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Dr. Eric Osansky discusses Overcoming Hyperthyroidism without Radiation or Surgery with Dr. Ben Weitz.  

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Podcast Highlights

Dr. Eric Osansky is a chiropractor and one of the leading experts on a natural approach to hyperthyroidism. He was personally diagnosed with autoimmune hyperthyroidism, also known as Graves’ disease, and he was able to overcome it using a natural, Functional Medicine approach.  He avoided both the prescription antithyroid medications and the radioactive iodine treatment, as well as thyroid surgery.  He has a Masters of Science degree in Human Nutrition and Functional Medicine, is a Certified Clinical Nutritionist, is a certified nutrition specialist and a certified functional medicine practitioner for IFM.  Dr. Osansky has published 3 books, Natural Treatment Solutions for Hyperthyroidism and Grave’s Disease, currently in its third edition,  Hashimoto’s Triggers, and The Hyperthyroid Healing Diet. His website is SaveMyThyroid.com.

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

Podcast Transcript

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

Hello, rational Wellness podcasters. Today I’m excited to be having a discussion on hyperthyroidism with Dr. Eric Osansky. We have had a number of discussions on this podcast about hypothyroidism or Hashimoto’s thyroiditis, which is an underactive sluggish thyroid, the most common thyroid disorder, the most common autoimmune disorder.  But some patients have an overactive thyroid. We referred to as hyperthyroidism and like hypothyroid. Most patients, it’s an autoimmune condition, but unlike hypothyroidism, when the body doesn’t make enough thyroid hormone in hyperthyroidism or Graves disease, which is the autoimmune version of it, the thyroid makes too much thyroid hormone, which means it’s speeding up the metabolism.  And there’s a series of symptoms that are related to having too much thyroid. Patients sometimes lose weight, though. Interesting. Not there’s patients who have trouble losing weight, who have hyperthyroid. I find that interesting. Sometimes they have tremors or rapid heart rate anxiety, a bunch of symptoms.

And not many functional medicine practitioners really talk about hyperthyroid. So Dr. Eric Osansky is really the go-to guy about this topic. Dr. Osansky is a chiropractor and one of the leading experts on hyperthyroid. He was personally diagnosed with autoimmune hyperthyroid, also known as Graves Disease, and he was able to overcome it using a natural functional medicine approach.  He avoided both the prescription antithyroid medications and the radioactive iodine treatment as well as thyroid surgery. Dr. Osansky has a Master’s of Science degree in Human Nutrition and Functional Medicine. He’s a certified clinical nutritionist, a certified functional medicine practitioner, and Dr. Osansky has published three books, Natural Treatment Solutions for Hyperthyroidism and Graves Disease, which is currently in its third edition, Hashimoto’s Triggers, and the Hyperthyroid Healing Diet. [00:03:00] Dr. Osansky, thank you so much for joining us today,

Dr. Osansky: Dr. Ben. Thanks for having me. Really excited to talk about hyperthyroidism and Graves Disease.

Dr. Weitz: So let’s get right into it. What is hyperthyroidism? What is Graves Disease, you know, and what are some of the consequences of having this condition?

Dr. Osansky: Yeah, well, you gave a little bit of an overview. So hyperthyroidism is when you have too much thyroid hormone. And the main thyroid hormones are T4 and T3, at least the ones that can be measured on the blood test.  So you have too much T4, T3, you also have what’s called thyroid stimulating hormone or TSH. So like you said, hypothyroidism is a lot more common. And when you see hypothyroidism, usually the first SI signs that doctors at least look at is that, that first marker is that TSH and they see that TSH on elevated and then that’s when they might do other tests like a T4, T3, then maybe [00:04:00] antibodies.  What hyperthyroidism it’s the opposite. So thyroid stimulating hormone stimulates the thyroid gland to produce more thyroid hormone in the case of hypothyroidism. But with hyperthyroidism, since you have too much thyroid hormone, it. Does you wanna have low levels of TSH. The pituitary gland does not want to tell the thyroid gland to produce more thyroid hormone and wants to do the opposite.

So usually you have not only low levels of TSH, but undetectable levels of TSH. So you have that low TSH elevated thyroid hormones, and you mentioned some of the symptoms. When you have too much thyroid hormone, you could have rapid heart rate, you could have heart palpitations, tremors, anxiety, and which can cause insomnia.  You mentioned weight loss. You are right that not everybody would hyperthyroid and lose weight. But when I dealt with Graves, I lost 42 pounds and I wasn’t trying to lose that much. I was 180 2 at the time, and Dr. One, one down to one 40. So my normal’s like [00:05:00] 1 65, 1 70. And so, yeah, I definitely lost a good amount of weight.  And some people also have what’s called thyroid eye disease which is also as it’s associated with graves, the same autoimmune component that causes grave. 

Dr. Weitz:  So what is this Thyroid eye disease?  Maybe you can talk about that for a minute. ’cause that’s, that can be a very serious condition, correct?

Dr. Osansky: Yeah. Oh yeah. So, so with Graves, so Graves, you have what’s called thyroid stimulating immunoglobulins, which is a type of TSH receptor antibody. And those. Tsi, the thyroid stimulating immunoglobulins attack the TSH receptors of the thyroid gland or bind to the TTSH receptors, and that’s what causes the excess production of thyroid hormone.  But those same antibodies could also attack the tissues of the eyes, and that could cause bulging of the eyes swelling. In some cases it could cause double vision. And you’re right, it could be serious in some cases, I mean, thankfully, only about three to 5% of cases of thyroid eye [00:06:00] disease is severe.  Usually it’s, I mean, it’s, even when it’s not severe, it could be pretty. Like if someone has bulging of the eyes, it’s you know, very distressing. But then also it could be very uncomfortable as well. So. Yeah, like, we gotta, what the same with Graves is of course more of an immune system condition than a thyroid condition.  And so thyroid eye disease is similar.  It’s more of an immune system condition and it involves the eyes, but you need to address the immune system ultimately when addressing the cause of a problem. When you go to conventional medical doctors, they’ll try to address it in other ways. They’ll suppress the immune system with things like prednisone.  You know, sometimes they’ll have to do surgery with thyroid eye disease. And there’s a, there’s also, I don’t know if you’re familiar with the medication Tepezza, there’s a Yes, I’ve heard of that. With infusions, they give infusions like three weeks apart every eight weeks. And and that, I mean, it’s effective, but the pro, especially with bulging the problem with tep eza.  [00:07:00] It could also sometimes cause hearing loss or tinnitus which obviously is not fun. So, yeah, so anyway, I’m not saying there’s not a time and place for the, for if you want

Dr. Weitz: to see better, you can hear.

Dr. Osansky: Yeah, exactly. So, yeah, and you know, I mean, to be fair, I’ve had, I can’t say I have a lot of people who’ve taken the Tepezza, but I’ve had a few probably like maybe at this point, maybe five or so.  And one person, a male patient did lose his hearing. It was temporary for a few, but still kind of scary when you lose your hearing for, ’cause you don’t know if and when it’ll come back. And then right. And then but I’ve had a and that same person where he lost the hearing, it did help with the bulging and then a few other people have taken it, it also helped with the bulging doesn’t seem like it helps much with double vision, but for bulging it could be life changing for some people it’s just a matter.  Are you willing to take the risks with not just the hearing loss? So the tinnitus, but it is fairly new, so we don’t know, like side effects like 10, 15, 20 years down the road. [00:08:00] Right.

Dr. Weitz: So when it comes to labs for hyperthyroidism, what level TSH do you think is definitive? I’ve seen 0.5, 0.4. You mentioned that maybe you should be undetectable.  What do you, what’s your take on that?

Dr. Osansky: definitive? You meaning what’s considered hyperthyroid?

Dr. Weitz: Hyperthyroid. Yeah.

Dr. Osansky: Yeah it’s a good question. I mean, obviously if it’s undetectable and that thyroid hormones are elevated, then that’s clearly hyperthyroidism. When you see TSH, let’s say of like 0.3 or 0.4 like below the range, or again, maybe 0.5, 0.6, maybe like on the lower side, like on, not like within the range sometimes, but on the lower side, but Right.  Many times that’s more subclinical. Like many times when we see that TSH, like 0.3, 0.4, 0.5, we’ll still see the thyroid hormones [00:09:00] within the lab range. And so, yeah, I mean, if it’s below the range, it’s considered to be. Subclinical hyperthyroidism. If the thyroid, assuming the thyroid hormone levels are normal, and if someone has low TSH, even if it’s not undetectable and thyroid hormones are normal, you could also have subclinical Graves disease where you still have those antibodies.  And and not common. I’ve had a few patients with that. Typically when you have the Graves antibodies, usually it’s overt hyperthyroidism, not subclinical. But yeah, I mean, I don’t know. I guess with me, if it’s, I mean if it’s 0.3, 0.4, I mean, I still consider it hyperthyroidism. I mean it’s, but it also depends.

I mean, there could be, I mean, maybe there’s something else underlying, I mean, you know, but it’s not normal, let’s put it that way. Someone comes in with. You know, at TSH 0.3 0.4, especially if it’s been like that for many months or many [00:10:00] years, and doctors just kind of dismiss it and say, oh, you know, don’t worry about it.  Your thyroid hormones are looking good. And maybe they test it for the antibodies for graves and everything looks good there. You know, it’s, to me, there’s still an underlying cause. But it is it is a little bit more challenging, honestly, like you would think graves is more challenging ’cause it’s autoimmune, but at least we know it’s graves and there’s that autoimmune component.  And when it’s subclinical hyperthyroidism it’s sometimes it can be more challenging to get that TSH up naturally, you know, if you take Antithyroid medication, that’ll drive it up, but that’s not addressing the cause. So as soon as you stop the antithyroid medication, like methimazole, it’s gonna go back to where it was.

Usually. Right

Dr. Weitz: now, during pregnancy, a lower level of TSH is considered acceptable. Right.

Dr. Osansky: Yeah, I mean if you’re pregnant I mean if someone’s pregnant, then yeah having that, if the TSH is, I mean, again, it’s typically shouldn’t be like undetectable. But it depends. Sometimes we’ll see TSH a [00:11:00] little bit higher ’cause there’s more demand for thyroid hormone from the baby too.  So it really depends. Yeah.

Dr. Weitz: And what about level of free T3 and free T4 for being able to diagnose hyperthyroidism?

Dr. Osansky: Yeah. Well, I mean, according to like United States values I consider an optimal T four, free T four to be between one and 1.5, an optimal free T three to be like between three and 3.5.  Now that being said, if someone has like a free T four of like. Yeah, 1.6 and a free T three of like 3.7. That’s usually still within the lab reference range, depending on the, because as you know, different labs use a different reference range. Of course, most of the time it’ll be within the range. But but then again, that sometimes that’s high enough to put the TSH lower or even undetectable.  But yeah, I mean, again, to me, I, it’s, I still would consider it more subclinical at those [00:12:00] levels. But again, still it’s worth looking at. ’cause I mean, what gr everybody’s different. Some people it happens really quick where they might, their thyroid hormone shoot up, TSH you know, gets depressed pretty quickly.  Other times it might start out as subclinical and then maybe a few months it kind of turns into full blown grave. So, unlike medical doctors, we don’t wanna play the waiting game and just say, I mean, we wanna look at antibodies. In that situation, just make sure that they don’t have thyroid antibodies and that we don’t have to start working on the autoimmune component.

Right. So

Dr. Weitz: That’s where you’re looking at TSI and sometimes patients with Graves also have elevated TPO antibodies as well.

Dr. Osansky: Pretty common. The research shows between 60 and 80% of people with Graves have elevated TPO antibodies. And I think Hashimoto’s, it’s like 90%. And then, yeah.

Dr. Weitz: Why would they have some of the same antibodies as [00:13:00] patients with Hashimoto’s?

Dr. Osansky: Yeah, I mean, it’s a good question. I mean, some people have all three antibodies.

Dr. Weitz:  So why is that?

Dr. Osansky:  Why does, like, when I dealt with Graves, I just had TSI, I didn’t have t TPO antibodies or th globulin antibodies. Some people have, a lot of people have TSI. And TPO, and then I’d say probably like 20 to 30% have all three antibodies.  So why is that? Why do some people have one, others have two, other have all three. I mean, there’s, as you know, there’s, if you have one autoimmune condition, you’re more likely to have multiple autoimmune conditions. And even though all three of those are thyroid antibodies, they’re different thyroid, you know, they’re attacking different parts.  Like the immune system is attacking different parts of the thyroid gland in all three situations. So similar where you could have those thyroid antibodies and then you could have other autoantibodies associated with other autoimmune conditions. So there are different, and there, there could [00:14:00] be overlap of triggers, but there could also be different triggers.  And I, I think that’s why sometimes let’s say if we have someone who has all three antibodies and in a perfect world. When trying to address the root cause of the condition, we’ll want to see the antibodies decrease and normalize, which is easier said than done. Sometimes it could drive you crazy trying to normalize them but it’s not uncommon to see, like, let’s say TSI eventually normalize, but then maybe TPO and ortho th globulins still remain elevated.  And so there might be, and usually there are multiple triggers. So, and like I said, the same thing with other autoimmune conditions. So if you have other autoantibodies, it’s just that, again, it could be one, potentially one trigger causing all the different autoimmune conditions. It could be multiple triggers and usually is multiple triggers.  And then according to that, tried of autoimmunity or three-legged stool of autoimmunity. You also have that leaky gut component that’s also playing a role. But then also there’s [00:15:00] genetics too. So like really do as wide as someone develop celiac disease instead of Hashimoto’s or someone develops both Hashimoto’s and celiac disease or a Graves disease.  Hashimoto’s and celiac disease, again, it’s a combination of genetics, environmental factors that increase in intestinal permeability. So that’s that triad of autoimmunity.

Dr. Weitz: Oh. So when a patient goes to see a conventional endocrinologist for Graves disease, what are the most common treatments?

Dr. Osansky: Yeah, it’s pretty much three treatments.  For the most part. One is medication antithyroid medication, methimazole. Is the MO or tapazole the most common antithyroid medication given? Sometimes there’s also what’s called propal thiol or PTU. That’s something, especially if someone is pregnant, like the first trimester of pregnancy, they’re usually given PTU or they can’t tolerate the metrazole.  They, many times they can’t tolerate the PTU either, but [00:16:00] sometimes they’ll, they can so usually the antithyroid medication, some people also on beta blockers certain beta blockers like propanolol affect that t like the, it inhibits the T4 to T3 conversion. So, and then number two, radioactive iodine, which pretty much using radiation to destroy the cells of the thyroid gland.

And usually making someone hypo. Not all the time though. Some people need multiple. Treatments with, if they get like one treatment, radioactive iodine, they might still remain hyper if the doctor used a lower dose. And then the third option, thyroid surgery, it’s usually complete thyroidectomy.  And I mean the great thing about that, it does cure the hyperthyroidism, but the bad thing is that two bad things. One, and I, well, one it, you do need to take thyroid hormone the rest of your life. Which again, that’s, I mean, some people do need to do that, but the probably the worst thing is that you’re not doing anything for the autoimmune component of graves.  ’cause again, it’s more, as [00:17:00] we discussed, more of an immune system condition. So you’re still at risk of developing other autoimmune conditions in the future with really any of those three methods. But unfortunately with radioactive on surgery, the most medical doctors just say that’s the cure. And you know, now you’re good to go.

Just take thyroid hormone the rest of your life. All is well. And and yeah, unfortunately that’s not always the case. Some people do well, you know, with surgery, some people do okay with radioactive iodine, but many people don’t do well and you just don’t know if you’ll be, if you with any procedure, obviously with that, you just don’t know.  So, of course I’m gonna be biased and say always try to address the cause of the problem. You could always get surgery, you could always get radioactive iodine, but once you get either one of those, you can’t undo that. You can’t turn back time.

Dr. Weitz: Yeah. Interestingly, the second of those, the second and third treatments you mentioned, the radioactive iodine in the removal of the thyroid gland, or it would be the same treatment as if you had [00:18:00] thyroid cancer.  Mm-hmm. So in no way is it really fixing anything, it’s just correcting some of the symptoms. Now from a functional medicine perspective, we want to ask. What has gone wrong now? Your immune system now is attacking yourself, whereas your immune system is supposed to just attack foreign invaders like bacteria and viruses and things like that help with wound healing.  But somehow the immune system now is attacking your thyroid gland and what, what’s gone wrong That your body is not doing the right thing.

Dr. Osansky: Yeah, another great question. And I mean, we’re still obviously learning about autoimmunity. You know, we have a lot of answers, but we still don’t have all the answers.  But, you know, there’s a lot of things that can cause the immune system to go haywire. I mean, we, you know, we definitely live in a more toxic world than we do, than we have you know, for [00:19:00] in the last like 10, 15, 20 years. Compared to 50 years ago. I mean, just it’s, and it’s getting worse and worse.  All these chemicals the xenoestrogens, the microplastics, the glyphosate just yeah, I mean they, they could, some of these can affect the thyroid directly and like as endocrine disrupting chemicals. But as far as the autoimmune component, they also could affect the immune system. And many of these, we know glyphosate affects, disrupts the gut microbiome.

We know that microplastics also affect the gut microbiome and nanoplastics and even heavy metals affect the gut microbiome. Which again, I didn’t know until a few years ago. I knew that they have negative effects on the immune system and mercury could affect the thyroid. But a lot of these things affect the gut and we’re just learning a lot more.  I mean, you really. Really didn’t hear a lot about gut microbiome like 10 years ago, you know, compared to today. Like there’s so much research if you just go on PubMed, it’s just amazing how much [00:20:00] research, and now they’re really, I mean, even I guess 10 years ago, I mean, I went through the, my, the Institute of Functional Medicine training.  I mean, I started that in 2014. And even back then, they were talking about the gut. But again, it’s just exploded compared to then. And so a lot of these chemicals affect the gut. The foods which relate to like the, again, a lot of chemicals in the food, the glyphosate, you know, and the pesticide. Other like, pesticides and just you know, and then of course a lot of controversy with the gluten.  And then there’s talks about molecular mimicry when it comes to

Dr. Weitz: yeah, that was the main mechanism that we currently understand as the reason why the immune system now starts attacking yourself because. It recognizes yourself as foreign. Exactly. Like you said, it’s a, you, the antibodies say to a virus and then there’s protein structures in the body saying the thyroid gland [00:21:00] are somewhere else that are similar to what they what the antibodies are attacking.

Exactly.

Dr. Osansky: Yeah. But you know, again, I think. I mean, I think about infections like viruses bacteria. I mean, they’ve been around for a long time, at least things like Epstein Barr, you know, and h pylori, which have been associated with graves. But like I said, the toxins are something different.  Even the gluten now is like different compared to many years ago. So. So, yeah I think that’s the big difference, like the, yeah. The infections are definitely a factor. I mean, when during the pandemic we definitely had an influx of people who got COVID. Yeah, no, there’s no doubt

Dr. Weitz: that, you know, one of the things that C did is help reactivate other viruses like Epstein Barr and Dr. Vojdani has published a study showing that the COVID virus is one of the most autoimmune, reactive viruses we have ever had, or [00:22:00] perhaps the most. So unfortunately, this virus infection that affected the whole world is liable to lead to an increase in autoimmunity.

Dr. Osansky: Yeah. Yep.

Dr. Weitz: I agree. And definitely have seen that.  Yeah. So, among the possible triggers. One of the triggers for hypothyroid is I is iodine. And we saw when, so across the United States, there used to be high rates of a thyroid condition known as goer, where the thyroid would become enlarged. And that was because of a lack of iodine. So in order to address that, the United States and a lot of other countries started adding salt to the diet in the United States, we did it particularly with w we added not salt.  We added iodine to the diet. And in the United States, we did it by adding iodine to the salt. I salt. Yeah. And we still have iod eye salt. And what [00:23:00] happened is rates of goiter went way down, but rates of autoimmune thyroid went way up. And we see that excess iodine induces an inflammatory response in the thyroid which is critical for the development of thyroid autoantibodies.  Does this also play a role in hyperthyroid?

Dr. Osansky: It can. Yeah. It, I mean, I definitely have people that start working with me and that was supposedly the trigger, or at least like the straw that broke the camel’s back where, you know, that’s where it changed, where they started. Taking, let’s say high dose iodine supplements that they, that maybe they’ve read a book somewhere or watch ’em videos and heard that it’s actually good for beneficial for thyroid health because yeah, it’s their like 10, 15 years.  I forgot when Dr. David Brownstein came out with his book, you know, iodine, why you need It, why you Can’t live without it. Right. [00:24:00] But, you know, that was, I know it was before I, you know, I was diagnosed with Graves in 2008 and I’m pretty sure it was before then. I mean, I interviewed Bro Brownstein on, not the podcast, but on, just before I had a podcast, the blog, and that was, came out in 2010.  So anyway, so his book’s been out for a long time and prior to my Graves Disease diagnosis, they were encouraging not only people with Hashimoto’s, but with hyperthyroidism graves. To supplement with iodine or maybe do a urinary iodine test. And again, based on brownstein’s findings. 

Dr. Weitz:  And this is very high dosages of iodine.

Dr. Osansky: Exactly, yeah, exactly. Like, like 25, 50, not micrograms, but milligrams. Right. Of potassium iodide. And I’ll be honest, when I, you know, years ago when I was dealing with graves. I took, I, you know, again I just, ’cause that’s what they were teaching, you know, when going through like standard process seminars for example and you know, they’re well known and just like, and the, and it wasn’t just [00:25:00] the companies, but the people who were teaching were, you know, it wasn’t until, if you’re familiar with Dr.  Diz, Ian yeah. And he came out with his book in 2010 or 2011. And then, you know, he was more, more talking about the the problem, the iodine controversy. And up until then, not up until then, but, and it’s not like I was taking high-dose iodine for years, but I took it for a few months. Not 50 milligrams, but about 25 milligrams.  And honestly I did fine. Like, it is not like it was this was after dealing with graves, so it’s not like it triggered the graves and it didn’t seem to make things worse in my situation. I was doing a lot of other things too. But for a year, for probably like a couple of years. I was recommending iodine, like do to my patients also.

Like, just ’cause that’s what I was taught and that’s what I, sure. So, so let’s do an iodine loading test. Let’s and then most people would show up deficient with that. And so let’s put ’em on an iodine protocol. And then, you know, I realized, oh, you know, I did start realizing that some people didn’t [00:26:00] do well with iodine.  And sometimes it, it could be a potential trigger. And and again, it could be, not obvious until you look at the antibodies and you see the antibodies shooting up. But then there are some cases, I mean, I remember and thankfully this person wasn’t my patient. Not that it made me feel any better, but I remember a person emailing me and just like saying just like she randomly took iodine and it really like flared up her thyroid eye disease like symptoms and, you know, just, I would’ve felt really bad if it was my, like, if I recommended that to a patient right.  And they did it based on my recommendations. I still felt bad for this person. But, you know, yeah. I mean I’ve, I have seen people get worse. What? Iodine?

Dr. Weitz: Yeah. I have Hashimoto’s and my TSH was like. Around seven, and it went up to nine. So I thought, let me try this high do iodine, and I took the 12 and a half milligrams and it shot up to 25.  So I, yeah. So I’d get [00:27:00] off.

Dr. Osansky: And they’ll say, I mean, if you read like the Brownstein’s book and dive into, I guess, you know, their research, they’ll say that the increased TSH is common when you supplement iodine. But the, I think the big concern is, you know, a, like how is it affecting the autoimmune component?  ’cause that’s what Dr. Kian talks about. Not necessarily just the impact on the thyroid, but is it actually like you said, a trigger, like an autoimmune trigger. And then with hyperthyroidism, when you think about it, you know, like you need iodine to produce more thyroid hormone. Now if you take it in high doses, sometimes it could have the opposite effect.  It could have like a suppressive effect. But it could also, in some cases, exacerbate the hyperthyroidism, or in some cases where people were taking it and they weren’t hyper to begin with, and then they see me because they were, you know, that’s what they were doing. They were taking the high dose iodine and became hyper upon, you know, the high dose supplementation.

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Dr. Weitz:  So let’s get into your natural treatment. Should we start with DIA first? What do you wanna start with?

Dr. Osansky: Yeah, that’s fine. Let’s, yeah, let’s go. I mean, it’s, I always like starting with the foundation, so like diet, stress management, sleep.  So yeah, we definitely could start there.

Dr. Weitz: So what are the foundations of a good therapeutic diet for somebody with hyperthyroid?

Dr. Osansky: Yeah, great question. You know, so the hyperthyroid healing diet, it’s a little bit misleading because it, when someone looks at the title, it might, they might get the impression there’s like a single [00:30:00] diet for hyperthyroidism, but I actually talk about three different diets because there’s really not.  One diet for everyone. And I mean, one, one could argue there’s not just three diets either that’s in the book, but but so the first, so you’re familiar, I’m sure with autoimmune paleo, like autoimmune protocol. Yeah. And you know, so in my book I talk about, I have like level three, which is like a modified a IP diet level two, which is a modified paleo diet.  And then level one, which, I dunno if you’re familiar with Dr. Steven Gundry’s work, which the Plant Paradox, right? So it’s like, kind of like a modified plant paradox diet. Okay. And so, yeah. So if like for Graves. I do recommend either like a level two LE or a level three diet, like e If not, if someone finds an a IP diet too challenging because it is pretty restrictive, then I recommend just at the very least like a paleo diet while healing, it doesn’t mean like a permanent diet.  And just and the, [00:31:00] I mean, the purpose behind these diets is, you know, obviously with any diet you want to avoid. Refined foods and sugars you want to avoid fast food, but with a IP also. And then I mean, the common allergen like gluten, dairy with both paleo and a IP you avoid grains because they could be harsh on the gut.  Even like the none like even the gluten-free grains nightshades oar are excluded. It’s almost like an elimination diet. I mean, you could say, well, not there, there are health benefits and nightshades. Eggs are excluded. And there’s definitely, I mean, I eat eggs, like there’s health benefits to eggs, but just like even a lot of regular elimination diets will avoid, maybe not so much the nightshades, but eggs is considered like a common allergen.

So, so it’s really just avoiding common allergens as well as foods that could potentially affect the healing of the gut since you have that leaky gut component. And and then like I said, with any healthy diet, you’re gonna want to avoid [00:32:00] the refined foods, the sugars unhealthy oils and all that stuff.  But yeah, so I usually lead people more towards the level three or like a IP type diet. But again, if they’re not for those are graves. If they find it too restrictive, then like a paleo diet. But if someone’s a vegan vegetarian, they might find even a paleo diet to be really difficult to follow, especially if they’re vegan and they’re, I mean, with paleo it allows eggs, but if you’re vegan, you can’t even eat eggs.  So with level one or a modified plant paradox diet, that does allow, like pressure cooked legumes as like a source of protein and just it does allow some more flexibility.

Dr. Weitz: Do you purposely have patients consume goiterogenic foods like broccoli that some people feel inhibit thyroid production?

Dr. Osansky: I have in the past I didn’t find it to work. It’s like years ago I’ve had pregnant, like, ’cause women who are pregnant who see me, [00:33:00] usually if they’re looking to take a natural approach, they don’t wanna take the medication during pregnancy, which I don’t tell ’em not to take it, but if they refuse to take it, it’s not good to have unmanaged hyperthyroidism.  So, you know, years ago what I did is I intend, I had like pregnant women eat large amounts of cruciferous vegetables, like broccoli for example. Seeing if that would suppress thyroid hormone and I really didn’t see that. Yeah, I mean unfortunately ’cause it would be great just take the bro eat a lot of broccoli and kale and cabbage, brussel sprouts and don’t have to worry about taking the antithyroid medication.  But I just didn’t see it really being effective.

Dr. Weitz: So what are some of the other components of your integrative functional medicine approach to hyperthyroidism?

Dr. Osansky: Yeah. So, well, stress management. So again, diet and lifestyle. We spoke about diet. Stress. Stress. Okay. Stress, huge. Not just emotional stressors, but [00:34:00] physical stressors over training, which I was guilty of when I was prior to my grave disease diagnosis.  So, most people I work with, they have a chronic stress components. So yeah.

Dr. Weitz: How do you address that?

Dr. Osansky: Yeah. Well, I, like, first of all, I like to test for adrenals. And the reason I like to test for adrenals. Is what my story. I knew stress was a factor, but I was in denial that I was I thought I was doing a good job of handling it.  So I was like, yeah, I know stress is a factor, I just could handle it good. But then I did my adrenals and I saw that was my adrenals were shot, my cortisol was low. My DHEA was low secretary IGA was low. Pretty much everything was low. And that convinced me that, okay, now I see my adrenals are a mess and I need to improve it.  And then I could also retest, which I did a few months later to see them improvement. So I know not every practitioner likes doing adrenal testing, but I do like, either doing an adrenal [00:35:00] saliva test or like a Dutch test that also looks at the adrenals as well as the sex hormones. 

Dr. Weitz: And which company are you using for your adrenal testing most of the time? 

Dr. Osansky:  Usually I use diagnostics. Okay. I mean, if someone, if I’m working with someone internationally, I might use Genova their adrenal saliva test. Like if someone’s in the uk, they don’t have access to Right. Like diagnostics. So, I mean, but I mean there’s other ZRT is really good. I mean, there’s a lot of a number of good saliva tests.

Dr. Weitz:  What are some of your favorite go-to supplements for patients who have decreased adrenal function?  Like you said, your adrenals were in the toilet.

Dr. Osansky: Yeah. Licorice root which you gotta be careful if you have high blood pressure, licorice root might increase blood pressure. I do like, 

Dr. Weitz: and for this purpose, you don’t want to use deglycerized licorice. 

Dr. Osansky:  Exactly. Yeah. The DGL licorice is good for a gut mucosa for the gut lining, but yeah, you want to use just a regular licorice [00:36:00] root for low cortisol. So yeah. I’m glad you brought that up. And then, b vitamins b like a B complex typically, right? Sometimes an adrenal glandular for support as well.  And I mean, there’s some really good herbs. One, one thing you might find, I mean you pro probably already know, but if not, or your audience doesn’t know aswa Ganza, which is commonly used for adrenal function there’s some controversy with ashwaganda and hyperthyroidism because it could also.  Stimulate not only the HPA access, but the HPT access, the hypothalamic pituitary thyroid access. And in some people it cause mild hyperthyroidism. So people gotta be careful. I love ashwagandha and I’m not saying I never give it, but but if you take like a separate ashwagandha supplement that has like 500 milligrams of ganza, you’re at a greater risk of developing hyperthyroid.  Now the thing is with ashwagandha, like if you, we spoke about, because it

Dr. Weitz: stimulates so much thyroid production.

Dr. Osansky: Well, it’s, [00:37:00] yeah. I mean, it stimulates the HPT access, but. So, which yeah, like the hypothalamus pituitary, which communicates that a thyroid and Yes. So essentially you’re getting some ex extra production of thyroid hormone, but once you stop it, it does seem like it stops.  And I bring that up. ’cause with iodine, sometimes it doesn’t stop. Like someone will, might take like high dose iodine and it might induce hyperthyroidism and then, okay, I’m gonna stop the high dose iodine. But they the hyperthyroidism persists with, so it’s definitely not the same mechanism as that.  But then also astro is a member of the nitrate family. So if someone is following a IP right, they probably want to also avoid it if they’re trying to strictly avoid a IP. But I, yeah, so Ash so I usually don’t give Ashra ganza specifically, but but there are other herbs. Rhodiola is really a good herb.  For adrenal support. Romania, you don’t hear as much about that, but that’s also. A good herb. Holy basil. So, yeah, so those are some of the support I would [00:38:00] give for blood cortisol. Okay. And then we have gut health. Yep. So gut health, we spoke a little bit earlier about the problems with everything destructing, the gut microbiome.

So probably the number one thing is to try to avoid those factors. The, there’s that five, the five R protocol. So remove, replace, repair remove, replace, re inoculate, repair, rebalance. So that remove component, you wanna remove gluten, it can, since it could cause the leaky gut, right? We spoke about glyphosate, which I’m trying to minimize glyphosate since it, it can cause gut dysbiosis.  And, you know, if you have gut infections which again, a lot of controversy with h pylori, some don’t even consider it a gut infection. Some say, well, you know, HB is, you know, normal. Same thing with parasites. A lot of controversy with parasites. But you wanna, you want to remove the factor or factors that’s disrupting the gut.

And then, you know, Reno replace things like digestive enzymes. If someone has low stomach acid address that, [00:39:00] like whether it’s petain, HCL or bitter herbs re inoculate, prebiotics, probiotics, repair, drinking things like bone broth or cabbage juice if you’re a vegan, vegetarian. And then of course, L-glutamine, aloe vera, zinc, carine, things that could support the gut.  DGL licorice, which you mentioned earlier. And then and then the last are rebalance. So rebalance the adrenals, the nervous system, the parasympathetic nervous system. So in a nutshell it’s not as easy as it sounds, but but yeah, just the biggest thing is like there’s so many things that are disrupting the gut.  So we obviously wanna do things to help repair it, but we can’t repair it if we’re constantly being exposed to these factors.

Dr. Weitz:  So you mentioned toxins. How do we address toxins?

Dr. Osansky: Yeah, that’s a big challenge. I mean, in our homes is where we could do the most like once we step outside of our house, we can’t really.  Do too [00:40:00] much. But in our home, we could again, buy organic food. We could use natural cleaners and cosmetics. We could get a water purifier, we could get an air purifier. So really just, I would say try to do as much as you can in your own home. And then you could do things to support detoxification. Eating.  We mentioned cruciferous vegetables are actually good for supporting the detox pathways. Obviously staying hydrated as well. And then there’s time and place for supplementation. Things like n-acetylcysteine or liposomal glutathione even milk thistle and then sauna. I do so now sauna, I’ll say this, I do sauna like two or three times a week.  If you’re hyper, you wanna be careful because if you’re in the sauna, it’s gonna raise your heart rate. And so if you have unmanaged hyperthyroidism, especially like if you’re in the process of trying to get those thyroid hormone levels down and you have a heart rate of. A hundred beats per minute or higher.  You probably wanna not go in the [00:41:00] sauna. Yeah. So, but sauna is really good for detoxification. Supporting lymphatics as well. Just which even just exercise, like, just re which again, you wanna be careful, so, but why

Dr. Weitz: wouldn’t you want to go into sauna there? Sauna gonna relax you?

Dr. Osansky: I don’t know.  I mean, I don’t find I honestly can’t say I fi I maybe find the first 10 minutes relaxing, but then when I’m like, heat it up, you know, after like 25, 30 minutes, I’m ready to get out of the sauna. So, okay. So some people might relax, but again it’s because it’s heating, it’s increasing that heart rate too.  So that’s the main reason for that.

Dr. Weitz: So, let’s get into nutritional supplements and herbs that can help manage thyroid conditions like hyperthyroid. So, I’ve heard you talk a lot about Bugleweed, which is a natural antithyroid

Dr. Osansky: herb. Yes. So, bugleweed is, that’s what I took when I dealt with graves.  I mean, I would’ve considered the Antithyroid [00:42:00] medication if the Bugleweed didn’t work, but when I attended some functional endocrinology seminars prior to being diagnosed, that’s when I learned about Bugleweed as well as the mother wart, which is kind of like a natural beta blocker. So I took the bugleweed to help lower the thyroid hormones.  And yeah, in my case, it did a wonderful job. I’d say probably like 70, 75% of people that take it, it helps some people, it just doesn’t work. But there’s bugleweed, there’s mother War, like I said, which focuses more on the heart rate. The cardiovascular system, l-carnitine in higher doses helps to, that seems like it blocks the entry of thyroid hormone into the cell.  And just a recent study came out on L-Carnitine and Selenium combined. August 2025, a study came out showing that not even a lot of. Of each, like there, there’s earliest studies showing that you need two to four grams of l-carnitine to help to block the entry of [00:43:00] thyroid hormone to the cell. And a common dose of Selenium given by practitioners is like 200 micrograms.

’cause Selenium, there’s a lot of research showing that could help with lowering antibodies, by reducing oxidative stress. Right. But there’s a 2025 study showing that 500 milligrams of alcarnitine combined with 80, I think it’s 83 micrograms of selenium, helped to not only allow people with graves, it was specific for Graves disease.  They were able to take less antithyroid medication, but then also in addition to that, they it led to their thyroid hormone not, I’m sorry, the thyroid antibodies lowering quicker com compared to the control group. So the combination of L-carnitine and Selenium. Something to maybe consider also for a symptom manage from a symptom management’s perspective.

Dr. Weitz: It’s interesting ’cause I’ve always found Selenium to be really helpful for high both thyroid.

Dr. Osansky: Yeah. Well, well it’s for both. ’cause again, it’s it’s more [00:44:00] bo you have oxidative stress with both Hashimoto’s and Graves. So it does make sense that for really either of those conditions, it could be beneficial.

Right.

Dr. Weitz: And what is the specific dosage of bugleweed? I, one of the things I’ve noticed with a lot these herbal products is they don’t always list a specific dosage and there’s often a combination and they’ll say proprietary blend of bugleweed, mother ward, lemon balm, you know?

Dr. Osansky: Yeah, that’s a great question because there are formulas like thyroid calming formula from Herb Pharm that has the bugleweed, the mother ward, the lemon balm, and then it just says like, I forget the dosing.  It has some kind of cactus as well. Take a drop.

Dr. Weitz: Yeah. Is cactus beneficial?

Dr. Osansky: I don’t know. I haven’t learned, again, I don’t know why that’s in there because again, we know that the bugleweed, the benefits of Bugleweed mother war, and then we didn’t speak about lemon balm that has some mild antithyroid properties.  But [00:45:00] yeah, the cactus I’ve seen that’s I think specific to the thyroid calming formula from Herb Pharma. I think that’s the one that has it. There’s also, there’s, yeah, it’s

Dr. Weitz: Herb Farm.

Dr. Osansky: Yep. Yeah. ’cause there’s a few others that have a combination of the Bugleweed mother war lemon balm. But you’re right, a lot of times their proprietary blends and what I tell people is the bugleweed is the most important.  So if you’re trying to lower thyroid hormones, you probably wanna just take it separately. I mean, if someone’s taking a combo and they’re getting, and they’re doing it seems like it’s helping, I’m not gonna tell ’em to stop doing it. But if they’re not taking anything, I’ll say, just take we separately, you know, what the exact

Dr. Weitz: dosage of of Bugleweed is supposed to be.

Dr. Osansky: I, so it depends on the person and it depends on the extract. So, okay. I took Medi Herb Bugleweed, which is a one to two extract, and I took. A one teaspoon twice per day, which is five milliliters, twice per day. That’s a common dose. Okay. Some people will take, maybe some people only need maybe like half a teaspoon of that if someone’s taking [00:46:00] Herb Pharma, like Herb Pharma is a one to five extract, so it’s not as potent.  So they might need to take more than a tea. They might have to take like two or two and a half teaspoons multiple times per day. So really depends on the potency. But that’s what I took. Well, and that’s usually I recommend the midyear bugleweed. It’s I mean, there’s other ones, or Herb Farm actually is good quality.  I think it’s just the potency is lower. But that’s also an option too. I mean there’s as you can imagine, it’s not as popular as like Vitamin z Bugleweed, where, you know, if you go to a health food store, you might struggle to find Bugleweed. ‘Cause it’s, again, it’s really more

Dr. Weitz: How many people have hyperthyroid?  Do we know how many people in the population?

Dr. Osansky: Well, Hashimoto’s is like eight times more prevalent, I believe. And that’s, I think the known causes, right? There’s a lot of people who are misdiagnosed. And so, I think every year there’s around maybe a million new cases of hyperthyroidism, which might sound like a lot, but when you look at how big the [00:47:00] population is, it’s not a huge number.  Maybe like one, 1.2 million the last that I saw. Okay. Okay. But yeah, so it’s I mean, again, so there, I mean, definitely enough, enough to keep me busy, but compared to Hashimoto’s it’s yeah not nearly as common.

Dr. Weitz: Are there any other supplements that could be helpful?

Dr. Osansky: I mean vitamin Z, you know, we mentioned vi vitamin D for modulating immune system.  Yeah. And that, well, I mean, you also mentioned from a symptom management standpoint, I think we covered it. There’s also lithium orate you’re probably familiar. Lithium carbonate is a medication that right. Used for depression. Not as commonly these days, but they realize it makes people hypo.  Right. But yeah. And then there’s lithium orate, which you can get over the counter and that Yeah. 

Dr. Weitz:  Which is also referred to as like nutritional lithium, and mm-hmm. We use that a lot for mood disorders.

Dr. Osansky: Yeah. So it could help us certainly with that as well. 

Dr. Weitz:  It’s even been shown to help with brain function.

Okay. Oh, cool. Yeah. Decreased risk of dementia.

Dr. Osansky: [00:48:00] Yeah. No that’s awesome. Yeah. So, yeah. But yeah, like other supplements vitamin DI mean, omegas, if someone’s not eating fish. You know, they probably are deficient in Omega-3 fatty acids, so they probably need to take an omega. I mean, I usually recommend probiotics to help support the gut microbiome.

And then depends on the testing. I do like to do functional me. So we mentioned like adrenals, for example, right? If we do an adrenal saliva test or Dutch test and you know, if someone’s showing issues with the adrenals, we’ll give usually, I mean, of course we’re gonna say also block out time for stress management, which is arguably even more important than taking the supplements.

Make sure he get sufficient sleep and which could be a work in progress in itself. And then yeah, if we do a GI map or another comprehensive stool test and we see h pylori clearly positive, I’ll put some on an antimicrobial protocol for that. Right. So, so some of it depends on the testing.

There’s definitely a general recommendations. And then there’s what do we see with the testing that we do,

Dr. Weitz: especially when we’re [00:49:00] looking for the underlying triggers. Exactly. Yep. You got it. If you’re doing hormone testing, do you find other hormones are affected by hyperthyroid?

Dr. Osansky: Yeah, I mean, it is pretty common for hyperthyroidism to affect the other hormones.  And I mean, some women will even stop cycling, like when they’re dealing with hyperthyroidism graves sometimes. I mean, not, I won’t say most people, most women but it’s not uncommon where, you know, we’ll see someone with graves and or even sometimes a non autoimmune hyperthyroid condition and, you know, they’ll stop cycling for a few months until the thyroid hormones are under control.  So, yeah, it does affect the hormones and I mean. Yeah, just like if you look at a Dutch test, it also affects, you could see which makes sense. Like the Dutch test not only looks at hormones but metabolites. And one of the things they’ll look at is cortisol metabolites. And so you usually see elevated cortisol metabolites ’cause it’s like increasing the metabolism of [00:50:00] cortisol.  So, so yeah, there’s cer there’s definitely some patterns you’ll see meaning it’s getting processed quicker. Exactly, yes. And like with hypo it’s the opposite. So if you do a Dutch test and you’re have overtly low thyroid hormones usually see like low cortisol metabolism. So, so yeah. It’s interesting.

Dr. Weitz: Another medication I’ve heard you mention is low dose naltrexone. Yep. LDN. Yep. LDN. What do you think about that?

Dr. Osansky: I mean, I’m okay with it. It’s you know, I can’t say I love it or I hate it. It’s just another tool. Like it’s so l low dose naltrexone modulates the immune system and it’s kind of hit or miss.  It doesn’t always work. And it could take time for it to work. They usually start out with a lower dose and then gradually increase it. I mean, if it works I mean the benefit is that it’s actually focusing on the immune system and we mentioned numerous times, graves is autoimmune. Same thing with Hashimoto.  So, [00:51:00] it’s it’s not just focusing on the thyroid. The downside is just like everything else, like the medication and other things. We, some of the other things we discussed, it’s not just in a cause that a problem. So if someone’s on LDN, it might actually normalize the thyroid antibodies, which sounds great, but if you’re trying to address the cost of the problem.

You might not know if what you’re, if other things you’re doing are working. ’cause you’re taking the LDN. So it’s kind of like with the methimazole, the antithyroid medication, it’s lowering the thyroid hormones, but it’s not normalizing the antibodies. So at least if someone’s on Methimazole, you could still look at that TSI and if they have other antibodies.

But if it’s on the L, if they’re on the LDN, then the antibodies are normal. You don’t know, is it due to the LDN or is it due to some of the other things that you’re doing? And yeah, so that’s where it could get challenging. Right. Great.

Dr. Weitz: So I think those are the questions that I had prepared.  Anything else you want to tell our listeners and viewers about, [00:52:00]

Dr. Osansky: I mean, you cover, you know, we, you asked a lot of good questions. We covered a lot. I mean, just I mean, the biggest thing is. There’s a few big things. I mean, you wanna be safe with managing the symptoms

Dr. Weitz: while, so you have a lot of patients are having seen an endocrinologist who’s telling them that maybe they need to go on medication or they need to, you know, have some of these other treatments.  It must be tricky managing some of these patients who are worried, do I need to do radioactive iodine? Do I need to get surgery?

Dr. Osansky: Yeah, I mean, definitely they’re, I mean, it’s it is challenging because there endocrinologists have this strong belief that they need this and could be very convincing.  And can make it very scary for the patients. And it is, and it could be scary. I mean, you hear things like thyroid storm, which does happen, where you know it’s a medical emergency and most people have a thyroid storm. They do. Okay. But still, [00:53:00] you know, is it possible that, I mean, people can die. I mean, bad things can happen, but that’s why.

I was saying you want to be safe, that’s the number one thing is being safe. And if it means taking the antithyroid medication, so be it again, like I’m not opposed to the medication. There’s a time and place for that. Again, if someone’s not taking it and they’re trying the herbs or they’re trying the natural agents like l-carnitine and if that’s helping grape, but if not and he needs to take the medication while addressing the cause, that’s fine.

So my goal is not to fight with the endocrinologist. Obviously we have different goals. Their goal is just to, you know, give the meds I mean on a con on the conservative side, give anep our medication for a year and a half, two years and pray that the person goes into remission, which is usually temporary ’cause they never did anything to address the cause of the problem.

On the aggressive side or radioactive I on thyroid surgery, you know, on, on my, you know, so when they work with an endocrinologist, it’s not, I wouldn’t say it’s real. I mean, sometimes it’s challenging because they’re anxious and they’re [00:54:00] scared initially. But most people who are working with me, they’ve read my books, at least one of my books, they’re familiar with my podcast.

So they kind of, it makes sense that, hey, this is more of a thyroid condition. Why? I mean, more of an immune system condition. So why am I going to remove my thyroid or, you know, nuke my thyroid? You know, it makes sense. Yeah. Let’s focus on the immune system. And like I said, you could always get radioactive iodine.

You could always get thyroid surgery, but if so many people over the years have expressed regret because they jumped into it and they didn’t even know that there was a possibility. Right.

Dr. Weitz: Once you remove your thyroid, there’s no possibility of doing anything else. No natural treatment or anything else.  So, and what you’re saying is, try a natural approach. If you’re so inclined, if you’re on a medication, you can still try the natural approach to get to some of the underlying root causes and get the condition under control. And if that’s the case, then over time you may be [00:55:00] able to wean yourself off with the help of your endocrinologist from the medication and like yourself, continue to lead a healthy life without taking medication, without having surgery or radiation.  Just by paying attention to diet and lifestyle and all the natural things that help balance out our bodies and our physiology and our immune system.

Dr. Osansky: Yeah, I could have said it better. So, yeah. And not

Dr. Weitz: only do you overcome your hyperthyroid or manage your hyperthyroid, how do you like to look at it?  Do you feel like you’ve overcome hyperthyroid or you feel like you’re managing it?

Dr. Osansky: Oh, no, I definitely overcame it. And I don’t like to use the word cure because there are genetics involved, but to me, managing would be like, if I was still taking bugleweed, which I haven’t taken since 2009, right? So if I was taking that to keep my hyperthyroid in checked, then to me that’s managing it.  But once you’re not relying on any medication or supplements Right. To keep the thyroid hormones in [00:56:00] check, to me it’s reverse. The goal is really to reverse the autoimmune component and to reverse the hundred thyroid. So

Dr. Weitz: What is your, what kind of TSH do you typically run? Say? Typically like,

Dr. Osansky: 1.1, 1.2.

Okay. Yeah. So on the lower end, but not hyperthyroid. Correct. Yeah. And yeah, I mean, if someone’s TSH is like 0.9 or 0.8, I mean, again, I like to see it above one, but if that everybody’s normal is different, just like, you know, I like to see it between one and 1.5. If someone’s like 1.7 and that’s where it is, like all the time, like 1.7, 1.8, but it’s not getting higher, not getting lower, and they’re not on anything, I mean, I’m not gonna try to force it and say, oh, we need to get it within that, you know, one to 1.5.

So yeah mine runs like lower, like above one typically, but on the lower side. And yeah, that mean if it was a little bit lower, I wouldn’t get too, you know, if it kept on decreasing. Now that’s not, [00:57:00] that’s a problem, right? But but that’s why also monitor it at least once a year. If not multiple times per year.

And that includes the antibodies, because the antibodies will typically change before the thyroid. So, you know, that’s the backward, backwards thinking of most medical doctors. They just look at TSH and then if that’s at range, then they’ll start looking at other things and including maybe the antibodies.

But some talk about predictive antibody testing, which would be great to look at antibodies first. Since, again, especially Hashimotos, you could have elevated TPO and ortho globulin antibodies for like 5, 10, 15 years and have a normal TSH or at least normal within the lab range. It might be higher than optimal, but Right.  The doctors are still ignoring it.

Dr. Weitz: Right. And this is where functional medicine can really potentially shine in preventing a lot of these conditions by picking out some of these patients who have these [00:58:00] autoimmune conditions. And it’s sort of like an iceberg under the water. And we don’t really need to wait until it rises way above to try to take corrective action and bring some balance to our system.  Yeah. But we have to be able to recognize it. Agreed. Yeah. A hundred percent agree. So, I mean, great. So how can listeners and practitioner and listeners and viewers find out about getting in contact with you and getting your books?

Dr. Osansky: Yeah. Thank you. Thanks Dr. Ben. So, save my thyroid.com is my, I have actually a few websites.  I came out, natural endocrine solutions.com. Is my original website from 2010, and then when I came out with the Save My Thyroid podcast which of course you’ve been on a couple of times now. And save my thyroid.com save My Thyroid, came out in. 2021, the podcast. Yeah. Two 2021. And so I’m like, you know, save my thyroid.com is a lot easier to remember than [00:59:00] natural endocrine solutions.com.  So I still have, both websites are pretty active, but save my thyroid.com is where we could find like the podcast episodes, natural endocrine solutions.com. More love the blog post and articles that I’ve written in the past and on my books. You could find all three on Amazon. That’s probably the easiest way.  Just search Eric Osansky. If you search hyperthyroidism, you’d probably find the two since there’s not a lot of books on hyperthyroidism. And and yeah, those, I mean. Work with dr eric.com if you wanna if anybody’s interested in working with me. But I guess those are the main oh, actually one other thing I just came out with too that I’ll plug here.  I have a healing Graves naturally school group, school community. I dunno if you’ve been with school, the platform school. SKOL? No it’s out off of Facebook. It’s, yeah, right now we have about 330 something people. Huh. In there. And it’s pretty engaged. I mean, yeah. Like, just hyper. 

Dr. Weitz:  Is this like a group on Facebook or [01:00:00] what is it?

Dr. Osansky: It’s not, it’s off ofs kind like similar to a Facebook group, but it’s not also, it’s not part of Facebook, but it’s not on Facebook. It’s off of Facebook. So you don’t have to deal with, you know, the rules of Facebook and Right. And again, it’s smaller. I do have a few, like, I have a hyperthyroid group on Facebook that’s 25,000 people, which is really, you know, I kid around, I say it’s great for my ego, but it’s really too big.  Like where, you know, like, you know how Facebook works if you post something, only a small percentage of those people are going to see it in the first place. But yeah school school is cool. So, save my thyroid.com/heal Graves disease. And and that’s to join the free school group.  And yeah, so that’s, those are the best ways to to find me. 

Dr. Weitz:  Is that an educational thing? The school group?

Dr. Osansky: Yeah, I mean, it’s a few things. You actually, once you join there you, there is a training, the Graves Survival Roadmap Training. Okay. Where just I talk about you know, [01:01:00] my process and kind of a lot of things we spoke about here, but in greater detail.  So that’s a free training. So they do get education. Once a month there’s a free group call with my, one of my nutritional health coaches. We call it the Hyperthyroid Healing Diet calls. And then of course, there’s the community aspect, you know, I try to encourage engagement and so far we, we had a challenge, a Find Your Graves Disease Triggers Challenge not too long ago.  And that went really well. We had I mean that’s how I grew the school group. We had initially, like over 700 people join the challenge. Not all those people joined the school group. Only like 200 plus join the school group. But whenever I have future live events, it’ll be in that group, in that community.  So, so yeah, if you have graves or even a different type of hyperthyroidism, there are people in there with like toxic, multi nodule goiter, subclinical hyperthyroidism. And still it’s, but that’s what it focuses on is just hyperthyroidism. And so far it’s been going well. Great. [01:02:00] Excellent. Thank you so much, Eric.

Yeah.

Dr. Weitz: Thanks. Thanks Ben. Great chatting with you.

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

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Dr. Peter Bongiorno discusses Natural Solutions for Depression and Anxiety with Dr. Ben Weitz.  

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

Podcast Highlights

Dr. Peter Bongiorno is a Naturopathic Doctor and Acupuncturist and he is the co-director of InnerSource Natural Health and Acupuncture, with offices in New York City and on Long Island.  He also works with clients around the world via phone or Zoom.  Dr. Bongiorno did research at the National Institutes of Health in the department of Neuroimmunology and then went to Bastyr University to study naturopathic medicine and acupuncture.  He wrote a number of books, including Healing Depression in 2010 and Holistic Solutions for Anxiety and Depression in 2015, both targeted for physicians, as well as How Come They’re Happy and I’m Not, and Put Anxiety Behind You: The Complete Drug Free Program. His website is DrPeterBongiorno.com.

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

Podcast Transcript

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

Hello, Rational Wellness Podcasters. Today our topic is an integrative approach to depression and anxiety with Dr. Peter Bonjourno. Depression, according to the Mayo Clinic, is a mood disorder characterized by a persistent feeling of sadness and loss of interest.  In 2025, 18% of adults in the US report currently being depressed. While 28.5% of US adults have been diagnosed with depression sometime in their life, anxiety is characterized by feelings of worry, nervousness, or fear that are strong enough to interfere with one’s daily activities. Anxiety is even more common than depress.  With 19.1% of US adults having experienced an anxiety disorder in the last year and 31.1%, having experienced an anxiety disorder sometime in their lives.

Dr. Peter Bongiorno is a naturopathic doctor and acupuncturist worked. He did research at the National Institutes of Health. He went to Bastyr University to study naturopathic medicine and acupuncture.  He wrote a number of books including Healing Depression, Holistic Solutions for Anxiety and Depression, which I have right here. And [00:02:00] this is one of the best books ever written on a topic and a

Dr. Bongiorno:  Oh, thank you.

Dr. Weitz:  Great reference. I use it all the time. As well as how come they’re happy and I’m not.  And also put anxiety behind you, the Complete Drug-free program. So welcome Peter. Thank you. So great to be back here with you, Ben. Absolutely. So it’s often stated by the mental health and medical community that mood disorders like anxiety and depression are not curable, but can be managed with medications and talk therapy.  Can you state the case, why this is not the case for all patients, and why an integrative/functional medicine/naturopathic approach can be important for helping such patients?

Dr. Bongiorno: Yeah. Yeah. Well, to say something’s not curable is you know, it’s an interesting phrase and in a way I’m not sure [00:03:00] exactly what that means or not, doesn’t mean Right.  You know, when I think about somebody’s symptoms it’s the body speaking to us. You know, in some fashion to tell us something that something’s out of alignment, out of balance here, and something that we’re outta balance with the environment around us, you know? So, and in most cases, something can be done about it, you know, it takes a second and there’s things they have to do to figure it out, but typically something can be done about it.  And so in the case of mood, anxiety, depression focus issues, those are the top three, right? People typically have you know, it’s the body telling us something. And I know when we go to a conventional doctor, typically they’ll look at you and say, okay, you know, maybe we’ll try an SSRI which is a drug to increase serotonin or maybe we’ll try a drug that increases dopamine or a drug that increases gaba, which is one of the [00:04:00] calming neurotransmitters.

And sometimes that works. And you know, and truthfully, if somebody you know, and if there’s anyone listening who wants to hurt themselves or isn’t in a safe situation, then of course, you know, go to the psychiatrist go get help. Sometimes drugs can be lifesaving in urgent care situation, so I’m not against the drugs.  But you know, when you look at the research, it’s very clear that most prescriptions. Are used in these mild to moderate cases and the underlying issues aren’t really looked at. And that’s where I think, you know, naturopathic medicine, functional medicine, holistic care, integrative care really shines because we look at the underlying issues to try to say, okay, even if the drug worked.  In this urgent care situation, serotonin came up and people didn’t, don’t want to hurt themselves anymore, which is a beautiful thing. Now we have to ask, okay, well why was serotonin [00:05:00] low? You know, why was the body lowering it so that they would feel this way? And what else can we do to support the body to do that?

Dr. Weitz: Right? And I, I think when they talk about curable we’re thinking about. Another, we’re thinking about a condition that has a possible cause, like you’re sneezing or coughing or blowing your nose and you have a sinus infection and it’s caused by a germ and you can possibly, your, either your body can do it or you can take something that can make that germ go away, and then you’ll no longer have those symptoms.  And I think that’s what we mean by curable. Not that you won’t have another episode sometime in the future, but at least for a period of time you’re not simply managing the condition. Right, right. By taking a medication that now you would expect to take the rest of your life.

Dr. Bongiorno: Yeah, no, that [00:06:00] makes sense.  And I think, you know, when it comes to mood and the word cure, you know, once we understand what the underlying issues are that we’re dealing with and we work on them, then I think a person doesn’t have to suffer with those symptoms.

Dr. Weitz: Right. So what you’re saying is essentially is there’s a physiological imbalance that potentially can be corrected that.  Will actually help the person to feel better and yeah. Not possibly not need medication anymore.

Dr. Bongiorno: Yes. And what I’ve even learned in my own life and what I’ve seen with other patients is when things come back, it’s not because you’re not cured, it’s because your body’s saying, Hey, there’s something.  Outta balance now, and now I’m telling you again. Right. You know, and maybe it’s the same issues from before that we need to readdress. Maybe it’s other issues that are new because the body has shifted a little bit. Right. You know, what I’ve learned is we, you know, with patients over the last [00:07:00] 23 years that I’ve been in practice.  I’ve learned that people’s bodies tell them something and for everybody it’s different. For some people it’s, it’ll come out as anxiety. Some people it’ll come out as constipation. Some people it’ll come out as palpitations. Some people it’ll come out as pain. Everyone, we’re all different.  Genetically and what we’re predisposed to. And, but the bo but one thing we’re all similar is the body talks. And if we’re listening, you know, it’ll tell us things.

Dr. Weitz:  And you mentioned the use of medications that modulate neurotransmitters. And we have this neurotransmitter imbalance theory.  What causes depression and anxiety, and it’s generally thought that if you have depression, it’s ’cause you have low serotonin. And we simply need to help raise the level of serotonin by, for example, using a selective serotonin reuptake inhibitor like Prozac, for example. And that will increase the serotonin levels and then you no longer have depression. But as you pointed out. Sometimes another neurotransmitter drug could be effective and there’s even a drug that reduces serotonin levels that seems to be equally effective. That’s right.

Dr. Bongiorno: That’s very true.

Dr. Weitz:  At this point we probably should conclude that trying to diagnose the cause of depression and these other mood disorders.  By just seeing it as one simple neurotransmitter being low or high. I think I is not gonna, is not an accurate way to understand it. I think the balance of these chemicals is very complex and at this point I don’t think we really have a clue what we’re doing.

Dr. Bongiorno: Yeah. I, you know, it’s interesting if you the research is pretty [00:09:00] clear about when somebody has depression.  You know, the drugs work about 25 to 35% of the time, which is a little better than placebo. So it tells you, you know, if you take that at face value with no other factors that you’re thinking about, you know, maybe around 20, 30% of people who have depression do have low serotonin, and for them it works. And for 70, like you mentioned, there’s another drug.  A lot of people don’t know that there’s another drug, I think it’s called Stab Lon. Yes. That they’ve studied. And they actually lower serotonin and they’ve noticed it works about the same percentage, which just tells you, yeah, sometimes it’s high, sometimes it’s low. And in those patients you give them an SSRI and they actually will get more agitated and the mood gets worse.

So it’s and that tells you something. It says okay for them. It’s not a serotonin issue, it’s something else, you know? Right. So, you know, I find when most of my patients, when they come in, they’re already on medications [00:10:00] and if I hear a medication really helps. ’cause sometimes the patient will say, oh my gosh, I took Fluvoxamine for my obsessive compulsive disorder.

Boy, it was like a light came on, it really worked, you know? And then that tells us, okay, that is. An important neurotransmitter for this person. It helps them feel better. And now we wanna get to the underlying root. Like what is the reason their serotonin dropped? Is it gut issues? Is it inflammation? Is it nutrient deficiencies?  Is it hormonal imbalances? You know, so, so that gives us a chance to start looking into all those things. So for those of you who are out there who are on medications and you think they’re working or working partially, you know, I’m not saying stop them and they’re evil or something. You know, I’m glad they’re helping, but here’s the opportunity now to really do some testing, to really talk about it and to really say, okay, where did this change happen in my body?  Now what can I do to really work on it?

Dr. Weitz: Right. So [00:11:00] how do you approach a patient who comes to see you with depression or anxiety? What are the first things you ask them?

Dr. Bongiorno: Yeah. Well, it’s a, it’s a. You know, my first question, believe it or not, is for most of my patients is if if I could wave a magic wand and just make something better or more balanced, you know, you know, I’m thinking magic wand.  I like, that’s probably what a lot of conventional doctors will worry about, that they go see a naturopath and there’s an actual wand, you know. Anyway you know, so if I could wave a magic wand and make things better or more balanced, what are the things, the thing or the things in priority that you would like to see?  Just get better, you know, because when I hear about depression or anxiety, it’s a diagnosis, right? There’s a code for it and it helps it get through insurance coverage and all that, but it doesn’t explain much. So what I’m interested in is, you know, when the rubber hits the road, [00:12:00] like what the person that I’m working with, who’s in front of me, or I’m talking through, you know, virtually, what are they really suffering with?  What’s really bothering them? That needs to be traversed. So, ’cause that usually gives a good clue on how to start helping. And then after that, you know, we go through the whole history of what, you know, what this person has lived through. And then I like to talk about a person’s schedule.

You know, like what do they have to do during the day? What’s their work life like? Do they love their work? Go through a whole review of systems to talk about any other medical issues, what’s going on with skin and digestion and you know, everything, if they’re taking any other medications, any other supplements.  I really like to hear it all. What are they eating throughout the day? Are they exercising? If not, what are the challenges to that? Because it’s not just a question of me saying, oh, okay, well you have to eat better and go to bed earlier and drink water and, you know, those are all fine, [00:13:00] but in reality, is that gonna be even realistic for this particular person?  You know? So, you know, you mentioned before as part of the definition of depression, you know, something about like not being motivated to go and do the things you know that people want to do in Chinese medicine. They look at it from a heart perspective and they look at it from a liver perspective.

In Chinese medicine for depression, when it’s a liver issue you know what you wanna do in life, but it is hard to motivate to go out and do it. And when it’s a heart issue in Chinese medicine. So again, for those listening, it’s not that there’s something physically wrong with your liver or your heart, but energetically, right?  And this is thousands of years old way of looking at mood when it’s a heart issue or a she issue, then the person. Just doesn’t typically have hope and doesn’t even wanna do anything. So there’s the people who, yeah, you know, if I [00:14:00] felt better, I would go back to school and I would learn, you know, I would learn this and, but I just can’t get myself outta bed.  And then there’s the people who go, oh, it doesn’t matter. It’s nothing I want to do. You know? So, and you know, and it helps from a Chinese medicine standpoint to differentiate because there’s even herbs and mechanism things that you can look into, you know, depending on. That way of kind of deciphering the mood issue.

Dr. Weitz:  Right? So part of what you’re saying there is that there’s not one depression. You have patients, people who are depressed, but one person’s depression is different once they start to describe exactly what it means for them than somebody else’s. Even though we give them all the same diagnosis.

Dr. Bongiorno: Right.  Right. And you know, if you look at my book, unless I kind of messed up, I really do my best not to write the depressed patient. I’ll write the patient with depression, right? Because a lot of people, you know, [00:15:00] get diagnosed and their psychiatrists will say, well, you’re a depressed patient now. And then you take that on and then that becomes who you are because, you know, it’s like, oh no, this is me.  I’m not gonna deny it. And what I like to do is also differentiate. ’cause you know, words are powerful and it’s like you are a patient with depression and that can change. You could be a person with good mood. Right. So it’s

Dr. Weitz: Yeah, I think that’s unfortunately one of the problems with the way medicine is practiced in the United States, where we focus on this diagnosis, and I think part of it’s done for insurance purposes and things like that, but I have noticed as a sports chiropractor and functional medicine practitioner that over the years that patients will get a diagnosis and they’ll walk in the office. Basically with the science saying, I have fibromyalgia, right? Do you know how to treat fibromyalgia? That’s me. You know? Right. And you’re [00:16:00] right.  When they own that diagnosis it’s not really a healthy attitude to have and Right. And it’s an understandable one,

Dr. Bongiorno: you know, ’cause you’re suffering and somebody you’re suffering. If you want to, you what you have and you say, okay, this is it. Right. But it does suggest, I think, a deficiency in how the conventional care system looks at it.  And again, you know, I bless the conventional care system, you know, for acute issues. For emergency issues. Absolutely. You get an accidently, you get a heart attack, you know, God bless ’em, they’re there and they save lives every day. But for things like this, unfortunately, sometimes it can kind of keep the dysfunction going.  Right? And that’s why you exist and that’s why I exist ’cause Right. We’re offering another perspective to really sit down and look at that. Right. So what role does diet play in mood disorders? Yeah, so, so diet is, you know, I remember when I was in in school, this is probably 26, 27 years ago, we had a, [00:17:00] one of the founders of BAS University in Seattle was a very famous well-known doctor named Dr. Bill Mitchell. He was a naturopath. I don’t know if he knew bill Mitchell. I don’t think I ever met him. No. He was a wonderful man. In fact, his plant medicine book is still out there and I think it’s phenomenal. Anyway. And so he was very much about biochemistry and understanding how things worked.

And, but I remember when he taught one of his first classes, he taught us we took, you know, at least a year of nutrition, I think it was a year or more. And he taught us, you know, he said that when you eat a carrot, it’s not a carrot, it’s information. It’s information that, that is related by, you know, the phytonutrients, the chemicals in the, in this carrot.  Right. And it goes all the way into the cellular level, and then it goes to your genes and it talks to your genes and it tells your genes. It turn things on and turn things off and, right. And that was the first time I ever thought of food that way, you know, because it’s like, wow. Yeah, you eat it, it [00:18:00] burn, you burn fuel and this way you live.  Right, right. But it’s so much more, it’s really. Information that our body takes in.

Dr. Weitz: Yeah, I got that same message from Jeffrey Bland from going to his seminars for so many years.

Dr. Bongiorno: Yeah, exactly. Well, you know, Jeff Bland, Bill Mitchell, one of my other teachers, Joe Pizzorno, they all kind of hung out together.  Yeah. And help coin the phrase, you know, functional medicine. Jeff Bland came up with the phrase, but it was through that experience with Bill Mitchell and Joe Pno. So those guys, you know, so Joe and Bill went and founded Naturopathic medicine. Jeff Bland went, founded Functional Medicine more, you know?  Yep. Yeah, it’s, yeah. So it all comes from that same beautiful spirit. I love Jeff Bland’s work.

Dr. Weitz: So what foods should patients who have. Mood disorders focus on eating and what food should they avoid? Yeah.

Dr. Bongiorno: So, without knowing a patient, ’cause everybody’s different. So, and you know, we’re talking to a lot of people here and of course I don’t know them.  If I had to pick one [00:19:00] diet, I would probably start with some version of the Mediterranean diet. There’s a group, a team out of Spain called Sanchez and Vega’s team, and they did a lot of work start starting in the early aughts, you know, the early two thousands when they started looking at the Mediterranean diet.  They looked at it in terms of inflammation in the body, in terms of anxiety and depression and what they showed repeatedly study after study and then this has been verified by other groups, is that a good Mediterranean diet can both help prevent and treat anxiety and depression. It does so through a number of mechanisms.

Some of the mechanisms are just the quality of the food nutrients are very good co-factors to help you make neurotransmitters. Part of it is because it helps the good bacteria in your gut stay healthy. And when that gut bacteria is healthy, it sends signals through the vagus nerve, [00:20:00] cranial nerve 10 from the gut to the brain to tell the brain to stay in balance and to have the neurotransmitter stay in balance.  And then it also is very important. For inflammation in blood vessels. And it’s been shown that anxiety, depression, mental health issues oftentimes has a pretty strong inflammatory component. So there’s at least three mechanisms there that the Mediterranean Diet addresses them all.

Dr. Weitz: So very powerful.  So what do you see the ME Mediterranean diet as focused on?

Dr. Bongiorno: So, that’s a great question. ’cause there are different versions, right. And I would say for me,

Dr. Weitz: That’s why I phrased the question like that.

Dr. Bongiorno: Yeah. So the first thing I think of is water. Making sure people are drinking enough water.  You know, when we don’t drink enough water, tryptophan doesn’t get into the brain at the same rate it should to get converted into serotonin. So water and hydration, you know, the brain is made of fat and water. If we’re not [00:21:00] drinking enough water, we’re not hydrated. It’s very hard for the body mental processes to work properly, right?  So, so even before the diet, I think about water. And then when I think about the diet, I just think about really good quality. Fruits and vegetables, especially green vegetables. You know, I know when I go to Sicily, you know, visit a family in Sicily that, you know, there’s a lot of green vegetables and it’s all fresh, you know?

Yeah. And there’s fruits, there’s vegetables, a lot of olive oil, like really good quality stuff. Right. So I think that’s the centerpiece of it. And then there’s a fair amount of fish. Sometimes there’s meat, but usually the meats are, you know, grass fed, organic a little bit of dairy, not too much dairy.

Yogurts can be a part of it. You know, yogurts can be very healthy and a lot less inflammatory than the other dairy foods. Raw nuts and seeds are a big part of it. So, all of those beans, of course beans are an important part of it too. And so it’s just a nice [00:22:00] mix of all those, you know, and when you eat food that way, you have nice bowel movements every day.

And, you know, bowel movements are really important because your liver is always putting out excess hormones, excess cholesterol, and what is it? Dump it, it dumps it into the intestines. And then if there’s enough fiber in the intestines, it pulls it out and you get rid of it, you poop it out. And so in that, and that’s how keeps the body in balance.  So you’re getting all the nutrients in, you’re getting rid of what you don’t need. And that, that makes the body healthier. And and the body rewards us with good mood, you know, because we forget wine is

Dr. Weitz: often part of the Mediterranean diet. Is that good or bad for mood?

Dr. Bongiorno: Yeah. So, you know, so especially lately, alcohol’s been.  You know, more talked about, and I’m glad it’s being talked about. ’cause I think for many years it was only considered kind of healthy. Right? Especially for the cardiovascular, right? Yeah. It was like his one,

Dr. Weitz: like one glass a day was Yeah. Good for the heart. And it was the whole French paradox. And

Dr. Bongiorno: That’s right.  And [00:23:00] I’ll tell you, I mean, it’s interesting because, you know, my mom, you know, my mom, I remember my mom and dad. My, my dad’s 91, my mom’s like 87, and they had some. Some kind of drink almost every day, whether it’s a glass of wine or a little Manhattan before a meal and never drunk, of course. Just have a little bit and my mom’s HDL is good.  Cholesterol is probably the highest it’s ever been I’ve ever seen of anybody. It’s like in the hundreds. So I think there is something to that. But having said that you know, we do also know that alcohol in any amount can contribute to cancer. So I think if somebody, if a female is more prone to breast cancer, if a male is more prone to prostate cancer and the risk is high.

Then I think even that one drink a day can be more than is healthy for that particular person. Right? So, you know, so what I tell patients is, you know, like I used to tell my daughter’s 17 now when she was little, I used to say, you know, [00:24:00] it’s if you want to have candy. ’cause every kid loves candy, right?

It’s gotta be an occasional treat, not a regular everyday thing. Right. You know, so that’s, you know, that’s where I kind of land on, on alcohol in general. I think wine is probably healthier. I personally don’t get a good sleep with wine, so I tend to keep it out because I notice it affects my sleep. So that to me isn’t worth it.

But you know. But if, you know, if you have it every once in a while and it doesn’t seem to overtly hurt, then it’s probably okay. But I worry for people who have, who are predisposed more to certain cancer risks. So what about coffee? Well, coffee, I have some right here. And so, I am a fan. I definitely recommend organic coffee, low mold coffee, and if you.

If a person has anxiety and they’re having trouble sleeping, then maybe coffee isn’t the best choice. You know, if they have gut issues and their stomach [00:25:00] lining is thin and it bothers them and it gets irritated, so you have to know yourself. Like for me personally, I do really well with coffee. It lifts my spirits, you know, effect.

If you look at the research on coffee, people who who drink one to four cups of coffee a day actually do better. In terms of anxiety.  Okay. Yeah and I mean, I’m sorry, in terms of depression, right. But if they have like six or seven or eight, then it’s no good. That’s too many. So, so I think coffee has a lot of health benefits. I just recommend no, no milk, no sugar, you know, just try to learn to drink it.

Dr. Weitz: Probably not as good for anxiety though, right.

Dr. Bongiorno: Well, you know, it’s interesting. It depends on the person, right? You know, it really depends on the person, right? I would say for most people in while I’m working with them, I tell them not to have coffee if they have anxiety right. And then we bring it back in and see how they feel with it. There are, you know, I wrote a blog.  Once [00:26:00] it’s on psychology Today, and it talks about how for some people who have anxiety, there can even be benefits to caffeine to some people, right? 

Dr. Weitz:  Like some people get anxiety where they can’t get out of bed, they can’t get motivated to do anything, and maybe somebody with that.

Dr. Bongiorno: Yeah. And it

Dr. Weitz: can raise

Dr. Bongiorno: their dopamine, right?

And then things that they were kind of fearful of doing, they get more motivated to do and they can. So it’s, so there are a subset of people with anxiety who, you know, while most people don’t do well with caffeine, that group actually can improve. So it’s just depends, like everything else Depends on the person.  Yeah. Everybody’s different. It’s

Dr. Weitz: popular in a world of natural healing for mood disorders to talk about. A low carb ketogenic diet. What do you think about that? And yeah.

Dr. Bongiorno: Yeah. So that’s certainly something that’s been talked about for the past few years. Yeah. There’s a fellow named [00:27:00] Palmer who has a book called Metabolic Psychiatry.  Yes. Yeah, I think there’s a lot of validity to do where I’ve seen it in my practice do its best work. Are people who have especially high levels of certain neurotransmitters that get things like psychosis and schizophrenia and things like that. Right. I’ve seen it work for depression sometimes for anxiety as well, although I’m always careful because.  When you lower the carb level for a number of people, sometimes that actually lowers serotonin levels. So if serotonin is important for them, then you can actually see their mood get worse. So I always recommend. You know, if we’re going to do this, we wanna start slow and see how you feel. But I have seen fairly remarkable results using some version of a ketogenic diet for different types of mood issues.  Absolutely. Yeah. I

Dr. Weitz: think the thought is brain, the way the brain functions. If you can get the brain [00:28:00] drawing its energy from ketones versus sugar, then Right. Some of the data indicates the brain functions better.

Dr. Bongiorno: And you know, the first data about that was actually in people with epilepsy, right? Where they would use a ketogenic diet and they noticed when the ketone levels came up, some of the calming neurotransmitters came up with them.

Dr. Weitz: Right?

Dr. Bongiorno: And that seems to be that mechanism there. And now we’re just applying it to other brain issues than just epilepsy. And it makes a lot of sense.

Dr. Weitz: And of course following a low carb diet may be part of trying to balance the blood sugar and blood sugar problems can be an issue for, right.

Dr. Bongiorno: Yeah.  ’cause a lot of people, especially with depression, there’s a lot of issues that go on with cardiovascular disease at the same time. And you’re really working on both. You’re balancing insulin, you’re balancing blood sugar, cardiovascular disease, as well as the mood issues. A hundred percent. Yep.

Dr. Weitz: Yeah, because if you’re not getting good blood flow to the [00:29:00] brain, then yeah, it’s hard to have a good brain mood function.  

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Dr. Weitz:  So what are some of the most important labs to look at?

Dr. Bongiorno: Yeah. So again, everybody’s different, right? So, that’s why a good conversation before we run labs is very helpful, right? So you can visualize the recommendations for that patient.

I like to look at blood sugar, insulin sensitivity. You know, an [00:31:00] anything that has to do with anemia, like low hemoglobin, low red blood cells, low iron, high iron thyroid function inflammatory markers which include general ones like CRP and more specific ones like homocysteine, which looks more at the blood vessel inflammation.

And then of course things like other like histamine for example histamine I think is one of the one of the processes in the body that can really contribute to mood issues and is not very thought about often. I find that’s very helpful. Now it’s hard to test for

Dr. Weitz: histamine, correct?

Dr. Bongiorno: Yeah. Well, I’ll look at well first of all. When you listen to a patient’s story, right, you know, if they have seasonal allergies if they’re put on a lot of antihistamines for different kinds of symptoms, if they get kind of blotchy and red while you’re talking to them about important issues, right?

Or if they tell you they get hives and, you know, so there’s a few ways to [00:32:00] check even without a blood test or a urine test. But then blood work. If it shows a positive, you know, there’s histamine issues. If it’s negative you might not have caught it at that time. So it doesn’t mean it rules it out.

A urine, a 24 hour urine could be a little more accurate. So that could be helpful sometimes, but again, you have to catch it, right? So, right. So that’s where the intake really, the, you know, talking to the patient and really getting to know them is important too. And then I look at a lot of nutrients and vitamins.

Which are the most important nutrients you like to look at? Oh, all of them. I feel like the list I’ve, my list is like increased. I’ve gone over the years. You know, vitamin D, magnesium, zinc, copper, manganese all the B vitamins, fo you know, it’s Omega-3 iodines important. What’s that? Omega threes.

Omegas. Yes, absolutely. Look at omegas. So they. They all do different things and and they’re all important as to be in balance. [00:33:00] And then finally, depending on the our discussion, if I suspect it, then we look at other testing that looks at mycotoxins, that might look at mold and mycotoxins that look at heavy metal you know, toxicity.

So it just, it’s just gonna depend, you know, gut stool tests,

Dr. Weitz: right? Hor,

Dr. Bongiorno: you know, more involved urine hormonal tests to look at the hormones and melatonin and cortisol and adrenal function. Very important, I think for most cases of mood issues. You know, there’s so many tests we can’t run them all.

And, you know, it’s very expensive and sometimes just not practical. So that’s where, you know, again, like yourself, you know, I like to really get to know the patient well and then try to figure out based on my knowledge base, like, okay, you know, I’ve heard this before and these are the tests we should run first.

And then if they don’t yield the results we need, then maybe we’ll look into other things. Right. Yeah. How important is sleep? [00:34:00] Critical. You know, when you look at my books, it’s always the first chapter. Yes. Right. So that’s to me that says it all. Like if I put it at first, that means it’s the most important, at least in my mind.

And yeah, I mean, sleep is when people. Fix things in their body. It’s like when, that’s when things really heal while you’re sleeping. So if you’re not sleeping, you’re not gonna have healing. That’s when you detoxify. That’s when mitochondria make new mitochondria and better ones. That’s when the muscles get stronger.

That’s when the gut cleans things out. It’s you know, without sleep you can’t do all those things. Right. And it’s an epidemic out there. The lack of sleep, absolutely. Epidemic. So what are your

Dr. Weitz: favorite supplements

Dr. Bongiorno: for sleep? Well, you know, when you, when I do the right testing, sometimes we’ll look at to see like, for example, if cortisol levels are very high at night.

And if that’s the case, then I like using herbs like magnolia and amino acids, like fosit sine [00:35:00] theanine can be really helpful to help people to get into that early stage of pres sleep, what they call that alpha state right of sleep. Of course, melatonin. You know, if we can run tests. I like to look at melatonin levels before I start supplementing.

And then there’s, you know, there’s melatonin to help people fall asleep which is regular melatonin. And then there’s time release melatonin, which is better for people who have trouble staying asleep. So, I would say magnesium, of course. Classic. Good choice for sleep too. And then even before the supplements, just making sure the room is nice and dark and it’s cool and people have made their to-do list so they’re not thinking about a lot of things.

And you know, maybe looking into the psychology of why they might be up processing things and talking about that and trying to come up with solutions there. So there’s, yeah, depends.

Dr. Weitz: Right. So let’s go into nutritional supplements for depression and [00:36:00] anxiety. Which

Dr. Bongiorno: ones

Dr. Weitz: Are the first ones you’ll consider?

Dr. Bongiorno: Yeah, so I kind of put them into two camps, even though they kind of intermingle a little bit. There’s this, the supplements I think about to help. Stabilize mood and lower symptoms. And then there’s the ones that kind of work on the underlying issues, which is a much bigger, broader category of supplements.

Right? If you look at for depression, you know, the supplements that have been studied by meta-analysis. So meaning multiple studies, right? Or studies of multiple studies, which ones work at least as well as the SSRIs. So head to head, you take a vitamin, or I mean a supplement or you take the drug ones that work as well as the drugs.

There’s a short list that have actually been studied and I like to think about those. Now, remember what we said before, right? SSRIs work [00:37:00] 25 to 35% of the time, right? So they work but not much better than placebo, right? And I would probably put the supplements in the same camp. Right, right. The only better, the benefit of the supplement is that they’ve also been shown in these meta-analyses not to have side effects that the drugs have.

Right. So. So having said all that I like to think of things like St. John’s Wart, which is classic. But you gotta be a little careful with St. John’s wart. ’cause then it can affect the how other drugs are metabolized. So if people are taking blood pressure medications birth control you know, blood coagulant anticoagulant medications and what they call blood thinners.

You gotta be a little careful with St. John’s work.

Dr. Weitz: And also with patients who are taking SSRIs. And you already said that most of your patients are taking SSRIs.

Dr. Bongiorno: Many of them are you know, one, I think they should work with a skilled practitioner because I don’t think it’s a, it’s an absolute [00:38:00] contraindication.

I just think you have to know how to dose them and start slow. And oftentimes they can be part of the plan to get people off the SSRIs. So, yeah. So then there’s that, there’s Sam ES Adenyl Methionine, right. You know, is also been studied that way. And curcumin has been studied that way. As well.

So Sammy

Dr. Weitz: seems like one of the forgotten supplements.

Dr. Bongiorno: Yeah, absolutely. It’s

Dr. Weitz: not forgotten

Dr. Bongiorno: for me. I kind of think that it was really popular

Dr. Weitz: at one time and I hardly ever hear people talk about it

Dr. Bongiorno: anymore. Well, you know, it’s, I’m so glad you said that because I think that happens in our world. You know, things get popular, they come in and out.

Nobody talks about St. John’s Ward anymore, and it’s brilliant. Right. But I think the issue is. Many of us aren’t thinking about how they work, so they just think about the patient who has depression. Oh, they took this herb St. John’s. It didn’t work. So now I’m not thinking about it anymore. [00:39:00] If you really match it to the person the way an neurologist would, the way a good kind of you know, almost biochemist would, and you figure out, okay, is this the mechanism that they need?

Then you can really, you know, open somebody up with something like that.

Dr. Weitz: Really. But I think the other thing is a lot of times, as we just mentioned, the patient’s already on a medication and you’re worried about using St. John’s war. That might cause a problem with Right. Having too much serotonin. Yeah. I worry

Dr. Bongiorno: less about that because I’m, I’ve been doing this for so long and I understand how the mechanisms of the drugs and how the mechanisms of the supplements work.

Yeah. So I’m a little less concerned about it. Okay. Me personally, I, but I think for those of you listening, you absolutely wanna work with somebody who’s really well versed in these things and don’t try yourself. So will you

Dr. Weitz: sometimes use St. John’s work with a patient on medication?

Dr. Bongiorno: Yes. Yeah, I will.

[00:40:00] But it, it depends on the medication. It depends on other medications that they’re on. Right. You know, ’cause the first thing is make sure they’re safe. Right. So, but yeah, as long as those things line up and it seems right for them then that’s certainly something we’d bring in. Now do you

Dr. Weitz: find that.

A patient who’s getting, you know, a certain amount of benefit from an SSRI or another medication and then they add a St. John’s war, maybe they get a higher level of benefit. Exactly.

Dr. Bongiorno: Right. Is that, you know, it’s interesting. A couple years ago there were some studies that came out about St. John’s War and Plavix.

Right now, and it is generally known that if you’re a blood thinner, right? Yeah. It’s a blood thinner and a clopidogrel and the, and it’s generally known that if you’re on that medication you shouldn’t take St. John’s work ’cause it affects the same liver processing enzymes. Right. Right. So it’ll change how you break it down and people can end up more bleeding and of course that’s very dangerous now.

What the [00:41:00] study showed. Now this was done more controlled with the number of people who are heart patients who had Plavix, but the issue with the Plavix is they couldn’t get the dose high enough because it was giving them too many side effects and people were getting sick with other problems. Right? So what they did was they gave them some St.

John’s wart, and what they found was they got the Plavix to work at the level that was needed at a lower dose, right? So, so, you know, we always think about these things as having negative interactions. Right? Well, the way they can be negative, they can be very positive Right. And helpful. Right. If you know how to use them.

And that’s a perfect example. Exactly. So, so it’s not, it doesn’t mean things are contraindicated. Absolutely. It just means. You know, work with a doctor who knows how to use these things. So Right. This way you get the benefits and not the side effects. Right. And the inter and the negative interactions.

Dr. Weitz: What are some of your other favorite medications? I know Lithium has been getting a lot [00:42:00] of discussion recently.

Dr. Bongiorno: Lithium the nutritional lithium, the supplement. Yes.

Dr. Weitz: Yep.

Dr. Bongiorno: Yeah. So Nutritional lithium, yeah. Recently came out about, it’s, they think about it. Probably is gonna be helpful to prevent things like Alzheimer’s and that literature has been out since actually 2010.

That’s actually not new. But yeah, lithium is a very sup, you know, it’s the. I think people who are hearing about it for the first time should realize this is not lithium, the drug lithium, right. You know, the drug, lithium is a very high dose, very heavy handed. It’s rough on the thyroid, it’s rough on the kidneys.

And and you know, and it comes with another molecule on it that’s, you know, that’s very potent. So that’s the drug Lithium. And that drug is one of the few things proven to lower suicidal ideation. So, and you know, it has its purpose and sometimes it, again, it can be lifesaving, but this is lithium.

The supplement nutritional lithium, [00:43:00] right. Somewhere between five and 20 milligrams instead of the hundreds or maybe a thousand milligrams. Right.

Dr. Weitz: Maybe we should call it LDL. Low dose Lithium.

Dr. Bongiorno: Low dose lithium. Yeah. ’cause that’s what it is. And that’s a great idea. And and you know, and it’s been shown in those small doses, you know, the way in the early 19 hundreds, what they noticed was that the areas around the country where lithium was in the water.  Levels versus areas that had none. People were happier, lower rates of anxiety, virtually no rates of suicide. Crime rates were lower as well in these areas. So, so they started kind of piecing it together, like maybe it’s the lithium, right? And that’s how the interest in lithium started. And so for a lot of us, we don’t get lithium in the water.  With, you know, lithium isn’t in high concentration in too many foods and if people are prone to anxiety and depression and mood issues, it can be [00:44:00] very valuable. I’ve seen it with, in children be very useful. Sometimes I’ll use it with a little broad spectrum. C, b, D, it works really well together for things like impulsivity.

Excuse me. So it’s, I think when used properly, like everything it can really, very valuable to kind of calm that primitive brain and stop some of the signaling that’s going to the cortex, the thought part of the brain that’s making us anxious.

Dr. Weitz: Yeah. What about a few other of your favorite nutrients?  Oh gosh. I love, I know there’s so many. I know. Vitamin, I love Magnolia.

Dr. Bongiorno: Magnolia is a Japanese herb, which is very good to help lower cortisol. Right. I find it can be very helpful for people at night or during the day who have who have a lot of stress and the cortisol levels are very high.

Dr. Weitz: Yeah.

Dr. Bongiorno: Sometimes using that with Sal Serine is very good. I sure can. Ashwagandha again, another beautiful one. And ashwagandha’s nice because it, you know, if cortisol levels are high, [00:45:00] it can bring ’em down. If cortisol levels are low, it could bring them up. It’s good for the hormones too, ashwagandha. So I think about it more when people are having hormonal issues, like let’s say a man with low testosterone and high cortisol, like it’s perfect.

So yeah, ashwagandha is a beautiful herb. Yeah, I mentioned curcumin before. It’s got wonderful anti-inflammatory benefits. Magnesium is classic, you know, I think one that’s not talked about a lot is potassium. Okay. I think potassium is really important, especially when people have more.

Heart related issues and like palpitations and anxiety bringing, you know, and blood pressure issues bringing in potassium can be useful if, the only caveat to that is if people are on potassium sparing medications, they really need to talk to their doctor before adding more potassium ’cause that might not be okay with those drugs.

Dr. Weitz: Saffron is a nutrient that I’ve been hearing more about lately.

Dr. Bongiorno: Yeah, interestingly, so [00:46:00] Saffron I had been working for a number of years for a nutraceutical company about 10 years ago, and I actually formulated one of the first mood formulations with Saffron. Okay. I think it was the first one.  And ’cause I fell in love with Saffron probably like 12, 15 years ago. It’s such a beautiful herb, and it’s even been shown in patients who have both men and women who have sexual side effects from SSRIs to be useful not only for the mood, but for the sexual side effects, then the low libido.  Interesting. So, so yeah, Saffron’s great. Great for the gut. And tastes good in food too. That’s true. And it love Spanish. Right. Nice. Yeah. That color is so beautiful, right? Yeah. That beautiful orange fall. Orange color. Yeah, that’s true.

Dr. Weitz: What about the importance of people being on their phones and being on social media and its effect on depression and anxiety?

[00:47:00] Yeah, I know. I know. We could talk forever just about that topic alone.

Dr. Bongiorno: Gosh. Yeah. You know. I mean, it’s impossible to avoid it. Right? ’cause it’s part of our lives. Right. And there’s no way, I mean, we set this up through screens and Right, of course. And but the issue is some people it affects more than others.

And men and all of us, especially when we’re young, when we have these young brains, when we start getting on these things, it raises dopamine, you know, the lights, the quick moving thing raises dopamine, and then it makes us feel good in the moment. And then when we’re not doing it, we look for it again.

We go, oh, I gotta, you know, you, you know, as soon as if you look. At a public place and somebody’s not doing something, they go right to their phone because we’re kind of looking for the next hit. You know, it’s, it is a drug. Yeah. And for those of us who already have some kind of derangement or dysfunction with neurotransmitters, it’s gonna really feed that.

So, and I do worry about the young people [00:48:00] because their brains are so young and they’re being molded, that taking that drug so often so early is going to change their neurocircuitry and studies are showing that. Yeah. So, so we, you know, it’s very important that we, especially for the young ones that we cultivate.

Their interest in not using them and being outside. You know, one of the things I notice, nature’s very powerful. I notice when kids are at the beach Yeah. They tend not to use their phones and their iPads and things like, they actually play in the water and they still go in the sand. And that’s very gratifying to me to see that, like, even today’s day and age, like the beach is still more powerful than the, I don’t know, maybe it’s the grounding you get at the beach or something.

Dr. Weitz: Well, the power of nature. Yeah. Yeah. So, you know, we have, it’s just to be out in nature and Right. The ocean or being in the forest and, you know, the power of nature.

Dr. Bongiorno: Yeah. So, so the idea is not to say you can’t have this and never use it, but the idea is [00:49:00] to know yourself and know what the balance is for you, and make sure we, you get out and do the other things you need to do, be out in nature and under the sun and, you know, and and then, you know, use your phone as you need to use it too.

Right.

Dr. Weitz: Great. And any other topics that you wanna mention before we close out and then give us maybe a, something to think about?

Dr. Bongiorno: Yeah, I mean, something that I’ve been doing a lot more work in, and I mentioned it earlier, is the vagus nerve and vagal nerve tone. Okay. Like I said, it’s a cranial nerve 10, which is a.

Big nerve that connects the brain right, to not only the gut, but to also the lungs and the heart. And and when we’re really stressed out when our nutrient levels are low, when we don’t get enough sleep, it shuts down. Right? Right. And it shuts down because the body wants to stay in stress mode because it’s gotta fight a bear, you know?

Or run from the bear. Right. And that’s just very it. It raises inflammation in the body. It lowers our [00:50:00] mood. It creates more anxiety. Right. And, you know, and we’re really learning that, first of all. Vagal tone plays an important role in not only mental health. Like I, I just did a dis a talk in in actually in Hong Hong Kong, in Thailand, in Bangkok on okay.

Vagal nerve tone and PTSD, post-traumatic stress disorder. And that talk really really focused in on, on how patients are post-traumatic stress disorder. You know, less than one third of the treatments work for post-traumatic stress disorder. And that is very much is a vagal nerve tone issue.

And that there are ways in patients to measure vagal tone, like using heart rate looking how the pupils work, looking at how digestion works. So there’s a lot of different ways you can assess vagal tone. And then there are ways to actually work on it. You know, there are ways [00:51:00] using meditation, using yoga, using vocalization singing.

There’s ways using vagal nerve stimulation, either from the ear or from this area specifically. They even have studies. In PTSD patients now using what they call invasive vagal tone stimulation, where they actually implant something that goes directly to the nerve. Wow. I don’t think most people need that, honestly.

And that’s not my first preference. Right. I think there are plenty of other ways to do it. And it’s also been shown that when you get things like vitamin D and at the right levels and magnesium and you lower metal toxicity, that you can also support. How the vagal nerve works too. So there’s a lot of ways, a lot of holistic ways to get the gut right, to get the vagus nerve working to, you know, to detoxify, to get the vagus.

And so I kind of feel it’s a really important center point of why we do everything we do, you know? So very exciting

Dr. Weitz: And of course in the gut plays such a big role [00:52:00] in brain function. As you mentioned, the vagal nerve. We have the fact that in the gut, the majority of neurotransmitters are produced.

Dr. Bongiorno: Right, exactly. So it’s it’s a really, you know, good place. I mean, there’s so many ways you can look at mood, and I think that’s a good way to look. One of the important ways to look at how to help a patient is by supporting that system. Right. Great.

Dr. Weitz: Okay. Any other final thoughts and then give us your contact information?

Dr. Bongiorno: Yeah, no, I mean, I would say if anyone’s listening and you know, and you feel that you know, you’re just, whatever it is you’re working with and maybe suffering with you feel like, well, it’s just never gonna go away, just know. That there is always a way to figure things out. You know, there’s always someone who cares and is looking to help.

And it might not be one person, it might be a couple of people as a team, you know, and maybe you can’t do everything at once, but as long as, you know, you work [00:53:00] with people who are organized and you find that, you know, you connect with them in the way you need to be connected with, which is of course different for everybody that you can organize.

What needs to be organized and find the help you’re looking for. So just keep looking. Don’t give up. You know, the body is speaking and it’s trying, you know, it’s trying to talk to us so we can come up with the right solution. So just don’t give up on that. Great. How can patients get in contact with you?

Oh, sure. My phone number for those who still call on the phone, which I prefer is 9 2 9. 3 7 9 0 9 2 7. And my website is dr peter bonjourno.com, so that’s D as in David, R as in Richard, Peter Bonjourno. For those who are on Italian, it’s B-O-N-G-I-O-R-N o.com. That’s great, and thank you so much, Peter.

Oh my gosh, what a pleasure. And thank you for [00:54:00] everything you do and for spreading the good word and just being such a source of light for people. That’s great. I appreciate that.

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

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

Podcast Highlights

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

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

Podcast Transcript

Dr. Weitz:  Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, dr whites.com.

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

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

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

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

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

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

I’ll show you the outcome gave in a

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

They recruited and used the

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

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

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

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

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

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

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

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

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

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

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

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

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

It’s up to spa is on

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

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

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

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

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

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

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

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

Dr. Budoff: younger patients, right.

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

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

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

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

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

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

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

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

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

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

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

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

Yeah. I would just hope

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

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

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

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

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

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

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

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

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

Dr. Weitz: together.

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

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Craig Mullen discusses Root Cause Medicine with Dr. Ben Weitz.

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Podcast Highlights

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

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Podcast Transcript

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

Hello, Rational Wellness podcasters. Today we’ll be speaking with Craig Mullen about the root cause revolution, which essentially means a functional medicine approach to health. Craig Mullen is a nurse practitioner who’s the founder of Remedy Functional Health Solutions.  Craig, thank you so much for joining us today.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Exactly. And

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

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

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

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

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

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

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

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

Craig: Yeah. Crazy.

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

Sure.

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

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

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

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

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

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

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

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

Dr. Weitz: how progesterone affects thyroid?

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

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

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

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

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

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

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

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

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

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

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

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

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

Craig: fantastic.

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

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

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

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

Craig: Oh, that’s fascinating. Yeah.

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

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

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

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

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

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

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

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

Sure. Absolutely.

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

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

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

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

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

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

Dr. Weitz:  so patients eat less.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Yes. If

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

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

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

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

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

Dr. Weitz: you’re taking a GLP one.

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

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

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

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

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

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

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

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

Dr. Weitz:  Oral, injectable, or both?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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