by expressing Yamanaka factors and giving them to cells, they actually epigenetically reset. So they go back to an age of a really young age for instance.
And so the idea would be, can we use those Yamanaka factors to restore function of different cells? And that’s certainly what’s happening now. They’re using Yamanaka factors to, restore vision in blind mice. They’re using Yamanaka factors to improve. Heart Failure in these animal models, it’s a way to go in and reset the instructions for a cell to its, it’s I would say like a hard restart of a computer, right?
Where you’re, going back to the factory [00:39:00] settings and starting from new where then your computer goes a little bit faster, it functions a little bit more like it should. And that’s what’s happening with those Yamanaka factors, is restoring them to the best version of themselves.
Dr. Weitz: Where, what’s the latest on the Yamanaka factors? Where are they starting to be used in humans?
Ryan Smith: Yeah not in humans just yet. I would say the, I just got back from a trial conference in Barcelona where you’re only allowed to share unpublished data. And over the recent couple of weeks, there’ve been some major breakthroughs here. Alatost Labs is probably the most notable company in this space. This is a company that got Steve Horvath from UCLA, got Morgan Levine from Yale. Got Yamanaka himself. So they’ve got the who’s who of scientific researchers. And they were funded by Jeff Milner with over 3 billion as a startup. Oh, really? Yeah. That’s not the usual type of startup money going to some of these areas, but they just released some preliminary data that showed
Dr. Weitz: Horvath’s no longer at UCLA and Morgan Levine’s no longer at Yale.
Ryan Smith: Correct. They’re now with Altos, along with a host of other, Nobel prize [00:40:00] winners and other who’s who of scientists. And so they’ve got the collection of an amazing team. And with that they just released their initial data and they showed that with a single injection, they’re improving lifespan in mice by 25 percent in over a thousand mice that have been studied.
Dr. Weitz: A single injection of what?
Ryan Smith: Yeah. They won’t say, that’s what I’m doing, but it is based off of the Yamanaka factors. So based on some of that technology and, that’s an expensive technology, but people are now even finding small molecules that might do it, about Valproic acid is a good example of, a molecule which can cause some reprogramming and people are investigating. What molecule? Valproic acid, which most people know, for seizure medications, right? Oh, okay. But but people are even using some of those molecules, and so there, there are ways that I think that it might become more accessible, but already it looks to be incredibly promising and the ability to regenerate, I think, as well as restore youthful information. Fascinating. Yeah, very. It’ll be, I think, one of the biggest breakthroughs in medicine. I’ve always been [00:41:00] very skeptical of this living to 125, 150, but now with these Yamanaka factors, it looks like it’s in sight. Really? Wow. Very fascinating.
Dr. Weitz: And what do you think about the regenerative plasma therapy that’s available out there?
Ryan Smith: Yeah, I think that it’s certainly interesting. We’ve done a couple studies here. We’re about to release one with the Buck Institute and Dobry Kiprov, who’s the father of plasma apheresis. The, I think it all started with this idea that, if you take an old mouse and a young mouse and you hook their vascular systems together, so the heart of the young mouse is pumping blood to the old mouse and the heart of the old mouse is pumping blood to the young mouse.
They saw that the young mouse the older mouse regenerated, right? It got rid of gray hair and improved its muscle mass. It just looked physiologically younger, but on the other end, the younger mouse got older. It started to develop other phenotypic signatures of aging. And so it brought up this idea that maybe there’s something in our blood or plasma That is both causing age to get worse, but also maybe improving that process.
And I think the preliminary data [00:42:00] looks super exciting. There are a lot of different improvements. The problem is it’s really hard to get access to, it’s a little bit expensive. And we also don’t know how often you need to do it to have all the benefits. And so I’m very hopeful about it. I think the preliminary data looks really good, but I also don’t know how sustainable it is. I also know the FDA doesn’t like plasma. Young plasma transfers as a strategy. So I’m not sure how widely robust it will be, but it certainly looks promising. Right.
Dr. Weitz: Essentially what you do is you go in and they take albumin from a younger person and re take, replace your albumin with that, right?
Ryan Smith:Yeah. So the whole plasma generally they also will supplement with new albumin and albumin is one of those biomarkers we know, again, declines with age and the higher it is generally the better we do. Binds the majority of proteins within your blood. It’s actually the number one factor, or should I say the secondary factor in our omic age algorithm. It’s weighted that highly. So we know albumin is certainly important and this, it brings up this hallmark of [00:43:00] aging. Proteomic dysregulation that might end up happening as well. And some people estimate that’s why saunas help improve health is by activating heat shock proteins and getting rid of non functional proteins.
So you get, get to see a lot of these same narratives and across this, but yeah, I think it’s certainly an impressive strategy and certainly merits more research. There are a lot of companies now that are basically creating synthetic versions of young plasma that might be more likely to get FDA approved.
Really? Synthetic versions? That sounds a little scary. Yeah. Well, what they basically do is they compile hundreds of thousands of plasma patients and then start to filter segments. And those segments are generally what they’re they’ll give. Alkahest is the company there that’s been doing a lot of that research. But but yeah, so definitely I think that there are probably ingredients in that plasma that can help improve aging. We’ve just got to find out what they are and then see how we can make it more accessible. And get rid of the parts of
Dr. Weitz: it that are making aging worse, which is the damage that occurs, the old proteins that are [00:44:00] incorporated, et cetera, et cetera.
Ryan Smith: Yeah, and that’s what a lot of people now are doing. Instead of just infusing young plasma, they’re just filtering their own to get rid of some of that stuff. Plasma,
Dr. Weitz: Phoresis, yeah.
Ryan Smith: Exactly. And so we’ll have trials published on both of them coming out relatively soon. That’s,
Dr. Weitz: that’s great. You’re right on the cutting edge of all this stuff and able to offer this test to clinicians and the public. So how do Clinicians and people watching this find out about getting the is it still called the true age test?
Ryan Smith: Yeah, it is. Yeah. The true age test is something that continually changes for us. We add algorithms as we just did with Symphony Age. We add other insights but they can, the best way to do, it’s to go to our website at true diagnostic.com.
If anyone has any scientific questions about the test, they can always reach out to me personally or our support team atRyan@truediagnostic.com or support@truediagnostic.com. We also have, just a lot of educational [00:45:00] resources. If anyone wants to learn a little bit more to go to our research page, you’ll see some of the research that we’re doing with all of these universities as well, if they want to read a little bit more about it.
Dr. Weitz: And clinicians can sign up to become to offer the tests to their patients as well.
Ryan Smith: Yes, definitely. The we actually specialize with physicians because some of this information is a little hard to interpret and you really need a really big clinical picture. And so that’s why for our main market, and we do lots of education for physicians. If you’re new to this topic, if you’re new to the idea of DNA methylation, I mentioned that, when I was in med school, And in undergrad I had probably less than a day of epigenetic education and that’s how new and innovative some of this is. And so we do a lot of education on this topic and love to I would say get clinicians up to speed and really try and implement these in clinical practice.
Dr. Weitz: And so when they order, when the test is ordered now, is the symphony age automatically included in that?
Ryan Smith: It is. It is. And generally you get all 11 reports that we do and those reports will continue to be expanded. The next areas that we’re really going to [00:46:00] go into is personalized nutrition. So we can actually tell you the levels of, things like alpha ketoglutarate or vitamin D or your omega threes with that same data set. And then very soon we’ll also be doing methylation risk scores for disease. So how likely are you to develop these different disease outcomes?
Dr. Weitz: So you’re not going to be measuring the level of vitamin D, you’re measuring epigenetic marks that code for vitamin D levels, right? Is that what you’re doing? Yeah, exactly. Okay.
Ryan Smith: Yeah, so we’re just using that DNA methylation data to predict surrogates and so we really do believe that in the future we’ll be able with one single fingerprick test, be able to read those DNA methylation patterns to do probably a large majority of the clinical testing that you currently do with a single diagnostic. And that’s really what we’re excited about. Very exciting. Thank you so much,
Dr. Weitz: Ryan. Yeah, thanks so much. Appreciate it.
Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition, and want to prevent chronic problems, and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office. Call us at 310 395 3111 and we can set you up for a consultation for functional medicine. And I will talk to everybody next week.
https://drweitz.com/wp-content/uploads/2024/09/rwp-376-smith-web.jpg350785drweitzhttp://www.drweitz.com/wp-content/uploads/2017/06/drweitzdsamplelogo-withtext.pngdrweitz2024-09-04 14:09:272024-09-10 06:30:26The TruAge Test of Biological Aging with Ryan Smith: Rational Wellness Podcast 376
Dr. Jamie Kunkle discusses Oronasal Infections with Dr. Ben Weitz.
[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.]
Podcast Highlights
4:00 Oronasal system. We can think of the oronasal system similar to the gut in some ways. And there is a continual mucosal barrier from the nose and mouth down through the gut. If there is immune activation in one area, such as from food sensitivies, you could see symptoms in another area. And like the gut, the air that we breathe in and any toxins contained in it and the food we eat can influence the oronasal system in a similar way as they influence the gut. And the health of the teeth can be very important here as well. And the oronasal cavity connects directly into the brain, which is one of the reasons why an infection can lead to brain fog and changes in brain function.
6:25The microbiome of the oral and nasal cavities. Conventional medicine has relied heavily on culturing, which may be effective for an acute infection, but not so much for chronic infections or mold. PCR DNA analysis can be more helpful and next generation sequencing may be even more effective. We also have to consider that many colonies of bacteria live in biofilms, which make it more difficult to pick them up. And complex biofilm colonies may include fungi and viruses as well as bacteria. For culture testing of the sinuses and the masal passages, Dr. Kunkle likes using Microbiology DX. They also test for biofilms for Marcons, staph, and bacterial infections. MicroGen DX is a company that does next generation sequencing. For PCR DNA Dr. Kunkle recommends DNA Connexions, that uses a floss sample for looking at microbiome of the mouth and teeth.
11:54 Biofilms. A biofilm is a small colony of bacteria or several bacteria and it can also include fungus and viruses that are surrounded by some kid of barrier that protect them from the immune system. Some have classified biofilms as phase one and phase two, with phase two being thicker and more complex.
15:30Preventative Measures to Improve the Health of the Oral and Nasal Cavities. Diet is important as is avoiding food sensitivities, allegens, and pollen to avoid causing chronic inflammation. Nasal rinses with sterile solutions can be helpful, esp. during times of allergies. Air purifiers can be helpful. Nasonebulization is a fine mist that gets to the highest sinuses and you can add low levels of peroxide or ozone.
Dr. Jamie Kunkle has a doctorate in Naturopathic Medicine and a masters in Acupuncture and Traditional Chinese Medicine. He has specialized in working with complex chronic disease patients including those with Lyme and other chronic infections and autoimmunity. He currently works at Gordon Medical in San Rafael, California. Their phone number is 415-767-6100 and the website is GordonMedical.com.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz. com. Thanks for joining me and let’s jump into the podcast.
Hello, Rational Wellness Podcasters. Today, we’ll be having a discussion about oral nasal infections with Dr. Jamie Kunkel. Obviously, many people suffer with colds and flus and various respiratory infections that affect the oral nasal sinuses. But in the functional medicine world, we often treat patients with various gut problems, such as SIBO or Candida, and these can have an oral nasal component. And not addressing this can be one of the reasons why our patients don’t achieve better health, why they don’t completely resolve. There can also be an oral nasal component. of other chronic diseases like Lyme disease, mold infections, which are also common conditions that those of us in the functional medicine world often treat.
I’ve asked Dr. Jamie Kunkel to join us to give some insights into how to analyze and treat oral nasal infections for nearly a decade. Dr. Kunkel has worked with complex chronic disease patients, including those with Lyme, chronic infections, autoimmunity, hormonal disturbances, chronic pain, chronic fatigue, and environmentally acquired illnesses. Dr. Kunkel grew up in the East Coast, as I did, and had early first [00:02:00] hand experiences with tick borne infection, and he’s witnessed the various stages of this illness on individual systems, including several family members. Soon after medical school, a notable prolonged mold exposure in Seattle greatly affected himself and his wife. And though his fatigue symptoms cleared over time, his wife developed an autoimmune condition and this event underlying the importance of early recognition of environmental illness and the diversity of individual responses that may manifest. In fact a close friend of mine, Dr. Howard Elkin integrative cardiologist, just passed away this week, and he had mold exposure at his house. And that may have played a role in his demise. In addition to his doctorate in naturopathic medicine, [00:03:00] Dr. Kunkel holds a master’s in acupuncture and traditional Chinese medicine from Bastyr University. And he’s extensively studied traditional medical systems, including Chinese integrative hospitals to better understand how to treat patients and get to the root cause of illness. So Dr. Kunkel, thank you so much for joining us.
Dr. Kunkle: Thank you, it’s a pleasure to be here.
Dr. Weitz: So, I have to admit that while I’ve treated quite a number of patients with various gut disorders and also with mold, Lyme’s never been something I’ve seen a lot of people for, but I never really focused that much on the oral, nasal components of these conditions. So, can you tell us how how this plays a role and then I’d like to go into how to analyze it, test for it, and how to treat it. Sure.
Dr. Kunkle: Well, I mean, I think you could think of the model of the oronasal system similarly to the gut in some ways. It’s sort of a continuum anyway, right? It’s a continual mucosal barrier in the system. If there’s immune activation in one area, you could see symptoms associated in the other area. This has been evidenced with like food sensitivity responses. For example, they always say, lower the dairy, for example. You might get some more nasal symptoms with dairy intake, and maybe that’s a local effect too, but sometimes it’s a delayed onset. So there is a circuit through the gut that connects into the system. But just like the gut, this has a very, the sinuses in the nasal cavity and the oral cavity have a very unique microbiome. And some of that microbiome is similar to the gut, but a lot of it is very different. So, the food we eat, the air that we breathe, the toxins we take in or breathe in or whatever, all influence this particular system.
And as you can imagine the health of one’s teeth can be incredibly important too in this conversation. And we can kind of dive into that as well. But the difference between here and the gut is the gut does connect [00:05:00] with the brain in a lot of different complex ways and some of it is through the nervous system. Some of it is through the immune system. Here you kind of have in the head region, you kind of have a very close proximity to the central nervous system. So if there’s something very inflammatory going on here, it’s kind of a skip and a hop to this particular system and some of the outlets of this system, some of the detox mechanisms of the head and the sinuses and the, just that whole cavity basically.
And I can go into more details on that too. So, so yeah, so you just have a unique sort of setup where chronic, anything because you probably all have at least experienced at some point in your life a common cold. Maybe you have a summer cold right now or you’ve had a sinus infection and just how you feel during those acute episodes. I feel brain foggy. I feel kind of tired. I feel kind of blah. I certainly don’t want to work or, use my brain all that much. But those are, small moments. Maybe they just go away with the passage of time. So imagine sort of a chronic low grade level of that type of response and how It can start to influence a normal brain function and functions at that level. So, yeah, that’s just a brief introduction and I’ll elaborate more as we go.
Dr. Weitz: So I understand that part of the way to understand your oral nasal cavity is to look at the microbiome of the mouth and the nose. Can you perhaps talk about that a little bit?
Dr. Kunkle: Sure, there’s different ways of doing this. I think traditionally, conventional medicine a lot of times has relied heavily on culturing certain things in the nasal passage or in the throat or whatever they’re swabbing and that kind of thing, but cultures, unfortunately, can have limitations. They’re very effective when you’re trying to analyze a dominant acute pathogen, like I have strep throat or something like that has utility in an acute setting. But in a chronic setting, you may not get a full view of what the actual microbiome is in there. So cultures are useful. [00:07:00] Sometimes there’s a test that’s often used for mold and checking something called Marcon’s, which is a staph infection that’s associated with mold and exposure to water damage spaces.
But there are newer technologies that go beyond even PCR DNA analysis, but you can use basic PCR DNA analysis. And then there’s something called next generation sequencing, too, that will sequence all the DNA that is present in the specific sample. So why is this important? Well, one It’s important to know what’s in there in its entirety.
So even if it comes up as like sort of a smaller amount, it doesn’t mean that it’s not living higher up in the nasal passages or something like that. So a culture may pick up the thing that has the biggest signal that grows the easiest, but it won’t pick up these little guys. Number two, biofilms. A lot of biofilm colonies can live in anywhere that’s water, basically. So, you better bet they can live here. A lot of that strandy stuff that comes out of your nose when you’re ill is, is partially biofilm. So imagine just more complex, aspects of that. So you’re not going to always get a perfect culture of [00:08:00] a highly biofilmed, colony, especially in the higher sinuses.
So nuances to testing and the same thing can go for the oral cavity. Generally speaking, you can use the same type of technology or you can try to use DNA PCR. Sometimes I’ll do both too. It’s just to try to get a broad view of the microbiome and try to be as accurate as possible. And when you’re, when it comes to fungal elements well, one, a culture can take up to 30 days, so it’s slow. You, so you’re going to get results much more quickly from these other technologies, but two you’re going to be more likely to pick it up too because a fungal elements are Much more difficult to diagnose through culture, but I’ve picked up a ton of them on these other technologies, so to speak.
Dr. Weitz: Can you give us some specifics especially for clinicians out here who would like some help in figuring out how to manage patients maybe mentioned for Mold for or Bacteria for Fungi for Candida, etc. What specific tests do you like to run?
Dr. Kunkle: Sure. Well, [00:09:00] I’d say that for the sinuses, first of all, or the nasal passages. For a culture, I still use Microbiology DX. I think, I believe they’re out of Massachusetts. They’re a pretty good culture system. They’ll do a fungal culture too with an add on. And they’ll do a biofilm analysis for the Marcon staff and bacterial infections. And it is good to see if you can pick up some other creatures in there too, not just the Marcons like Klebsiella pneumoniae, for example, is a significant creature that comes up there. And then MicroGenDX is a company that does the next generation sequencing and kind of classic PCR. They were originally designed for, identifying chronic urinary tract infections and cystitis, in, in males and females or STIs that are hidden or something like that. So, but they can do almost anywhere in the body pretty much. So you could do a skin sample with them. You can do a sinus, nasal, throat, whatever. So I use them quite frequently too. Those are probably my top two in terms of those particular technologies. And there are others that are out there, but I, if it’s not broken, don’t fix it. I found that those work pretty well.[00:10:00]
Dr. Weitz: And how about for the mouth in terms of DNA testing?
Dr. Kunkle: Yeah, DNA Connexions has an okay one. I think there, you can do it with a floss sample generally speaking. So that, which sample…
Dr. Weitz: Floss?
Dr. Kunkle: Yeah. Floss. Yeah. So if you want to go around a tooth that, that is infected or something like that, you could also take out and an infected tooth as well. There are several others for the mouth too, depending on what you’re looking for. I believe there’s one called like periopath, if I’m remembering correctly, that’s kind of more for gum disease, which I think is important, especially people have gum recession, gum bleeding, and it’s all very important for recognizing in connection to even cardiovascular risk factors and neurocognitive stuff. There’s the bristle test, I believe that one is a good one too for just general microbiome, because what you’ll realize is that some of them are very much more pathogen based and trying to find what the bad guy is and kill them or whatever. But you also want to kind of look at what the good guys are. So I believe the Bristle Health one that [00:11:00] seems to look at more of the broader microbiome. So it’s really nice to know if you have some good creatures in there too, because it may not be that you want to. kill all the time too. You may just want to, whatever, regulate the biofilms. There’s nasal probiotics and oral probiotics. There’s other ways to go that aren’t just nuking the earth.
Dr. Weitz: By the way, you mentioned biofilms. For those who are not familiar with biofilms, explain a little bit what a biofilm is and what its importance is.
Dr. Kunkle: Oh yes. So biofilms are very important concept. They’re sort of the elephant in the room sometimes with any chronic infection, as in we’re not, we don’t have a perfect way to measure them to begin with. But we know through extensive research that they exist. And even the CDC is recognizing that drug resistant biofilms are on the rise and they are very dangerous. And we don’t have a lot of good conventional drugs and tools to address them. So what is a biofilm? Think of it this way. It’s a small colony of bacteria or several other bacteria or sometimes fungus. It’s basically a little micro city that’s kind of surrounded by some kind of barrier. And there’s [00:12:00] different complexities of biofilms. People have classified them as like phase one, phase two. Phase one might be easier for your immune system to handle. It might be easier for basic stuff like herbs or essential oils or even condiments, things we use in daily life to take care of. But phase two might be like more like a bunker system that just becomes like this big, thick, resistant concrete structure. And it can be multiple organisms living in this structure they can cohabitate.
So it is possible for say, like strep to cohabitate with candida or something like that. And theoretically, viruses can get stuck in there too, or they can, be a part of it. So you can have this elaborate colony that sits there. What’s the importance of that? The immune system is not great at regulating some of the more complex structures that develop. And it, it seems like, yes, you can get infected with a complex biofilm. That’s evidence with like hospital resistant infections and stuff like that. But it is also possible if you are chronically ill and immune suppressed or immune dysregulated to, to be at higher [00:13:00] risk of developing more complex biofilm structures in your body too.
So if you see somebody with a chronic illness, who’s been on a lot of antibiotics especially, or a lot of antimicrobials over time, yet is still showing signs of infection or microbiome dysregulation, you have to almost assume those people probably have some level of microbiome. And once again, MicrobiologyDx does have at least a microbiome analysis. And there used to be more. They’re, FriLabs, I don’t think is collecting samples anymore, but I suspect in the coming years you’re going to see more testing to, to find these. And you’re also going to see that they’re releasing more FDA approved drugs to treat them too. So, yeah.
Dr. Weitz: You mentioned next generation DNA sequencing. Can you just explain what that is compared to PCR?
Dr. Kunkle: Yeah, my general understanding and, since I’m not a bench scientist, I’ll try to explain it the best I can, but my general understanding is it just actually takes the DNA structures and parcels them out and actually sequences them. So theoretically, there’s not just this set [00:14:00] database that is present there. It will find, hidden pathogens that aren’t, commonly found or treated or stuff like this. So it just, it’s supposed to have a little more sensitivity and specificity. It’s slight, the limitation to PCR and all those DNA things in the past has really been not so much the technology as it is like the sample. So like getting something in the sample To measure is the hardest thing for any of those technologies, and the same thing goes with culture. So if you have to it’s also important to be able to do like a higher sinus swab if appropriate, or the sample is kind of a more important piece. But yeah, that’s my understanding of NGS. It’s just a slight up on PCR technology in terms of finding some of the hidden pathogens.
Dr. Weitz: What are some of the important preventative measures we can do to improve the health of the oral and nasal cavities?
Dr. Kunkle: Sure. Well, I think it starts with your immediate environment in a lot of ways, and I already mentioned that, The food that you eat can influence that cavity in a lot of ways too. And it goes [00:15:00] without saying it can influence the oral cavity and the health of your teeth and everything. So eating healthy foods is very important for that reason, but food sensitivities, if one has them too, sometimes can also cause chronic inflammation in those regions. Same thing goes with allergens. We can’t always avoid, pollens and other things like this, but I think it’s important that if you are in a allergy time of year and stuff, that you can maybe do some nasal rinses or some mitigation techniques and tools. And there is a time and a place for using either antihistamines or even your nasal steroids and stuff, if appropriate. And it kind of comes down to how much do you have to mitigate inflammation and how much is that inflammation creating? Further or deeper disruptions or dysregulations in the local systems, whether it’s the nervous system or the cardiovascular or otherwise just as examples off the top of my head there.
So rinses are good. So avoidance, it’s usual. If there’s any environmental influences, try to avoid them. But if you can’t avoid them, Try to mitigate them. If you can lessen the load, air purifiers. I love air [00:16:00] purifiers. If people can do them, especially if they’re in moldy areas, because we can’t sterilize our environment of all molds too, honestly. I mean, if you have mold in your home and the ERMI scores are high or whatever testing you’re doing, it looks pretty terrible. Yeah, certainly remediate that. I mean, that would be my number one thing, but if you’re just in a place that’s very humid and moldy or, there’s many places in the United States that are like that, honestly, that have high mold counts.
And I believe you can find that online too. If you’re in a high mold region, you want to use air purification appropriately, and you want to do your nasal rinses. What kind of nasal rinses? You could do classic nutty pot, as long as the water’s clean. Some people say you really should just use distilled water because there’s been some, contamination and stuff like that, or you can get a, sterile saline solution. I believe even Arm Hammer has a sterile mostly sterile saline solution, I should say. Navage is a newer technique. It’s like a vacuum and a pressure system. So it’ll really work stuff out of there. So, if you want to pressure wash your nasal passages, go for it.
[00:17:00] Nasonebulization is a very fine mist that gets to the highest sinuses. You can do it as a rinse, but you can also add in medications to it or other substances. So, that’s best done through compounding because it needs to be pretty clean when you’re putting meds in it. But if you can just get a sterile saline base, you can do high rinses there. And then as far as the oral cavity goes, I mean, that’s all oral hygiene, but I really love the water picks and the irrigations. And if appropriate, you can use low levels of peroxide or ozone other things like this too. So it depends on what level you need to intervene there, but the oral health is equally important when it comes to the head.
Dr. Weitz: As far as the nasal cavity, I’ve heard of doctors recommending using glutathione and other substances. Are there specific substances, nutritional substances or otherwise that you find helpful for some of these nasal infections or nasal components of chronic infections, say mold or candida?
Dr. Kunkle: Oh yeah, I’ll tell you some [00:18:00] gentle agents first. I mean, for one glutathione is harder to get, but it is a good agent on the last and it’s cousin, NAC or N acetyl cysteine or acetyl cysteine used to be able to use that as a mucolytic or a thing that thins the mucus. Glutathione is also a
Dr. Weitz: You can’t use NAC anymore, are you saying?
Dr. Kunkle: It’s just harder to get. It’s not impossible to get, it’s just, I don’t know, it’s harder to get, I don’t know why. But you might be able to find them. But the point is, if you can find either of those, then yes, use them.
Dr. Weitz: And you can’t just buy like a liposomal glutathione and nebulize that. You’re saying you need to get it from a compounding pharmacy?
Dr. Kunkle: Yeah, ideally. I mean, that’s my official recommendation. I mean, people can do other things, but it’s just, since it gets into those higher spaces, any kind of nebulization you need to be a little bit cleaner with just basic sprays and rinses, you could probably get away with it safely because it’s not getting into those higher spaces, but the closer it gets to your brain, essentially the cleaner, you have to be with it. So that’s, that was the whole, even the nutty [00:19:00] pot, risks. But anyway, so. Natural substances. So yes, if you can do glutathione or NAC, they’re also biofilm agents, they’re mucus thinners, and they can also cross into the blood brain barrier, and they can help with, detox.
Dr. Weitz: Otherwise, do NAC or glutathione?
Dr. Kunkle: I just do NAC oral with most people, honestly, and then I’ll do glutathione nasal. So if I was going to do them, I’d do them that way, honestly. Right, okay. Because then you get better bang for your buck in the, because the oral works better. Just as well with NAC and it’s really easily accessible. And then you can use silver in the nose, like, 23 parts per million at the lowest is fine. You can go higher, but it, that’s a good starting point. Silver is a good biofilm agent. It in fact addresses multiple types of infections. The dose is so low, it’s not toxic. It’s not going to really cause a toxicity reaction and it’s mostly water. So it doesn’t burn really badly. And then Xylitol and Grapefruit Seed Extract, aka XLEAR, X L E A R, is pretty good for Low level biofilms and fungal elements and thinning mucus and, it’s xylitol. It has a [00:20:00] little bit of a sweet flavor. It’s not terribly offensive. It’s a sugar alcohol. It doesn’t absorb and you’re not getting a really large dose of it really.
It’s just a couple sprays in your nose a couple times a day. Those are great. Starting agents generally. And as I said, you can also get creative and put other herbals in nasal rinses. I think the rinses are usually the best thing to do there. And I’ve used even like Biocidin, for example, as a company that has been used with Lyme and other chronic infections and stuff like that. And sometimes you can use their liposomal formulation. So I agree the liposomal formulations, if you’re using herbals tend to be better tolerated in rinses and they tend to also absorb, better or. Stick better sometimes too. So yeah, those are all, fairly, really easy simple, but often quite effective starting agents for people. And if you can gain some traction there, you can decide later.
Dr. Weitz: Anything specific for mold?
Dr. Kunkle: Yeah, so for mold, the grapefruit sea extract and X clear and silver can work a little bit because they’re pretty broad spectrum, I’d say. But yeah, the grapefruit sea extract is probably one of the stronger herbal antifungals to kind of [00:21:00] begin with. You can get creative with gentle drugs like Nystatin and stuff like that too, I think if you’re going to like, start kind of at a lower level, depending on how the person is before you have to use really heavy stuff. And then you can inhale essential oils too. So a lot of people like doing that with either a diffuser or steam inhalation. I like the steam sometimes if they’re really dry people generally, just to get some moisture up in there. But yeah, essential oils are incredibly helpful if you don’t have chemical sensitivities or other contraindications. And you want to make sure you’re using organic food grade ones. And oregano is a really good one. Thyme is a really good one. There, there are several, but those are very antifungal too. And they get into those higher spaces and they also do have a little bit of absorption through the nasal passages.
Dr. Weitz: You mentioned Biocidin and I was at a conference and they were presenting a bunch of products they have for the oral cavity.
Dr. Kunkle: Yeah, they do. They have a whole line for the dental, so the teeth and the gums, and I have no financial [00:22:00] relationship with them, by the way, but I do like them. So they have a toothpaste, they have a mouth rinse they have a throat spray, which I really do love too for people that have any kind of chronic pharyngitis or throats.
It can be even good if you’re like a big talker. Like you, you lecture a lot or you do this kind of thing too much. It can actually help your voice too. It kind of reduces inflammation there. It’s pretty cool. And then you can put their they have a liposomal and a regular biocide and the liposomal you can put in the nasal rinses, as I mentioned, pretty effectively, which is pretty cool. And then the regular one is good for the gut. Or if you’re trying to get, like, if you do have candida or thrush or other things in the oral cavity, you can use it locally just as well. So their products are gentle. It’s like. small amounts of a lot of herbs. So none of them are really too toxic, which is great. And they also aren’t really hard on your microbiome. So you can use them to augment in a killing phase without like causing too much collateral damage, usually.
Dr. Weitz: Yeah. They also have a oral mic probiotic as well.
Dr. Kunkle: That’s right. They do. I’ve used that [00:23:00] one before too. It has xylitol in it as well. So it kind of, has, it has a decent flavor, but it also helps as a synergist with, controlling and regulating biofilms. And yeah they have some good products. They have a whole bunch of other stuff too. You can definitely check out.
Dr. Weitz: How does the health of the oral nasal system influence our sleep?
Dr. Kunkle: Well, the obvious answer is sleep apnea or obstructive forces like snoring and different things like this. And if anybody’s known somebody that snores, they could If they’ve slept next to them or seen them or otherwise you can see how that’s not really the best quality of sleep for most of these people. Sometimes they will stop breathing, which is actual sleep apnea, which can lower your oxygenation, which is really problematic. Or they could just be drying out their mouth in their oral cavity. ’cause if you get dry mouth, you know you’re not. And that saliva is lower. You’re leaving yourself open and vulnerable to more gum recession or more infection activities there.
So you need to kind of have your immune system and your [00:24:00] mouth working too. So, there’s a lot of different things that can happen here between people that have chronic inflammation in the sinuses are more likely to develop obstructions in the nasal cavity and affect and influence the sleep. And then people with structural issues or sometimes central nervous system issues too but all of it still ends up influencing this cavity because at the most you’re just not breathing normally you’re not oxygenating normally, and you’re probably causing a lot of dryness and irritation mostly.
Dr. Weitz: What about the relationship between the inner ear and the vestibular system, and balance, and vertigo, and things like that, and the oral nasal infections? We’re always looking for new ways to try to treat patients with some of these symptoms like vertigo, and even tinnitus.
Dr. Kunkle: Totally. Yeah. And sometimes they are related. So it is important to understand that where that might be coming from. And so the inner ear, the station tube these are connected [00:25:00] systems with the oropharyngeal cavity. So their drainage is dependent on the health of the rest of that system too. Or if there’s an issue in one area, it can You know, go over to the other area too. So this has been evidence with allergies and other chronic sinus issues and things. People can be more likely to develop vestibular issues of, vertigo, dizziness sometimes tinnitus as well. And so, clearing out those systems is important and that there can, in my experience too, I’ve seen a lot of viral elements contributing to those things as well. So it seems like. Stuff like Epstein Barr virus, for example, and other viruses can influence the inner ear and the sinuses, for example. So, determining sort of what the relative infectious landscape is there is important. And if you can get the sinuses draining and clearing in one form, in one treatment form or another sometimes those things will improve.
But also, if you’re just reducing overall neural inflammation it tends neurologic component of it. And so just by [00:26:00] simply treating this cavity, you’re often helping once again, that, that particular interface. And, tinnitus, for example, is a complex manifestation that doesn’t always have a very straightforward answer, but if you can influence it through these means you’re doing a service to the individual.
And I’ve seen different things work too, like structural arrangements between well, I used to do acupuncture and some of these points around the ear, for example, but I’ve also in the past done craniosacral and other things to kind of help the mechanical drainage system in the nasal passages and the sinuses. And I’ve seen that also help with. the dizziness, vertigo, and inner ear issues. And, some of the deeper communication lines, as I mentioned, in the brain are also involved in this whenever there’s localized inflammation.
Dr. Weitz: Yeah, similar experience I’ve had as a chiropractor doing manipulation to the upper cervical spine.
Dr. Kunkle: Yeah, that’s right. Yeah. The C1, basically the whole cranioscervical junction does have influence on this, the oxyploid, basically C1, C2. So [00:27:00] if there’s stuff going on there, it’s good to look at. If you’re a person that’s really hypermobile though, I’d be really cautious doing traditional forceful adjustments, but there are forms of chiropractic technique like NUCCA, for example, that are much gentler that could be used to still augment the C1. But if the C1 is unstable or sort of shifting in one direction or another, like as we see in CCI, some of our patients have something called cranioservical instability. It’ll actually affect Some of the outflow and the drainage from the head, which is, pretty crazy, including the glymphatics and even venous outflow and can affect pressure dynamics and changes. So you can have a coexisting issue there. That’s probably worse by the inflammation happening in the oral pharyngeal. But, pushing it further. So, I mean, that’s a complex thing, but it’s not as uncommon as we originally had thought in chronic illness, cause we’re talking about, we see some of the most, chronically ill patients. Sick people in the world here those things get, will get missed quite a bit. So don’t neglect the structural elements is just the plug I want to put in.
Dr. Weitz: Can you explain what the glymphatic system is?
Dr. Kunkle: Ah, [00:28:00] yes. The glymphatic system is a relatively new concept, although it seems strange that we didn’t recognize it earlier. What it comes down to is the brain has its own lymphatic drainage, which is important for the immune system function, your lymphatics serve the immune system and kind of clearing and even activating immune system responses. The nodes are sort of the central points where the immune system cells will live. So the glymphatic is the brain lymphatic system. It doesn’t have traditional vessels, lymphatic vessels and things that we would normally think of, which is why it has largely eluded anatomy people over the years.
But it does serve as a primary detox and waste disposal system, kind of like a a sewer system, so to speak for our brain and our CSF. And you better bet we have a lot of we accumulate up there, especially, we live in a toxic world and we also can get misfolded, proteins and various elements in our brain that could actually be really harmful.
It could be precursors to Alzheimer’s and stuff later. They’re [00:29:00] finding associations with ALS and Parkinson’s even in later life. So, the glymphatic system becomes more sluggish the older we get. Generally, and it can be influenced, once I said, by structural elements and trauma responses, but you better bet it’s also influenced by, local factors, including the health of the sinuses and the oral cavity too, so you do want to think about that system.
It actually drains the best while we’re sleeping. So that’s another thing that is kind of weird. But when you get into proper deep sleep they’re working on devices, I think of like 40 Hertz or so to like induce lymphatic drainage, like artificially. It’s kind of cool. But you know, the importance of good sleep once again, and the importance of addressing your obstructive apnea issues or whatever else can all aid in, in healthy brain function and normal brain energy.
Dr. Weitz: So when you say 40 Hertz, you’re talking about some kind of light?
Dr. Kunkle: Yeah yeah,
Dr. Weitz: that would be applied on top of the skull or I believe so.
Dr. Kunkle: I think it’s like a head device of sorts.
Dr. Weitz: Yeah.
Dr. Kunkle: Yeah. It’s [00:30:00] really interesting. I know those light therapies are pretty, Amazing different photodynamic therapies. I’m still learning about all that stuff, honestly, but it’s something to keep an eye out for. They’re not as hokey as they sound on the surface.
Dr. Weitz: There’s a lot of different things. There’s red light, there’s blue light, there’s a lavender there’s one device that just circles your head like this. It’s hard to see how that could really get much penetration. And then there’s various helmets, What about addressing the oral nasal cavity when working with a patient with dementia or Alzheimer’s?
Dr. Kunkle: Oh, yeah. I think that’s incredibly important for some of those reasons mentioned. First of all, I mean, it’s really best to treat those things as early as possible with Alzheimer’s dementia. They oftentimes in conventional systems just call it early cognitive decline and they don’t do anything until it becomes a bigger problem.
Right. But if you recognize quote unquote early cognitive decline, that’s kind First of all, you wanted to start it yesterday, but let’s just say that’s a better place to start intervening to [00:31:00] make a real functional change here. And so I’ll go my, go through my usual process of assessing all those things through the testing appropriately taking a thorough history, assuring that they if they’ve been exposed to mold or something like that’s really important because one thing to note about mold and Alzheimer’s dementia seem to have a close connection.
There’s, there’s been some case studies on that, I think is Bredesen and those guys were doing studies on that and they were looking at different parameters, but Lyme Borrelia, and all of its friends, the tick borne world, and then mold and all of that stuff. And when they were able to like remediate or even use harm reduction techniques to mitigate.
The mold in the environment, they were seeing improvements in that cognitive function, even so it was pretty significant. So you want to kind of, deal with the environment like anything else. And then you want to treat those sinuses appropriately, preferably in this case, probably with a naso neb device.
And if there’s something you can do to optimize lymphatic function, and there are a lot of herbs that do that too. There’s the sleep stuff and some of the emerging therapies. You might have a really good foundation for trying [00:32:00] to turn their brain around. It may. At the very least, you want to try to slow or halt those types of responses or prolong, any kind of digression. You don’t want to just sit and wait like the conventional system does.
Dr. Weitz: Absolutely not. And we have the Bredesen model, which now has demonstrated. In several studies, there are smaller studies, but that cognitive impairment can be reversed. The, he’s published, for those who are not familiar, Dr. Dale Bredesen has published three or four books on the end of Alzheimer’s. And he’s been he’s got a program that he teaches to doctors and practitioners, and how to treat. take patients with cognitive impairment. And one of the things he mentions is there’s something called what is it? There’s subjective cognitive impairment before you actually really have the signs of cognitive impairment. And if you can catch patients at that stage, That’s probably your best chance of intervening once [00:33:00] they’re in what’s called mild cognitive impairment, they’re actually severely impaired, unfortunately.
Dr. Kunkle: So listen to your patient, or the spouse of the patient, or whoever, like, spent a lot of time with that patient. If they’re telling you, like, yeah their cognitive function is changing and shifting just cause it doesn’t work. Check out on one of the, the conventional testing platforms or something, listen to them. That’s the first step.
Dr. Weitz: Right. And there, there are some more sensitive tasks for these early signs than the MoCA score, which is probably more appropriate for somebody who has at least subject, at least mild cognitive impairment. But we’re CNS Vital Signs that can pick up some of these early patients. Right on. That’s awesome. So what about the relationship between oral nasal cavity and the eyes and visual system?
Dr. Kunkle: Oh, yeah. Well, yeah, that’s always an interesting one. If you’ve ever had a allergies, it’s in a lot of sinus congestion. It’s not [00:34:00] just that your eyes get red. Sometimes they might actually get like pressure or they make it like gooey. The consistency of the lacrimal secretions are basically the tears can change and stuff too. And so because there is drainage points around your eyes here too, that connect with the sinuses and other areas it’s like you’re crying, your nasal stuff moves too. Obviously this can be influenced, but if it’s really severe, there’s also a possible local influence in the, And the optic nerves are, it’s not that it actually kills your eyes or anything like that, but it can affect visual processing sometimes in some cases.
And the visual system is very much involved in the vestibular system too. There’s a lot of connection points there. Our body really relies a lot on visual cues for balance and even proprioception, place in the world, our sense of where we are in space and everything And so if anything starts getting influenced there it is possible when it’s more severe, especially if it’s, I see this mostly with mold because you can also do the Shoemaker VCS visual [00:35:00] contrast model. And you’ll also see that there’s shifts.
Dr. Weitz: Oh, so that’s the explanation for why that test might be positive?
Dr. Kunkle: Well, partially, I’d say partially. It may be because what I’m trying to say is if there’s local colonization, there can still be mycotoxin or toxin formation in that area. Okay. It is possible that one of the mechanisms is a local mechanism and, don’t entirely quote me on what Shoemaker thinks on that, but I’d say it could still be influenced. In other words, you can shift and change those manifestations through the local treatments. That’s what I do know sometimes. So you have to, Dr. Ben Weitz, Orfanos, Annatto E, LDL, HDL, Lp a, Bernie, Boston Heart, Do we, do we treat those things with antifungals or not? And there’s been so much controversy there.
That’s kind of why I brought that up is that a lot of people don’t think we should be doing that entirely [00:36:00] because it could be creating more resistances or it may not be necessary. And then another world says, well, if they’re there and we find evidence of them and the patient’s symptomatic and they’re chronic, then why aren’t you treating them?
Right. And and. I don’t hardline anything in the world, but what I’ve seen is if you do treat them, sometimes those things can improve. And so you don’t have to always treat them with drugs. I agree. There’s a lot of drug resistances that have been coming up, especially with the azole. Anything with the azole at the end of it would be the ones that I’d be most concerned about overusing, but, herbs are great. They don’t tend to create as many resistances. Yeah,
Dr. Weitz: And if you do treat them with drugs, are you suggesting local treatment or systemic?
Dr. Kunkle: Local I think is better for mitigating some of those influences. You could still create resistances theoretically, but you can do a longer local treatment with less toxicity. And then you can do recolonization with whatever else afterwards. And you always pair it with a biofilm agent, say EDTA or something like that. So you can do Idraconazole, EDTA or if you’re worried about resistances, [00:37:00] another thing is you can use Nystatin or Amphotericin. Amphotericin locally doesn’t absorb just like Nystatin. They’re sort of superficially related, but they’re very much topical therapies. So you can use these bigger drugs if you have to, just locally. And you have to compound them, of course, because there’s no, conventional system there, but it’s probably better that way anyway, because it’s much cleaner mix. There’s not a lot of extra junk in there, and you don’t really want that in these cases.
Dr. Weitz: Is there any relationship between this pressure in the eyes and glaucoma and these other eye pressure diseases?
Dr. Kunkle: Yeah, I mean, it’s possible that they have a contributing force or influence. It’s interesting to think about because Intracranial pressure in general seems to have an association here. And then also in some cases like low intracranial pressure or CSF or spinal leaks too. Some of those can happen through the sinuses and the nasal passages too. And I’ve seen this in my like hypermobile EDS patients before is that they don’t always have to have a trauma. Certainly if they have a trauma, they’re more likely to [00:38:00] develop it. But their meninges, the outer parts of their brain and that sort of barrier system and possibly even. Some of the vulnerable points at the apex of the sinuses, like the olfactory nerve sheaths and sort of, that’s your smelling nerve where they enter into the brain at the apex can all be vulnerable for leaks too.
But anyway, to answer your question, originally issues in this area, chronic inflammation can influence pressure in the brain at large whether it’s, through that cervical area, those outflow issues that I mentioned before, or whether it’s, a process locally or whether it’s microglial activation of the immune system in the brain and neural inflammatory response. So, in other words, I’ve had a lot of people with quote unquote pressure issues in their eyes that maybe aren’t even always defined as classic glaucoma, but they are seemingly related to What’s going on in this particular region and they often will come down. And so it’s very hard sometimes to diagnose all that stuff because you don’t want to subject people to spinal taps and other things, but the glaucoma test is much easier. So if you do that, [00:39:00] I would do that routinely every year. But certainly if you haven’t had it for a while and you’re diagnosed with these things and you’re having any visual disturbances, you do want to roll out if there is actual pressure changes there because they are theoretically possible.
Dr. Weitz: Interesting because I know working with some glaucoma patients over the years, it’s a very tough condition to treat. We’re always looking for new strategies. So this might be something to look at.
Dr. Kunkle: Yeah, it’s worth, it’s worth exploring. I mean, nothing’s off the table. Every case is different. So it’s like whatever your individual situation is, if it’s not being resolved, there may actually be another factor to it that you just didn’t see before. That’s usually the case. That’s great.
Dr. Weitz: So this has been a fascinating discussion. I think I’ve those are the questions that I came up with. Are there any other things that you wanted to talk about?
Dr. Kunkle: Oh yeah, good question. Yeah, I mean, I think just when you’re treating these things too like I said, it’s important to kind of go through all those different steps, like figure out what you’re dealing with microbiome wise, assess the environment around you appropriately and mitigate whatever you got to do harm reduction techniques or purification rinses and different things like this. But also it’s important to think about other things. If the interface is the brain, like I said, one of the interfaces is the brain. What other things can you do to support the brain while you’re going through this type of work? And I think. I could, just say a few comments on that, but
Dr. Weitz: that’d be great.
Dr. Kunkle: Some of the common things to think about would just be your usual like turmeric, curcumin, boswellia type setups, the herbs that are really anti inflammatory for the brain generally, but and other bioflavonoids are really good, like say luteolin, quercetin, things like this. But also you can think from the hormonal perspective, this is something I just wanted to plug in sometimes is that when people are, chronically ill or chronically inflamed. You have to look at the adrenal access in a lot of these people too, and see what their cortisol systems are doing. Cause that’s like kind of your, one of your primary natural regulators of not just circadian rhythm and stuff, but [00:41:00] also inflammatory responses. And so you do want to see what’s going on in that area.
Dr. Weitz: And that’s why I like the salivary cortisol test with Okay.
Dr. Kunkle: Yeah, I usually use the salivary test. I’ll still do an AM cortisol with whatever conventional blood lab sometimes and check it at 830 or something like that. And then I’ll run like pregnenolone, DHEA and some of the other things. That’s kind of what I wanted to bring to too is pregnenolone, DHEA and progesterone even are all what are called neurosteroids. And so when the adrenals become stressed over time, and let’s just say you’re a menopausal woman or an andropausal male or like an older male or something a lot of those natural.
Hormones become depleted and dysregulated, and they actually serve a natural purpose to reduce or augment inflammatory responses in the brain. And they can also help you sleep and help, serotonin, GABA, and all kinds of other things. And so I really do look closely at the big three really, which is like your adrenals, your thyroid and your sex hormone systems and how they interface with the brain in these cases. And [00:42:00] especially if you’ve had a traumatic brain injury on top of all of it, there’s a good chance those systems can be even more likely to dysregulate with the HPA, the hypothalamic pituitary access.
Dr. Weitz: And a lot of patients don’t even realize that they had a brain trauma. Maybe they just hit their head and they thought everything’s fine.
Dr. Kunkle: I think it’s important to put a plug in for TBI traumatic brain injury in general for this discussion because it doesn’t have to be I got knocked out or kicked in the face by a horse or something crazy or a car accident. Some people, especially when they’re already ill, I’ve seen what seem like small inconsequential hits. The big responses. And you can also see the same thing as in the sports world. You might see a guy get hit in the head 20 times and not have any perceivable problems at that moment. Maybe later he will. But then you have one guy that was kind of hit and then, he has really severe concussion signs or something like that. And so it’s just like any trauma, I guess they say that with any child.
Dr. Weitz: We even see patients with whiplash injuries because you can actually get this diffuse shearing of [00:43:00] neurons in between parts of the brain.
Dr. Kunkle: Yeah, totally. So, I mean, I think it’s important also if there was a mechanical motion movement, or it’s Vector C1, or the cranial bones, or anything those trauma responses can influence the drainage of the system, and, the lymphatics once again, and like I said, the HPA. Yeah, I just would say put a plug in for, in these cases, you’re always treating the whole person the best way you can, and That was just an extra little thing I wanted to make mention of, but you’re always looking for those little pieces of what, where’s the system also dysregulated and how does it relate to this inflammatory response?
How does it relate to the health of the mucosal tissue? Like women, when they get menopausal, their estrogen goes down and that actually affects their secretory IGA. Some ENTs are starting to use nasal estrogen even. Really? Yeah. Which is interesting. So I’ve dabbled with it a little bit, but you see low IGA in their body and their gut and their gut.
nasal passages. It’s like, it’s going to be hard for them to clear infections. So you can also use these systems naturally to manipulate the mucosal tissue. So kind of cool stuff.
Dr. Weitz: I [00:44:00] want to ask you a question. You mentioned pregnenolone and progesterone. Now I run hormones in men and I often see progesterone low. And I often wonder, does it ever make sense to give a man some progesterone?
Dr. Kunkle: You certainly can. I think a lot of people do it mostly for the traumatic brain injury stuff, or the acute neuroinflammatory, so they’ll put them on it for like a short duration usually. That being said, less is more in some cases with men. You can do maybe lower doses for augmentation. Progesterone is definitely like the strongest of the neurosteroids. So if you’re not getting anywhere with pregnenolone you can give men progesterone. I would just be careful going from zero to 200. Like I’ve seen, like I had a patient that went to like 200 right away and that’s a lot for a male because men don’t produce that much. Right. And he started having kind of more like, neuropsych responses. They weren’t severe and like crazy or anything, but [00:45:00] he certainly felt a little different and I was like, okay, too much too fast. So if you are going to titrate people, you have to kind of go slowly that way, but it isn’t unsafe technically.
It’s not really, it’s just an intermediary really for men. They don’t use it for the same reasons as women do, but it’s an intermediate step in the process of creating other hormones. It’s before cortisol even. So if your body is actually producing a lot of cortisol, cause it’s chronically stressed or inflamed, your progesterone is going to be down anyway, but. Given whether you give pregnenolone or progesterone, you’re kind of feeding that system from the upper part of the steroid pathway.
Dr. Weitz: So if you’re going to use pregnenolone for a guy maybe who might have had a history of traumatic brain injury, what kind of dosage would you use in that situation?
Dr. Kunkle: For traumatic brain injury, it’s like usually 100 to 300 milligrams. Okay. Yeah. For men. And then you can technically go higher, but that’s a usual range and you shouldn’t have to use much more than that, depending on the severity. My average patient [00:46:00] uses 100, honestly. So you shouldn’t really need more than that. But Sometimes you do if it’s really severe and they’re really, I treat a lot of complex neurologic folks and it’s like a question of like, how much can I give them that they can tolerate? Cause most of my patients are really sensitive. But also, how much they need to meet the demand, whatever the state is.
Dr. Weitz: I recall interviewing one doctor who mentioned that for a patient who just had a traumatic brain injury to apply glutathione topically to the back of the neck.
Dr. Kunkle: Interesting. There are some really good topical glutathiones out there, theoretically. There’s one called Glutaryl that just came out. Once again, no financial relationship here. I think it’s from Oro Wellness and it’s supposed to have a more stabilized form of glutathione topically. And it kind of feels a little bit like putting aloe on your skin. It has a little bit of a sticky feel, but it’s supposed to get into the brain a little more efficiently and a little more intact because the concern is that most glutathione that you take, it’s broken down into cysteine pretty quickly. And some people, a lot of, some [00:47:00] of my patients have, you Cysteine or CBS issues, basically sulfur issues in processing, and sometimes they’re not able to tolerate it as well. So theoretically these topicals could be really cool. And yeah, I would try putting it on the back of the neck and see if it works. Otherwise, generally speaking with topicals, I’ll just use a thin skinned area, like the inner arm or something like that. And it’s, supposed to get there anyway, but it’d be worth trying. Yeah.
Dr. Weitz: Very cool. Cool. So maybe some final thoughts and then let people know how they can get a hold of you.
Dr. Kunkle: Sure. Yeah, so final thoughts. Don’t neglect your sinuses. You may have subtle, your sinuses or your oral health, by the way. And if you don’t like your regular dentist, go find a holistic dentist, like a biologic or something like that, because they tend to be a little bit more likely to listen to you. And a lot of us have a lot of dental trauma, so don’t let that, Stand your way of getting the help that you need. Same thing with ENTs. Sometimes they don’t help you as much as you’d like them to. Or they wanna just do surgery on you, which might be necessary. That’s, but don’t get scared away of by other doctor.
Dr. Weitz: God do certain ENTs in the area, everybody [00:48:00] I send them, they automatically recommend surgery.
Dr. Kunkle: automatic surgery. It’s just a routine day of surgery.
Dr. Weitz: I know you have this slight bleeding, we need to do this. You can operate. Sinus surgery.
Dr. Kunkle: Don’t get scared away by some of that stuff. Some of us normalize our symptoms, whether whatever form they may come in, like, Oh, my gums are just bleeding. They just do that. Or, I wake up really congested every day and like, Oh, whatever, I just blow it out or a netty myself. Don’t let those things go on forever, like, seek some help, because there are solutions to it, and it might not be as quick of a solution because I’m not saying go out and just take Flonase or Esteroid or whatever, because that’s not really, that’s just suppressing it, it’s not really addressing it, but if you’re able to really understand it and address it, it can make a really big difference for your quality of life.
I promise you, you will sleep better, you will have less brain fog, and you will sleep good. And you’ll just feel like, Oh, I can breathe. And that’s great. And I can, I can eat a little more freely too. I’m not as worried, so if you actually [00:49:00] address the issues in the mouth and the flora and all of those things, even if you have to be on a restrictive diet for a period of time, if you get through that and treat all those things, you can come out the other end and be a little more free in terms of what you’re able to eat and deal with, as long as you have a good you know, cleaning regimen.
So, yeah. So even though it seems like, Things are really difficult and overwhelming. There’s a light at the end of it. It just may take some time. And, that could be like one to two years in some cases, on the top end, but that’s a small portion of our lives really for the wellness and the potential freedom that comes at the other end of it.
So don’t give up hope there and take your head. Health, seriously, in whatever form it may come in. Anyway, this was a pleasure. You can find me at GordonMedical. com. I’m at Gordon Medical Associates office of Dr. Eric Gordon and all our friends. We just merged with Pacific Frontier, which was another Lyme and chronic illness focused clinic.
So we have a lot of wonderful practitioners. Feel free to find us. Most of us understand these dynamics that I’ve spoken about today, but look forward to talking to some of you. in the future. [00:50:00]
Dr. Weitz: What would be the website and or phone number?
Dr. Kunkle: Oh yeah, GordonMedical. com. You can just do it all one word GordonMedical.com. And the phone number’s on there. I didn’t memorize it, but Use the website. YouTube and other areas. So if you look at Jamie Kumkel, ND, Gordon Medical you’ll find a lot of other talks that I’ve done. So if you’re interested in anything else I’ve talked a lot about nervous system stuff over the, over the years here too. So, Please find me. Excellent. Thank you.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310 395 3111. And we can set you up for a consultation for functional medicine. And I will talk to everybody next week.
