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Dr. Dale Bredesen discusses Revolutionary New tests for Alzheimer’s Disease with Dr. Ben Weitz.

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Podcast Highlights

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Dr. Dale Bredesen, MD is a neurologist and an internationally recognized expert in the mechanisms of neurodegenerative diseases like Alzheimer’s Disease and the Chief Science Officer at Apollo Health. He is the author of the best selling books, The End of Alzheimer’s,  The End of Alzheimer’s Program, and The First Survivors of Alzheimer’s, and his newest book, The Ageless Brain.  Dr. Dale Bredesen’s career has been guided by a simple idea: that Alzheimer’s as we know it is not just preventable, but reversible. Thanks to a dedicated pursuit of finding the science that makes this a reality, this idea has placed Dr. Bredesen at the vanguard of neurological research and led to the discoveries that today underlie the ReCODE Report.  Dr. Bredesen offers training for doctors and practitioners in his ReCODE system at his website at ApolloHealthco.com.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcript

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

Hello, Rational Wellness podcasters. Today we have an exciting interview with Dr. Dale Bredesen on the latest testing and research related to Alzheimer’s disease. Dr. Bredesen is a internationally recognized neurologist with a specialty in the mechanisms of neurodegenerative diseases.  He’s now the Senior Director of Precision Brain Health at Pacific Neuroscience Institute here in Santa Monica, and the Chief Scientific Officer at Apollo Health. To this day, the prevailing view in the medical community is still that Alzheimer’s is a degenerative neurological disease that’s ultimately fatal, and at most we can slow its progression with some of the newest monoclonal antibody drugs.  However, Dr. Dale Bredesen has shown that a Precision medicine, functional medicine approach has been able to reverse and prevent Alzheimer’s disease in the majority of cases, even when there are unfavorable genetics, such as having an APOE4 gene. Though his work has not yet received the recognition that it should, I predict once it is that Dr. Bredeson will receive a Nobel Peace Prize.  But as of now, The Alzheimer’s Society of Canada says that Dr. Bredesen’s protocol offers false hope. Dr. Dale Bredesen has published over 200 scientific studies and three books, The End of Alzheimer’s, the End of Alzheimer’s Program, and The First Survivors of Alzheimer’s, with his fourth book soon to be published, the Ageless Brain.  He has published the results of a study using his Recode Precision Medicine approach, showing that 84% of 25 patients with dementia or mild cognitive impairment improved over a nine month program. And this study was published in the Journal of Alzheimer’s Disease journal of Alzheimer’s Disease in 2022.  And this study was repeated, or this program was repeated in another study by another researcher, Dr. Heather Sandison, using this protocol in 2023 with patients with more severe dementia. Getting similar results. There’s currently a peer reviewed study being conducted in six different centers around the world using the Bredesen protocol.  Today, I would like the first part of our discussion to summarize your Precision Medicine approach to Alzheimer’s and other neurodegenerative diseases, review some of the latest developments, and then I’d like to discuss a collection of three newer blood tests that can help us to diagnose and track progress for patients with Alzheimer’s disease that, that Dr. Bredesen calls the neuro code. So Dr. Bredesen, thank you so much for joining us again.

Dr. Bredesen: Thanks, Ben. Great to talk to you.

Dr. Weitz: Have you found any increase in acceptance by the conventional neurological medical community?

Dr. Bredesen: There’s beginning to be some recognition that you can actually do something about this.  But if you go and, you know, ask 10 people on the street at random, you know, nine or 10 of them will tell you that they think that nothing can be done. And you may have seen just over the weekend there was an opinion piece by. The by a writer, Charles pillar who writes for science the, the journal, the scientific journal called Science, and he was writing about fraud and the, the amount of fraud that has gone on in Alzheimer’s research.  And this was widely read, and one of the points he made is that there’s nothing that can be done. And here’s a guy who’s reading about this all the time. And actually he and I were on Megan Kelly’s show together a few years ago, so he should have been aware of what we’re doing.  And I sent him some of our papers and he said, as soon as the his book comes out, he will you’ll get to work reading some of these and see, you know, see what he thinks.  So, you know, it, it’s unfortunate because just compassionate use dictates that when you have an untreatable disease, if you have anything that is suggestive that you should at least use what you can to hope for best outcomes for literally compassionate use. And this came up for back in the late 1940s, so about 80 year, almost 80 years ago when Dr. Dana-Farber, who is a pathologist. At the time there was no treatment effective at all for childhood leukemia. And one, and the observation that he made was that childhood leukemia seemed to get worse when people would be treated for their anemia. And one of the things, of course, that they, that was used was folate.  And so he thought, Hmm, is it possible that we could retard the development of childhood leukemia by using an anti folate?  And they started with aminopterin of course later. This led to things like methotrexate and dapsone and things like this. And although he just had a few cases and a few had been killed by the treatment, that’s how bad it was.  He had the first. Even somewhat successes in childhood leukemia. And this changed the field and now the majority of people with childhood leukemia will survive.  So, and that was published in the New England Journal of Medicine. And so people recognized at the time, Hey, this is compassionate use, you gotta start somewhere.  And even though there were people killed by the treatment, which we don’t see with Alzheimer’s treatment, with the approach we’re taking, we get people healthier. Then it was still, it turned, it was still used because we needed it, and I, I would hope that people would ultimately come to the same conclusion.

We want anything we can do to give us better outcomes. I’ll tell you though, Ben, the most important thing that we could all do is early testing. It’s just like a pap smear. It’s just like a chest x-ray, just like hemoglobin A1C and things like fasting insulin looking before you have full blown diabetes and start to have all sorts of glyco toxic problems.  You can pick it up early and do something about it, and we have the same now we have wonderful early tests for pre, literally, literally pre-Alzheimer’s disease.

Dr. Weitz: And it’s not like you’re advocating bloodletting or some of the standard care of medicine years ago that could potentially be harmful.  Even if some of those patients didn’t improve their brain health, their overall health is going to improve by eating a healthier diet and exercising and, and getting their blood sugar under control and doing some of the other factors involved in your program.

Dr. Bredesen: Yeah. And you know, the bottom line here is that there is a set in, what we spent many, many years in the lab studying what actually gives you this neurodegenerative phenomenon, whether it’s Alzheimer’s or Parkinson’s or Lewy body or frontotemporal dementia or what have you. And what we found is, there’s a whole set of signals that are synaptoblastic that are literally creating new synapses that are, that are helping you to have neuroplasticity, learning and memory, that sort of thing. Then there’s a whole set of demands, things that are pulling back, things like inflammation that are telling you, pull back, pull back. And so what happens is as long as you’re on the right side, you’ve got more supporting than you have the detractors. You’re in good shape, but as you age and as you now get exposed to various toxins and various infections and have metabolic syndrome and leaky gut and chronic sinusitis and all these things, what happens is your supply goes down, your demand goes up because of the inflammation and toxins and things like that.  And now what’s happening is your, your brain literally is switching from a connection mode to a protection mode. It is putting its resources into dealing with these various insults. I. So when you do that, of course you are now decreasing your synaptic number. You don’t notice that until, which is again, why early testing is so important.  You don’t notice that you’re decreasing synaptic number until you start to have symptoms, and that takes a while. And so the announcing, wait a minute. I could have remembered this before, or I could have done this before, or I could have been quicker [00:09:00] before, or I could have focused better before those sorts of things.

Now you’re actually seeing this effect of a reduction in the number of functional synapses in your brain. So as you said, getting in early and it’s absolutely, there are all sorts of diet and lifestyle things that can be helpful. But there’s also, beyond that, I. Knowing what to look for. There are specific chronic infections that often go undiagnosed.  Things like sleep apnea, that is a common contributor, changes in the oral microbiome. Specific biotoxins and specific metallo toxins, inorganics, organics. These are the major groups that can give you problems. So identifying those and addressing them. Often removing the source and then detoxing and things like that.  Again, and again and again. We see people, no surprise, they get back to where the supply is better than the demand, and they bring back the ability. So imagine that you had. Imagine you had [00:10:00] a, a big box and you could store, you know, a thousand, a thousand of your baseballs in there and you need your baseballs, you know, to, to play, play baseball every day.  Okay? So if you, if the box gets smaller, then you start getting smaller, you’re gonna say, okay, I can’t put any more baseballs in here, because it’s, it doesn’t, it won’t hold anymore. And so that’s what your brain actually does. It says, look I’m shrinking in terms of the synapses. And you can even see, of course, the atrophy on MRI.  When you do that, it says, okay, the first thing that goes, is the ability to add new stuff. I mean, that makes a lot of sense. Interestingly, there are two things that go at the same, pretty much the same time. One is what we always hear about the inability to store new information so people have trouble learning new things.  The great news they can still do things that they’ve learned for their rest of their lives. So there’re still quite functional. The other thing that goes is in the locus ceruleus, that is the place in your brainstem that [00:11:00] projects onto your cortex with the norepinephrine. So this is basically the stuff that is out there when you’re you know, when you’ve got adrenaline going, boom, and you’ve, so what it’s really telling you is we don’t have room to store more, and we’re not gonna let you go into turbocharge speed anymore. You can do just fine going on, put, you know, putting along at 25 or 30 miles an hour, you’re gonna be able to do a lot of stuff, but you can’t stress it out. You can’t go into this mode. And you do see people very frequently as they’re beginning cognitive decline.  They’re a little passive. They don’t have that spark. And one of the things we hear most frequently as they start to turn around is their spouse will say, wow, they’re just so much more engaged. You know, the light has come back to their eyes. They’re now able to do the things that they just couldn’t do before.

Dr. Weitz:  And you were just talking about toxins and I’m here in Santa Monica and we’ve had these horrible fires that have ravaged Los Angeles. And unfortunately for all the people who’ve lost their homes and everything else, and as these homes burned, they released all these toxic substances that spread throughout the city in the air, landed on homes, buildings, ground, everything and all this soot is liable to contain all sorts of toxins.  And ought to think seriously about making sure that we clean these toxins out. And all of us probably ought to be on some preventative detox.

Dr. Bredesen: No question about it. One thing would be, you know, take a vacation for a while if you can get away from that area. Another thing is you indicated you have some HEPA filters or have some things like that in your home to get rid of.  You want these particulates you know, as well as some of the organics, both of those to, so things like, you know, IQ Air and things like that. And they’re all sorts of different ones. I, I am, I, I’m not a representative for any of them, but a any of these things, very, very helpful. There’s Molecule, I think is another one.  And there are, there are a number of these. And then as you said, getting your detox. And then that’s a really good idea for anybody. And, you know, making sure your glutathione is up to snuff. A lot of people like to take sulforaphanes. Making sure you have plenty of fiber in your diet that helps you get rid of these toxins that are in your gut.  You’re gonna have exposure obviously through your nose. And so, just optimizing these things, having plenty of crucifer make, making sure that you can do everything possible for detox is actually not even a bad idea to check your genetics, see if you’re a good detoxer or a bad detoxer. There are a number of these groups that do this.  3X4 Genetics does this. Telex DNA, does this. I think it’s DNA life is another one. There are various ones to that make, to make sure that, see if you are a poor detoxer or a good detoxer. And then of course having a good low toxin diet, not being exposed to a lot of ultra processed foods. You know, having filtered water, doing sauna.  Sauna’s been very helpful for a lot of people sweating and then using a non-toxic soap to get rid of that sweat.  It’s been shown. I mean, the sweat contains a lot of you know, a lot of toxins that are being excreted from your body. Your body’s doing everything possible to get rid of these things. Yeah. So, and they go, as you know, they affect every organ, including your brain. So there is a lot that people can do and many things that people are not doing but a lot we can all do to minimize our toxicity.

Dr. Weitz: And one of the key ways in which your approach is different than the conventional approach is that while we all recognize that amyloid plaques and phosphorylated tau protein are often present in the brains of patients with Alzheimer’s, while the conventional neurological community has largely focused on trying to remove the amyloid plaque, right, using monoclonal antibody medications, the results of which have largely been a failure in my opinion. You have focused on the underlying metabolic, immunological, physiological reasons why the body lays down this protective plaque and these tangles.

Dr. Bredesen: Exactly. And you know, it’s a little bit like if you were called to try to improve an area where a lot of people have been killed and you get out there and you see that the police have guns, you say, okay, if we can just get rid of those police, everything will be okay.  No, that’s not the way to go. They’re there for a reason. So what, one of the things we’ve been interested in is. What is the physiological response? Everyone’s focused on the pathology. Oh my gosh, look, there’s tau. Oh my gosh, look, there’s amyloid. Let’s get rid of it. That’s not the way this works. We wanna focus on the physiology.  Why is this there? And your body makes the amyloid because it surrounds and kills microbes. It is an [00:16:00] antimicrobial peptide. Tau is an antimicrobial protein. So these things are dealing with insults. Interestingly, the amyloid also binds metals, and when you have that combination of an antimicrobial and something that binds metals, that means it’s an, it’s an anti-biofilm agent because it can take apart the biofilm and kill the bugs inside.  And amyloid been shown to have antiviral effects, antifungal effects, antibacterial effects, antiparasitic effects. I mean, it’s pretty remarkable stuff. Unfortunately, of course, in the long run with inflammation, you now start decreasing the neural network. But what we are suggesting is that I. This amyloid, this response is something that can protect your brain for years, as long as there’s not a lot of inflammation there you can protect the brain for years. You can isolate these various pathogens and you can sequester them and kill them while your brain goes on functioning normally. And we know there are many people. Who die. And at autopsy they have brains with lots of amyloid but no cognitive problems. So it doesn’t make sense.  You can’t just say, this is the cause of Alzheimer’s. Sure, it’s associated with Alzheimer’s, but it’s not the only thing that causes it. So we gotta kind of separate that. And what we want to do find to remove amyloid or tau, as long as you remove the reasons they’re there first. And we have seen a number of people where they had the amyloid removed by an antibody and they got worse.  So we want to remove the cause of the problem. What are the insults? Is it metabolic syndrome? You know, is it we were talking about earlier, you know, is it a chronic sinusitis? A leaky gut. So common sleep apnea. So common changes in the oral microbiome. So common. There was a real recent, very interesting paper looking [00:18:00] at the brain’s microbiome instead of the guts or the oral microbiome.  And it turns out the brain actually has a microbiome, which I wow. Always taught that it should be sterile, but it’s not. There is a microbiome in your brain, but most of the organisms that they find in the brain are oral species. So a lot of what’s going on in your brain is related to your dentition, which is one of the reasons I think that best outcomes requires that good, well-trained dentists get involved as well.  And I think we’re, we’re beginning to understand this disease and these neurodegenerative conditions like Alzheimer’s, much better than ever before.

Dr. Weitz: It’s amazing in which the oral microbiome plays a role in heart health, in brain health. It’s incredible how all these things are connected.

Dr. Bredesen: Yep, absolutely.

Dr. Weitz: So, when it comes to diet, you advocate a keto flex diet. Can you explain what that is?

Dr. Bredesen: Yeah, so if you look at all of the different pieces, you know, what do you need? So you know that you need to increase energetics. That’s a huge, the six big players in Alzheimer’s are energetics, inflammation, toxicity.  Those are the biggest three, and then the lesser three are neurotrophins or trophic activity: that’s hormones, nutrients, and neurotrophins like NGF and BDNF, neurotransmitters, like acetylcholine. And then interestingly, stress. And as a scientist, I never used to think that stress was going to be a big deal for, for patients.  It turns out it’s a huge issue and no question it can shrink your brain, that alone. So those are the big players.

Dr. Weitz:  What is, what is, what’s the mechanism by which stress can shrink your brain?

Dr. Bredesen:  Yeah, so it’s thought that if you look at the, the production of corticotropin, so for example, just CRF one is one example.  CRF one is a receptor in the brain for corticotropin releasing factor. And it actually is basically part of stimulating your brain and saying you’re under attack. You need to switch from connection mode to protection mode. So you ramp up your amyloid, you ramp up your tau. You’re, again, you’re pulling back on your neural network.  You’re switching from this connection mode to protection mode. What’s been amazing to me is you see this at every level in the brain when you make this choice, when you, when you’re under assault, you change your likelihood of having thrombosis. So you change your endothelial lining, you change your renin levels.  Renin is part of what helps your neurites find the right place. You’re now pulling back. You have a low renin, you have less neuroplasticity. You’re changing your a POE signaling. You’re changing, literally changing your epigenetics. You’re changing the production of amyloid. You’re changing the phosphorylation of tau.  You’re changing something called hippo signaling, which is related to your, your lysosomes. It’s amazing. Your total body, you undergo this shift is literally like going from sleep sleep to wakefulness. You know, your whole systems change when you go from sleep to wakefulness. And the same idea, these systems change when you go from connection to protection.

Dr. Weitz:  Fascinating.  Last time we spoke, you have mentioned a nutrient called Homotaurine that prevents the oligeramization of A beta. Has there been any further progress on that compound?

Dr. Bredesen:  And I should finish responding to your, your issue of the diet first. And yes, when you look diet,

Dr. Weitz:  oh, okay.  Well, let’s, let’s finish with the diet first. Yeah, I’m sorry.

Dr. Bredesen:  It’s plant rich, mildly ketogenic. Doesn’t have to be only plants. Wild caught fish, great. Some grass fed beef, fine. You know, some pastured chicken, pastured eggs fine. Or if you don’t want those fine too. But, but it’s fine to have some, but it’s a plant rich.  Mildly ketogenic diet. And you know, you need either ketones or glucose to, to power your [00:22:00] brain. Your brain is much like a Prius that you’ve got two different things that will power it. And if you’re low on both, which, if you’ve got insulin resistance, you typically are low on both. You’re sputtering.  You don’t have that normal. So we want to bring these back for everybody, make them insulin sensitive and give them some ketogenesis. And so I just recommend at the beginning, just take some exogenous ketones. This is why people have had such good results with coconut oil, MCT, oil ketone salts, ketone esters, any way to get that up.  Then over time, you’ll be able to become insulin sensitive and generate them on your own, but your brain needs that energy. It needs the oxygenation. So if you’ve got some sleep apnea that’s undiagnosed, as so many people do, that needs to be addressed. This is again, where wearables is so helpful.

Dr. Weitz:  And we need the right fatty acids as well, right?  

Dr. Bredesen:  Absolutely. You want to have a good Omega-3 index ratio of about 10% or so. For sleep, you know, you wanna have at least [00:23:00] one hour of deep sleep every night, at least an hour and a half of REM sleep, and at least seven hours of total sleep with a an oxygen saturation. Of at least 94% during the night. So, again, the targets that you can do wearables can be very, very helpful.  You want to have this, you know, the high fiber in the diet, which helps with detox and with help helps improve your, your lipid status, helps improve your glycemic status. All these things. Very, very helpful. Now you mentioned Homo Toine which is an amino acid, but not one of the 20 building block amino acids.  But this thing has an interesting property, and this was shown several years ago by the ion group. That this actually prevents the oligo modernization of the amyloid. When the amyloid comes together to kill bacteria typically multiple ones stick together and it’s usually in like groups of three.  So for example, they’ll make a 12 me 3, 3, 3, 3. And these, these are much more potent against this. And so when that does that, they can also damage your mitochondria. They’re also involved with neurodegeneration. So we’re trying to prevent that, and especially for people who are a POE4:4, that’s 7 million Americans, and unfortunately, most don’t know it, it’s a good idea for everyone to find out.  They then that will they actually do quite well with some hoori knives. Just heard within the last week from Dr. Christine Burke, one of the excellent physicians who’s practicing this approach up here, just outside Sacramento, that the group that was shipping the Homotaurine from Europe has stopped doing that.  So I don’t know how available it is today. Oh, interesting. Certainly, it’s, it, I think it’s, it is a promising approach. They’re looking at a drug trial with a precursor of it currently, and we’ll, you know, we’ll see where that goes.

Dr. Weitz: And then exercise is super important and as exercise is also super important for making sure we maintain our muscle and our bone density in a similar way to make sure we maintain our brain.

Dr. Bredesen: Absolutely. So it’s important to have aerobic and these are really synergistic. It’s important to have some strength training, which really does different things that really helps your insulin sensitivity, for example. And you know, people see again and again that’s associated with longevity. I. So it’s, it’s a very important piece of this.  Some people like to use katsu bands, which are these which are these resistance bands, which kind of gives you more bang for your buck. Some people like to use EWOT is one of my personal favorites because it gives you both the aerobic part, you get better blood flow, but you also get better oxygenation. 

Dr. Weitz: EWOT is Exercise without Oxygen?

Dr. Bredesen:  EWOT is exercise with oxygen. With oxygen. Okay. So it’s giving you extra oxygenation. So that, that’s all good. And then you know, sleeping, we just talked about [00:26:00] stress, a huge issue. Again I like to use my wearable and just look at heart rate variability. 

Dr. Weitz:   Do you, is that the oral ring? Is that what you use?

Dr. Bredesen:  I use an Apple watch, but Okay. People like Oura rings. Absolutely. Our daughters really like those and you know, others like Garmin or Fitbit or any of these things, whatever you like whatever you feel comfortable with they can be helpful to you.  Of course. Another wearable that’s so helpful is the CGMs, the continuous glucose monitors that so many people, you can now get ’em. Over the counter, which is fantastic. So you can look to see we are you spiking? Are you troughing? They’re both a problem. If you’re spiking your glucose that is a problem that’s gonna give you insulin resistance if you are going down in the trough, like a lot of people will wake up at three or 4:00 AM and they don’t know why they’re waking up until they do CGM, and it turns out their glucose is down to 45.  So they’re not kicking in that glucose when they need to. And that’s often associated with a high carb diet, so you want to smooth that out. 

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Dr. Weitz: I’ve really been enjoying this discussion, but I just want to take a few minutes to tell you about a product that I’m very excited about. Imagine a device that can help you manage stress, improve your sleep, and boost your focus.  All without any effort on your part. The Apollo wearable is designed to just to do just that, created by neuroscientists and physicians. This innovative device uses gentle vibrations to activate your parasympathetic nervous system, helping you feel calmer, more focused, and better rested. Among the compelling reasons to use the Apollo wearable are that users experience a 40% reduction in stress and anxiety.  Patients feel that they can sleep. Their sleep improves up to an additional 30 minutes of sleep per night. It helps you to boost your focus and concentration and it’s scientifically backed. And the best part is you can get all these benefits with a special $40 discount by using the promo code Weitz.  W-E-I-T-Z, my last name at checkout to enjoy these savings. So go to Apollo Neuro and use the promo code Weitz today. And now back to our discussion.  

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Dr. Weitz:  I was just talking to a patient and he says, well, I keep seeing my primary doctor and I’m. Pre-diabetic. I’m almost at diabetic, but he’s waiting until I’m diabetic, before he treats me.

Dr. Bredesen: That’s such old fashioned, just outdated, antiquated thinking. Unfortunately,

Dr. Weitz: right? All these things happen. These chronic diseases gradually happen. We need to catch these early [00:29:00] and not wait until you have frank disease as early as possible.

Dr. Bredesen: That’s the trick. 

Dr. Weitz: And when it comes to cognitive function we’ve gotta catch this as early as possible.  And even before mild cognitive impairment, which as you’ve pointed out, is actually an advanced state.

Dr. Bredesen: Yeah, that’s a really good point. Telling someone they have mild cognitive impairment is a little bit like telling ’em they have mildly metastatic cancer. It’s a relatively late stage, so when you develop dementia with Alzheimer’s, you go through four stages.  You have a stage that is asymptomatic. And the good news is we can now pick this up with PTA two 17. Then you go through a stage where you have SCI, subjective cognitive impairment. By definition, that means you know, something’s not quite right, but you’re still able to test normally on cognitive testing.

If we could just get people in those two stages to come in. Then there would be very little dementia. You don’t have to get further. We, we have pretty much a hundred percent improvement in [00:30:00] SCI. In the MCI. As you mentioned in our trial, 84% of people got better, but you had to work much harder with MCI than you do with SCI to get things to turn around.

That’s the third of four stages. SCI lasts on average about 10 years. Then you go to MCI, which lasts a few years, but each year with MCI, you have a five to 10% chance of converting to the fourth and final stage, which is dementia. Now we’ve had some people who’ve just been hearing some where they were all way down to significant dementia, and they’ve been better.

They haven’t come all the way back to perfect. You know, they come back from dementia to MCI or they come back from MCI to SCI. So we wanna get people to come in earlier to get much more complete turnarounds. So yes, MCI is the third of four stages. What? By definition, what that means is now you’re not testing normally on cognitive testing.  Now the tests are showing some abnormalities. However, you’re still able [00:31:00] to do your activities of daily living. You’re still able to care for yourself. That’s all part of MCI.

Dr. Weitz: And you’re using this approach and other practitioners are including myself for other neurological diseases like Parkinson’s, other forms of dementia and I understand you’re also experimenting with patients with a LS.

Dr. Bredesen: So, yeah. So if you just can go back to what drives these diseases, it’s this mismatch. It’s, it’s not enough supply, too much demand. Now you have to adapt it for each disease. So in Parkinson’s, the common things are not so much about what you see in Alzheimer’s, it’s really more about exposure to organic solvents, trichloroethylene ethylene dron P-C-E-D-D-T.  Paraquat, all these sorts of things are associated more with Parkinson’s, and so we wanna focus on those but we still want to obviously improve [00:32:00] health with it. In fact, one of the best things for Parkinson’s patients happens to be exercise. I. Huge. We know that in Parkinson’s, the rate limiting step, the problem with the nervous system is at the level of the mitochondria and specifically mitochondrial complex one.

So that gi we, we then want, it gives us a lot of understanding of what we wanna do. We wanna support the mitochondria. To get these people to be better. Now for others. So we have some people with macular degeneration who are doing better as well. That’s a different adaptation. They have different things.

So each of these has its own signature because each one has its own achilles heel. These all come because of the way we evolved. We evolved to select for performance. Over durability. So you keep doing that. And of course, if you don’t select for performance, the creatures that did select for performance kill you and they survive.

So because of the way evolution wor that works, always selecting for [00:33:00] performance at the expense of durability, we have these remarkable neural networks. You know, you can store as much information in one human brain. As over 2000 home computers. Wow. It’s equal to some of the largest supercomputers and this tiny little, you know, tiny little 1400 gram, three pound thing in your brain.

It’s incredible. But in so doing, in selecting for these amazing neural networks, you’re giving up some durability. If you look at a LS, again, what you’ve selected for is this incredible power amplification. You go from a thought to the maximal use of your muscles like that, and the amplification is huge.

In fact, there’s more amplification going from one thought to maximal muscle use, which a human can do than there is from take going into your car and stomping on the accelerator and getting up to. 300 or 400 horsepower, you actually get more amplification. It’s [00:34:00] incredible. You look at Parkinson’s, incredible motor modulation.

Look at what Simone Biles can do that shows you what a human brain is capable of with fine tuning of the motor of the motor modulation. And then look at macular degeneration. Humans, their macula. With support, appropriate vascular oxygenation, support, and not too much inflammation, they can distinguish about 1 million color variations.

Wow. So all of these things are these amazingly finely tuned networks. They are, it is just like taking out your super tuned Ferrari on the road. You can get into problems. It’s not, it’s, you’re not gonna drive that Ferrari at super high speed for 500,000 miles. It’s just not gonna work that long.

Dr. Weitz: Yeah.

 

Dr. Bredesen: You were talking about

Dr. Weitz: a LS with the a LS boy. You see that neurological collapse, that muscle atrophy, it just kicks in so severe, so quickly. It’s, it’s a [00:35:00] horrific disease.

Dr. Bredesen:  And again, if everybody could have a way to check that before it ever happens, wouldn’t it be great? Right. To my knowledge, there is, that’s the one area where there’s not a great, very early test.  We’ve got good ones for Alzheimer’s, fairly good ones for Parkinson’s, very good ones for macular degeneration. We don’t have a great prediagnostic test for a LS yet. Right.

Dr. Weitz: Ha. Has, is anybody using your approach with ALS right now and getting some success?

Dr. Bredesen:  Not to my knowledge. Okay. And this is just the beginning as, and as you indicated, I mean, this is a tough one because it tends to be faster than Alzheimer’s.  Alzheimer’s people, you know, have years of decline. A LS if you at present at presentation, if you have any symptoms above the neck, the average time of survival is one and a half years. Wow. If you, if you don’t have anything above the neck. The average is three years. So it’s a tough one. And [00:36:00] the good news is we understand a little bit about the, the Achilles heel in that neural sub network, which is the power amplification one, and it does seem to be about glutamate uptake.  You’re using this. This cytotoxic neurotransmitter glutamate, which stimulates and it helps you to have this dramatic burst of muscular power, et cetera but also can damage neurons over time. And so if you don’t take that stuff up, once you liberate it into the synapse, if you don’t take it up quickly and inactivate it, then it can be damaging.

So anything that damages your ability to take this stuff up and inactivate it. We’ll increase your risk for a LS unfortunately, do we have some ways to take up glutamate and inactivate it? So normally the astrocytes do that. So the, you know, your glial cells around will do that. So if you’ve got a mutation in a you know, in, in one of these transporters, that’s a problem.

If you’ve [00:37:00] got oxidative damage to the transporters if you overstimulate, as you know, this nice work from, from a group that’s that is looked at L-B-M-A-A beyl, methyl amino l alanine. So BMAA is one which is produced by things like cyanobacteria. And that also can be a problem because it acts like the glutamate and so it can continue to stimulate.

So there’s some studies now that they’re doing Dr. Paul Paul Allen Cox in his group. And they’re looking at l serin as a way to interfere with this glutamate toxicity. And we’ll see they have not reported their results yet. Then we’ll see where it goes, but I’m hopeful that that will be helpful.

Dr. Weitz: Interesting. Let’s talk about your study that’s currently underway right now at six different centers and. What a challenge it must be to conduct a study. You with so many different variables. The the model of what is considered a [00:38:00] scientific study that’s valid is the drug trial where half the patients get the drug and the other half of the patients get the placebo and everybody’s getting the exact same treatment.  Whereas a precision medicine, a functional medicine approach requires individualized care.

Dr. Bredesen:  Absolutely. So, the idea here was instead of just ahead of time saying everyone’s get the exact same thing, or they’re gonna get a placebo, the idea is we’re gonna look to see what’s driving it in each person.  So each person’s gonna get a personalized precision medicine approach. Addresses their various things, and they’re different for each person. Some people will have sleep apnea, some won’t. Some will have HSV one, some won’t. Some will have P. Gingivalis, some won’t, and so on and on. So these are all gonna be addressed and we are just actually finishing in a couple of days.  We are finishing enrollment and so the, the trial will be over by the end of October. We should have results to report shortly after that. So far things look very good. We did a kind of halfway analysis, you know, where do things stand? Things look good. And we are seeing differences. So the, the control group in this case is getting standard of care.

They get the standard drug treatment. If they you know, if they are. If they have dementia and we’re looking at people who, who have both MCI and early dementia. Those, that’s the group very similar to what’s been used in the drug trials. So that’s the idea. And as you indicated in the past, people have said, well, you can’t do a multi-variable trial.  But the argument is, but this is a multi-variable disease, so you’ve gotta look at these different things. And I’m really. Honored to be working with such outstanding physicians with Dr. Anne Hathaway here in Marin and Dr. Kat Toups, Dr. Christine Burke, Dr. Nate Bergman, David Haas, and Dr. Craig Tio down in Southern Florida. So we’re really fortunate to have some outstanding [00:40:00] physicians doing this trial.

Dr. Weitz: Yeah, I think we need a different paradigm to understand the type of medicine that I know I’m practicing with functional medicine because the, the trial, the double plan, placebo control trial that’s used to test drugs, it’s just not appropriate for this type of medicine.

Dr. Bredesen: Yeah, this is a, you know, this is a network insufficiency, so you’ve gotta look at all the different players in making that network work.

Dr. Weitz: Are there any new peptides or any other things that you’re finding might help a little bit in moving the needle?

Dr. Bredesen: Mean, there are all sorts of things that are helpful that are interesting.  I, I would say. But the, the most important thing we’re finding that the people who don’t do well aren’t doing the basics. They aren’t just Right. Doing the, so you really have to optimize the basics. Right. And that’s seven things. You know, you talked about it. Diet, exercise, sleep, stress, brain training, so brain [00:41:00] stimulation and training, things like photobiomodulation, very helpful.  Detox and some targeted supplements. Those are the basics. And then beyond that, the specifics. Are there any infections that you have that you have to treat? And are there any toxins that you have to detox from? Those are the critical pieces to do this. Now there are some new things, the armamentarium.

Is growing rapidly. And when you mentioned Homo Taurine there’s something interesting called, called Pentasol that a number of number of people have used. And one of the things that does is also to prevent the oligomer of the abbe that looks quite promising. Oh, really interesting. Yeah, both Dr. Is, I’ve talked to him a number of times.

Exactly. Yeah. So, so that, and then as he would, as he would note when they were doing their trial, they noticed that people were actually doing better with their cognition. Oh. I think that’s a, that’s a promising avenue as well. Of course, there’s some stem cells. Adipose derived regenerative cells, a DRCs that have had some good results in people.

There are there’s [00:42:00] uly and a, there’s been a lot of push on uly and a, which is, gives supports. Mitochondria. Of course PQQ also increases mitochondrial number. So those things can both be helpful. And then there’s an interesting new group called mi with Tom Benson and his group. And they are looking at what, what is essentially mitochondrial transfusions, so isolating mitochondria that are healthy and then giving you these, in these little.

Encapsulated what they call millets. Basically little encapsulated way to deliver large numbers of healthy mitochondria because so many of these diseases, energetics plays a role. 

Dr. Weitz: And so really, so it’s mitochondrial transplants or something.

Dr. Bredesen: Essentially like a transfusion of healthy mitochondria.  Wow. Exactly. I think that’s, it’s promising. And again, I think if you look at one advance, that’s the most important of all. It is earlier detection. ’cause if what we’re seeing it every day. The people who come in early, it’s, we now can do this pretty much every time. It’s pretty easy to make people who are in really early stages do well and stay well.

We just published a paper, the first example in history of people who stayed improved and stayed better, sustained their improvement for over a decade. And that’s free available online so anybody could read it.

Dr. Weitz:   And what is that paper called and where is it published? 

Dr. Bredesen:  Yes. It is sustained improvement.  It’s published in a journal if you look at biomedicine, so just look up under my name and biomedicines, you’ll see it. It’s again, freely available online. Most of our papers are so that you can see these. [Sustained Cognitive Improvement in Alzheimer’s Disease Patients Following a Precision Medicine Protocol: Case Series] 

Dr. Weitz:  So that’s great.

Dr. Bredesen:  You know, we’re seeing this sort of thing, so again, get in early. You can, it’s so easy.  The later it later you can still get some improvement, but. It’s harder, you’ve got to do more. And it’s, and it’s not as likely for for improvement. So and I, and again, coming back to, to, you [00:44:00] mentioned neuro code earlier, this is a. Very important advance. I think it’s the most important test that’s come out in years and I’ve just had my own done a few weeks ago.  So what, what we’ve done is we’ve worked with neuro code because they have the most sensitive approach and it combines three blood tests. So simple. You don’t have to have a PET scan, you don’t have to have an MRI. Get this blood test. It’s called Brain scan. And you can go, you can literally get do get a get a brain scan.com and I had it drawn at my house.  You can have it drawn by mobile phlebotomy, or you can go into a draw station either way. 

Dr. Weitz: And it looks now getting it through neuro code or brain scan, is that different than just ordering these three tests through LabCorp or Quest?

Dr. Bredesen: Yes, it’s different because this group, neuro code, they are pioneered this.  LabCorp has kind of copied it, but theirs is not as sensitive. Oh. Specifically the neuro code uses what’s called single molecule [00:45:00] assay, Samoa, S-I-M-O-A. And they use a special machine called Alts Path and they, so they have the most sensitive look and they’re actually coming out with an even more sensitive one in the next few months.  So very excited about that. Really. What is, what is gonna be different about that one? I. You know, I don’t know yet. They’re, they’ve been reporting this to us, so, okay. I’m excited to see, but they’re actually upping the sensitivity. So again, this would go back, imagine, you know, 50 years ago people would tell you, oh, Ben, you got diabetes.

I’m so sorry. And already you got diabetes. You’re already damaging your eyes, you’re damaging your kidneys, you’re damaging your blood vessels. Now they can tell you, oh. You’ve got a high fasting insulin. You’ve, you’re, you’re headed for diabetes. You don’t ever have to get it because we can detect it early, pre-diabetes and literally pre, pre-diabetes.  That’s where we are now. With this test, we can detect pre-Alzheimer’s and pre pre-Alzheimer’s. And so it looks at  PTau 217. This is what happens is really fascinating with tau. So tau is a molecule that stabilizes your microtubules. So when you’re sending out these neurons to make connections. You’re stabilizing these with tau it.

So it is part of connection mode. When your body senses uhoh, things are bad. There’s an insult I’ve gotta pull back. Now it phosphorylates the tau. So you have an enzyme called GSK three beta. So this thing phosphorylates the tau, it changes the shape and the charge. Because of the phosphorylation, it pops off the micro tubule.

And now this becomes a PreOn that goes and looks to kill bacteria. So you kind of go double duty this thing one day is working to stabilize your connections and now it says, no, no, you’re needed for protection. It now changes shape and it now starts to kill bacteria. It’s kind of amazing. Wow, what a system.

It’s, it’s [00:47:00] like, you know, go back to the Minutemen from the Revolutionary War where they were farmers and all of a sudden the British are coming. They give ’em a musket and now they’re out there as soldiers. It’s the same sort of thing. This changes. And so Isn’t that interesting? You started your career studying prence.

Yeah, exactly. So these things are, they are, prions and prions are involved in all the major neurodegenerative diseases. Now we believe, we understand why these things are anti infectious agents. They’re good ways to get, they’re antimicrobial proteins, they’re protecting you. So, what happens is you can measure the PTau 217 in your blood.

Then the second thing is called

Dr. Weitz: gf and, and what does the PTau 217 is? It. This tells you whether or not you have Alzheimer’s, right?

Dr. Bredesen:  It tell, so it tells you are you on the side of pulling back where the, where you’ve got a lot of phospho tau or are you on the side of connection where your phosphol will be low?  So you want your phospho tau in this neuro code assay, the brain scan to be  0.0 0.34 or less. And if it’s high and especially if it’s 0.63 or higher that’s associated with amyloid in your brain and with some cognitive changes in between there, you’ve got an area that is indeterminate, which is 0.34 to 0.47, and then you’ve got the 0.47 to 0.63, which is a little bit high.  Not yet associated with cognitive decline. So you wanna pick it up there early. And I tell you, we’ve got some amazing stories just in the first couple of months of these things, we’ve had a number of people who were a POE four four, so they’re in the worst genetic group. They already had symptoms several years ago.

They went on the program, the protocol we developed, they got better. Now they check their phospho and it’s normal now. Wow. I would, I wish we had it, you know, several years ago when they started. It would’ve been so helpful, but it just wasn’t available then, right? To, to have it be normal when they’ve already [00:49:00] had symptoms is unheard of.

So it really shows we’re on the right track here and I’m very excited about that. Then I should mention the third test is NFL Neurofilament Light, and that gives you complimentary information. It says. Are my neurons being damaged? And that can be from that can be from a car wreck, that can be from too much play in football and get hit in the head punching.

It could be from a vascular disease, Alzheimer’s, frontotemporal dementia. But for example, I’ll see people, so we have a report that we write up for each person. If you have high phosphol, but low NFL and low GFAP, the GFAP tells you about inflammation. You don’t have very active Alzheimer’s, but we’ll see ’em sometimes where we’ll not only have the high phosphol, but we’ll have high GFAP.

And high NFL, and that tells you this is active, very active, ongoing, and you really better jump in there and do everything possible. Then the good news, we can follow these as they come [00:50:00] back to normal, as people do the right thing. So this is gonna change I. And allows so many people to avoid Alzheimer related dementia because you can look at this early and prevent the continuation, prevent the progression.

Dr. Weitz: And GFAP is glial fibrillary. Acidic protein. Acidic protein, right?

Dr. Bredesen:  So GFAP, that is actually an intermediate filament protein. So what happens is. Your astrocytes are sitting there and they’re in a quiescent state. When you need help, when you’ve got an inflammation, when your neurons are damaged, they’re basically caretakers for the neurons.  You turn them on, you say, you know, the alarm goes off. Hey, we need you guys. They boom, they jump into action and they swell. They get bigger and they, you, they make more of this GFAP. As they’re getting to be larger and jumping into action. So that’s what you’re measuring in the blood. You’re measuring that GFAP.  Some of it will get into the blood and you can see it go up as [00:51:00] you have inflammatory things going on in your brain. Wow.

Dr. Weitz: Let’s see. Can other diseases degenerative diseases of other kinds related to kidneys or cardiovascular make these markers change, or these are purely related to neuroinflammation?

Dr. Bredesen: So the phospho Tau is specific for Alzheimer related processes. By the way. It is also teaching us something about what’s giving you more risk. One of the things that we’ll bump it up a little and tell you yeah, this is pushing you toward Alzheimer’s is COVID-19. So just having that inflammation from the Covid, we will bump it up a little bit.  Then the second thing is the GFAP is, so the PTO is specific. The, the GFAP is non-specific for inflammation, so anything that’s causing the inflammation and attempted repair bumps up that GFAP. And then the NFL is specific for neuronal damage, but not [00:52:00] just Alzheimer’s. So you’ll see it with Alzheimer’s.

Sometimes you’ll see it with frontotemporal dementia. So one of the classics is if someone comes in and they’re having problems with cognition. If their PTO is completely normal, but their NFL is high, you’ve gotta be suspicious of frontotemporal dementia. Another way to go. You also could be suspicious of Lewy body disease.  They are non Alzheimer conditions. And so it’s really helpful now to say, aha, this person, you need to focus on this, this person, you need to focus on that. So again, there’s so much that can be done. The armamentarium in these diseases is just expanding rapidly. I. Nobody should be getting Alzheimer’s anymore.  This, this is be rapidly becoming an optional condition. If everybody would just get checked and we recom recommend, just check your brain scan, check your, your, those, the neuro code numbers. These, this so-called brain scan when you turn 35 and then just every five years, [00:53:00] 40, 45 when you hit 60. Do it every two years.  That makes it easy. You don’t have to do it very often, but just like everyone should know their blood pressure, everyone should know their lipid status. Everybody should also know their PTA status because it is such an important determinant and will allow you to prevent problems in the future. I. That’s great.

Dr. Weitz: So where should listeners patients practitioners go to find out more about your programs that you offer?

Dr. Bredesen: Yeah, so the easiest thing to do, and I think the best is just do I. Go look at, so-called my CQ test. So CQ is your cognitive quotient. So if you just go to my CQ test that’s free. It’ll, it is a free way to look at where, what is your cognitive status.  And then we recommend again that everybody. Get the brain scan so that they can make sure not to have problems. And you can do that at Get a Brains scan at.com. You can follow what we’re doing on Facebook, [00:54:00] Dr. Dale Bredesen. You can follow it on X, you can follow it on Instagram. We just started recently.  You can also follow it on Blue Sky. So, any of those things all, and as you mentioned earlier several books out have a new one coming out March 25th which is called The Ageless Brain. And the whole idea of that was, we’ve talked a lot about what to do about Alzheimer’s. What about for all of us?  How do we get to make sure the whole goal of this is. Protection and performance. We wanna make it so that everybody’s brain span is as long as their lifespan. The big problem, of course, is people who live to 85 and they, their brain only only is working well until 65. That’s 20 I. Tough years. Yeah. When I talk to like the YPO group, I always say, you know, all these anti-aging guys, and I’m like, how many people wanna live to 140?  Everybody goes like, okay. And they say, and spend half of that time in a nursing home with dementia. Like, whoa. So, you know, we want to avoid that. We want to make sure that our brains function for as [00:55:00] long as our lifespan is, get that brain set up and that’s what the Ageless Brain is all about. So I have a couple examples I give of people.  Catching early in one case, catching Parkinson’s early in one case catching Alzheimer’s early. Neither one has any long-term problems. They do very well because looking at it early and doing the right thing makes all the difference.

Dr. Weitz:  That’s great. Thank you so much Dr. Bredesen, Great to talk to you. 

Dr. Bredesen:  Always. Thank you so much for the discussion and look forward to continued discussions in the future. This is an exciting time, you know? Oh, yes. It’s very exciting. All my career. Yeah, we had nothing, nothing. When I was training as a neurologist, we had nothing to offer people, and so just to be able to see people getting better, it just makes my day. 

Dr. Weitz: That’s great.

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Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star 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 wanna promote longevity. Please call my Santa Monica Weitz Sports chiropractic and nutrition office at 3 1 0 3 9 5 3 1 1 1 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.

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Dr. David Rabin discusses The Apollo Neuro with Dr. Ben Weitz.

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Podcast Highlights

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Dr. David Rabin, MD, PhD is a board-certified psychiatrist, trauma specialist, and neuroscientist.  He is the Co-Founder of Apollo Neuroscience, the first scientifically-validated wearable system to improve heart rate variability, cognitive performance, sleep, focus, relaxation, and access to meditative states by delivering gentle, layered vibrations to the skin.  The website is Apolloneuro.com and if you use the affiliate code Weitz you will get $40 off. 

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcript

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

Hello, Rational Wellness Podcasters. Today, we’ll be having another conversation with Dr. David Rabin about stress and the science behind a wearable device, the Apollo Neuro, that uses vibrations to help us to activate our parasympathetic nervous system.  Also known as our rest and digest nervous system. So we can have a better balance with our sympathetic flight or fight nervous system. We last spoke three years ago [00:01:00] and Dr. Rubin and his team have been very busy refining his products and conducting research. Documenting some of the many benefits of these wearable devices.

It’s interesting that the last time we spoke, we were in the 19 crisis and the whole world was on edge, in sympathetic dominant mode. And now, The city I live in Los Angeles has been living through Another high stress trauma these horrible fires With continuing reports of strong winds coming and continuing dry conditions leading to Everybody being back in sympathetic dominant mode Dr. David Rabin is a board certified psychiatrist, trauma specialist, and neuroscientist, and he’s also the co founder, along with his wife, Catherine Fantuzzi, of Apollo Neuroscience, the first scientifically validated, wearable system to improve Heart rate variability, cognitive performance, sleep, focus, relaxation, and access to meditative states by delivering vibrations to the skin.  Dr. Rabin, thank you so much for joining us.

Dr. Rabin: My pleasure. Thanks for having me, Ben.

Dr. Weitz: I mean, this is amazing that a perfectly safe easy to use product Can deliver all these valuable benefits.

Dr. Rabin: Yeah. It’s a, I mean, it’s not unheard of, right? We know that music can deliver a lot of the similar benefits we often take for granted, but you, you know, as well as all of our listeners that.  When you are having a bad day and you step into your car or walk into a room and one of your favorite songs is playing, you almost instantly [00:03:00] forget that you were having a bad day and you feel better. Right. And it’s, that’s, I always liked that as a, as a former musician, amateur musician and music lover, I’ve always noticed that effect. And as a neuroscientist wondered, you know, how does that work? Because it’s nearly universal across all humans and music has the ability when it’s fast and loud to give us energy and it has the ability to calm us down and help us fall asleep when it’s slow and soothing. Right. And yet again, neurosciences had very few explanations over the last 100 years for why that happens.

And so, when I was in the lab studying how to create, I was, you know, I was working with a lot of veterans and people with severe trauma that were not getting better with medicine. And we were trying to figure out, well, Maybe there are ways to help alleviate some of the suffering of these folks using technology and maybe music that the body feels as a solution because music through the ears works [00:04:00] so well, but you can’t have stuff in your ears all the time.

Like, I couldn’t be listening to music while I’m talking to you, but I can use Apollo. On my chest when I’m talking to you and you can’t hear it right right and so this is the same for our patients with PTSD and the same for most working people in the world who are busy throughout their day. They can’t have music in their ears.  And so we thought, well, maybe if we study the neuroscience of music and rhythm. That we could start to understand how to give, deliver to people many of the same benefits that you get with music, but through your body instead of your ears. And so, effectively, that’s what Apollo is. And anybody who wants to try it on OneVibe, we have OneVibe for free on the Apollo app on iPhone.  And you can download the Apollo Neuro app on your Apple Store and just Turn it, open it up and it will play automatically for you. And you can hold that to your chest and you’ll feel exactly what we’re talking about.

Dr. Weitz: So is it well known that music works through vibrations?

Dr. Rabin:  Yeah, so it is in the science world.  In the non science world people think about music and, and vibration differently, but everything in music is auditory and vibrations is tactile.  Right. But the whole premise of what sound is, is vibration. So, vibration means frequency over time that is moving like this, like it’s moving air. Right. Right? And that’s what sound is. It’s physical Energy that moves air like this in a certain frequency and rhythm and that frequency is what we feel when, for example, you’re standing next to a subwoofer at a show or you have you’re in a movie theater and you feel the base in your body.  That is all from the movement of air and the air or through the through the floor and through the seat you’re in and that transduces the vibration through the physical physical form of air or a physical seat into your physical body and you actually don’t need to hear sound to feel the benefits, which has been known for a long time.  But of course, hearing it is great, but we don’t always have that option. But I think to your point. Everything we experience on a bigger level, everything we experience in the world is made of vibration and frequency. So this is, you know, something that was discovered by Einstein and many of the other most famous physicists of our time.  Even Nikola Tesla described the entire world of experience is vibration. And vibration just means something moving over time. So whether it’s the whether it’s smells, taste, touch, vision, you know, vision being light being a very high frequency vibration, sound being lower frequency vibration, touch being even lower frequency vibration.  It’s just what is our body’s physical, physical [00:07:00] organ sensing as part of the frequency experience around us. But everything in the world is vibrating and everything is frequency.

Dr. Weitz: Can deaf people appreciate music by feeling the vibrations?

Dr. Rabin:  Absolutely. And there’s lots of evidence of that. Even before current times, there were people who were deaf musicians.  Right. So I think so one of the most famous try to remember my classical music history now, but I think one of the most famous, I think Beethoven was deaf, right? And he wasn’t deaf in the beginning of his career, but he did lose his hearing nearly completely from what I recall of my music history towards the end of his career.  It’s been a while. And, and that’s really remarkable, right? That he was able to compose so many tremendous pieces. Concertos and, and symphonies after losing his hearing in large part because he was able to sense the vibration of the sound. And, and in addition to knowing already what the, in his [00:08:00] memory, what the notes sounded like, he was able to feel the music and other folks like David Eagleman make products now.  Based on the theory of how to help people who have lost their hearing still feel sound. And, and this is a growing era, area of research.

Dr. Weitz: Interesting. What about wearing it on the chest? I am not familiar with that. I thought you had to wear it on the wrist or the foot or the leg, ankle.

Dr. Rabin: Oh, no. So Apollo can be worn anywhere.  We designed it to be worn anywhere because not everybody likes to wear things in the same place. And we wanted to make this really easy for people. So, this is Apollo with a clip. You just take it off like that. It’s like a little money clip. And you can put it on and, you know, attach it anywhere.  I, ultimately It’s because low frequency vibrates Apollo delivers gentle soothing sound waves to your body that you can feel so in the same idea of what we’re talking about Apollo is [00:09:00] sound that you can feel it’s not electricity. It’s not sending you shocks. It works through clothing so you don’t have to have it against your skin.  You can have it anywhere in your body over a sock. I have an undershirt on and it’s not against my skin right now. And. It works by sending these very deep base rhythm vibrations through your, your body to your skin touch receptors that are the same touch receptors that get activated when you feel soothing, touch from a loved one or a pet, or you get a hug from a friend or you feel ocean waves slowly crashing over you.

Those are, those are all deep base vibrations and so they have sound component and they have a in the case of the ocean. But in the case of or a purring cat, but in the case of a hug, there’s no sound, right? It’s just it’s just feeling. And so we have you know, at least six or seven different tactile or touch receptors in our skin that receive the feelings of pressure that that come from getting a [00:10:00] hug, for instance, and that those receptor systems are tightly connected into our nervous system that go all the way up to our brain, and particularly the emotional brain.  And this area is called the limbic system and the area that they go to is an emotional memory area that reminds us that that feeling feels safe and that particular area of the brain, that these kinds of frequencies that we discovered with Apollo activate. That part of the brain, the, which is called the insulate cortex directly interacts with the amygdala, which many of you probably have heard of, which is that fear center of the brain and for almost all of us who live in modern society, the fear center in our brains, that amygdala is it.

It’s overactive, it’s blasting off all the time because it’s overstimulated, it’s too much input from screens and news and responsibilities and all of the things that we have to deal with every day, the amygdala is sensitive to the fear center, it’s sensitive to overstimulation. And so basically [00:11:00] too much, too fast, too loud sends that amygdala into overdrive and that makes us feel afraid, even though there’s nothing around us to be afraid of.

There’s no survival threat. There’s no predators. There’s no lack of food, lack of water, lack of air. All of our major needs are taken care of. And yet we still feel anxious, worried, afraid, alone, right? And Why is just because that’s that our nervous system never evolved for the overstimulation of modern society.

So to counteract that, there’s lots of different ancient eastern tribal techniques, deep breathing, yoga, meditation, mindfulness, soothing touch. But we know from trying to teach our patients that for 100 years that it’s really hard to learn and master those techniques. It can take a really long time, like years.  And so we wanted to make something that could help deliver some of the benefits to people. Of feeling safe and present in your own body without requiring you to master those techniques. That also trains you how to do those techniques more easily. And so that’s what [00:12:00] the rhythms of Apollo do. And that’s what we discovered in the lab at the University of Pittsburgh.  And I’m gonna say like it was like, I guess it was like 10 years ago now. Wow.

Dr. Weitz: Wearing it over the heart. I wonder, have you looked into the possible benefits for patients with arrhythmia conditions like AFib that have to do with the rhythm of the heart being off?

Dr. Rabin: So, so the location that you wear it in doesn’t really matter from what we can tell from our research.  As long as you can feel the gentle vibrations, the effect is still is happening. You’re getting the benefit of the, of the technology. We have had people who are wearing Apollo and other parts of their body tell us that they have been using it for A fib for high blood pressure for a high heart rate, tachycardia, other cardiovascular issues.  And they’ve had great results personally. And this is in the order of like, I don’t know, a couple of hundred people who just have sent in their, their data over the years showing, Hey, I track my [00:13:00] blood pressure or I track my heart rate and. I have less AFib episodes or lower heart and lower heart rate and lower blood pressure when I use Apollo and look at my data.  And so we have seen that from individuals and that’s really exciting. We have a cardiovascular health study that’s in the works, but it hasn’t started recruiting yet. So we have to wait and see on the study of that.

Dr. Weitz: Okay. Since we’ve been talking about the sympathetic and parasympathetic nervous system, maybe you can talk a little more about that, how that relates to stress and, and then, you know, the balance between the two where we’re supposed to be at and how the Apollo can help us to create a better balance.

Dr. Rabin: Sure. Yeah. And, and I think the, this, this is the most important. So what was one of the most important things to understand if you take anything away from this conversation is how our stress response system works, because it’s very poorly taught. And I had to go through college and medical [00:14:00] school and graduate school and residency.  And I still didn’t learn through all of those studies, exactly how this, the stress response system was working in our bodies until I actually read. And studied Eric Kandel’s Nobel Prize winning work from 2000 which was probably towards the very end of my training and Eric Kandel is fascinating character.  He’s a neuropsychiatrist Holocaust survivor who had basically pioneered the research on with a, we’re building off a lot of other amazing researchers on how memory works around fear and safety learning and fear being the major reason why our stress response nervous system gets turned on. And this is not, this is not unique to humans, which is really important.

So all, all animals going back to ancient sea snails from 300 million years ago, we probably talked about this on the first conversation, but it’s good to, good to recap. All [00:15:00] animals have the same basic core stress response system, and it goes back hundreds of millions of years. So it’s hardwired into us.  So it’s really, really important to understand. And that is that when we experience anything that makes us afraid, fearful, and that’s real, real threat, like a real survival threat, like lack of food, water, air or predator chasing us, or it’s perceived survival threat, like too many emails or being late for a meeting or any of those kinds of things, then we get.

Transcribed Our fear response gets kicked on in our nervous system, and that’s called the sympathetic fight or flight response. And that’s the response that takes the main function of that response is to take all of our blood flow and divert it to the systems that are required to get us out of a survival threat situation.

Right. So if you imagine we have an entire body worth of organ systems in it, and [00:16:00] there’s not enough blood to go around to all those systems at the same time, there’s only enough blood to feed certain systems at certain times, and then keep other ones on like background alive, but not functioning highly.

And so the way the body, the way and the brain determines what systems get prioritized is based on where the blood goes. So when we are under threat, actual threat or perceived threat from emails, and we believe ourselves to be afraid or under threat, the body constricts the sympathetic fight or flight nervous system activity, the amygdala fear center goes off and it’s and it constricts through through downstream activities through the nervous system throughout the whole body, all the blood vessels that are going to our the Our reproductive system, our digestive system, our immune system, our sleep and recovery system, our empathy system, everything that’s not required for survival gets reduced blood flow so that all of that blood [00:17:00] flow can go to skeletal muscle.  Our heart, our lungs and our motor cortex of our brain and our fear center of our brain to get us out of that threatening situation as quickly as possible. 

Dr. Weitz: In other words, our bodies are perceiving this stress over emails the same way it perceives the fear of a lion chasing us and that we’re trying to run away from.

Dr. Rabin: Exactly. Unless we tell it, hey, these are just emails, don’t worry, everything’s going to be okay. If we don’t remind ourselves of that, which is what makes humans really unique, is we have the ability to, what’s called, top down control. So we can say, hey brain, I know you’re freaking out right now, I feel my heart rate going up through the roof, I feel my face getting flushed, I feel my vision shrinking into tunnel vision, those are all signs of Fight or flight nervous system getting priority, we can say, Hey, brain, I know I’m not under threat.  These are just emails. Don’t worry, let’s take a [00:18:00] couple deep breaths, everything’s going to be okay. And as soon as you do that reminder of those couple deep breaths, you have convinced your brain that you’re safe enough to take a couple deep breaths. And if you’re safe enough to take a couple deep breaths by decision, because you decided to do it, then you can’t possibly be running from a lion in that moment, because if you were running from a lion in that moment, your body would not allow you to stop and take a couple deep breaths.

Does that make sense? Yes. Thank you. So, so that is how that’s that system process works of what’s called de escalating yourself or calming yourself down is with breathing count to five, count to ten, we’ve all heard all these things, right? Right. Nobody’s ever explains how it works, but that’s how it works.  is count to five count to ten you take a couple deep breaths ideally like 60 seconds worth of deep breaths if you can and you’ve just reminded yourself that you’re safe enough to not let your stress response fight or flight system run amok and steal all of your [00:19:00] blood flow from all your organ systems that matter and so when you get to safety by taking those deep breaths and reminding yourself you’re safe or by getting a hug or using Apollo or whatever it is that you’re doing to make yourself feel safe And reminding yourself that you’re safe in this moment, then your, your vagus nerve system gets activated and your vagus nerve is called, is cranial nerve 10.

It’s the most important nerve that governs rest and rest and recovery relaxation in the body. And it’s the core nerve of what’s called the parasympathetic system, which you mentioned is also known as the rest and digest system. And so when that system gets activated, it says, Hey, we’re not under threat.

We’re safe. And that system gets activated by safety and it says we’re safe. So let’s send signals to the body that dilate all the blood vessels to the organ systems important for recovery. The reproductive system, the digestive system, the immune system, the skin, the empathy system, [00:20:00] creativity, all those parts of our brains that we want to be active when we’re not being chased by a lion.

Get activated by the vagus nerve through releasing more blood to those systems, and then it constricts blood flow to all the stress response systems to divert blood back to recovery. And so the more, this is why, so this is why doing relaxation techniques decreases blood pressure. Because you’re, you’re opening up blood vessels, quite literally, to so many different organ systems in the body that are important for recovery.

And so guess what? Your blood pressure comes down because it doesn’t think it needs to be, it doesn’t think you’re being chased by a lion and need to have your blood pressure high. That’s when you need to have your blood pressure high is when you’re being chased by a lion, right? It doesn’t need to be high the rest of the time.  And so our, our stress response system is constantly being regulated in the background for these purposes, but it’s up to us to remind ourselves or use technology. Or tools like [00:21:00] breathing and techniques like breathing, meditation, mindfulness, yoga, all of these things to remind ourselves when we’re not actually in a survival situation, so that our bodies can recover and heal.  And then what’s beautiful about this system is your body starts to actually heal itself, which is really just stunningly incredible.

Dr. Weitz: When it comes to vibrations, do all people respond the same way to the same types of vibrations or is it an individual response?

Dr. Rabin: Well, there’s always some variability with stimulation, right?  In all kinds of stimulation are variable, but most people, for instance, so we’re talking about like vibration of all spectrums. Think about like sunlight, right? Sunlight is a very high frequency vibration. It’s when you, when most people experience sunlight, most people, if not, everyone feels good.

Dr. Weitz: Okay.

Dr. Rabin: Right. So that’s like one of the more universally positive reactions to vibration. Music little more [00:22:00] variability, right? Some people have certain kinds of music they really hate. Other people have certain kinds of music they really like. My parents get recovery responses when they listen to classical music and show tunes.  They get stressed out when they hear house music, right? But if you look at what music is most popular in the world. It’s actually house music for dance, for dancing and, and human interaction. It’s house music. Why is house music so popular is a question that people in my generation and above ask all the time.  Why are so many people into house music? There’s a scientific reason for it. It’s because the beats per minute of house music, the rhythm of house music is very, very similar to, if not the most similar of all the kinds of music we hear. To the rhythm of the blood flow in the womb, right? Interesting. So think about that.  It’s a sub, completely subconscious experience. When you listen to music, a song you like, you’re not saying, Oh, it’s because I reminds me of the [00:23:00] womb, right? You’re, you’re, you just like start moving and your body starts doing its thing. 

Dr. Weitz: What I mean, is that deliberate?

Dr. Rabin:  Nobody knows that, right? Do they? No, I mean, you know, people have studied music, people who study music know it.  But, but the, but the people who first started making house music didn’t know it. They just made music that people like, like any producer. Right? They just made music that they like. They know they like it. And I think that’s what’s so interesting, is there’s a subconscious thing happening where with, especially with music, we notice that We, we experience it all the time, but we don’t necessarily notice it, which is that the body knows what it likes and touch is very similar, right?  So touch is less variable than music on the lower end of the spectrum. Most people who have their hand held by somebody they trust really like it. Or like if you, if, if your crush holds your hand. Is that an experience that anybody ever dislikes? Usually not, right? [00:24:00] It’d be very strange if your crush held your hand and you were like, Ew, gross, right?

Like you never hear that happening. Same with hugs. If you get a hug from somebody you trust, or, or you snuggle a pet, almost everyone universally likes that experience. And so, the, the question is where, when you’re talking about vibration, like how do you deliver the right thing to the body where the body doesn’t.

Become aversive to it, meaning it doesn’t recoil and music is tricky because again, music has a melody. It has a base. It has a middle, a midsection has all these different instruments and rhythms that has vocals. And so music can polarize people one way or the other. And so It actually, for a lot of reasons, is not ideal as a therapy, even though it can be very therapeutic when it’s chosen properly in the right setting light, super therapeutic if used properly, especially sunlight.

We know and touch low frequency sound, like sound vibrations that [00:25:00] induce touch, which is what Apollo is. almost everyone responds the same way, which is really interesting. I would say about 5 percent of people that we exposed to Apollo, we’ve had over 150, 000 people using it to dates since we last spoke.

And only about 5 percent of people respond differently to the vibrations than the norm. Most people fall into the norm, and the norm is that if you’re using it properly and you feel the gentle waves of vibration, like if you were to download the app and feel it on your phone right now, most people respond the same way, which is that they feel relaxed, calm, their heart rate starts to come down, their breath rate starts to slow down, and they feel a little more at ease and present in their bodies, and the reason why that is is because we designed it based on how The body responds to touch, not how the body responds to music.  So Apollo is sound waves. It is music, but it’s composed for your touch receptor system instead of your ears. And our ears are much more picky [00:26:00] than our touch receptor system. And so that’s how Apollo is able to affect people in such similar ways, regardless of your background or size, effectively.

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Dr. Weitz: I’ve really been enjoying this discussion, but I just want to take a few minutes to tell you about a product that I’m very excited about.  Imagine a device that can help you manage stress. Improve your sleep and boost your focus all without any effort on your part. The Apollo wearable is designed to just to do just that created by neuroscientists and physicians. This innovative device uses gentle vibrations to activate your parasympathetic nervous system, helping you feel calmer.  More focused and better rested among the compelling reasons to use the Apollo wearable are that users experience a 40 percent reduction in stress and anxiety patients feel that they can sleep. There’s sleep improves up to additional 30 minutes of sleep per night. It helps you to boost your focus and concentration and it’s scientifically backed.  And the best part is you can get all these benefits with a special $40 discount by using the promo code whites. W E I T Z my last name at checkout to enjoy these savings. So go to Apollo neuro and use the promo code weitz today. And now back to our discussion

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Dr. Weitz:  Heart rate variability. This is something that Apollo Neuro helps to improve.  This is related to recovery from athletic performance and ability to be successful. Can you talk about heart rate variability and how Apollo can help with this?

Dr. Rabin: Sure. So, so heart rate variability. Since we were just talking about the vagus nerve, right? The vagus nerve being the critical nerve of recovery in the body.  Right. So heart rate variability is our best measure of your vagus nerve activity. It doesn’t look at anything else other than vagus nerve activity. That’s like the main thing. 

Dr. Weitz: By the way, when you talk about vagal nerve, I know you say it doesn’t matter where you Put it, but could you put it like where the vagal nerve is?  And would that have an additional potential benefit by stimulate? Can you physically stimulate like the vagal nerve?

Dr. Rabin: Yeah, absolutely. But, but the vagus nerve is

Dr. Weitz: like devices, like electrical devices. And we’ve used red light therapy directly over the vagal nerve to help patients with, for example, gut problems for sure.

Dr. Rabin: Yes, that’s all true. And the main way [00:29:00] that you activate the vagus nerve through one of the, what’s called, it’s called an afferent site, A F F E R E N T, is through like through the neck or through the inside of the outside of the ear or by implanting a device into the body that stimulates the vagus nerve directly is by using electricity. And electricity is very useful to activate the vagus nerve, but it activates the vagus nerve very strongly. And when you activate the vagus nerve very directly and strongly by actually sending a signal straight to the vagus nerve, you do increase heart rate variability in the moment, and you do slow heart rate, but you can also have side effects, like You, when you increase anything too much, you can have side effects, so you can over sedate people, people become too tired, they can pass out, people can have what’s called orthostatic hypotension, so they stand up and then their heart rate doesn’t catch up and they pass out people can get headaches, they can get dizzy there’s lots of other things that can happen, you can burn the [00:30:00] skin, right, or you have to have surgery for doing an implant vagal nerve simulator.

Right. Right. So that category of vagal nerve stimulator is very important and it’s actually the foundation of our field of vagus nerve study is electrical stimulation of that nerve. But the that category of device that uses electricity to do that is called direct Vagus nerve stimulation meaning it’s hitting the nerve directly.

It’s all straight on the nerve Okay, that form of vagus nerve stimulation has side effects because it’s very strong You can only use it for about 20 to 40 minutes max a day for instance And you can’t use it when you’re doing other things. It’s very hard to focus on anything else when you’re actively Directly stimulating the vagus nerve.

So when we were working on this Direct vagus nerve stimulation was one of the leading new treatments for PTSD when we were working on Apollo, and so we thought well Why aren’t more people using this and then we realized there were side effects from it And you can’t do other things when you’re using it.

You have to take time out of your [00:31:00] day and And there were, and it’s also, you know, shocks your skin. So at that time, the only devices that did that mostly were FDA clearance devices, which require a prescription. And so there were lots of barriers and issues with that treatment. And so we thought, well, what if there’s a way a vagus nerve activity activation is so important and health of the vagus nerve is so important.

Then maybe we can activate it indirectly, right through not hitting it right at the source, but to hitting in other parts of the body because the vagus nerve goes everywhere in your body. It literally innervates your entire body. So that’s, that’s why somebody holding your hand where there’s no technically no vagus nerve receptors, somebody holds your hand and you like that person, you vagus nerve because Your positive touch receptors in your hand or positive signaling of your touch receptors in your hand is sending a signal to your emotional brain that says, Hey, I like this feeling.

And then that activates the vagus nerves to the brain and then the brain stem. So there’s all these other ways to get to the vagus nerve. And [00:32:00] so we thought, well, Let’s look at indirect vagus nerve stimulation and see if that can be delivered on the go for people without taking time out of their day.

And that’s how we actually, one of the ways we actually discovered Apollo was because we forced ourselves to look outside of the traditional electrical stimulators, but HRV heart rate variability, not just in the moment, but over time is a major indicator of success because if you’re doing yoga, deep breathing, biofeedback Regular healthy meditation practice, getting regular healthy exercise, you, or any kind of vagus nerve toning technique, any techniques that regularly improve the health of your vagus nerve, you will see heart rate variability go up, not necessarily in the moment, sometimes in the moment if you have a Lab grade EKG machine, but definitely over time if you do them over time and the more the higher your HRV, the reason why this metric is interesting is because it’s the best way for us to measure vagus nerve activity and now we have [00:33:00] studies of HRV showing in the population that if you have low heart rate variability, then you’re more likely to get sick.

You’re less likely to recover quickly if you get sick. You’re more likely to get injured in athletic pursuits. You’re more likely to make mistakes at work. You’re less likely to live a long, healthy life. And the opposite is true if your HRV is high, meaning if your vagus nerve activity is high, And you’re well recovered, you’re well, you’re sleeping well on a regular basis, sleep being the number one way we improve heart rate variability and vagus nerve activity.

So if you’re getting, if your HRV is high on a regular basis and trending upward, doesn’t mean high today necessarily, but trending up over time, that means that your recovery is getting better, you’re more likely. To function and close to your peak, you’re more likely to overcome and resist illness if you get sick, and you’re more likely to live a long, healthy life.

HRV is now one of the leading biomarkers of longevity and healthspan, so [00:34:00] it’s critically important. And up until this point, there’s never been devices or technology that have helped to improve vagus nerve tone and heart rate variability. What we call passively, like in the background without you having to do anything, you always had to do something.

You always had to take time out of your day, go meditate, go breathe properly, go sit in this breathing apparatus, go sit in a float tank, right? Go do these things. And very few people, we don’t acknowledge this a lot, but very few people actually have the time. to go and do those things on a regular basis.

It’s hard. And so, and it can be frustrating. And so, we thought, well, like, let’s, let’s focus on making things that don’t require a lot of time. And it’s hard to do that too, but if we can do it, it’s a huge win. And so, we tested different vibrations, different sound waves that increase heart rate variability in double blind randomized placebo controlled trials in the lab to try to understand what [00:35:00] rhythms Do the touch receptors respond to that increase heart rate variability just like getting a hug?

And it turns out that there are very specific slow wave rhythms that are between five and seven breaths per minute, which is important because if you were to breathe at five to seven breaths per minute, in fact, if any human on the face of the earth was to breathe at five to seven breaths per minute for a, for like 120 seconds, you would increase your heart rate variability.  Immediately. That’s really cool, right? That’s like the the cheapest, easiest way to boost your health in the moment and to help yourself feel calm and relaxed. So we thought, well, maybe there’s something special about this 5 to 7 times per minute rhythm. And so we started to explore that rhythm with sound and then that ultimately proved to be true That you can use.

You don’t need to breathe that rhythm. If you send that rhythm to the body, the body will figure it out. It recognizes that rhythm just like listening to a song that you like and you [00:36:00] start to dance automatically that your body likes that rhythm and it starts to breathe at that rhythm automatically. And then when you breathe at that rhythm automatically, your heart rate variability goes up and you feel better.

And that continues over time. So that was a really important discovery that we published in the first study was a double blind, randomized, placebo controlled trial published at the University of Pittsburgh in, I want to say like it was 2021 that showed for the very first time that you can send these vibrations to the body.  From Apollo and your HRV goes up significantly and that had never been shown before. So that was the first, that was the first of many studies that have now shown this. And it’s exciting because it’s a new era for mental and physical health that we can use technology to augment our well being without putting so much work into it.

Dr. Weitz: And this is also, this would be a good anti aging marker, wouldn’t it? HRV.

Dr. Rabin: Well, that’s what’s coming out now. So the most recent data around, this is from [00:37:00] epidemiological studies, which means, fancy science word for population based, large population based studies have shown that if you, if you look at populations where people live the longest and have the healthiest longest lives.  The blue zones. Yeah, like the blue zones. The people who live the longest in blue zones have the highest heart rate variability. So that is interesting. We never known that before. But that is just, it’s not, it’s not causal, but it’s another clue that suggests that having high vagus nerve activity and doing activities that increase our vagus nerve activity, getting a good night’s sleep, exercising regularly, Eating healthy, all the things we teach, we tell people are important, right?

This is not, shouldn’t be news to people, but this is just evidence that all the things we tell people are important, including living a low stress lifestyle, are critical to living a long, healthy life. Right. And the more that we do all of those things, the better. It’s not just, there’s no, there’s no silver bullet for health [00:38:00] and longevity.  It’s, you try to do as many things that reduce your stress as possible, and you’ll increase your chances of living a long, healthy life as much as possible.

Dr. Weitz: I, I was reading somewheres where you were talking about some of your studies or, and you were mentioning how there aren’t a lot of biomarkers to track with stress.  What about salivary cortisol levels that can be measured throughout the day? Is that something that could be correlated and see improvements using the Apollo?

Dr. Rabin: So, yes, but salivary cortisol. So, so HRV is by far the heart rate variability is by far the easiest, best biomarker to track around stress. The reason why is because you can track it with one of these.  Or, or with one of these, right? You don’t have to spit into a tube or do [00:39:00] anything. Yeah, no lab tests. So one, it’s a one time fee for each of these things, right? You just wear it and then you can track it over time and you get the, you get the day daily results, and you get the overtime results. And it’s not a hundred percent accurate, but it’s like 90% accurate if you’re wearing the devices properly and using them properly over, not in the day, not day to day resolution, but.

Weeks and months resolution, you’re looking to like a 90 percent accuracy, which is pretty darn good. Yeah. Now, let’s look at salivary cortisol, right? Salivary cortisol is challenging because we love, you know, in Western medicine, we love labs. But, but, but salivary cortisol I love labs. Yeah, no, they’re great for certain things, but they have their downsides.  And one of the downsides of salivary cortisol, or measuring cortisol in the urine or in your blood or in any way, is that your cortisol levels change every, like throughout the day. There’s a normal cortisol cycle. 

Dr. Weitz: But that’s the advantage of the salivary measurement is you can do it multiple times. You can, you know, you can do it when you first get up and see the cortisol awakening response.  You can see it in the morning, afternoon, evening. Right. But how much does it cost to run each of those tests?

Dr. Rabin: I mean, everything costs, right?

Dr. Weitz:  Yeah, sure. I mean, it is a box to do a panel.

Dr. Rabin: Right. And then you and then you have one day’s worth. Right. Of data. Right? So you’ve paid the same amount as you paid for an Oura ring for one day’s worth of data.  Right. And then you have to do that to get an actually accurate assessment if you’re a man. Right. If you’re a man, to get an accurate assessment that’s useful, you need at least two weeks of that. 14 times, three times 300 Right. Is a lot of money. I see. Right. It’s not, it’s not cost effective for a healthcare system to deli, to, to assess stress in that way.  If it, if you’re looking at a woman’s stress, you have to do it for at least a month because of their menstrual cycle. [00:41:00] 

Dr. Weitz: Right. Well, yeah, we, we, we, we could talk for about 12 hours about how non cost effective our healthcare system is.

Dr. Rabin: Right. Oh, yeah, for sure. But I think to your point, like they’re like, you know, there’s lots of different lab grade measures we can do that are that have been around for a while that Interesting.  But they’re not repeatable. They don’t give you immediate feedback, et cetera. Yeah. Yeah. And they also have a decent margin of error. So like, if like me as a, as a physician, if I was going to say, I need to assess somebody’s stress level and do it in a cost effective way, that’s going to give me the data I need quickly.

I would tell them, buy an Oura ring and let’s track your heart rate, your heart rate variability, your respiratory rate, your activity levels, because it’s one of the most accurate and you’re going to just wear that every single day for. 30 days and then wear that and then keep wearing it for a couple more months and then we’ll introduce interventions and we’ll watch your HRV go up and we’ll watch your sleep go up and we’ll watch your heart resting heart rate come down [00:42:00] and to me, you know, not just from the money, the money is a big piece of it because a lot of people don’t have the money to pay for all those tests and insurance doesn’t cover them, but that is revolutionary for health care quality delivery because I can then look at your data.

Yeah. Real time through the ordering portal, I can look at your data and I can see, Hey, by the way, you just had a week where your HRV dropped by 10%. You need more sleep and I don’t need them to come into the office. Tell me that, but I do need them to spit a significant amount of saliva into a cup multiple times and then send it to a lab and have a lab run it and then sending the data and then I need to review the data and compare it to all the past.

I mean, it’s like a huge hassle to do that. I can give an assessment and feedback right away with technology. And I think that is that’s the real exciting piece about the future of where we’re going as a field that we’ve never had the opportunity for before because we didn’t have technology that was this advanced.

Now we [00:43:00] have such advanced technology for measurement and therapy delivery. That we can start to combine the two and actually personalize medicine to the individual, which we started to do in Apollo with smart vibes, where we’re using AI to actually personalize the experience to you and you can watch your biometrics go up because if I don’t have to be involved and you don’t have to pay me, that saves you even more money, right?

Dr. Weitz: So the Apollo improves sleep. I understand total sleep, deep sleep, REM sleep. Improving all of those parameters is pretty amazing.

Dr. Rabin: Yeah, well, that’s what Vegas that’s what doing Vegas nerve activity or improving Vegas nerve activity does right if you if you do 30 minutes of meditation a day, you 2030 minutes of healthy exercise.  If you do deep breathing every single day, you’re boosting your Vegas nerve activity every single day. Your deep sleep, your REM sleep and your total sleep time will increase about as much as what you get from Apollo. If you combine those activities, you can [00:44:00] get it even higher. But that’s the benefit of the vagus nerve activation is because sleep is our most vulnerable state, right?

Like in REM and deep sleep, we’re basically paralyzed. And so we’re physically vulnerable to anything in the environment. That could come our way. So when our body senses threat around bedtime or sleep, even subtle things like the thought that there might be something wrong with me, that I can’t sleep when everybody else can.

Well, guess what? That’s not true because everybody’s having trouble sleeping, but it’s because of those thoughts that make it hard for us to sleep because they make us afraid. Of ourselves, if you believe there’s something wrong with you, then your body becomes an unsafe place, psychologically speaking, and then it resists dropping into deep and REM sleep stages.

So that’s where a lot of psychotherapy and sleep practices come in is just helping and vagal practices. They help you feel safe in your own body. And when your body feels safe, all of a [00:45:00] sudden. It conks out because it wants to sleep desperately. Our bodies want to sleep for all of us, like 99. 99 percent of humans.

We were built to and born to sleep for a third of our entire lives. A third, right? How much do we actually sleep is much less than that. Right. But we were evolved and built to sleep for that much time. So it’s really more about allowing ourselves to access those deep sleep stages by helping and reminding our bodies to feel safe.

That is what the vagus nerve vagus nerve practices do. And so that’s why we saw those effects with Apollo, which we actually saw by chance because we didn’t design Apollo to do that. We designed Apollo to help you focus during the day, but then people were sending us their data from wearables saying, Hey, this just gave me 30 more minutes.

Of sleep at night and we saw this across like thousand people and we’re like, okay, we got to run a study and then we ran the study and the preliminary results showed what you just described, [00:46:00] but the full study is coming out in the next couple months showing a very significant improvements in sleep like Two times what you’d get from a pharmaceutical sleep aid just by wearing Apollo to help you wind down at the end of the day and during the night.

Dr. Weitz: Vagal nerve controls gut motility, and there are a lot of patients with gut motility problems. Some of the most common conditions like IBS, reflux, etc., there’s often a problem with the motility component. Have you researched the ability to track Improvements in gut motility with using the Apollo.

Dr. Rabin: We have not researched that yet.  That’s one of our areas that we have not looked into. We have started some studies looking at microbiome and the health of the microbiome, but those studies are really expensive. So they’re still in the works. I think the. [00:47:00] It’s it’s hard to say what would happen. I mean because a lot of it also has to do with your diet And so even if you’re calming your body, but you’re eating the same bad diet Your gut health may not improve significantly, so there may, you know, there’s, there’s many, yeah, of course,

Dr. Weitz: there’s definitely the dietary component, but separately stimulating gut motility is a big deal that device on the market that you swallow and you have to swallow one every day that uses vibrations to stimulate gut motility.  Oh, is there really? Yeah. Oh, that’s fascinating. Dr. Satish Rao developed it.

Dr. Rabin: Oh, wow. I’ll have to check that out. That’s really, that’s really interesting. But I could, I could imagine that working for people because you know.

Dr. Weitz: If you could just use the Apollo and not have to swallow this device every day, which.

Dr. Rabin: You know, yeah, well, well, I think suffice to say, to your point [00:48:00] doing the evidence supports that if you have healthy vagus nerve activity, regardless of Apollo, because I can’t tell you if Apollo improves gut health or not, we don’t have that data, but if you improve your vagus nerve activity with these other practices that we’ve been talking about, then your gut motility will get healthier and you will absorb more of your food, Because when you’re stressed out, your gut motility often slows up and speeds down and you get a speed slows down and speeds up and you get this IBS type response in irritable bowel syndrome, which is now extremely common.  We see this all the time. And irritable bowel syndrome is alternating constipation and diarrhea. That is often almost always worsened by stress. 

Dr. Weitz: And so add to that millions of people now who are taking medications to help them lose weight that act by slowing gut motility. Yeah,  that’s true. So Apollo could be very beneficial for them.

Dr. Rabin:  So it could stay tuned for those studies and they come out. Hopefully, hopefully to be published. I think, I think with that study, we’ll hopefully publish this year or next year, the gut motility study.

Dr. Weitz: Oh, so you have a gut motility study

Dr. Rabin: coming? Oh, sorry. Sorry. Microbiome study. We don’t have a gut motility study.  It’s a microbiome study.

Dr. Weitz: Yeah.

Dr. Rabin: Because you see the microbiome in the gut also changes when we’re experiencing stress and that’s, that has a lot to do with gut motility. And so this particular study did not look at motility. It looked at the microbiome, but the microbiome study will hopefully be coming out in the next.  Yeah. 

Dr. Weitz: You should talk to Dr. Pimentel at Cedars about doing a study on the gut motility. I just interviewed him. Oh, that’s a great idea. I’d love to chat with him. Okay, cool. So, I think it’s time to probably wrap up. What about final thoughts?

Dr. Rabin: I just really appreciate you [00:50:00] for having me on the show.  Grateful again to, to catch up. I think the, you know, the, when, when will this be aired by the way? In about a month. Oh, in about a month. Oh, well, in that case, I have a new, I have a new product. I can tell everyone about so. Okay, cool. Yeah. So maybe I’ll, I’ll restart that final thought section. You can edit this out.  So. Yes, it’s so one thing that we have. It’s very exciting. That’s coming in is and that actually should be available right now. It’s called Apollo sessions. It is a mobile app only version of Apollo. Most people look at our website. They look at me wearing this wearable on this interview and they say, Oh, that’s just a wearable tech.  Another wearable technology. As you’ve heard us discuss, Apollo is very different than your standard wearable. It actually impacts your body through vibration. And so, we, over the years, developed Apollo not just to be, to work through our wearable. We, we figured out how to use other technology in your life that [00:51:00] vibrates to deliver Apollo to you.

And so Apollo vibrations. And so if you’re listening to this and you have an iPhone, you can go to the app store, you can download the Apollo neuro app, and you can just open the app and it will play an Apollo vibe for you that increases your Vegas nerve tone just by holding it to your chest and feeling the vibrations.  And by the time you hear this this, that mobile app will be available to you. To subscribe, and you can actually get Apollo vibrations scientifically backed on your iPhone as a free upgrade on us to give you calm, soothing, science backed benefits of vagal nerve improvement in instantly on your iPhone.

And then if you want to upgrade to the premium version, you can, and you can get. Full access to many different vibration patterns that improve Vegas nerve tone for different activities. But the main, we really wanted to make Apollo more accessible because wearables are expensive and they’re not for everyone.  I’m just thinking about the cost benefit and, and the [00:52:00] challenges that many people are having, you know, you mentioned the L. A fires. A lot of people are, Are really struggling right now financially and otherwise. And so we made Apollo the core core of Apollo for free now for everyone. Thanks to, you know, tons of work, years of work and great innovations in technology.  And if you have an iPhone, you can try it right now. And if you like it, upgrade and we love love your support and please reach out to me and tell me what you think. I’d love to hear from you. And you can find me on socials at Doctor David Rabin. On Instagram and Twitter and at my website drdave. io or apollo.clinic. And you can find Apollo Neuro at apolloneuro.com or wearablehugs.com, which is what the kids call it.

Dr. Weitz: Thank you so much. It’s my pleasure.

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Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple 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.

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Dr. Namrata Patel discusses A Functional Medicine Approach to Dentistry with Dr. Ben Weitz.

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

 

Podcast Highlights

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Dr. Namrata Patel, DDS is a graduate of the University of California’s School of Dentistry and she specializes in Green Dentistry in San Francisco, a holistic, functional, Ayurvedic approach to dentistry.  Her website is SFGreen Dentist.com.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcript

Functional Medicine Approach to Dentistry with Dr. Namrata Patel- Rational Wellness Podcast 399

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 About a functional medicine approach to dentistry Dr. Nami patel Dr. Nami Patel is a graduate of the UC School of Dentistry. She specializes in green dentistry in San Francisco, California.  She’s a holistic, functional, and she takes a holistic, functional, Ayurvedic approach to dentistry. And part of her mission for her practice is to help to prevent chronic diseases like diabetes and heart disease. So, Dr. Patel. Thank you so much for joining us today.

Dr. Patel:  Oh, I’m delighted to be here. Dr. Weitz.  This is wonderful.

Dr. Weitz:  That’s great. So maybe you can tell us When did you first decide to become a dentist and why?

Dr. Patel: You know, I was actually not thinking dentistry at all I knew that I had a mission in life and I wanted to do something that was really preventative I was actually going to become a neurosurgeon so I actually went through all my schooling for neurology and then it wasn’t until the last semester in summer school.  Actually, I was taking organic chemistry because I needed to finish that up for my pre med applications. So I actually went in and my my chem partner was a pre dental student. And so she was like, hey, I volunteer at this non profit government clinic. They really need help. Can you come? And I was like, [00:02:00] you know, I mean I at first I was like not really I think I feel like mouths are really gross I don’t really want to you know but you know, she you know, she convinced me to go and it was really you know, lovely because You know, once I got there, like, I didn’t, couldn’t think about the mouth.

All I thought it was about people and it was like that people connection that really made me feel really comfortable and I really felt like I made a difference because I didn’t really do a lot, like, I mean, at that point, I basically sucked spit, right? Like I held a suction or like I held their hands or I did something really basic, but I realized the value of that.

Like people were really appreciative because at the end of the, you know, visit, they were just. like, thank you so much. We really appreciate you, especially in a non profit setting. It’s not, you know, they really felt like they got, the patients felt like they got dignity, respect, and care. And that really made me feel purposeful.

And so I decided Okay, well, you know, well, the first one, I wasn’t really much, you know, I was like, I went, I felt good. It was [00:03:00] great. And then she asked me again the second time. And then the third time, then it started just going there. And it kind of feels like dentistry found me versus me looking for dentistry.

So that’s how I got into the dental aspect. And then You know, once I got it out, I was like, I am a really purpose driven person. I’ve always been, I’ve been raised like that. I’ve been very you know, focused on like leaving, you know, really having a meaningful life. And so when I got out of dental school, I really didn’t love what I saw.

And it was really I guess upset is the right word. I was really angry with what I saw in the healthcare system. And I was really you know, just disappointed. For lack of a better word and so I started the green dental dentistry aspect and then making sure that it’s eco conscious and making sure that we’re being really mindful and then I kind of evolved it to functional dentistry.  I read dentistry because I come from a background of Ayurveda. So I do really feel like I was led to be who I am today and I do feel like it’s you know, purpose driven for sure.

Dr. Weitz: That’s great. I think it’s unusual. My experience is, generally speaking, dentists are focused on your teeth and not you as a person and thinking about your whole health

Dr. Patel: Yeah, and you know, that’s the other thing that I saw and you know What helped really much is like having that background in neurology because you I had to learn pathophysiology I had to learn How the body worked, I had to learn all of that stuff.  And so I really feel like everything kind of transpired to be where I am today. And then also believe it or not, talk about like, you know, destiny, I guess, is when I went to school, I went to USC. which is the first program for dentistry that combined medical school and dental school together as problem based learning.

So it wasn’t the traditional pedagogy from dentistry, which is like drill and fill. This was all about full body health. And you really only got clues, kind of like we get from our patients. You got a clue like, Hey, Mrs. Richardson comes in and has trouble swallowing, and that’s the only information [00:05:00] you got for a week, and you had to go study, like, what were the reasons, what could it be, and then, you know, next week you got a little bit more information.  Oh, she did say she has acid reflux and has gurgitation, and then you really started going down this path and really started looking at the entire pathophysiology of the mouth and the body and how they’re connected.

Dr. Weitz: That’s that’s awesome. So that brings us to the next question, which is Why is the mouth so important for health for longevity for preventing all these chronic diseases?

Dr. Patel: That is a fantastic question and I love to answer it so the two most I would like to say two most important ways, you know, traditionally we’ve heard about cavities and gum disease and sure, yeah, that is important. But when we think about the oral systemic connection and longevity, there’s two more important ways.  Number one is a bacteria in your mouth, your oral microbiome. You swallow five gallons of bacteria every single day. [00:06:00] Five gallons. And that is a lot of bacteria. And just we hear, you know, there’s a gut connection. Obviously, we don’t want the enteric lining to be broken because that’s how bacteria get access to your bloodstream.

So that’s number one and your gut is your immune system. So that number one, they’re all microbiome is super important. Second is going to be the nose breathing. What happens is right on your upper jaw is your sinus. And right on your lower jaw, it’s connected is your windpipe. Now, air is the one thing we can’t live without.

So if we don’t have a functional airway, if we don’t create that nitric oxide, which helps prevent heart attack, diabetes, cancer, Alzheimer’s, and gets our own body to work on its own, it’s never going to work. You know microbiome your guts in your immune system, right? Second is your functional airway the one thing you can’t live without those two most important links are the key to longevity And also the key to making sure you have a life, that is proactive [00:07:00] Something you enjoy not only that we also start looking at the emotional components that come along with Dentistry and the mouth really being able to be present Really being like when people are at the, don’t have a functional airway, they have sleep apnea, right?

Or upper airway resistance, they’re not able to sleep really well. And boy, are they cranky? You know, it’s kind of hard to be in relationship with somebody if somebody’s cranky all the time, right? So it makes a huge difference in really making sure that you know, dentistry is a critical component. And especially when you look at dentistry, we’re looking at holistic, functional dentistry in the way that I practice the oral systemic connection.  Really looking at how we are connected as quantum beings because that’s who we are.

Dr. Weitz: So I wonder how you can take a green functional approach to dentistry when Doesn’t dentistry involve the use of [00:08:00] so many? Toxic substances from heavy metals to BPA to resins, to glues, to fluoride, to, so many of these materials seem to be very toxic.

Dr. Patel: Right. And they are, you’re absolutely right. And, you know, as you know, bisphenol A is linked to so many cancers, so many different things. So many you know, especially we can find in our pots and pans and, you know, all sorts of stuff. But the reality in dentistry, you

Dr. Weitz: go to the dentist and you’re, you’re getting a crown or you’re getting a bonding or, and you’re putting all these chemicals on to glue it together and mixing up all these chemicals.  And you just know that they’re very toxic.

Dr. Patel: Right. And that used to be the case. I’m proud to report that there are definitely better chemicals out there. So a couple of things that we use in our practice we definitely use resins that are bisphenol free. So that’s number one. 

Dr. Weitz: Let me stop you one second.  There’s been a tendency to have [00:09:00] this sort of whack a mole game. BPA is toxic. No problem. BPA free. Well, we’re actually using BPS, which is more toxic. So do we know that they’re actually using non toxic products or just not using the one that everybody knows about?

Dr. Patel: Sure. I would have to say everything in this world is toxic.  So that’s the truth, right? Like the reality of it is everything’s inflammatory. Exactly. Exactly. And so what we try to do is find the least toxic. Right. And so when I go into the dental world and I look at, you know, what are my options, like for example, you know, you mentioned fluoride, so we don’t use fluoride in our practice, but we use hydroxy nano appetite.  You know, and we use hydroxy nano appetite, which mimics, you know, helps mimics fluoride activities in the ways in a healthier way, which helps enamel recrystallize and helps prevent cavities. So we really do enjoy having that in the concentration. We use it as about 8 percent 8 to 10 percent or so, and that we’re using the nano crystals [00:10:00] because nano crystals are super small and we’re recommending mostly for adults in there.

And also, even with children, we’re making sure they’re not swallowing it. So we’re not. Creating any sort of risk with, you know, microplastics or anything like that. Is there a, you know, my wish, you know, before I leave this world is going to be a stem cell that we put in and it fixes teeth, it fixes any problems that there exist, I would love that.  That would be my wish. But in the meantime, we’re doing the best we can with the products that we have and what’s available and then continuously pushing the envelope to find better, more natural products out there.

Dr. Weitz: What about some of these products? Like, for example, I had a crown recently and it was made of zirconium and the dentist assured me it was perfectly safe.  And I even researched it and, you know, let him know that it was a metal, which he wasn’t quite aware of. And and then he took it out and was kind of grinding it [00:11:00] down. And I said, Do me a favor. Don’t do that because you’re liberating, you’re liberating, you know, all this whatever the zirconium is into the air that you and I are both breathing in.

Dr. Patel: Right. And that’s actually a really good, good, good point. So in my practice, though, what we have is we have ionic suction. So everything gets Sucked up like this in the practice. So it isn’t and like even before COVID, I, the way I designed the practice back in 2000, like five or so is like what we did is we had unit directional flow, but we have suction that’s properly designed so that nothing’s being liberated into the air or not nothing, but something is being liberated, but we’re sucking out as much as we can.

We have air doctor filters in each of the rooms. So I’m making sure that air gets we have even our furniture is you know, not off gassing, which is formaldehyde free, which is always really awesome as well. But going back to what you said about the materials, the cronium material. So I actually use a material called [00:12:00] EMAX and the reason I like that is it’s a glass particles and they don’t off gas and that’s I tend to like to use materials that are inert in the body means that they do not cause any sort of reaction.  So it doesn’t cause a positive reaction. It causes an or a negative reaction. It just causes no reaction. And that’s usually the way I decide what materials I’m going to integrate into the past. 

Dr. Weitz: Would you use for crowns?

Dr. Patel: Yeah. Yeah. So we have a 3D milling machine. So I bet when you went in, they, you know, numbed you up, prepped your tooth, put a temporary on, made you go away for three weeks, and then you had to go back.  Yeah. We don’t do any of that. The way that I’ve designed my practice is that we numb you up once, we, you go home with a permanent crown the same day. I have a 3D printer. And so that 3D printer it, Makes this crown we polish it, we buff it and we put it into the mouth and you’re done. And so that way we’re minimizing the amount of toxins that go in your body.

We’re minimizing the amount of anesthesia that goes in. We’re not creating like when you have a temporary, it creates a brewing ground for bacteria to grow and sensitivity occurs. [00:13:00] We don’t have any of that stuff. So we’re not dealing with a lot of the things that traditional dentistry had. And we’re really blessed to have technology nowadays.  I mean, we’ve got self driving cars, right? Technology is really allowed us to be able to, you know, really up level and I’m really excited

Dr. Weitz: about that because so you’re using this glass material. What about some of the other materials? What do you what about zirconium? What about porcelain? What about some of these other materials?

Dr. Patel: Sure. So the material I use is a porcelain. Zirconia is fine too, but though I tend to find it too hard. So there’s several things I look at when I’m looking at teeth. I’m not just putting like, you know, I look at what you have on the opposing side and what you have on the bottom side. Right. The reason I like the material that I use, which I called as the Emax it’s a disilicate particle.

It’s silica, right. Glass particles. The reason I like that is because it, it doesn’t where you’re like, sometimes what happens if you have zirconia. And your teeth kind of touched like this, you’re going to wear the opposing teeth down because the bottom one’s so strong. So it’s kind of like [00:14:00] in I guess, you know, when people are on crutches, you know, you, one side gets overdeveloped because it’s being utilized more.  The same analogy is you got to make sure the materials that you have are compatible. So the reason I like the Emax is because it’s not going to wear the opposing tooth down.

Dr. Weitz: It’s a material to be hard enough, but not harder than your teeth on the other side.

Dr. Patel: Exactly. Exactly. So we, I mean, obviously you want to look at the, you know, the toxicity portion as well.  We want to look at the hardness portion because remember all this stuff off gases when you’re Right. When you’re grinding and doing, so that’s why we want to make sure that we’re evaluating what materials are going in. And also making sure that you’ve got stable materials that last a lifetime, obviously.

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Dr. Weitz: So I’ve really been enjoying this discussion, but I just want to take a few minutes to tell you about a product that I’m very excited about. Imagine a device that can help you manage stress. Improve your sleep and boost your focus [00:15:00] all without any effort on your part. The Apollo wearable is designed to just to do just that.  Created by neuroscientists and physicians, this innovative device uses gentle vibrations to activate your parasympathetic nervous system, helping you feel calmer. More focused and better rested among the compelling reasons to use the Apollo wearable are that users experience a 40 percent reduction in stress and anxiety patients feel that they can sleep.  There’s sleep improves up to additional 30 minutes of sleep per night. It helps you to boost your focus and concentration, and it’s scientifically backed. And the best part is you can get all these benefits with a special 40 discount by [00:16:00] using the promo code white. W E I T Z. My last name at checkout to enjoy these savings.  So go to Apollo neuro and use the promo code Weitz today. And now back to our discussion.

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Dr. Weitz:  How, how does our oral health play a role in chronic diseases like heart disease? I’m sure most people have heard of the fact that. If you’re going to have a hard procedure that having your teeth worked on can be problematic because of bacteria can travel from your mouth down into your heart.  But what are some of the other ways that your oral health impacts your cardiovascular health?

Dr. Patel: Absolutely. That is a great question. So I will talk about like so what happens is remember earlier I said you have the oral microbiome, right? You have the bacteria, you’re creating saliva throughout the day and we want that saliva.  So what happens is sometimes if you [00:17:00] don’t go to the dentist for a long time, it creates bad bacteria in the mouth. I always say, you know, we want a pond. Sometimes it turns into a swamp. If we’re not cleaning it is one way. The second way that it happens is if we’re using like anti anxiety medications or something like that dries the mouth out.

The other reason it happens is with older age people are snoring or mouth breathing. It dries the mouth out, creates these bad bugs to overgrow. All of those bacteria, they’re pretty pathogenic. So what happens is when you swallow these bacteria, they go into your stomach. From your stomach, they actually break the enteric lining.

And then when they break through the enteric lining, the gut barrier kind of like we talk about in, in different gut diseases and stuff or SIBO or something like that. When they get into the bloodstream, your body sees these bacteria and they’re pathogens. And so your body attacks it. As it attacks it, it binds into cholesterol.

And as it binds into cholesterol, it starts occluding the arteries. So it actually is causative. for heart attacks. Number one. Number two is some of these bacteria are very [00:18:00] pathogenic. So they actually look at like a heart valves and they’ll grow in heart valves or in joints. And when they go into those areas, it will cause a massive inflammatory response.

Dr. Weitz: That’s just when it comes to the oral microbiome. What are some of the most common First of all, what oral microbiome tests do you like to use? What are some of the most common pathogenic bacteria? What are some of the most common commensal or healthy bacteria?

Dr. Patel: Sure. So the ones that I actually look at is, you know, there’s two ways you can look at or fix disease, right?  One is to look at what is there, or the other one is to look at what’s Not there, right? And so the way I like to approach it is because I do believe in nature. Nature is designed to work really well. We’ve survived millions of years for a reason. So I believe in that. So there’s two things I like to look at in the test I like to use personally is called oral DNA.

The reason being is that I get to customize all my care for the patient. So number one, I [00:19:00] look at their genetic risk for inflammation and chronic diseases. I look at interleukin six. Are they at high risk for heart attack, diabetes, cancer, Alzheimer’s and gum disease? Like that’s the first thing I look at.

And then the second thing I look at is a specific bacteria. There’s 12 species of bacteria that actually look at. The five ones I’m most worried about. Is gonna be, and don’t ask me for the specific names, ’cause I’m gonna mess it up, you know. Okay. Not my, from my first language, , but you know, we have, we call ’em five you know, red light bacteria.

We have aa, pg fn we have TD and tf. So those are the ones. Like for example, like pg p gingival is actually found in gum disease. It’s also known to cause it’s actually causative for Alzheimer’s. Because it’s so small and it crosses a blood brain barrier and when it goes in the brain, it does the same thing what I said with a heart attack.

It actually attacks, your body attacks it and then there’s brain tissue that’s damaged. So that’s one and then AA is also [00:20:00] causative for heart attacks. So just looking at their, they’re pretty potent when we go down these and then they’re also anaerobes, meaning that they don’t survive in oxygen.

That’s how we determine the potency of them. And once we figure out exactly where they are, I personally don’t like to use antibiotics as my first method of attack. So I first always start with laser deep cleanings to remove them. And then we work with probiotics. We work with probiotics to see if we can naturally kind of give you back into health And then

Dr. Weitz: what’s your favorite oral microbiome test?  And what are you your favorite probiotics for the mouth?

Dr. Patel: So the oral dna is my favorite microbiome test and like I said, I do two things One is genetic predisposition for inflammation and then and the test is called alert two So it tests the genetic predisposition plus it Tests the actual microbiota like the bacteria that it’s signed and then money.  I have several probiotics that I really enjoy. The ones I like are lozenges. They’re the ones you suck [00:21:00] on because what I do find is that a lot of the people with the A. A. P. G. The, you know, the really potent bacteria. They tend to have some sort of a dryness in the mouth. And so the reason why I like for them to suck on that is because it gets a saliva to, you know, produce itself as well.

And so the ones I like to use is probiola P R O B I O R A. And then the second one I like to use is called from biogaia, B I O G A I A. And there are lots of this. Yeah. And so the reason for the lozenges versus, and this is a different probiotic than the one you take normally for overall health.  And the first one is from what company?

Dr. Weitz: Probiotic, P R O B I That’s the name of the company as well, okay. Yeah,

Dr. Patel: yeah. So I really like that and I feel like they’re really solid probiotics and, you know, the other thing I like to do is I like to research my companies and make sure they’re really solid and their goal is to Have you tried the one from Biocidin?

I have so biocide has been tested. So there is we actually have it. It does work. We [00:22:00] just have our preferences, like I said, and I like to get to the root cause. So the biocide in is helping you prevent like the biofilm once everything is cleaned off. But as we’re getting into balance, I feel like we need a little bit more support.

And so biocide and again has been tested against all the different bacteria that I just talked to you about and it’s not as effective as, you know, like ozone therapy or it’s not as effective as laser therapy. So we have different ways on how we customize all of our care for our patients because once we see what specific bacteria we have, we can actually create a specific treatment plan to make sure that it’s restored.

Dr. Weitz: What about the use of anti microbial herbs or nutritional strategies that can be built into toothpaste or added to maybe when you rinse your mouth or use a water pick like toothpaste. I know there’s some toothpaste on the market that maybe have clove or have [00:23:00] silver and I’ve heard of people using oregano oil or some of the other antimicrobial herbs.

Dr. Patel: Sure all of those have validity. So I will say that all of it, all of them have a validity and I feel like it’s a great start for somebody at home. Personally, I like to be really data driven. So once I figure out the specific bacteria, I look at the specific where we’re going to get the best results in the shortest amount of time, because that’s the whole reason why people want to work with a professional, right?

And then once we get the results, honestly, I like to have my patients you know, You know, I say this to patients all the time, like best dentistry is no dentistry, right? The best health is preventative health. Like, the more they don’t need me, the better it is. And the more I really don’t want them, I don’t want to like, I guess my biggest beef sometimes with medicine or even functional medicine is that I don’t want to replace a pharmaceutical with a nutraceutical, right?

I don’t want to, I don’t want to replace, I don’t want to swap it out. I want their body to work on its own. So [00:24:00] that’s really my goal and purpose. So once I get them into balance, what I find that works really well is just, you know, honestly, like a hydroxy nano appetite toothpaste. The one I absolutely love is Boca, B O K A.

It is wonderful. It has like different flavors, great for kids. It’s fantastic. That way you say

Dr. Weitz: hydroxyapatite we’re familiar with Calcium hydroxyapatite as a form of calcium. Is that what we’re talking about?

Dr. Patel: It’s nano appetite. So when you talk about the hydroxy calcium appetite, they’re big crystals. I want the nano crystals.

They’re so Microsoft Spock, I’m sorry, microscopic and so small because I want them to embed in the tooth. So what it does is, you know, in the mouth, what’s always happening is that you have this beautiful crystal and it’s Constantly getting demineralized because we’re eating and then it gets remineralized because demineralized remineralized.

So what we want with the calcium crystals is we want them to deposit and make that tooth stronger and more resistant to decay. That’s really what’s [00:25:00] happening with the hydroxy nano appetite. And the nano appetite is really the key here. Otherwise it won’t work because the other crystals are too big.

That’s why looking at toothpaste, I love the Fantastic. Cost effective does a great job. And it’s really great. The second thing I recommend patients is electric toothbrush. So I’m using an electric toothbrush. You are hitting your teeth with like 50, 000 pulsations for minutes. That is faster than Superman.

I

Dr. Weitz: mean, preference for Sonicare versus RLB.

Dr. Patel: My preference is Orly. I mean, I have to say I love Orly. And it’s because, you know, I like the circular motion of it. And I also like that I can’t hit my gums because one of the biggest issues with electric toothbrushes is people brush too hard, like on the Sonicare.

Or push it and then you end up getting a gum recession. So it’s like, well, what’s the point, right? So it’s like you fix one thing, but then cause a different disease. They’re like, okay, so I like to think it through and I feel like that you know, using the oral B for me is my favorite. And for some [00:26:00] patients, you know, I do want to share this tip if it’s okay, is that sometimes they feel like the Oral B or the is too strong.

So the second one I like is from Boca, B O K A. They actually do have an electric toothbrush and it doesn’t hit with like 50, 000 pulsations per minute. It’s like 20, 000 pulsations per minute. So people are a little bit more sensitive to that vibration. They can use that one and it works really well.

Dr. Weitz: What

Dr. Patel: about Waterpik?

Oh, I love the Waterpik. Waterpik is fantastic. And so Waterpik is really great. So what I usually recommend patients is well, I, blotting is always ideal, right? And then if not Waterpik, Waterpik is fantastic. And then you can brush your teeth. I also want to have your tongue scraped. Tongue scraper works really great.  It’s all natural. It’s not another additive, right? And then the last thing I do really find that is really useful is oil pulling. So I would say oil pulling is fantastic for mouth reasons and also for systemic reasons. Your tongue is highly vascular. So it starts chelating. So it starts pulling out all the [00:27:00] metals that you taught.  We were talking about all the toxins that are in your body. It starts really helping the liver kind of pull all of that stuff out. So I really am a big fan of oil pulling. 

Dr. Weitz: And then the last one is the one critique I’ve heard of oil pulling in the past was you have to do it for Prolonged period of time.  I think I’ve heard 20 minutes or you don’t get a benefit. Is that true?

Dr. Patel: Yes, it is absolutely true. So from the oral cavity, I mean, honestly, if you just took a finger and brought coconut oil on your gums before you went to sleep, it would be fantastic because it has natural antifungal activity. It has natural antimicrobial activity, so that would be fine with a systemic portion.

It does take 20 minutes because again, your tongue’s not that big, right? And if you want you know, you’re swishing things around to get that circulation going. And also it’s not going to be a one time thing where you’re going to see massive differences. You’re going to see massive differences once you use it for three months, six months, nine months, right?

From the systemic chelation properties. Now, if you wanted to, you know, get your [00:28:00] body be way healthier, you can do ozone IV. You can do chelation products. Pull everything out. Just as much at a faster rate, right? So there’s different products or different ways to be able to accomplish the same results.

And I just wanted to, I like that as a good additive, especially the reason being is we have so many toxins in our environment. You know, that’s one of the reasons that oil pulling is really great, especially if you can do it for 20 minutes every day, or even like start with one time a week, you know, just healthy habits.

That’s really my goal is just start with healthy habits. Anything that’s going to benefit you.

Dr. Weitz: Why do you, some patients have tooth sensitivity or sensitivity that comes and goes,

Dr. Patel: One of the major reasons for two sensitivity is gum recession. So remember I talked to you about brushing too hard. So that’s one of the biggest reasons for sensitivity.

Second reason for sensitivity is also aside from cavities and stuff like that, is going to be if people are clenching and grinding their teeth. One of the major reasons people tend to clench and grind their teeth is a lot of times their sinuses are stuffed up so they can’t breathe really [00:29:00] well so that’s one of the biggest issues the second thing is that sometimes stress makes them clench and grind more, right?

That’s another reason why the clenching grinding it causes micro cracks on the teeth and it’ll cause sensitivity basically is what happens.

Dr. Weitz: What about the sensitivity that comes and goes, like one day your teeth are just really sensitive and the next day they seem fine.

Dr. Patel: It’s the sinuses that are congested, or if somebody has sleep apnea, what happens is that their nose is blocked, so what, or their tongue falls back and they can’t breathe really well, so their jaw.

We’ll grind in order for them to be able to you know, have a functional airway. But the next day they might be fine, you know, so it comes and goes. And a lot of times you’ll hear it a lot in winter times, especially, you know, I get patients all the time thinking they need a root canal because their sinuses are stuffed up.

And I’m like, actually, let’s try to decongestant.

Dr. Weitz: You just mentioned root canals and of course, there’s this big, big ongoing controversy root canal versus [00:30:00] implant. What do you say about that controversy?

Dr. Patel: So I feel like honestly, I tend to be more natural, right? And I remember having the knowledge that I have and the way that I like to operate my, if it was my mom what I would do is there’s.

I’m okay with root canals as long as they’re done properly. The root canal is done 10, 15, 20 years ago. Crapola, get them out, right? Now there’s technology, just like I was sharing with you, like the technology we have with 3D printing. We actually have technology that we can actually use a laser beam and we can disinfect that entire root canal.

And we can also use ozone gas to get underneath there and make sure that entire cavity is sterile. If we can make sure that entire cavity is sterile. Sterile. I’m okay with a root canal. Why don’t they just put bleach in? Yeah, see, that’s old style, right? You don’t have to do that anymore, right? You don’t have to do that, and what we do is you know, there’s so many different materials out here now, and they’re updated, and there’s a lot of [00:31:00] science and data that it really works.

And my main reason for trying to save a tooth, just so you know, is that at the root of the tooth there is something called the periodontal ligament that houses that actually is a little bouncy spring that you’re, you can chew with, right. And that actually contains stem cells. So I’m a big proponent of keeping as many stem cells as possible.

And I feel like that is one of the best things I would much rather keep a tooth.

Dr. Weitz: So you brought up the question of root canals and there’s a big controversy. Is it better? To have a root canal and one of the arguments for a root canal is that you’re keeping your tooth arguments against the root canal as a tooth is dead.

You can have bacteria in there. It’s much better to get a implant and yet you can argue an implant. Is putting a piece of metal in your mouth? And is that really better? And who’s to say that you’re not gonna have bacteria in there with the implant? So [00:32:00] those are a couple of my thoughts. But tell us what you think about root canal versus implant.

Dr. Patel: My honest opinion is if root canals are done properly, they’re safe. So Just like I mentioned earlier, we have machines that make 3D printing and does you know, biocompatible restorations. I would recommend seeking a dentist that uses specific technology for root canals. And what we’re doing with that is we’re using lasers that actually go into the root canal all the way down to the bone to disinfect it.

So we’re getting rid of the biofilm number one. Number two, we’re using gases like ozone and things like that to get all the way underneath it to make sure that because the gas can penetrate in areas in so many different areas, right? So we utilize a gas that gets in there and cleans things up very nicely.

And then we’re putting get a project, which is a, which is a inert means that has no reaction. And, you know, there used to be a big problem with sealers. We don’t even have to use that much sealers anymore because we can actually melt the gutter perjure down because technology’s evolved so much [00:33:00] that we have rare, rare amounts of sealer that is needed in order for a root canal.

And the reason why I am a pro root canal person is because at the roots of the tooth, there’s actually peritoneal ligament and that actually houses the stem cells in them. I’m a big fan of keeping your natural tooth. Now You sure, you know, if there, if there’s not an option, you already had a root canal, things aren’t great and you need to go towards our implant, so be it, but implants can fail, especially if you have low vitamin D.

Sure, you put the implant in right away, it’s fine, but 10 years down the road. Because as we get older, all of us become more vitamin D deficient it’s gonna, you’re gonna lose that implant, right? It also causes you know, microfilm or a biofilm to develop and they’re very hard to clean. And especially when you eat food it tends to pack a lot of foods in between.

The purpose for a tooth is to keep the bone in place. So I tend to be a big fan of doing root canals properly, [00:34:00] making sure that it’s safe and the risks are mitigated because the biggest risks we have with root canals is that they can cause cancer and things like that when they’re not done right, right?

And that’s really the issue is when they’re not done right. When they’re done properly, it’s absolutely okay.

Dr. Weitz: Right. And who’s to say when you get an implant, you’re drilling this hole into the bone that you’re not going to get microscopic amounts of bacteria in there as well.

Dr. Patel: Yeah, you absolutely will. And then around the implant, right?

Because the implant is like, you know, it has like a bottom portion and there’s around this area at the ridge because It’s connected to the oral cavity. You’re always going to get bacteria around it So even if it’s an implant, you know us, you know humans tend to want like like a pill right or a solution, right?

One thing that takes care of everything but it really is really important That we start really thinking things through and deeper and really thinking for things long term. There is no easy solution We have to brush and floss,

Dr. Weitz: We have to exercise You also [00:35:00] mentioned the immune system and I think the thing that’s often Overlooked is it’s not a question of whether or not you get exposed to microbes because we’re always going to be getting exposed to microbes.

The question is, why didn’t your immune system take care of it? And that’s, if you have a healthy immune system, then getting exposed to bacteria is generally not a problem.

Dr. Patel: Right. Absolutely. Exactly. And that’s the whole thing. You know, when we talk about toxins and all that stuff, our bodies are designed to work, right?

Our bodies are designed to have certain amount of inflammatory response. In fact, we want it to because that’s how we know it’s working properly. It’s just that we don’t want like mycotoxins. We don’t want you know, like amalgams. We don’t want any things. These are completely inducing a massive response.

That’s all we’re trying to do. And to say that, you know, there’s, Things that will never cause that it’s not real, right? It’s we just have to maintain that balance and that’s what we’re doing and that’s how we increase longevity. If we control the microbiome, we get rid of the bad [00:36:00] bugs, we let the good bugs survive, we put good multiminerals and vitamins and things like that in place, we get good functional breathing in, everything works really, really, really, really, really well.

Dr. Weitz: What what about strategies to whiten the teeth? Are those healthy?

Dr. Patel: Yes, there are certain things that are really great. The easiest one is coconut oil. Oh my god, coconut oil is amazing at whitening your teeth. It works really, really, really well. So I always say the first method of, you know, whitening your teeth, get a good scrub, get a good cleaning, go to the dentist.

And I actually recommend every three months versus six months because it keeps that oral microbiome super healthy. Second, electric toothbrush. When you hit that toothbrush with, you know, 50, 000 pulsations per minute, it’s going to make the, you make your teeth super nice and white. The third one is coconut oil, rubbing coconut oil on there.

You can also use charcoal toothpaste. The one I recommend to you earlier is boca boka They actually have a charcoal toothpaste as well that you can utilize and it works really well.

Dr. Weitz: Okay Charcoal is definitely a popular product these days

Dr. Patel: Yep, it is.

Dr. Weitz: When it comes to gum disease, what are the best ways to improve our gums?  We know about flossing. I looked at your website and you talked about something called pinhole gum rejuvenation.

Dr. Patel: So gum disease, easiest way to prevent gum disease is gonna be to flossers. Brush your teeth, come into the dentist. Always hands given, right?

Dr. Weitz: By the way, let’s say if your oral hygiene routine includes brushing, flossing, water pick, what should you do first and last?

Dr. Patel: So I always say flossing would be first. The reason I like to floss first, it gets rid of all the bacteria and you can brush them away. Like you take them out from in between the teeth and then you can use an electric toothbrush to brush them away. And then I say scrape your tongue, right? That would be the next thing that I would recommend.  And then you can [00:38:00] oil pull after that or water pick after that is fantastic.

Dr. Weitz: And then brush at the end.

Dr. Patel: No floss first brush your teeth. Okay. Scrape your tongue. And then you can use a water pick. Okay.

Dr. Weitz: Okay. I’m sorry. Go ahead on gum disease.

Dr. Patel: Yes. So gum disease, best way to prevent that is going to be, you know, obviously going, doing home care regularly, kind of like going to the gym regularly.

It’s really important to do it on a daily basis. And then going to the dentist for routine cleanings maybe every three months to six months, especially if you’re over 40, every three months. If you’re younger, you can probably get away with about six months but after 40 hands down every three months, because we’ve got so many hormones changing, we’ve got so much stuff that’s changing with our body that it really makes sense to do it every three months.

And then the biggest thing, a couple of things you can do at home for preventing gum disease. You know, I mentioned the coconut oil, which is fantastic mouth taping. So that way you are close. Your mouth isn’t dry. So it’s not making bacteria overgrow. That’s [00:39:00] huge. And then also, you know, people sometimes forget, should you just brush once a day or twice a day?

I always say minimum twice a day and morning and at night, at night really making sure all the bacteria is out of your mouth. So that way you’re not leaving this you know, film around and then also, you know, overnight why there isn’t a lot of salivary flow. Nope. So those would be some things I would say would be really great.

Now, treatment wise, there’s something called the pinhole gum rejuvenation. Now, that is an amazing product because we, or a service, we actually use your own body to work really well, or to induce your own body to make more collagen. It’s not needed for everyone. It’s needed for patients who have exposed root surfaces.

So if you have exposed root surfaces, kind of like the people I talked about, maybe brush a little too hard exposed root surfaces, that’s what you need pinhole gum rejuvenation for. We can add, create a better thickness around the gums in order to make sure they’re looking good, they’re working properly and helping you keep your teeth for a long time.

So that’s pretty [00:40:00] fantastic. But as far as gum disease goes, gum disease means there’s loss of bone, which can be from bacteria, which can be from brushing too hard, or it can also be from clenching and grinding. So we always want to take a look at those pieces too.

Dr. Weitz: All right. It’s another controversial topic.  As you’re thinking changed on fluoride what do you think about fluoride either in toothpaste in the water, et cetera?

Dr. Patel: You know, I have always been fluoride for me is it’s a neurotoxin, right? So I’m not a big fan of it. And that’s one of the reasons I love the, you know, Boca, which is a hydroxy nano appetite version.  So I really, really, really do enjoy having the Boca in my practice and different materials I use. for hydroxyl. A

Dr. Weitz: lot of dentists are schooled that fluoride is beneficial and it should be promoted.

Dr. Patel: The main reason they recommended having fluoride and the thing with fluoride is also the concentration, just like we talked earlier and you said, you know, everything’s inflammatory.

It just depends on which one is more than the other, [00:41:00] right? So yeah, the dosage is really critical. So at one part per million, technically it’s safe because we’re getting it more in like different foods, like potassium or milk or something along those lines versus The, the problem that I have with fluoride is in a lot of lower socioeconomic societies or communities, they were prescribing fluoride pills.

Now, that fluoride pill is like a thousand times more than one part per million, you know, and what that was doing was causing brittle bones. It was causing neurotoxicity and all these other things that are, you know, that are You know kind of side effects right of having fluoride and just like with you know, my husband says this funny phrase It’s like moderation including moderation

Dr. Weitz: The problem is when it comes to fluoride They might say put a certain amount in the water and go.

Well that level’s safe, but you drink fluorinated water You use fluoride toothpaste They measure the amount of fluoride based on a tiny [00:42:00] amount that you’re supposed to put on your brush, as opposed to people covering their entire toothbrush with toothpaste, they swallow the toothpaste and it, which you’re not really supposed to do.

And then they’re using a mouthwash with fluoride on it. So now you’re talking about a total amount of fluoride.

Dr. Patel: That’s exactly my point. Thank you. I loved it. That was fantastic. You kind of said what I was saying to begin with. This is fantastic. It’s the dosage, right? It’s the dosage that’s an issue. And especially like, it’s like, why even use fluoride when there’s so many other options available?

You know, let’s get, you know, let’s like look at stuff that’s available. Let’s, you know, be more conscious of our health. Let’s be more proactive. There’s no It was

Dr. Weitz: just a meta analysis that was just published this morning in the Journal of Pediatrics. That found that higher levels of fluoride are associated with lower IQ in children.

Dr. Patel: Yeah, it’s very true. That’s very true. So, you know, I guess I could say this and these I’m [00:43:00] not a big fan of fluoride. I don’t think that we need it especially in especially in toothpaste and in mouthwash and things like that. You know, unless it’s like a super severe case of something I don’t, unless somebody has like something called amylogenesis imperfecta where they can’t make enamel or something like that was a genetic disease.

I don’t really see a need for fluoride in the dental industry at this time. Honestly, I feel like currently there’s so many great options available that are fluoride free, including mouthwashes, including toothpaste, that it’s just not necessary anymore. And I couldn’t even find them like writing a pill, you know, a prescription for fluoride too.

It’s not needed, you know?

Dr. Weitz: What about mouthwash? You just mentioned mouthwash.

Dr. Patel: So mouthwash is great. You technically don’t need it. You know, like I said, if you’re a philosophers, brush your teeth, all of that stuff, scrape your tongue, you should be in good shape. The reason why not, I don’t want to add too many things onto the oral hygiene.

Less is more, right? I want you to be more effective with doing less. Now some mouthwashes can have alcohol, so which dehydrates the mouth and [00:44:00] also kills some good bacteria, so we don’t want that. But if you needed to have a mouthwash, it’s sometimes it just really honestly gives you the feeling of being fresh, right?

That’s just a psychological marketing feeling that mouthwash is

Dr. Weitz: saying, it’s not really important for oral health.

Dr. Patel: No, not for everyday person. There are some patients that I recommend you know, mouthwash for they’re usually going to be my cancer patients. There are some patients that have oral systemic disease, something else that’s going on.

They may need a mouthwash, but you know, Regular everyday people who don’t, they’re just looking for, you know, proactive, being easy and stuff like that. It’s not needed. If there’s no dry mouth, it’s not needed. It’s not needed for a lot of patients. So why would cancer patients need a mouthwash?

Because when cancer patients you know, they’re using chemo, what it does is it kills all the actively dividing cells and it’s not specific. So salivary gland is an active dividing cells. So kill that off. Yeah. So you won’t, they won’t create saliva. And if they don’t create saliva, all [00:45:00] the bacteria that builds up, they’re not able to wash it out.  So we use a product called OraCare, which I absolutely love. It’s fantastic. It creates a chlorine dioxide gas and it gets into little surfaces and cleans everything up. So that’s the mouthwash I recommend for cancer patients. But other than that, like, I mean, I don’t use a mouthwash every day.  You know, if you are brushing your teeth and scraping your tongue, you really should get that. Fresh feeling off the back. There’s no need for additional

Dr. Weitz: scraping

Dr. Patel: the tongue. Why is that

Dr. Weitz: so important?

Dr. Patel: So earlier we also talked about like, you know utilizing you know coconut oil to help detox the body our body actually detoxes to our tongue In ayurveda, we look at the tongue to be able to diagnose disease We look at the tongue in Chinese medicine to be able to diagnose disease as well.

So when you the tongue actually has a layer of bacteria on top, so you want to get rid of it every single day. Not just bacteria, but fungus as well, right? So again, in order to keep that balance getting rid of that bacteria by scraping the tongue [00:46:00] really make sure that our oral microbiomes is balanced for the good versus the bad. 

Dr. Weitz: So that’s great. Final thoughts and then give us your contact information.

Dr. Patel: Sure. Final thoughts is, Dentistry is huge and it has a massive impact on longevity and helps you live a longer, richful, joyful life and i’m delighted to be part of it. I’m delighted to be here with you.

This was a great conversation. Thank you And then if anybody wants to get in touch with us, we’re at S. F. Green. S as in San Francisco and F as in obviously San Francisco. Green. G R E E N. Dentist. D E N T I S T dot com. We are based in San Francisco. We do telehealth. We are happy to help in any way we can.  I also have courses if you want to learn more about the oral systemic connection and really how all of this stuff comes together. You can purchase the courses. You can ask us any questions that you may have. Be happy to help.

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

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Dr. Weitz:  Thank you for making it all the way through [00:47:00] 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.

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Dr. Mark Pimentel discusses a Deeper Understanding of SIBO and IBS with moderator Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on January 23, 2025.  

[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.] 

 

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Dr. Mark Pimentel has  

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

 

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Podcast Transcript

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

Dr. Pimentel:  It’s great to be here, and thanks for the introduction, you remembered everything.

Dr. Weitz:  So, maybe we could talk about how you first figured out what’s, what was the cause of IBS, and if you could include my favorite Dr. Pimentel story, it’s a story about ordering that toxin book. 

Dr. Pimentel:  Oh, yeah, I can tell you both those stories. I’ll tell you that was the second one second because it’s, it’s funny and entertaining. Maybe not today, but it’s funny and entertaining. I’ll still tell it. No, I, you know, I finished my fellowship in 1999 and during my fellowship, we were seeing these patients with bloating.  Breath testing has been around since the 80s.  So we were doing breath testing at Cedars and we saw a lot of patients with bloating and then we’d do the breath test and the breath test is positive and we give antibiotics and they get better. And so, and the question kept coming up, well, this, this is an IBS patient. This isn’t At that time, SIBO was thought of separately.  It’s a separate thing. And then we started to put the two and two together that these are IBS patients. I remember distinctly a story of a 65 year old woman who came to the office and we did the breath test. We treated her with neomycin back in the old days when we didn’t have her vaccinated.  And she came back and she says, I’ve had this for 30 years. And in two weeks, you made me 90 percent better and she opened her bag and she brought a paper bag full of antidepressants and she literally dumped them on the table and she says, I’ve been taking all this crap for years and this fixed me.  Neomycin fixed me in two weeks. And so, you know, it’s, and I’ve had countless stories like that, but it’s just, that was sort of the thing that said, you know, we got to, we got to work this out. We got to figure this out. And you know, over, over time, we started to understand that. The, the bacteria are changing because of food poisoning and we did a study where we gave food poisoning to animals and they got overgrowth.

So food poisoning causes IBS and it causes IBS by causing overgrowth. But I was like, well, but Salmonella can do it, E. coli can do it, Campylobacter can do it, Shigella can do it, but they’re all so different. Maybe they have something in common.  So this is after 9/11.  And about, and the anthrax thing was going on, if you remember that and so I ordered a toxin book, which is like this big book, and it comes in the mail.  It took a long time to come. It finally came in the mail. By the way, the book helped me figure out the toxin, but that’s not the important part of the story. I get the book, and in the book, From the national security association that says we have registered your name having bought a toxin book on bacteria. We know you’re from Canada and we are keeping an eye on you and I’m like, wow So they knew who I was where I’m from all that kind of stuff and that toxin book.  I still have it but It’s a wild wild wild time and that toxin is cytolethal distending toxin toxins cytolethal distending toxin, which It is the cause of IBS, and then it actually creates or triggers your immune system to form an antibody to you, which is the vinculin, and that became the anti vinculin antibody.

Dr. Weitz: So maybe you can explain more, and it’s the cause of the hydrogen form of SIBO.

Dr. Pimentel: Almost. Yes, it’s true. So the food poisoning causes the diarrhea form of IBS, but when you get the toxin, Your microbiome gets screwed up in one of two ways, hydrogen form, which is too much E. coli in the small [00:04:00] bowel or the hydrogen sulfide form, which is too much desulfovibrio.  So we started to see that there are literally two bad SIBOs or overgrowths. One is the hydrogen and one is hydrogen sulfide. And that’s where sort of it started. And then EMO is the other form of SIBO. Right. It’s intestinal methanogen overgrowth. So. Not from food poisoning, but if you have too many methanogens or methane producers in the gut, the methane actually constipates you.

And we learned a lot about methane in those days. We, we started to put methane into into the guts of, sorry, live animals and watched what the transit looked like. Some of those studies aren’t easy to do or fun to do, but But methane slowed the gut down. And then we were able to show that methane actually doesn’t paralyze the gut.

It causes the gut to stop contracting forward and start contracting. Like this, it doesn’t move, so it keeps it stiff and, and prevents [00:05:00] movement. So methane was, became, became really important. And then the goal was to figure out, well, what are all the characters of SIBO? What are all the characters of this sulfur overgrowth?  And what are all the characters of methane to allow us to develop new drugs? Even all the while we had developed rifaximin, at least as a starting point. Now we’re way ahead of that. 

Dr. Weitz: So does everybody understand what he said so far about the autoimmune concept?

Dr. Pimentel: Speak louder. Yeah. I gave a two and a half hour lecture yesterday and my voice is, it’s, it’s me and my voice is weak. So, yeah. So, sorry. You wanted me to speak about,

Dr. Weitz: Well, so you got a question, Bernie,

something maybe I’ll ask again.

Dr. Weitz: Go ahead. What do you wanna ask?

Dr. Pimentel: Yeah, so that’s a extremely good question and we’ve tried to unravel that question. In many ways. So let me maybe you just repeat the question. So the question is, is there a predisposition or a genetic predisposition to developing SIBO? So we knew food poisoning caused SIBO. In our rats, if we give them Campylobacter jejuni, which is the number one bacterial food poisoning for humans in the United States.  27%, 26 percent of the rats get SIBO, they get IBS SIBO. In humans, it’s 20%, so it’s about the same. And what we see is that, for example, in Iraq and Afghanistan, when they deployed to Iraq and Afghanistan, Tons of IBS came back. These patients, people came back with IBS and it was all due to the food poisoning that got there, not the stress, not the, the, the trauma that they experienced or witnessed and, and so we understood that, that [00:07:00] stress is not the cause of IBS from that study, but it’s food poisoning, but why only, 10 or 20%.

Why that number? What’s, what, why are 80 percent getting food poisoning and not getting IBS? We don’t know. It’s got to be a genetic component to it. There’s one study that was done talking about some of the cytokines that might be altered like IL 6 genetically. But we, we just don’t know. And we can’t find a mutation in vinculin.

which is where the antibody gloms on to to say, well, the antibody forms in you and that’s why this happens. But what we do know is that if you get food poisoning and you develop IBS, it’s because of this antibody that develops that you get. And that antibody causes your cleaning waves of the gut starting at the top, not to work.  And when those cleaning waves don’t work, the bacteria build up.

Dr. Weitz: Is there something about some antibodies that are more likely to cross-react than others? Can that be one of the factors? So Well ’cause it’s a cross [00:08:00] reactivity. Yeah.

Dr. Pimentel: From CDTB to bin CDTB. And we figured this part out, which I don’t talk about yet because exactly the sequence, but we figured out the sequence in CDTB where the antibody then looks or the sequence looks like vinculin three dimensionally, and that’s where the antibody learns to go after you. And, and that’s, that’s really how it happens. It just goes after your vinculin, and then you’re stuck with this thing. The, the nerves are impaired.

Dr. Weitz: Wait, by the way, is the same concept why most autoimmunity happens through this cross reactivity.

Dr. Pimentel:  Exactly. It’s called molecular mimicry is the technical term. This molecule is mimicking or tricking you into thinking Vinculin is the same molecule. So you’re attacking yourself because of that. The way that tricked your immune system. So food poisoning multiple definitions, because you could have it from parasitic infections.  You could have viral infections, but generally food [00:09:00] poisoning, we think of as from food like E. coli, Campylobacter, Shigella, Salmonella. Those are the four primary food poisoning organisms.

Poison.

Dr. Pimentel: Right.

And, and, and that’s been shown in multiple studies. There’s now 49 studies of food poisoning, developing IBS, and that’s in a big meta-analysis that I presented yesterday in, in, in the talk I gave. Campylobacter is the worst. It’s the worst. It’s more likely to make you have IBS than anything else that you could get but they all can do it.

And that’s, that’s, but, but food poisoning, when I mean food poisoning, I’m using more lay terminology, but it’s really what we call acute gastroenteritis.  So it’s the antibody reaction more than the toxicity.

Dr. Pimentel: Right. So what happens over time is sort of like [00:10:00] the COVID vaccine, right? You get the COVID vaccine, your antibodies go up, you get the booster, they go up and then you don’t get the vaccine anymore.  And the, it goes down, down, down, down, down. When you get the food poisoning, the CDTB antibody goes up immediately. Because you got exposed to CDTB, not Vinculin yet. This antibody starts to drift down and about three months later, you start to get the autoimmunity buildup. And then CDTB goes away. Because you haven’t gotten CDP, you haven’t seen it in a while.

Let’s say it’s three years later, CDTB is gone. I use an example of of somebody, a case example. There was a guy I had who, you don’t get both antibodies all the time. This is, this is kind of an anecdote. He swam in his neighbor’s pool when they were on vacation, but the neighbors turned the pool off.

So the pool was kind of gross, but he thought, okay, it’s fine. It’s cold. But he went in it, he got really, really sick. And then ever since then, he had IBS. And he only had anti CDTB. He never developed the antivinculin. And over three years, he was on lots of medications, Rifaximin, [00:11:00] Prokinetics, everything. And then over three years, the antibody drifted to below detection or below thresholds for IBS.  And he stopped all drugs. But he’s susceptible. So if he goes on vacation, he’s got to be more careful than the other people because he can form antibodies and he can get the IBS again. And maybe next time it won’t be so friendly.

Dr. Weitz: Now, these bacteria secrete other endotoxins like lipopolysaccharides, do we form antibodies to LPS?

Dr. Pimentel: Well, I think you do, especially if the bacteria goes systemic but what, what we were trying to identify here is, and you form antibodies to a lot of different things that are, that your body doesn’t want But you’re, but most of the bacteria of your gut, and there’s a lot of E. coli in there that are friendly E. coli. So the E. coli I’m talking about for food poisoning is pathogenic E. coli, but friendly E. coli, they’re there. You don’t, and they have a lot of polysaccharide, but you’ve acclimatized to your [00:12:00] normal microbiome, and so you don’t really attack it. But what I wanted to say about the antibodies is that the, these antibodies, like you, you’ve seen probably antibodies for celiac or antibodies for Crohn’s disease, right?

They’re markers. They’re not causative. Vinculin is causative. We’ve, we’ve proven that. So the higher that antibody is, the sicker you are, the more neuropathy you have. That antibody is causative. So, why is that so important? First of all, it’s important because the test make, becomes more accurate. The second thing is, if we get rid of that antibody, we cure IBS.

We cure SIBO, and we sure as hell are working on that right now. So, So isn’t emo also a cause of IBS? It’s a cause of constipation IBS. And emo does not come from food poisoning. We don’t know why people get a buildup of methanogens. We just don’t know. You know, we think that it’s from your family.

So we see methane run in families, for example. You, your, [00:13:00] your mother had it, your father had it, you’re sharing the same bathrooms, you’re sharing a lot of different things, and then you end up being colonized early, and then it blooms at some point, and then you get constipated.

Dr. Weitz: Is everybody familiar with the term IMO?  Yeah, it stands for intestinal methanogen overgrowth. So the three forms of SIBO that Dr. Pimentel has deciphered is SIBO, which is hydrogen and it includes hydrogen sulfide. And then ISO is hydrogen sulfide. ISO is hydrogen sulfide. And then IMO is intestinal methanogen overgrowth. And so if you have IBS with diarrhea, it’s probably from hydrogen sulfide or hydrogen.  Whereas if you have IBS with constipation, it’s probably from methanogen overgrowth. Yeah.

Dr. Pimentel: And we don’t know why methanogens bloom or overgrow like that but when they do, they cause a lot of constipation. They also cause weight gain. They cause other consequences as well. [00:14:00] Is

the bacteria that cause the methane gas or methamphetanes different than the bacteria that cause the hydrogen?

Dr. Pimentel: So, so methanogens are not even bacteria. They’re archaea. So they’re, they’re a totally different kingdom of life, separate from bacteria. And, and they have different DNA, different this, it’s very different organism. More ancient from the primordial soup or, or so they suspect. So they’ve been around a long time and they produce methane.  That’s one of the things they produce. And and there’s a lot of methanogens, but we, we know one organism is the culprit in IBSC and it’s methanobrevibacter smithii. So. Don’t memorize that. He will, but you don’t have to. It shows up on a stool test we do all the time. Methanogrebiacter smithii.  Smithii. Yeah, it was discovered by a guy, my last name’s Smith. Everybody’s naming bugs, so. Yes, sir.

A lot of things that people are [00:15:00] worried about. solution, then the cows produce a lot of methane gas,

Dr. Weitz: right?

Does this mean that they have more of that part of, we don’t call it material, do they have more of that, which produce more metal gas?

Does this mean cows have Yes,

Dr. Pimentel: so it’s a very complicated question to answer, but I will try because, because the cow stomach, of course, it has multiple stomachs, ruminating animals have these, there’s a lot of methane produced by ruminant animals, cows being the largest. Population and they’re contributing to global warming because of the methane they produce.  And yes, it is these methanogens like methanobrevibacter smithii that are colonizing cows. The question is, does the cow need that preserve for proper digestion? Is that the way it’s supposed to be? Or are they being colonized in [00:16:00] overabundance and maybe that’s not normal? We don’t know the answer to that, but there is a a disease in, in cows.

So if you give a cow. antibiotics and wipe out its entire microbiome, a cow will die in three days. Because the cow cannot survive without bacteria. The cow can’t digest grass. The cow is not digesting grass at all. It’s chewing the grass, putting it in its stomach, the bacteria and archaea in the stomach are breaking the grass down, it then brings up the bacteria, chews the bacteria, and gets the calories from that.  So cows are very, you know, ruminants are very different. So if you get rid of the methanogens in cows, is that going to hurt the cow? We don’t know the answer to that. But we could turn down the methane in a cow and maybe help the environment. So that’s something that, you know, we’re looking at and others are looking at.

Dr. Weitz: And you were researching a form of seaweed that was used with cows to reduce

Dr. Pimentel: methane. Right. [00:17:00] There’s a Hawaiian seaweed that really blocks methane synthesis. And people started to find out about it, especially the cattle industry, because they want to reduce methane because they got a bad rap for the environment for cattle.  And the problem is that Seaweed is quite rare and Hawaii does not want all of it harvested because that would be bad for their environment. So there’s a group in Oregon that’s cultivating it in small quantities and selling it to the cattle industry. And so that’s all I know at this point, but there are some patients who tried it and did okay.  But it’s hard to get hard to get.

Dr. Weitz: So you’ve identified methanobrevibacter as the cause of IMO and what are the organisms that are the cause of hydrogen and hydrogen sulfide?

Dr. Pimentel: So what’s interesting in, in the hydrogen side is which is the most common form of these overgrowth scenarios SIBO as we call it, is that it’s not colon, which is why it’s SIBO, small intestine, because everything’s happening in the small intestine and it’s an overabundance of E. coli and Klebsiella. [00:18:00] Now, I don’t know how much any of you know about traditional SIBO, but it used to be thought that SIBO was the bacteria of the colon are moving into the small bowel because you don’t have an ileocecal valve or this or that, or the other people still say that is not what this is.  It’s actually just two bugs. That are overgrowing and they’re overgrowing because the small bowel slow on the small bowel slow E. coli can outperform outcompete and destroy everything around it. So they’re like a wrecking ball to the rest of the microbiome. When we look at, we call them networks, but you couldn’t think of it as a city.

And if you look at the city, you’ve got doctors, plumbers, lawyers, all these different components of the city that make a city healthy. When the E. coli and Klebsiella there. The whole thing craters. And so E. coli and Klebsiella have taken over everything and everything’s wiped out. So when we actually give Rifaximin, for example, to a SIBO patient, we get rid of the weeds and the garden comes right back to normal.  So it’s counterintuitive with [00:19:00] Rifaximin because it’s an antibiotic, you think, Oh, it’s going to wipe out the microbiome. It actually regenerates the microbiome by getting rid of the bullies. So that’s SIBO. Those are the characters.  These two bugs, they are in the small bowel, also in the ovary, and they have overgrown in both of these places.

Dr. Pimentel: So for SIBO, it’s primarily that they are overgrown in the small bowel. That’s why the terminology is small intestinal bacterial overgrowth. For EMO, they’re methane, they’re overgrowing everywhere.  That’s why the small intestine is not part of the acronym. And same with ESO, they’re overgrowing everywhere.  That’s

These two, they are present in colon.

Dr. Pimentel: They’re present in small bowel in overabundance.

In overabundance.

Dr. Pimentel: Yeah. And they’re from the small bowel. They’re just now, they, they have taken advantage of the slow transit and they’re wiping everything else out. They’re winning. In the back. So they [00:20:00] have

a slow genetic.

And then what was the

Dr. Pimentel: last part?

So if you have, so there are some genetic motility disorders for example, visceral myopathy is a genetic disorder or scleroderma, maybe not genetic, but a very slow, small bowel, very difficult to treat a lot of overgrowth. It’s so slow, the transit that it’s hard to keep it away. So those patients, some of those patients, I keep them on chronic rifaximin because as soon as I stop the rifaximin.

They’re back in the hospital, very expensive. So we have to come up with better ways, but we try to put diet on board and, and pro kinetics and other things to try the best we can so that we can use as little antibiotics as possible.

So loaf, let me say it in an extreme form. [00:21:00] Okay. If you eat nothing, your bloating will go down because you’re not feeding the bacteria and they’re not producing gas or bloating and you’ll starve them to death. We also starve yourself to death. The low FODMAP diet. On that side of the equation where you’ve restricted so much that you actually can cause nutritional deficiencies.

It works, but you want to use it for a short period of time and you don’t want patients, you don’t want to say, Hey, go on low five map diet and see the patient two years from now. And they’re still on it. That’s, that’s not healthy for the patient. We we’ve sort of devised a softer version of that. That actually predates the low FODMAP, so it’s not like we got it from them.

I would call it a low fermentation diet, where you don’t, you’re not as restrictive. You can go to any restaurant in the country and you’d find something. You know, one of the things that, that sort of bothered me about IBS all this time is number one, it’s called a syndrome and it’s dismissive to patients and patients feel like IBS is in your head and that’s what they were told.

I hate that. Second [00:22:00] is that it’s a woman’s disease. It’s not true and it’s not, you don’t blame a gender for a disease and that’s what people were doing. And, and, and, and so these are the things that, and third is that these pages, 

Dr. Weitz: I’m sorry, Dr. Pimentel, that’s a DEI version of IBS. It’s not allowed.

Dr. Pimentel: You went there. It’s scary times. But but. Anyways, and then the other part is lifestyle, right? These patients are miserable. They can’t go out. They go to, they go on a date and they’re at the restaurant, they eat food, there’s something to have diarrhea, they disappear for half an hour cause they can’t stop having diarrhea for half an hour.

Then they come back. How does that date go? You know, stuff like that happens, or they go to the restaurant and they’re the person asking the waiter, does it have this? Does it have that? I can’t have gluten because I’m on low fodmap. I can’t have butter. Does it have butter? And then the rest of the table is like, Oh my God, we’re not bringing that person again.

[00:23:00] You know, I want people to be able to live their life. And not be embarrassed and not to be sort of discriminated against as a patient because it’s in your head or other reasons. So, that’s why we devised the diet.

Sam?

Dr. Pimentel: Oh, for sure. I can send it to Dr. Weitz. Sam. Hey, Sam.  So nice to see you again.

Dr. Rahbar:  Likewise. Mark, do you ever check the MAO in your patient? Try and check it on the side. Yeah. So, that’s usually the time with Exocan.

No more patients of you that we can exist and doesn’t anything to make a drop in. Oh, and the kid is in the U. S. Really?

It’s in production.

Dr. Pimentel: Yeah. So, we are studying TMAO. [00:24:00] We have some data that just, just got produced because TMA and TMAO are also risk factors for cardiovascular disease when they’re produced in the gut, maybe, maybe, you know,

Dr. Weitz: right. Cleveland clinic. But by the way, fish is the leading source of TMAO.

Dr. Pimentel: Yeah. So, but we’re looking at it and there is a, if you think there’s some in the blood, Wait till you see what’s in the gut.  There’s a ton being produced in the gut. And it’s being decontaminated or, or, or converted. So, we’re looking at that. But, one of the things with methanogens, to your point, that I think is really important, we can create an animal with methane. You know how we do that? High fat diet. We put them on wheat or egg yolks or whatever has high fat.

High fat makes methanogens grow. We don’t know why, but it makes them grow like crazy. And then the rat gets constipated as the methane goes up. And we use that rat to study drugs. So [00:25:00] what you’re saying, if you go on a low fat diet, you could actually make possibly the methane go down just by doing that as well.  Oh, that’s what I mean. And methane will go down and then there they’ll be less constipated. Yes, sir.  You mentioned good question, but you mentioned seaweed.

Dr. Pimentel: Yeah.  So if we go to an restaurant, Japanese, on the menu, there’s a seaweed salad.

Dr. Pimentel: Yeah.

So with somebody with sibo.

Dr. Pimentel: So it’s only, first of all, IMO is the only one that would respond to seaweed, and it’s not that seaweed.  So it’s a special one, special seaweed that’s from Hawaii. So another question is mentioned cost of random is, yeah. And the generic is AXA or rif. Correct. So from personal experience. I was in Columbia, five 50 milligram made by Abbot, which is the company [00:26:00] was 42 tablets, was $72, and in Mexico that’s a great deal.  It was $56 for the same two tablets, while with not insurance in the SA is 2,800 and this insurance is nine.

Dr. Pimentel: And I was in, and I was in India in November and I got a hundred tablets for 14 that paid for my plane ticket.

So why is it because the company that makes it here don’t allow generic to be made or why is this?

First of all, is it okay to take something which is Made in by Abbott, let’s say, and distributed in Colombia.

Dr. Pimentel: So, my understanding is the Abbott product is identical to the one here. That’s my understanding. The, the, most of the Rifaximin in India is made by a company called Lupin, which also sources some of the Rifaximin [00:27:00] for here.

So, It’s my understanding. It’s the same. I can’t answer your question as to why it’s expensive, except that there is no generic here currently. And that’s maybe the only explanation.

Dr. Weitz: Unfortunately, in this country, it’s written into the drug laws that they will not negotiate for lower drug prices. So, other countries negotiate for a lower price. Yeah.

I mean, that’s an aerobic bug, isn’t it? Right. There’s always a little air up there. You must have created some sort of aerobic environment for that, because if you follow oxygen, you probably can kill the bugs.

I mean, is there any theory as to how you remove oxygen from the upper

Dr. Pimentel: gut? You know, I don’t want to digress, but when we, when we started to put [00:28:00] Campylobacter in rats to see that it developed IBS, I asked around with some people who had animal models. They say, don’t do that. Rats are dirty.

Campylobacter will never infect them. It will never work. It will never do anything. They’re dirty animals. First of all, they didn’t have the antibody at all, so they never saw Campylobacter before. Second of all, we created beautiful IBS from that model. We were told that, well, overgrowth is colon bacteria getting in the small bowel.

That’s not what it is. It’s E. coli and Klebsiella. We were told that, oh, we checked for methanogens. They’re only in the left colon. They’re only in that anaerobic environment. And we just presented a DEW. We found M. smithii in the small bowel, and it correlated with the breath methane. So this one is producing this breath, or at least part of it.

But. So the question is Ms. M. Smithii is very oxygen sensitive, so it will die in oxygen, but it can be buried in that [00:29:00] mucus and create micro environments where the bugs around it are sucking up all the oxygen, making a micro anaerobic environment for them to survive. And, and there are things like that, that happen in the microbiome.

Yeah, you have another theory?

Because I have my own theories on this. Well, tell me. I want to know. But

Dr. Pimentel: if it’s top secret, you can keep it. Top secret. Top secret.

So, when you did your study of the economics of the small valve, how did you get the samples for the proportion of the fungi that you detected in the valve tube?

Population was low. That is not consistent with our clinical impression. We’re observant also. Right. And our observation is the number of times is a clinical response. I can’t ignore it. Just see [00:30:00] it by having clinical experience. Right. And we also aspirate the samples, not as we thought it gets it, but you know, some of the samples, the microbiology.

Now that is some sample of the action group on guy and sometimes they show, you know, the DNA testing. Yes, may show it. Yeah, but the proportion is not small, but more, especially when you look at the new genome and interesting. If you see a white coating like slow white appearance, very, very likely that is I believe My question is, how did you get the sample?

All the way down to the genome, was it biopsy, aspirate?

Dr. Pimentel: So, we now have the largest collection of duodenal aspirates and the microbiome of the small bowel in the world because of this reimagined study we’ve been doing for the last five years. But the first two years were all about validation. So we, we developed a double lumen catheter with a cap on it [00:31:00] because the catheter has to come out sterile.  We can’t pass this aspiration catheter, a single lumen. Open through the scope, you’ve sucked mucus, you’ve sucked saliva, you’ve sucked esophageal gastric juices, acid from the stomach, how are you going to culture once the bugs are exposed to acid? So we’ve got a double lumen catheter when we get, we, we, when we do the re imagine.

We don’t look at anything. We just go boom, boom, boom, boom, into the duodenum second portion, and then we put the catheter in, displace the cap, put the inner catheter out, and then suck juice. And then we, then we take biopsies of that location. We’ve got blood cytokines, we’ve got like a whole bunch of things that we do in addition to that genetics.

And in doing, in doing that. We have very, very, very little contamination. We can tell.

And we get saliva,

Dr. Pimentel: too, just to be sure we’re not contaminated.

Let’s take a look at one thing. You sampled the jejunum.

Dr. Pimentel: Yes. Not the jejunum. About 10 feet of a small bowel.

Dr. Pimentel: Yep.

Dr. Rahbar:  That sample. My question, what’s your diagnosis for [00:32:00] fungal overgrowth?

Can it just be I’ll

Dr. Pimentel: get to that. I’ll get to that. So, and then if the patient’s going for double balloon endoscopy, we get duodenum, jejunum, and ileum in that patient for the study. And what we find is that the duodenum, are almost identical, almost identical. And that includes fungi. And so we recently, and 16S doesn’t identify fungi well at all.

It’s very inaccurate. So we’ve actually gone to shotgun sequencing, which sequences all the DNA that’s there, including human. And then you’ve got to remove the human DNA, purify it to the bacterial DNA, which it takes a number of steps. And then we find fungus. We actually find fungus there. And when it’s high, and usually when it’s over a thousand, it is associated with symptoms, and it’s almost always, but not always, candida associated with symptoms.

So, [00:33:00] and what are those symptoms? The symptoms are bloating, pain, sometimes diarrhea, but mostly bloating and pain.

And muscle activation.

Dr. Pimentel: Can be. Yep.

Dr. Rahbar:  Now Ali made a comment which I wasn’t quite convinced is the case, that there’s no hyphy format. I have literature publication from the European source, obviously not from the U.

S., that they have actually described the pictures with the hyphy. I mean. I have two different opinions here, because I think hyphae

Dr. Pimentel: All I can say is that if you do a double lumen catheter, you get no contamination. Yeah, you can have hyphae in the upper gut. The esophagus can have hyphae, and we see that all the time.

Or not in the small bowel. Maybe it’s the acid, maybe it’s the bile, maybe they grow better without hyphae, I don’t know why. But we don’t see hyphenated, we don’t see hyphae in the small bowel much.

That level to be able to see it at the microscopic level.

Dr. Pimentel: Yeah, but we haven’t seen it. [00:34:00] What we have seen, which is extremely interesting, is we actually can see that because we sequence the entire microbiome DNA, we find penicillin, penicillium fungus in the small bowel.

And when they’re there, There is more antimicrobial resistant genes in the bacteria because penicillium is there. So now the question is, is antimicrobial resistance to antibiotics due to the fungi that are there? Are the fungi there to help control the microbiome properly so that you don’t get an overgrowth?

Oh my God, this opens up an immense number of questions that we don’t have answers to, but when we saw penicillium in the small bowel, which was not uncommon, uh, that opens up a whole window of ideas. What’s going on?

Mark, two questions. I’m so sorry.

Dr. Pimentel: Yeah.

When you did your study, did you make the biofilm using Always.

We have to. the centrifuge in it? [00:35:00]

Dr. Pimentel: No, we use diphthyl 3 etol. It’s a a mucolytic. And so we, we learned that if you don’t do that, you don’t see the entire microbiome. And other centers that publish on the microbiome don’t do that. We published an entire study validating that you have to break the mucus.

You have to do all these steps. Otherwise, you, you miss half of what’s going on

there. Wide angle brush. Brushing of the small bowel as opposed to biopsy.

Dr. Pimentel: No, we haven’t done brushing. But we do take the biopsy and immediately take it to the lab in anaerobic conditions and then we vortex the surface off with a mucolytic so that we get the surface bacteria in a separate container for further analysis.

So

White angular crush cytology similar to what they do for parrots. It could be done.

Dr. Pimentel: Oh, so we got to be careful because the microbiome world thinks [00:36:00] of luminal bacteria. And there’s mucus containing bacteria, and then there’s the bacteria along the lining. And you’re, you’re going to get a little bit of everything, I think, if you do it with a brush.

But that’s, that’s okay. You can do it.

You can do it. A practical question. I assume the first line of defense, if there’s a placebo, would be antibiotic treatment, would be taxidermy or whatever. If either they don’t have insurance, it’s going to be cost for, you know, tablets They had some side effects, the cookie didn’t have doxazycline in combination with neomycin and maybe a third medication, or flagyl or whatever would be a second, third choice.

Dr. Pimentel: So we used to give neomycin, we used to give doxycycline just by itself, used to work fairly well. Metronidazole is useless, absolutely useless. Cipro is useful, can do it. [00:37:00] The problem we encountered, and we published this paper, where if you took any of those antibiotics and it worked once, If they relapsed, it would not work again in about two thirds, because they would develop resistance to it.

So you’d have to be going to another antibiotic, a different one, and a different one, and eventually they’d be resistant to many of them. And so then you end up in a cycle of, now what do I do? Rifaximin doesn’t create resistance. We’ve given it again and again and again. And I’m, I’m, I can’t argue with the cost.

I understand that that that’s a really big problem, but rifaximin doesn’t have that problem. And that’s why it’s kind of special in that way. Bloating is one

Dr. Weitz: of the most common symptoms. Right. of SIBO. Have you had patients who had Bloating just from the time they wake up all day, not around meals.

Dr. Pimentel: Yes.

And those patients I do barium studies on because I’ve had patients and I had one recently, another one [00:38:00] where they have never had surgery, but they remember when they were 18 years old, they had this really bad pain ended up in the emergency room. It turns out they had an appendicitis that healed spontaneously, which can happen just like diverticulitis.

And it scarred the ileum. And they have a narrow ileum from an adhesion and the surgery, they went in, cut one adhesion took like two minutes and now they have no bloating. So anybody who’s bloating all day, all night will get overgrowth. But it’s not because of the usual stuff with the antibodies and the IBS.

It’s you got to look for other things. We’re not saying they’re all like that, but you have to start to look for other things is what I mean. Have you had patients get the like clear passage soft tissue, myofascial work on the adhesions? Yes. And I’ve done that for some patients, especially patients where they have more of a locked in bowel where they have so many adhesions that the surgeon’s like, I don’t want to go in there because I’m, it’s so bad.

I have one patient right now who just got out of the [00:39:00] hospital who had this situation. And she had done clear passage, but you know, where do you start in that patient? It’s, it’s so hard, you know, but doing surgery to remove adhesions is tricky. Cause this, this lady had just one little strand. Okay. It was so simple.

And even the surgeon was like, wow, this was the easiest thing. And then the patient just felt so good.

Uh,

Dr. Pimentel: you mean in the lumen or outside the loop inside the peritoneal cavity, but wrapped around the bowel on the outside. Appendicitis, but it could be trauma. It could be a prior surgery. I’ve had patients where they had a blunt trauma from football and then they got one adhesion and they didn’t even know it just somebody hit them in the abdomen and they were in the ER and then three years later now they’re bloated.

It’s it’s just a slightly perforated bowel. I think you got a question first. So before we[00:40:00]

A lot to be honest, it’s quite a bit, it’s about 10 percent have intestinal sulfide overproduction. And those, those, for example, I had a patient, it was hydrogen, it was hydrogen, and they’d seen a gastroenterologist and they’d had Rifaximin three times, got a little better, a little better, but not much.

And they did a full workup trying to figure it out. And then they came to us, we did the three gas, it was hydrogen sulfide. I treated her one treatment with Rifaximin with Pepto. A year later, she’s still normal. Still normal. Abysmal? Yep, still abysmal. Yeah. Which gets rid of H2S. And she’s still normal.

Which, and, and it’s frustrating because if we, if we knew, we didn’t know this five years ago either. But that, that helped a

Dr. Weitz: lot. A lot of patients are just getting two gas tests because a lot of the gastroenterologists have a two gas test in their office. [00:41:00] The three gas is TrioSmart. Right. Now, are there plans to make that machine available for purchase by

Dr. Pimentel: gastroenterologists?

So it’s, it’s not currently in, in the works that way. It’s at a CLIA certified laboratory currently. So that’s how they do it. But, but the TrioSmart test is very helpful because the other thing about hydrogen sulfide, hydrogen sulfide, even if you have the other gases, predicts a greater severity of everything.

So if you’re, if you have pain and you have H2S, the pain is worse. If you have diarrhea and you have H2S, the diarrhea is worse. So it’s a predictor of severity as well. Rifaximin. So I use 550 three times a day of Rifaximin, the typical dose for 14 days. And at the same time you take the Rifaximin, you get a cap full of Pepto Bismol, which is about 520 milligrams ish, something like that.

Two weeks. Sort of like H. pylori actually, [00:42:00] the old H. pylori. Oh, sorry. This gentleman was

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Dr. Pimentel: to our discussion. Oh, I see what you’re saying. So, the GI infection that you had, the food poisoning or gastroenteritis that you and I were dialoguing about earlier, so, that causes the antibodies to go up and causes you to be dysfunctional. That puts you at risk for recurrence and relapse, so that, now if you get another food poisoning, the antibodies go even higher, and you’re more likely to relapse.

[00:44:00] But I think your question is, if you take the antibiotic, most people do really well for many, many months. I have patients who, Take it once and two years later, I see them at the mall and they’re still doing well. But I would say the majority of patients have some degree of relapse over time and need to take another course without food poisoning, but Yeah, but I counsel all my patients on travel and just to be careful.

This lady first.

My lens for me is like fungus and mold exposure and that’s what I’m like focused on, love treating, but I see a lot of SIBO. Yeah. So the fungus component is interesting to me, just to speak about it, treating the fungus and the fungal burden, and that kind of then brings down the nasty pathogens, we find that the cereals seem to kind of withdraw a little bit.

And I’ve had a lot of banter, I don’t know if you know

Dr. Pimentel: Nicole Bisnick. I know the name.

She’s a nutritionist, but loves it too. [00:45:00] We’re trying to banter about the fungal side of it often.

Dr. Pimentel: So have you done breath tests like the TrioSmart breath test or one of those kinds of breath tests before and after your antifungals to see if it works?  

Because antifungals, going back to Dr. O’Barra’s

question. Yeah, going back to your reason why, it doesn’t make sense that fungals

Dr. Pimentel: become a two different thing. But remember and this way may be why more women have IBS than men, because women tend to get autoimmune diseases more than men, for whatever reason we don’t understand.

Maybe the immunity of the person who might be sensitive to some of these other toxins also puts them or at risk for these events that we’re seeing with SIBO. We don’t know, but there’s something wrong with the immune system that some people react to mold and some people don’t because mold is pretty ubiquitous around.

Neighborhoods and houses and just some people are really sensitive to it and others maybe not you can correct me if you see the same thing.

Dr. Weitz: Yeah, isn’t one of the reasons why women tend to get more autoimmune [00:46:00] diseases is because generally prior to menopause they have a more robust immune system and then we see autoimmune disease frequency decrease after menopause.

Dr. Pimentel: Yeah, some, most of them do decrease. Rheumatoid arthritis goes up, but okay. Yeah,

the autoimmunity part, or bone exposure, I think makes you more susceptible to food poisoning and things along those lines. That’s what

Dr. Pimentel: I’m wondering, and I don’t know the answer to this because I don’t see enough of the cases like you see, but If the people who you know that are sensitive to mold, are they more susceptible to food poisoning?

Do they get it more often?

Well, you talk about their history, it’s hard to tell. Yeah. Everybody remembers. Everybody

Dr. Pimentel: remembers food poisoning.

We haven’t been testing the trio after very often because they don’t have

Dr. Pimentel: symptoms. No, I was more thinking for academic reasons. For scientific reasons.

Dr. Weitz: Yeah. Given the fact that there’s a fairly substantial percentage of the population whose [00:47:00] immune system is, Less than optimal.

And just looking at U. S. response to COVID, for example can a Less than optimal dysfunctional immune system be one reason why patients fail treatment for SIBO. Should we be analyzing the immune system in some way, such as looking at secretory IgA levels on stool testing or something like that, and then addressing the immune system component as part of the treatment for SIBO?

Dr. Pimentel: All possible, but we haven’t done it.

Margarita asked the question what is the relationship?

I thought that your study showed that that were not correlated.

Dr. Pimentel: I don’t, I don’t generally order the antibody if they’re methane or constipated. I think you study, I think

how easy

Dr. Pimentel: it is. Yeah. So if you look at the original studies we did with the first [00:48:00] generation, the less, less accurate test, but we do see that diarrhea and mixed IBS, they’re the ones that have the majority of it.

So about 58 percent is the exact number, because I did the talk last night, of IBSD will have the antibody, which is about the percentage of IBS that’s post infectious. In the constipation it’s about 27%. In healthy it’s about 15%. So it’s still higher. in the methane group, and it’s still statistically higher, but it doesn’t feel like it’s as important to the mechanism, and not as often important.

So, yes, you’re right, I don’t measure it generally.

What’s the significance of excessive mucus in the stool? Do you correlate that with the biofilm in the gut?

Dr. Pimentel: So, you know, there’s a lot of work, you probably are aware of this, of stripping the biofilm from the colon to help patients with certain symptoms, including bloating, and they go in and they power wash, basically, and peel the biofilm off the colon when they see a very thick [00:49:00] biofilm, and some people get better from that, but it, it’s, I don’t see it that often, but I do see it sometimes when I do colonoscopy, I don’t know your experience.

In

our experience, amazingly, that’s correlated It’s almost like the body creates that

Dr. Pimentel: defensive

to keep it out

Dr. Pimentel: in the colon or in the small bowel you’re talking about.

I even have one patient from the local community. He did a colonoscopy. The amount of mucus after the colonoscopy was it was so excessive.

I could not colonoscopy. Wow. Interesting. I know. That particular patient, the one that was moving. And mold toxins are commonly associated with immunosuppression, which promotes the fungal overgrowth. But that’s what our patients are admitting.

Dr. Weitz: Interesting. Very interesting. You said before, last time we talked, that [00:50:00] emo can be only in the colon, and yet the breath test can

Dr. Pimentel: pick that up.

Yeah, no, what I was saying is that, that We were told it was only in the colon, but it wasn’t true. When we actually did the sequencing of the small bowel, we found methanogens everywhere. Right. But a patient who has emo Yeah, right. Might just have it in the colon, right? Correct. Yeah. That can happen. And they could still have a positive breath test.

That’s correct. Because EMO is by definition that that excessive methane is causing constipation. Doesn’t matter where it’s coming from, it’s constipating. That patient,

Dr. Weitz: if

Dr. Pimentel: that’s the

Dr. Weitz: case. We think of the breath test as just measuring the small bowel, but if it’s measuring methane from the large bowel Couldn’t it be measuring hydrogen from a large bowel as well?

Dr. Pimentel: So I can tell you the answer is no because when we do the hydrogen If you don’t put fuel The bacteria that are producing hydrogen run out of fuel very quickly. The [00:51:00] types E. coli, Klebsiella.

Dr. Weitz: Okay.

Dr. Pimentel: They are, it’s when we did the, what we call metabolomics, metabolomics means, we’re able to see what the bugs can do metabolically.  Like what is their function? E. coli. SIBO in the small bowel, your ability to make gas from sugar, is 63 times faster than a person without SIBO. So when a patient comes to your office and they say, I get gas and bloating 10 minutes after I eat, and you say, yeah sure, 10 minutes, they’re, they’ve got a, they’ve got a Ferrari engine for making hydrogen in there.

But when we check it in the morning, after a fast, It’s turned off. There’s no fuel. They’ve burned through all that fuel overnight so fast. And so I think when they run out of fuel, they’ve run out of fuel because we, that’s why the breath test in the morning for hydrogen, we can see methane because methane is just going and doing its thing.

So you can see methane first thing in the morning. You can [00:52:00] see it even on a breath test. The first sample could tell you they’re already emo before you, but you have to give the lactulose or the glucose to get the energy. You ever

Dr. Weitz: see methane without the lactulose?

Dr. Pimentel: Oh yeah, for sure. First, first breath sample, you might see 20 and that’s an emo patient right there.

You don’t have to continue. So, so they could be having gas before they even eat. Because methane is different. So what methane does is, and this is why you can’t, it’s nothing isn’t about a two hour test. The methanogens, they basically, how it works, you take the lactulose, the lactulose gets to wherever the methanogens are.

The hydrogen producers produce hydrogen. That takes about, you know, 20 minutes, an hour, whatever it is, and then that hydrogen then has to go to the methanogens. And then the methanogens slowly convert it to methane like a very slow engine, an old engine, because they’re archaea, right? They’re ancient, and they’re generating methane slowly to generate energy.

And [00:53:00] they keep doing that all night. And so you wake up in the morning, you’re fasted, you still see the methane. That’s, that’s how it works.

Dr. Weitz: There seems to be an interaction between a percentage of patients that I’ve seen who have methane, especially the ones who are resistant to treatment. And we sometimes find out that they had mycotoxin mold exposure.

And when we reduce the mycotoxin level, then their treatment for the emo ends up being more effective.

Dr. Pimentel: Yeah, I mean, it’s possible that could happen. So I, I can’t, can’t argue with that. Yes.

Question about the sugar. From my understanding that if you drink something with pure, or eat pure sugar, the basic sugar.

Dr. Pimentel: Like the white stuff. Yeah. The

white stuff. Then this is being absorbed by the stomach. It is the esaccharide or polysaccharide, like fructose and lactolose, that gets absorbed in the small intestine. It doesn’t

Dr. Pimentel: get absorbed. Lactolose goes all the [00:54:00] way through. No absorption at all. Yeah.

So pure sugar. Is it okay, let’s say, tea with one spoon of sugar, as compared Having a fruit which has fructose or a glass of milk with lactose for people with SIBO.

Dr. Pimentel: You just invented my low fermentation. That is exactly the principle. Because sugar, table sugar, or glucose, it’s not glucose. It’s glucose fructose combination, but there’s a glucose fructose or sucrose transporter for it. Pure fructose is hard to absorb, so that’s why fructose, you want to limit it.

Lactose is hard to absorb, you want to limit that on your diet. But pure white sugar, no problem. You get most of it. The bacteria don’t even have a chance. You’re way better than E. coli and Klebsiella to get sugar. And, and so sugar is an acceptable food. thing that these patients, these patients can eat.

Dr. Weitz: But this is exactly why so many of us in the nutrition, functional [00:55:00] medicine world just have a tough time with the low fermentation diet because they eat sugar and white bread and white rice.

Dr. Pimentel: Well, so I’m not, okay. So let me be clear. The low fermentation diet isn’t. You sitting at home spooning sugar as your meal.

Okay. It’s a, an allowed item, but it, I don’t intend for people to be Right. Sugaraholic. No, I understand. So that would be bad for sibo probably. ’cause you’d overwhelm your system and give it to them. And, and I wouldn’t, I wouldn’t want that. But, but there’s one aspect of this that I wanna draw attention to because a lot of people do glucose breath tests.

So if a diabetic gets a low blood sugar, what do they do?

Where do they put it? Why? Because you can absorb glucose from right under your tongue. So if you do a glucose breath test, and you take that little cup of glucose, and let’s say I’ve got a, [00:56:00] a 4 foot 10, 16 year old, getting a breath test, or me, I’m going to drink the same amount of glucose, I’m going to absorb it in this big mouth, this big esophagus, this big stomach, how much is going to get to the small bowel?

My breath test, sure as heck, is going to look a lot different than that because very little of that glucose is going to get to the bacteria. I’m going to be negative. And that person might see more glucose in their small bowel. Lactulose, you don’t have that problem. It doesn’t get absorbed. It’s going through for both of us.

So glucose has a problem and we see it and we know it and that’s why we don’t like glucose. Even though some of the scientists continue to argue we should do glucose, it’s more specific even if it’s less accurate.

We talk about the heterogenic SIBO. And there’s the area type and constipation type.

Assume the constipation is also the bloating and so is the enemy of SIBO as well. So, what would [00:57:00] be the best treatment would be Miralax. Integrity would be . Would you wanna take it from diet and control the constipation?

Dr. Pimentel: Right. Well, I mean, so I, I’ve had, I’ve had this argument last night in my, in my talk, one of the biggest problems we have in irritable bowel syndrome is the Rome criteria, the criteria that tell us they have IBS, the old criteria that would develop in the late, in the early nineties.

The Rome criteria says you have IBS, if you have pain. and diarrhea, that’s D IBS. If you have pain and constipation, that’s C IBS, assuming you have no other disease. Okay, so you gotta do all these tests, everything’s negative, you put these criteria. So IBS, by definition, is defined as a symptom disorder.

What happens when you go to the FDA with drugs? You want a drug that treats symptoms. Where’s the drug that treats causes? Crohn’s disease, there are 40 [00:58:00] drugs out there that are FDA approved that treat all the inflammatory cells that are causing Crohn’s disease because they know what’s going on. And IBS, in our IBS guidelines, I wrote part of the guidelines, I’m on that guideline paper.

We have Imodium there, Imodium in the guideline for, Imodium wouldn’t be in a Crohn’s disease guideline because Crohn’s disease, Imodium, yeah, it would make the diarrhea better, but nobody’s, who would think to use Imodium for Crohn’s? It treats the symptom. It doesn’t treat the cause. And so my argument. In all my career is stop treating symptoms, start treating causes.

And I think you guys know this because this is what you do every day. Isn’t that the

Dr. Weitz: story of conventional medicine?

Dr. Pimentel: Well, you trapped me now. But, but, but yes, stop treating this. I mean, of course you want to relieve symptoms. Linzess will relieve symptoms. It’s not treating the cause. You know, the GC guanylate [00:59:00] cyclase agonist is using a mechanism from bacteria to cause diarrhea.

But GC has nothing to do with the cause of IBS. It’s just relieving constipation. It’s a good drug. I’m not saying it’s a bad drug. I’m just saying, I’m kind of tired of drugs that are out competing each other to cause diarrhea. And the other thing that I say, and I go, now I’m on a rant, now I’m on a rant, you see?

Diarrhea is not the treatment for constipation. And constipation is not the treatment for diarrhea. I want to make my patients normal. But all these drugs do what I just said. They treat constipation by causing diarrhea. So we need to start to think differently. That’s my Should we, should we be, go ahead, sorry.

So if you can’t afford Zyfaxan, there are other antibiotics that you can try. And I, and I hate to say it, but yes, those were the ones I listed earlier, Doxy, Augmentin, and those. But You don’t want to

take your boy from Canada?

Dr. Pimentel: We [01:00:00] talked about buying it from India. We went further. So yes, Canada, Mexico, and

Yeah, so, stress is not the cause of IBS, but it is a trigger. It is a, it worsens the symptoms. So when you’re in a stressful patch, your IBS will be worse. Your cleaning lines will be less. Your overgrowth might go up. So yes, these, this is, this is a true statement. But to tell a young woman you have IBS.

Everything’s going to be better here. Take this video. And, and, you know, this kind of stuff to try and relieve stress. No, I mean, yes, do it. But that’s not the full answer.

Dr. Weitz: Now, one of the mechanisms by which stress could play a role is if the person is stressed a lot, [01:01:00] they’re in sympathetic mode, and that’s going to affect the vagal nerve.

And so aren’t strategies to have the person. Spend more time in parasympathetic mode, potentially beneficial because it’s not, not because of psychological, but because they might stimulate the vagal nerve and yeah,

Dr. Pimentel: well, I mean,

Dr. Weitz: I definitely address

Dr. Pimentel: stress, psychological trauma and other things very regularly with my patients because it is a very big problem among all our patients.

And when we identify it, they have to be treated by professionals. And it’s a serious thing. But what I’m trying to get away from is the notion that it’s in your head, your IBS is in your head. Yes, stress affects it, and stress modification can make it better, but it’s not going to cure it. And so we have to focus on both aspects.

So I agree. What about strategies

Dr. Weitz: to promote vagal nerve stimulation [01:02:00] and parasympathetic

Dr. Pimentel: tone? There’s nothing that we know of, like even stimulators, auricular stimulators and various other vagal stimulators, right? None, none of that have triggered cleaning waves that we could see. They, they’ve tried pacing the cleaning waves with pacemakers in the stomach.

Electrophysiologists have done this. Can’t get it. Can’t turn it on. It’s stubborn. It’s stubborn like Moeity makes it go. Erythromycin makes it go, low dose naltrexone might make it go, but electrically, you can’t turn that thing on, you can’t jumpstart it. But you had a second question.

I’m wondering if there’s a hide from this, there’s one drop in there.

No,

Dr. Pimentel: I’m happy to discuss lots of different things. For example, for methane, Alimed or Allicin, which is a garlic extract, works quite well for that. Temporarily, it can reduce methane. Peppermint has some effects, antimicrobial effects, but I see it very short [01:03:00] lived, so that doesn’t work as well. Elemental diets work terrific to get rid of bacterial overgrowth, better than antibiotics.  Way better than antibiotics. Also very expensive, though. That’s the shame. M Biota, we just published, we just presented it, M Biota gets rid of methane by 70, 75 percent of patients who took M Biota, methane’s gone. It’s a new elemental diet, but that’s palatable 14 days. It’s palatable, tastes great. It really tastes good, not like the Vivenex.  M, like M, like Mark, Biota, but not after me, not my name.

Dr. Pimentel: If you use neomycin for SIBO, you’ve got about a 30 to 40 percent chance of it working versus 60 to 70 percent with rifaximin. That’s the difference. And then if you want to use neomycin again, [01:04:00] it’s 10 percent chance of working the second time. It’s a third, it’s two thirds less. So 30 percent goes down to, to one in three or 10 percent.  That’s it. There’s no issue of cost. How often So you treat somebody who’s been off for 40 days, Right. And then, they get better.

Dr. Pimentel: Yes.

Then they come to you, they have another symptom, you repeat the test, and again, the methamphetamine gas is way up, and so on. You treat them again.

Dr. Pimentel: Yes.

Now, obviously, antibiotics have some side effects as well.

No. But how often You can give Rifaximin every 3 months, every 6 months, 10 times over 5 years, if there’s any. So what’s your longest status with patients?

Dr. Pimentel: So we’ve given it up to a dozen times and it works just as well the 12th time as it did the first time. Rifaximin, we looked at a, we published a paper in the American Journal of Medicine, very high profile [01:05:00] journal, looking at.

number needed to harm for all IBS drugs. Tricyclic antidepressants are used for IBS. In the old days, still some doctors do it. For every 2. 3 people that get better from a tricyclic, one is harmed. For every 846 people who took Rifaximin and it made them better, one person stopped the drug from a side effect.

Out of 8, 800 people, one person dropped out of trials for Rifaximin. It has no side effects. And we now repeated the analysis. We’re doing it at DDW, and I’ll tell you only one thing about Rifaximin. Placebo was worse than Rifaximin, so we can’t even calculate the, this, the, the danger of Rifaximin because placebo was worse.

So Rifaximin is extremely safe.

Can you give it in conjunction with another antibiotic? [01:06:00] No.

Dr. Pimentel: Well, yes, for methane. For methane, it’s rifaximin plus neomycin. For hydrogen sulfide, it’s rifaximin plus hydrogen, plus pepto. And for a SIBO, regular SIBO, it’s only rifaximin. Now, I agree with you, I keep talking about the same drug, but that’s because the questions are directing that way.

But there are other therapies, but this is the one that really works the best. That’s unfortunately the way it is. And we have a drug for methane that’s coming. It’s already working. I can’t talk about it, but it’ll be next year. We have another drug that advances Rifaximin to much better effectiveness.

That’s going into clinical trials in April. It’s a phase 2b trial with the FDA. That’s Rifaximin with specialized NAC? Right, right. And then we have we’re working on a biologic agent for vinculin. So we’ve got lots in the hopper that are coming down the pipeline that will be better than anything we’ve ever had.

Is,

Dr. Weitz: is the methane drug, [01:07:00] I know one time you were working on some form of lovastatin? Not lovastatin,

Dr. Pimentel: something new. Okay. Sorry you go, you go first. Yeah, you’re on the outside.

I’m not an expert in SIBO. I’m not a prescriber, so. I don’t have access to her food. But what I’m getting is this biopsies always SIBO, or it can be a dysbiosis without SIBO?

Because what I’m, what I’m getting is like everything is some sort of a expression of SIBO.

Dr. Pimentel: So, so when we looked at the, we have over a thousand patients in this reimagined study that I mentioned earlier. In that study, the most apocalyptic microbiome we see is SIBO. But there are other dysbiosis. So, and we haven’t talked a lot about that today, and it would open up another hour of conversation, and I think maybe, maybe not.

But but one of them is SIFO, the fungal overgrowth that was brought [01:08:00] up. There are other things. So there are other dysbiosis is what I’m getting at. So you are right. It’s not all, but the conversation was meant to be about SIBO today, so that’s why we focused a lot on this.

Dr. Weitz: You’ve said that methane tends not to be present in patients with IBD.  If it were available, should we be giving probiotics of methanogens to patients with Crohn’s?

Dr. Pimentel: You’re thinking like a scientist. So, so, look, when I think about the microbiome, it sort of dovetails with your question. First of all, your microbiome is different than your microbiome is different than your microbiome, which is why we’ve had such a, there is no publication that says, this is the normal microbiome folks, everybody should have this.

There’s no such thing. Because, and the other thing is, Sweden, Italy, they’re eating different food, different microbiome, everything’s different. Okay. We’re versatile. So if we move to different countries, our microbiome will shift a little [01:09:00] bit, but, but there’s no one magic microbiome. But is diversity still important?

So if I put you on Linzess, your diversity is going to go down. Crohn’s patients have diarrhea. Their diversity is going to go down. So the question is, is the low diversity causing the illness? Or because you’re having diarrhea, you have low diversity? I think it’s the diarrhea. I’m not sure that that’s the culprit.

So, you know, we put a lot of stock in diversity, but

Yeah, when I dealt in the low carb submarine, I talked a lot about carnivores and all that. And the balanced diet, you need the microbiome, but those things are, those people are, seem to be

Dr. Pimentel: thriving, so.

Microbiome is different for everybody.

Dr. Pimentel: Your question sparks a lot of things that I’ve answered questions on in the past, and one of the things that I tell my patients, you know, because patients will say to me, you know, I have this IBS SIBO, and yeah, I [01:10:00] took Rifaximin, still having symptoms, but I went to Italy.

And I felt great the whole time I was there. Well, everybody feels great in Italy, but it’s the food, right? So you can look at it in different ways. Maybe it’s GMOs, maybe it’s the preservatives. Obviously, that’s part of it, right? There’s a lot of crap we put in food here. But there’s also in Italy, what do you eat for lunch?

Italian food. What do you eat for dinner? Italian food. What do you eat for breakfast the next morning? Italian food. Yeah, and it’s brilliant. It’s wonderful. And I could live like that forever. What do you eat in L. A.? Sushi one night, Mexican the next night, Indian the next night, and then you’re going off to another part of town to have Greek food.

So, your gut’s like, what’s going on? You know, because it’s all this different variety, and is that healthy? Why does your mom say, eat chicken and rice, eat chicken and rice, your stomach’s not good, eat chicken and rice, just everyday chicken and rice. But it’s consistent, right? And the microbiome kind of goes, okay, we know what’s going on, this is what we are today.

And stay that way. And [01:11:00] sometimes that’s good for the gut to get that stability. So,

part of the low

Dr. Pimentel: fermentation diet is not just the food composition. It’s that fasting business because the more you fast, the more likely you’re going to have a cleaning wave and clean up. There’s a reason why cleaning waves, okay, so people say, oh, you should have five meals a day.

That’s a healthy diet because that gets your metabolism up or whatever, right? Weightlifters do this. You eat five meals a day, you never have a cleaning wave. You never have a cleaning wave because you’re always in fed state. So why do you need cleaning waves if you’re never going to use them? We grew up or evolved, you killed a buffalo, nobody had a refrigerator.

You ate that buffalo. The whole tribe ate that buffalo until they were full. And then they didn’t eat for a few days. And then the cleaning waves cleaned up and stuff. And then you killed another buffalo and, and that’s, that’s, it’s feast or famine. That’s what our bodies are designed for. [01:12:00] Clean up between.

Yes. Oh, you’re, are you paleo?

I work in that environment. That’s what I teach people. I tell them exactly that. You need to imagine yourself 20, 000 years ago in a cave. Exactly.

Dr. Pimentel: Yes, exactly. You didn’t have

a closet full of cereals and oatmeal and blah, blah, blah. No. So we need to mimic that. That’s what I tell

Dr. Pimentel: my wife.

I’m changing in the closet. She says, what are you doing? I said, I’m changing in the closet. They didn’t have closets back then. You know.

Anyways, that was meant to be a joke. I didn’t pull it off very well. So,

anyway. Is there any, like, do you have any thoughts on any, any,

Dr. Pimentel: any link? So. I was a disbeliever in, and this happens, I’m a disbeliever in something and I prove myself wrong and that’s [01:13:00] always fun. So gluten, so we looked at people in the reimagined study who self identified gluten intolerant and self eliminated gluten.

And they felt better as a result of it. And we looked at their cytokines, and their cytokines are much lower than people who are on gluten. So there’s something about gluten that fuels cytokine production, and we haven’t gone back to it because we want to look at the microbiome in all those different states, and why gluten is triggering that.

But there’s something pro inflammatory about gluten, and we know, of course, the ultimate pro inflammatory is celiac, but maybe there is some true gluten sensitivity that’s out there. And, and needs to be explored further.

Dr. Weitz: We have Alessio Fasano talking about how gluten is often a contributor to LeakyGuide.

Yeah.

So we have wild, that’s full of molecules of water and gluten, I think. Well, it’s just like I think I don’t want people to go to

Dr. Pimentel: Italy.[01:14:00]

And Bruce Lee all we need is cow milk. It’s there’s an original variety of cow milk.

A2.

Dr. Pimentel: A2, that’s it. A2. We don’t have A2 here. And so it’s more allergenic cow milk here than A2 milk and more intolerant. Now we do. Now we do. Yeah, I know.

Dr. Weitz: And pretty much all wheat is sprayed with glyphosate. Maybe glyphosate is one of the problems creating inflammation.

I think Dr. Bahr is working on the role of toxins and

It’s a very comprehensive protocol we wrote to look at symptom presentation and ICD diagnosis on the second visit and the number of chemicals and toxins that we show in the urine. We’re checking 120 [01:15:00] different metals, chemicals, and both toxins and the PFAS and the POAs. Wow. The study has been approved.

I get toxins that you show. Eventually, I’d like to have something like yourself on here. Part of the editorial review the volumetric work, but

Dr. Pimentel: Send me an email.

Alright, have we gone over time? No. Okay. Yeah.

Dr. Weitz: So I, thank you so much. I’m not trying to cut it. But I don’t. So generous with these time.

Dr. Pimentel: These people have, you know, been amazing. You guys, your questions are really quite amazing. So, did you have a question? One last one?

Who is it? Methanogens may be beneficial, but we’re not there.

We didn’t get

Dr. Pimentel: there. Because I sort of didn’t. Well, yes. It’s possible. Methanogens are anti inflammatory. So what I was going to say is that. I don’t think of, I don’t use the word good or bad bacteria ever. Because good [01:16:00] bacteria are good if they’re supposed to be here. They evolve if they’re in the right place where they belong and they’re not hurting you.  It’s as soon as they hurt you that they’re no longer doing the right thing. There’s too many of them. There’s too, they’re in your bloodstream. You can’t have lactobacillus in your blood. It may be a good bacteria in the gut, but it’s not a good bacteria in your blood. So there’s no such thing as good. And methanogens should be here, not here.  Or here, but they should be here. So my goal is not to wipe them out, not to exterminate them. My goal is to rebalance them. And I think that’s sort of the philosophy in this room. You want to rebalance. You don’t want to just catastrophically destroy things.

Dr. Weitz: One more thought about what have you looked into using phages?

These are viruses that

Dr. Pimentel: kill bacteria. So there are people, we aren’t, but there are people in France, for example, looking at phages for methanogens. that are specific for methanogens. Again, the question is, is that the apocalypse for the methanogens? Or is it just going to tone them down? I don’t know the answer to that.

Phages scare me a little because [01:17:00] they’re a little, it’s like a wild card.

Are they working for that, for the

Dr. Pimentel: environment or

something? What’s that? On that kind of intervention for the environment, the methane environment.

Dr. Pimentel: Oh, for trying to reduce it using phages. Yes, they are. Yes, they are. That is correct.

So, but pages are, to me, are scary. They’re, they’re very I don’t know, I don’t know if you can titrate them just to get things down, or are you going to wipe everything else out? I’m not sure. So that’s sort of, I’m timid about that, but I could be wrong. Final questions?

So I do use sometimes Atrantil, which does reduce bloating and, and it does for methane particularly, you know, sometimes it’s beneficial, so that one I do use. What

is it?

Dr. Pimentel: Atrantil. It’s a natural product. A T R A N T I L. Are you familiar with it?

On a practical level, let’s say, what are your recommendations for someone with a high blood pressure?[01:18:00]

Oh yeah. For you. Can’t do that breath test. I’m not doing that Breath test. There’s no, they’re in pain.

Dr. Pimentel: I have 95 year olds doing breath test. I don’t understand why somebody would not do a breath test. It’s so super simple. But I, I get it. I, I, if they don’t wanna do it, I’m not gonna shove it down their throat, obviously. You know, you could technically do, if you’re looking for methane. Or if you’re looking for sulfur, you could order the kit, not give them the sugar, just blow in one bag, and it should show up in that one bag.  But, if you can get them to do that much, you might get something out of it. I don’t know if that’s helpful.

Dr. Weitz: Is there any benefit to doing the test for three hours? There’s still a percentage of practitioners that insist on doing three hours and even use a Tredo smart test for three hours. They just do like every 20 minutes instead of every 15.

Yeah, cheating the

Dr. Pimentel: [01:19:00] system. But it’s, you know, maybe there is, but it hasn’t been properly validated. So I can’t say no, but what we’ve seen is two hours seems to be the magic amount. You had a question and you never asked a question yet, so I’ve got to get to that one.

The correct spelling of the expensive medication, is that

Dr. Pimentel: Rifaximin?

Rifaximin. R I F A X I M I N. Rifaximin.

Dr. Weitz: All right. Great. So thank you everybody. Thank you.

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Thank you for making it all the way through this episode of the rational wellness podcast. For those of you who enjoy listening to the rational wellness podcast, I would very much appreciate it. If you could go to Apple 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.