Dr. Nathan Bryan discusses Increasing Nitric Oxide for Better Health with Dr. Ben Weitz.

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Podcast Highlights

The Vital Role of Nitric Oxide in Health with Dr. Nathan Bryan on the Rational Wellness Podcast
In this episode of the Rational Wellness Podcast, host Dr. Ben Weitz interviews Dr. Nathan Bryan, a leading expert in nitric oxide research. They discuss the crucial roles nitric oxide plays in various body functions, such as circulation, energy production, brain health, immune balance, and sexual function. They delve into how the body’s ability to produce nitric oxide diminishes with age, and explore natural and clinical strategies to boost nitric oxide levels. Dr. Bryan explains the biochemical pathways of nitric oxide, its impact on human health, and the science behind nitric oxide supplementation and products. Topics such as the impact of diet, oral microbiome, lifestyle factors, and the misinterpretations around nitrate and nitrite in foods are also covered. Finally, they highlight the potential future of nitric oxide-related diagnostics and therapeutics.
00:26 Meet Dr. Nathan Bryan: Nitric Oxide Expert
01:38 Understanding Nitric Oxide
02:49 The Role of Nitric Oxide in Health and Disease
05:39 Measuring Nitric Oxide and Its Metabolites
12:38 Dietary Sources and Misconceptions of Nitrates
17:06 Oral Microbiome and Nitric Oxide Production
20:55 Innovative Nitric Oxide Products
31:08 Physiological Benefits of Nitric Oxide
31:12 Nitric Oxide and Cardiovascular Health
35:04 Nitric Oxide and Brain Health
38:13 Nitric Oxide in Drug Therapy and Nutraceuticals
40:48 Nitric Oxide and Sexual Function
44:21 Lifestyle Factors Affecting Nitric Oxide Production
52:26 Soil Health and Nitric Oxide
54:47 Oral Probiotics and Nitric Oxide
55:43 Conclusion and Further Resources
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Dr. Nathan Bryan is an internationally recognized scientist and leading expert in the field of nitric oxide research. Dr. Bryan has spent the last two decades studying the biochemical pathways of nitric oxide and its impact on human health, including cardiovascular health, immune function, and healthy aging.  Dr. Bryan has published numerous peer-reviewed papers, books, and he has developed innovative products to restore and optimize nitric oxide production, currently through his N1O1 company available at N1O1.com.

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

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Podcast Transcript

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

Hello, Rational Wellness podcasters. Today we have a very special guest, Dr. Nathan Bryan, one of the world’s leading experts on nitric oxide. Nitric oxide is a molecule that plays a critical role in circulation, energy, brain health, immune balance, even sexual function.  Unfortunately, most people begin to lose their ability to make nitric oxide. As they age, we’ll dive into what nitric oxide is, why it matters, and the best strategies to boost your levels naturally and clinically. Dr. Nathan Bryan is an internationally recognized scientist and leading expert in the field of nitric oxide research.  He spent the last two decades studying the biochemical pathways of nitric oxide and its impact on human health, including cardiovascular health, immune function, and healthy aging. Dr. Bryan has published numerous peer-reviewed papers, authored books on nitric oxide, and has developed innovative products to restore and optimize nitric oxide production.  Dr. Bryan, thank you so much for joining us.

Dr. Bryan:  Thanks for having me. Great to be with you.

Dr. Weitz:  Great. So what is nitric oxide and why is it so important?

Dr. Bryan: Well, it’s what we call a signaling molecule. It’s how cells in the body communicate with one another. It’s a neurotransmitter in the central nervous system. It’s a molecule produced by our immune cells that kill bacteria, prevent viruses from replicating.  And then, you know, it’s a vasodilator, meaning that it dilates the smooth muscles surrounding all blood vessels, thereby improving circulation, blood flow, oxygen delivery. It’s a signal that tells our own stem cells to mobilize and differentiate so we can repair and replace dysfunctional cells.  It activates our mitochondria, so it’s critically involved in energy production inside the cell. And, you know, it, it activates an enzyme called telomerase, which prevents our telomeres from getting shorter. So when we look at the hallmarks of aging, nitric oxide really addresses all aspects of aging.

Dr. Weitz: You know, one of the things that’s amazing is you give me that litany of accomplishments, and I’d say, well, this person who did all that must be a hundred years old, and yet nitric oxide is a gas that sometimes lasts for less than a second. So how can it accomplish all those roles when it’s not around for very long?

Dr. Bryan: Well, that was what we tried to solve more than 25 years ago, because when I started in the field in the late nineties, you know, nitric oxide was recognized as a gas, and once it’s produced, it’s gone in less than a second. [00:03:00] So the challenge in the field was, okay, when nitric oxides produced, where does it go?  What does it become and how does it signal? Okay. And once we created this fingerprint of immunobiology, then we could see what were the relevant metabolites, the signal, the second messenger systems that were activated once nitric oxides produced. And you know, today, we certainly know when nitric oxides produced it can, you know, activate second messenger.  Systems like GU cyclase increased cyclic, GMP lead to calcium dependent smooth muscle relaxation. It can bind to proteins or these metabolites can modify cysteine residues on proteins and affect protein structure and function. It can you know, change DNA methylation, so epigenetic regulation. So it’s involved in many important and foundational biological processes.

Dr. Weitz: So this gas produces metabolites that then last longer that can have an effect in terms of signaling and affecting all these different organ systems.

Dr. Bryan: That’s exactly right. And so what we were trying to figure [00:04:00] out was when you have an adequate production and sufficient production of nitric oxide, what are the, what does those metabolites look like in the blood, in the saliva, in, in actual tissue?  And then how do these second messenger systems what’s the half life of them and how do they signal? And then what happens in people who develop disease and are nitric oxide deficient? And what we find, we published on this back in 2004, that fingerprint looks completely different. There’s a different set of metabolites, typically lower.  There’s these different you know, nitrogen oxides that form. And, you know, when you have more oxidative stress and less nitric oxide, then that leads to oxidative stress. And, you know, the hallmarks of aging and chronic disease

Dr. Weitz:  What are some of the most important metabolites?

Dr. Bryan: When nitric oxides produced, there’s it bind to the cysteine of glutathione, so it reacts with oxygen and can form these higher in oxides like inorganic nitrite, which then, you know, the half life circulating half light of nitrite’s about 110 minutes.  So sometimes we get two hours or [00:05:00] more when it binds to the cystine of glutathione, which is a tripeptide, it can survive in the circulation out for hours. And then, you know, it binds to other cystine residues on proteins or peptides and even amino acids like cystine. So then it activates, you know, binds to metals and can be transported as a nira heme and activates, you know, the soluble ate cyclase, which then increases cyclic GMP production, which causes smooth muscle relaxation.  And you know, when we look at the PD five inhibitors, they prevent the breakdown of cyclic GMP, and that’s why they’re effective for improving erections in men because it leads to enhanced vasodilation. Interesting.

Dr. Weitz: So can any of these metabolites be measured? Because I, I know that being able to measure nitric oxide is tricky.  Right?

Dr. Bryan: We don’t really have good methods. I know you developed a saliva test, but but that’s not necessarily a great measurement either, correct?

Dr. Weitz:  I think I’ve heard you say, yeah.

Dr. Bryan:  Clinically there’s really not, you know, in the research environment we can, we have, you know, some pretty sophisticated analytical equipment where we can measure inorganic nitride and nitrate and measure the amount of nitric oxide down to cystine dials or to bound to metals.  And that’s how we mapped out this nitric oxide metabolome. But clinically it’s not. Utilized. But, you know, 15, 16 years ago I developed a salivate test strip just to give us a sense of what may be going on with these different metabolites that are recycled and produced in our saliva. And I think it’s, you know, it’s still probably a good tool to have in your toolbox.

But, you know, I’ve gotten away from those test strips because there’s a lot of false positives. There are no false negatives. So if your saliva tests low in inorganic nitrite, which is what we’re measuring, then it tells us that your ability to produce and recycle nitric oxide is compromised.  But, you know, if it shows optimal or normal. That doesn’t always an accurate [00:07:00] interpretation. We’re finding that people with active oral infection, whether it’s a symptomatic or even an asymptomatic infection, turn that test strip bright peak and it’s reflective of a local immune response dealing with an infection rather than systemic nitric oxide production.  Okay. So that’s when we have to parse out, and I think this, there can be misinterpretations of those test strips, so I don’t use it anymore. 

Dr. Weitz:  So are there any blood tests or are we close to having a blood test to measure nitric oxide?

Dr. Bryan: Yeah, I mean, look we’ve published on this for the past 30 years, so I mean, we do it in the research environment.  Now, whether it’s ever gonna be utilized clinically as a relevant. And useful biomarker. You know, I think the jury’s still out because what we’ve, what we’re finding is that, you know, these metabolites can be influenced by diet, right? When we consume green leafy vegetables, the nitrates converted to nitride it’s we see an increase in plasma levels of that.  So, but that’s not reflective of endogenous kind of endothelial [00:08:00] production of nitric oxide. So these metabolites are a mix of all sources of production of nitric oxide. And so you would have to interrogate each and do, you know, prolonged fasting and do you know, endothelial function tests to really parse out where that nitric oxides coming from or where your deficiency may be coming from.

Dr. Weitz: So, to explain we’ll get into some of the functions of nitric oxide in a few minutes, but to explain the physiology of it is nitric oxide production produced without eating foods that have nitrates.

Dr. Bryan: Yeah, absolutely. In fact, the first pathway to be discovered was the recognition of the discovery.

Dr. Weitz:  Oh, L-arginine, right?

Dr. Bryan: Yeah. So there’s an enzyme called nitric oxide synthase that’s found in our endothelial cells. And that enzyme takes L-arginine, which is an amino acid, and through a five electron multi-step oxidation, produces nitric oxide. And then the metabolite of that reaction is L-Citruline.  So L-Citruline is a byproduct of nitric [00:09:00] oxide production. It’s not a precursor. And so that enzymology has been completely elucidated, and so we’re never deficient in L-arginine. So it’s never made sense to me as a biochemist, why anyone would supplement L-arginine.

Dr. Weitz: Okay. You’re pointing out the fact that there are products on the market and some of the first products that have been marketed to promote nitric oxide used L-Arginine and or L-Citruline or both.

Dr. Bryan:  That’s right.  And when you would. And so because people thought, if arginine, if the body takes arginine and converts it to nitric oxide, if you’re nitric oxide deficient, well let’s just give arginine. And early on, you know, 30 years ago, 40 years ago, that was a practical and rational thought. But we’ve learned so much more about the function of the NOS enzyme since then.  Now we find that if the NOS enzyme is uncoupled and not functional and you supplement with high dose arginine, you can actually cause more harm then provide benefit. And this is demonstrated in post infarct. [00:10:00] Patients were given L-arginine actually increased mortality and morbidity in fo post infarct patients.  And you had the same thing with patients with peripheral disease.

Dr. Weitz: So explain how that production of nitric oxide is harmful because you’re producing nitric oxide that, did you say it’s uncoupled?

Dr. Bryan: So the enzyme is uncoupled. Okay, so what happens when, so the NOS enzyme is two, we call it a homodimer. So it’s two twins that come together that allow for this transfer of electrons from the oxidase to the reductase domain because the, IT has to oxidize a five electron oxidation of the, what we call the guino nitrogen of var.  And so if this enzyme is uncoupled, then there’s a disruption in the flow of electrons. And what happens is we reduce molecular oxygen into superoxide radical, so you can in exacerbate the oxidative stress. So instead of producing nitric oxide, you’re producing Super Ox. Which is an oxygen [00:11:00] radical. It steals electrons, causes oxidation and oxidative stress is the root and hallmark of many chronic diseases.  So you’re actually getting the opposite of the intended effect.

Dr. Weitz: Now, what if you consume antioxidants at the same time as you con consume arginine or citruline to to bind up that reactive oxygen species?

Dr. Bryan: Well, there’s two things we have to address. Number one is prevent the oxidation of tetra.  That’s the rate limiting step in nos on Pepin. But so the answer to your question is maybe because you have to understand the electrical potential that’s needed to extract an electron from BH four, and that’s why there’s called redox coupling, right? Because the electrical potential or the redox potential for each molecule is different.  The redox potential for glutathione is different than ascorbic acid is different than alpha lipoic acid. And that’s why there’s always this transfer of electrons at this potential gradient that’s required. So if you’re not consuming the right antioxidants to provide an electrical potential to protect that electron from BH four, then you’re not gonna get, you’re not gonna protect from no coupling.  And then there’s different antioxidants, whether they’re water soluble, fat soluble, or enzymatic antioxidants that can scavenge superoxide and hydroxyl radicals. So it’s a it’s a very complex electrical system that you have to understand. But antioxidants, I think in any regard are typically good protective molecules, but it’s, it goes beyond that.

Dr. Weitz: Right. So, we have the one pathway, which is turning arginine through Enos into nitric oxide. And then the other pathway comes from us eating food that contains nitrates. And the foods that are highest in nitrates are dark leafy greens and beets.

Dr. Bryan: I mean, typically, you know, there was a misconception of nitrate and nitrite over the past, you know, probably 80 years where it was, you know, thought that [00:13:00] nitrite, nitrate cured meats like bacon, hot dogs, lunch meat, would form carmines and form and cause cancer.  But, you know, we debunked that myth, you know, probably 20 years ago. And now we find that the highest burden of exposure to wait.

Dr. Weitz: Can it be that different? A nitrate in bacon is different than a nitrate in a green, leafy green in green leafy vegetables. The same exact molecule. It’s the same molecule.  Same exact molecule. Okay. Yeah. ’cause I’ve noticed that some of the companies that make some of these cured meats now are adding nitrates from celery.

Dr. Bryan: Yeah. No, look, it’s, I mean, it’s really deceptive marketing, right? Because to get a, to, to cure a meat product, it requires nitrite. There is no substitute for it.  So because, you know, consumers were misled and misinformed, consumers were demanding a nitrite free product. So what they’re doing is they add cultured celery extract, then they add a starter culture of bacteria, nitrate, [00:14:00] reducing bacteria, so the bacteria reducing the nitrates and nitrite curing the meat.  It’s still nitrite cured meat. Okay? But there’s just no nitrite itself added they’re doing. But you’ve got to have nitrite present. To cure meat and to prevent overgrowth of clostridium and, you know, to ensure food safety, right in these cured meat products. But no, it’s the exact same molecule. You know, the matrix and the chemistry is, can be different because the, you know, the antiox oxidant capacity of a green leafy vegetables is much different than a muscle matrix.

But we know that in order for any nitride cured meat product, you have to have a super sto metrical amount of ascorbic acid, or in the meat industry they use Eryri Bay. But it provides called an accelerant because it facilitates that one electron reduction of nitride to nitric oxide and completely prevents any nitros chemistry.

Dr. Weitz: Okay. So, when we consume these nitrates in green leafy vegetables or beets, [00:15:00] we convert it into nitrite. Which then goes to the stomach, and if there’s sufficient hydrochloric acid, then we produce nitric oxide. Is that how the cycle works?

Dr. Bryan: That’s in an ideal situation. But you know, there’s problems that each step, so number one, and we publish this in 2015, that depending upon the vegetable you eat and where that vegetable’s grown and where you’ve purchased it from, is dependent upon the nitrate content, right?   So just because you’re eating spinach or beets for example, you know, are probably the worst source of inorganic nitrate.  Somehow beets… 

Dr. Weitz: The worst source? 

Dr. Bryan: the worst, especially the commercial beat products. You know, I’ve tested all the commercial beat products on the market, and 95 to pay, 98% of them contain no detectable nitrate.  Really, they had beats, in fact, we used them as placebos in our clinical trials because they’re a great placebo. They provide zero nitric oxide benefit, and companies don’t [00:16:00] understand this. Some companies do, and they’re deliberately defrauding and deceiving their customers. But, you know, a lot of these companies are buying the cheapest beet product on the market, putting it in a powder and calling it nitric oxide.  Beets are not nitric oxide.

Dr. Weitz: So does it depend on whether they’re grown in soil that’s fertilized with nitrogenous fertilizer?

Dr. Bryan: Yeah. To make nitrate and to assimilate nitrate, you have to have nitrogen in the soil. And so it depends upon the soil conditions, the amount of lightning strikes per year, whether you add nitrogen based fertilizers to the soil.  

Dr. Weitz:  The number of lightning strikes?

Dr. Bryan:  Yeah, lightning fixes nitrogen.  The atmosphere is 78% nitrogen. And that triple really is a very strong bond. And so when you have lightning storms, it breaks that triple bond of nitrogen and fertilizes the soil. So you’re getting nitrogen and usable forms of nitrogen.  And that’s why, you know, the rust Belt to the southern US is some of the most fertile soil in the US because of the number of lightning strikes.

Dr. Weitz: Wow.  Fascinating.

Dr. Bryan:  Yeah. Yeah. So then, [00:17:00] so there has to be a certain threshold of nitrate that’s, that’s necessary to see an effect. So that’s number one.  Number two is you must have the right oral bacteria because nitrate humans cannot metabolize nitrate. So we’re a hundred percent dependent upon the oral bacteria. So if you’re using fluoride toothpaste, if there’s fluoride in your drinking water, if you’re using an antiseptic mouthwash, then you eradicate these oral bacteria, then you can consume spinach, beets, lettuce till the cows come home.  But if you don’t have the right bacteria, nitrite is excreted in the urine, it’s excreted in the feces, and it’s excreted in our sweat. So you’d get no benefit from it. And then the other, the kind of the terminal step in this…

Dr. Weitz:  So, so you have to have a healthy oral microbiome, right? Absolutely. Now, to have a healthy oral microbiome, you have to have a lot of healthy bacteria commensals, and you don’t want a lot of pathogenic bacteria.  

Dr. Bryan:  That’s exactly right.

Dr. Weitz:  Can’t it be the case that some [00:18:00] antimicrobials will kill the pathogenic bacteria, like say P. gingivalis, that you don’t want and can, couldn’t that ha promote a healthier microbiome?

Dr. Bryan: Well, I think that’s the intent, but the reality is these antiseptics, non selectively kill all bacteria, right?  There’s no selection for P. gingivalis, but it’s, it, there’s collateral damage. It’s killing the pathogenic, it’s killing the non-pathogenic commensal bacteria. Does. Didn’t

Dr. Weitz: matter what we use. Like, for example, there are herbal washes and toothpaste that say contain things like silver or antimicrobial herbs or coconut oil.

Do any of these natural products promote a healthier microbiome? The mouth. Well, let me tell you what we know and I’ll tell you what we don’t know, okay? Because we learned a lot, but there’s still a lot we don’t know. And so I don’t have the answer to some of those questions, but here’s what we do know.[00:19:00]

Dr. Bryan: You published this, if you use an what’s called an antiseptic mouthwash, whether it’s chlorhexidine scope, Listerine, it selectively, it non-selectively kills all the bacteria. It basically wipes out all bacteria. And you’ve seen the commercials. It kills 99.99% of the bacteria in your mouth. Right? That’s not a good thing, by the way.  And they, they advertise this on TV and I’m going, it’s unbelievable. So, so that’s what we know. Anything that’s labeled antiseptic believe it. It kills all bacteria, not just the pathogens. Now, what we don’t know is, you know, oil polling I think is fine. Use of coconut oil. I don’t know about certain herbal rinses or herbal toothpaste because we just, we haven’t done the studies to see is it’s selectively killing pathogens and improving the diversity of the non-pathogenic commensals, which that’s the goal, right? We, I developed a toothpaste several months ago that it’s pretty selective for the pathogens and then [00:20:00] improves the diversity of the oral microbiome. So we’ve taken the fluoride out, we’ve put prebiotics and things in there that can build up the ecology of the microbiome and improve diversity, improve micro oxide production.

And we’re working on a mouth rinse now that we’ll probably have out in the first quarter of 2026, again, trying to selectively kill the pathogens, the gingival bacteria that cares causing bacteria and improving the diversity of the non-pathogenic bacteria. Because what we’re finding is if you can increase the diversity of the microbiome, then the good guys are the bad, are the cops and keep the bad guys at bay.  But when you throw an atomic bomb in your mouth with chlorhexidine or fluoride or mouthwash, you’re killing everything. And then many times the pathogens will outcompete the good guys. Then you’ve got complete dysbiosis, periodontal disease, gingivitis, prone to cavities, low salivary pH, and it’s a recipe for disaster.

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Dr. Weitz:  I want to give you a hard time for a second about the fluoride. Now, fluoride has some antimicrobial properties, which is what you’re focused on. Personally, I don’t use fluoride or use it for my family, but there is an argument that fluoride promotes the mineralization of the enamel that makes the teeth stronger and it prevents cavities for that reason.

Dr. Bryan: Well, that’s what we thought a hundred years ago, but as the science advances, we have to make changes based on new understandings. Okay. You know, there was a study by the National Toxicology Program, which is the gold [00:23:00] standard if there’s ever a question about the toxicity of a molecule we’re exposed to through food, diet or environment.  And it’s the national toxicology responsibility to do dose escalation studies and define the levels of toxicity for fluoride. And so what we look at is risk benefit. What benefit is it providing and at what risk? And this National Toxicology program, which by the way, they delayed publishing this for four years because the industry.  Wasn’t ready for this data. What they found was there’s really no benefit to fluoride in terms of remineralization of teeth. What’s the risk? Well, it’s a neurotoxin, it shuts down your thyroid function. It lowers IQ in kids by as much as seven points. And it’s an antiseptic, I mean, so if there’s no benefit and it’s all risk, that’s a very easy quotient.  And the policymakers and regulators should get fluoride out of everything we’re exposed to. Remove it from toothpaste, remove it from the water supply. [00:24:00] 72% of the municipalities in the US put fluoride in the drinking water.

Dr. Weitz: But now I think, didn’t all this fluoride stop start because they noticed that certain communities where there was a lot of fluoride in the water, that they had fewer dental problems.

Dr. Bryan: Yeah, but look, when you look at epidemiological studies, there’s always confounders. So it may be an association but not causation. Okay. And so now it’s recognized that it really provides no benefit. There are other remineralization. Molecules Hydroxyapatite, for example, and just, you know, a good whole food diet remineralizing the teeth, right?  It’s sufficient there, so there’s no need for fluoride.

Dr. Weitz: Right? It’d be more natural to have calcium as part of the mineral content of your teeth and fluoride anyway.

Dr. Bryan: Yeah. And the reason they put it in the water supply is ’cause it kills the bacteria in the pipes. Well, it kills the bacteria in our pipes, our GI tract.  Right. It kills the bacteria on our body when we bathe in it. Right? I mean, it’s a toxic molecule. And I encourage people, you know, get rid of fluoride, [00:25:00] buy a fluoride free toothpaste, and if you live in a city where they put fluoride in the drinking water you almost, you’re almost forced to buy a home filtration system to remove it.

Dr. Weitz:  Right? That’s what we have. Is it beneficial to measure the microbiome of the mouth?

Dr. Bryan: No, it is. I, you know, we’re working with some diagnostic companies now because most dental diagnostic companies are only looking for the pathogens, which is very important, right? You, if you have these pathogens, you have to get rid of them.  ’cause the increased risk of, you know, I think all cause mortality, especially cardiovascular disease. So what we’re trying to do is part of this diagnostic, let’s not only look at the pathogens, but let’s look at these nitrate reducers and see if we can selectively build up these populations, which will then eradicate the pathogens on their own.  But, you know, we do this in the research environment. We do tongue scrapings, we do full metagenomic analysis and genetic screening of these bacteria, but it’s not available clinically or commercially.

Dr. Weitz: Is there a way to get beets that are higher in nitrates, or should we use a different vegetable? I noticed [00:26:00] in one of your products you have fermented beets.

Yeah.

Dr. Bryan: No, I mean, that’s the trick, right? Because again, it’s not nitrate is inert. And so we’re dependent upon bacteria to convert this two electron reduction of nitrate into nitrite. So what we do with our beets, we take a superior source of beets, which is high in nitrate, and then we apply the bacteria.

Dr. Weitz: Where do you get that source of beets? That’s highend nitrates. Well, we have to control the soil conditions, okay? And we have to control the environment. So we understand the soil conditions, the agronomy, to make a nitrate enriched. Beep. But again, if we’re just focused on nitrate, 90% of the population who would consume that product wouldn’t get a benefit, a nitric oxide benefit, because of the the oral bacterial issue and the stomach acid issue.

Dr. Bryan: So what we do is if your body can’t. Make nitric oxide or convert nitrate to nitrite, then we’ve done it for you. So we’ve pre-con converted this beets through fermentation. So now when you consume our beets, it’s not dependent upon [00:27:00] your oral bacteria. It’s not dependent upon stomach acid production.  We make nitric oxide for you. So everybody who takes our beat product gets a nitric oxide benefit.

Dr. Weitz: And where, so when you ferment a beet, what happens to the beet?

Dr. Bryan: Well fermentation in general is a way to optimize certain nutrients so you can ferment things and optimize certain nutrients. What we focus on is the fermentation process to convert nitrate to electron reduction to nitrite.  So now we have a nitrite enriched fermented beet powder.

Dr. Weitz:  I see.

Dr. Bryan:  And you put it in solution and you take it systemic. When you drink it, it’s producing nitric oxide gas. Whether you’re taking because we put electron donors in there that facilitate that one electron reduction of nitrite to nitric oxide.  And that’s what makes our technology different than all these other yahoos out there schlepping. Beep root is that most of them don’t have any nitric oxide activity whatsoever. And ours, because I understand the science and the biochemistry, if your [00:28:00] body can make nitric oxide, then we do it for you.

Dr. Weitz: Right? So rather than taking arginine and citraline, rather than just taking some bee root powder that may not have a high level of nitrate, you get a beat that’s grown in soil condition. So it’s higher in nitrate to start with. Then you ferment it. So you’re now converting some of the nitrate to nitrite and then you also add nitrites to the product, correct?

Dr. Bryan: No, but we’re, we do like the meat companies, we’re pre-con converting this. Beep powder into usable forms that are direct, so there’s no added nitrite. Oh, okay. We just, we’re we allow the natural process of the bacteria fermentation to provide it for you. But, you know, we can quantify this and we understand the chemistry and we can control that reaction to where every time you take a single serving of a beep, you’re getting the same amount of nitric oxide.  And it’s an efficient delivery. And again, it’s not dependent and it overcomes all the body’s [00:29:00] inherent limitations to produce nitric oxide. And the reason why many people are deficient. I see. But you also have a product that has sodium nitrite in it. Yeah. So we make an orally disintegrating tablet that, you know, I designed many years ago that releases a certain amount of nitric oxide over a certain period of time.  This earliest integrating tablet, you know, you put it in your mouth, it’s, this matrix falls apart again, it’s sodium nitrite with electron donors and we’re controlling the metabolic formation of nitric oxide gas. So it’s releasing about 20 to 30 parts per million nitric oxide gas. Over five to six minutes.

And that nitric oxide release from that lozenge is vasoactive. We can see dilation of the carotid within about 12 seconds. We see, you know, dilation of other blood vessels. We see a reduction in inflammation. We see an improvement or increase in the number of circulating stem cells. After taking the lozenge within 20 minutes, we’ve improved endogenous production of nitric oxide by 20%.  So it’s more than delivering nitric [00:30:00] oxide. It’s providing antioxidant capacity that prevents BH four oxidation and improves endothelial nitric oxide production. And because it’s resides in the mouth, it’s completely restoring the oral floral. So our products, again, if your body can’t make nitric oxide, we do it for you.  But more importantly, I think is it’s repairing the body’s ability to make nitric oxide on its own.

Dr. Weitz: So if I wanted to take a nitric oxide product, say before I go to the gym, yeah. Is it better to take, which one? Is it better to take?

Dr. Bryan: We positioned the N1O1 Beets powder as a pre-workout because again, it’s immediate release.  As soon as you put in solution and you put in two to three ounces of water and you take it as a shot, it’s not something you sip on through your workout. It has to be taken as a shot, as a bolus. Okay? But we, it generates nitric oxide. We put electrolytes in there to improve cellular hydration, and we also put a patented peak, a TP in there.  So again, it produces mitochondrial a TP, the energy currency of the [00:31:00] cell. So those three, improved hydration, improved nitric oxide and improved a TP production. It’s gonna give you an incredible workout.

Dr. Weitz: Cool. So let’s go over some of the physiological benefits. Let’s start with cardiovascular health and how nitric oxide plays a role in endothelial function and blood pressure.

Dr. Bryan: Well, nitric oxide, when it’s produced in the endothelial cells. Again, it’s a gas, so it diffuses into the lumen of the blood vessel. It diffuses into the underlying smooth muscle, and then it leads to vasodilation. When it diffuses into the lumen of the blood vessels, it downregulates adhesion molecules.

So when we look at chronic disease and the vascular component of chronic disease, there’s always vascular inflammation where monocytes and neutrophils start sticking your blood vessels become like Velcro, platelet stick. Monocyte stick. Red blood cells stick.

Dr. Weitz: Yeah we measure markers of inflammation in the arteries.  So we look at myelo oxidase and we look at oxidized LDL. We look at HsCRP.

Dr. Bryan: Yeah. So nitric oxide mitigates the inflammation that you see in vascular disease. In fact, it’s the functional loss of nitric oxide. The lining of the blood vessels that lead, that’s the earliest event in the onset and progression of vascular disease.  So when you can make nitric oxide, you get an upregulation of adhesion molecules, monocytes. Neutrophils start to stick. They migrate through the endothelium, they develop foam cells. You start to develop myelo peroxidase, you get plaque instability, plaque rupture, and there’s your heart attack or ischemic stroke.  So if we can maintain adequate nitric oxide production leads to better vasodilation, downregulation of the adhesion molecule. So you don’t get monocytes that adhere and extravasate through the endothelium so you don’t get plaque formation and you’re mobilizing stem cells. One of my patents on a method of reducing C-reactive protein. So even the acute phase markers of inflammation, if we give nitric oxide, we see a reduction in C-reactive protein. We can [00:33:00] look at intravital microscopy and look at the number of monocyte to neutrophils that are rolling and sticking to the endothelium, and it completely inhibits that. Then it’s, you know, it’s reducing oxidative stress and it’s correcting the immune dysfunction that we see in patients with cardiovascular disease.

Dr. Weitz: And it reduces hypertension as well, correct?

Dr. Bryan: Absolutely. So when you look at all the risk factors for developing cardiovascular disease, not just the risk factors, but the consequences. Nitric oxide addresses all of them.

Dr. Weitz: Can you ever have too much nitric oxide?

Dr. Bryan: Of course. Yeah. So too much nitric oxide will lead to systemic vasodilation, loss of profusion pressure, and you may get syncope or lightheaded.  And then the other, only other sign of toxicity is what we call met hemoglobinemia. So too much nitric oxide will oxidize the heme iron of hemoglobin form hemoglobin, and then you reduce the oxygen carrying capacity of the red cell and you become cyanotic and you know, you’re, you lose the ability to deliver oxygen.

Dr. Weitz: So what can lead, typically [00:34:00] blood pressure will fall long before What can lead to too much nitric oxide? What leads to too much? Yeah.

Dr. Bryan: There’s really not a clinical condition where there’s too much nitric oxide. Okay. It was one thought that sepsis, you know, the end organ failure you see in septic patients, right, was due to too much nitric oxide being produced by our immune cells that caused a systemic vasodilation, loss of profusion pressure, end organ failure in death.  So in the nineties, they did a clinical trial where they gave nitric oxide inhibitors to inhibit nitric oxide production by our immune cells, and it’s an analog of arginine, so it’s a competitive inhibitor to arginine. What they found was in that double placebo controlled clinical study, the septic patients who were administered Anas inhibitor got worse.  Again, more people died from giving the ENOS inhibitor than the placebo. So that told the entire field that nitric oxide, the overproduction of nitric oxide in sepsis isn’t a cause of death. It’s probably a [00:35:00] protective mechanism, and when you shut that down, patients get worse.

Dr. Weitz: How does nitric oxide influence brain health and cognition?

Dr. Bryan: Well, when we look at neurological disease, take dementia, Alzheimer’s, for example, we know that there’s a vascular and metabolic component. In fact, Alzheimer’s has been called diabetes type three. So when all these neurological conditions, if you follow the work of Daniel Aman, he shows through spec scans, there’s focal ischemia.  There’s a lack of blood flow to certain regions of the brain. So what does nitric oxide do? It acts as a vasodilator, opens up the blood vessels, both the conduit blood vessels, the micro blood vessels, and it peruses the brain. So now you’re getting adequate oxygen delivery to those cells and they can actually work.  And then the other aspect of that is the cells become insulin resistance, and that’s why it’s called diabetes type three or Alzheimer’s. And so what nitric oxide does, and we were the first group to publish this in 2011, nitric oxide is the signal in the cell. That allows for glucose [00:36:00] Tate. So when insulin binds to the insulin receptors on cells, it starts an intracellular signaling cascade that’s dependent upon the cell’s ability to make nitric oxide.

When nitric oxides produced in the cells that binds to ine residue on glute four, which then tells that protein to go to the membrane and bring glucose in, so that cell can actually make a TP and cellular energy from glucose. So if the cell can’t make nitric oxide, you develop insulin resistance. And insulin resistance is a symptom of nitric oxide deficiency.  So if you give nitric oxide and we’ve got a, a drug study, an FD, a drug study where we’re working on a s nitric oxide drug for Alzheimer’s. If you give nitric oxide to a patient with vascular dementia, Alzheimer’s, we improve blood flow, we improve glucose uptake, overcome insulin resistance, and their cognition improves.  And when you enhance perfusion and enhance cell function, you don’t get misfolding of proteins. You don’t, 

Dr. Weitz:  Is there a way to direct the nitric oxide focus on the brain? Is there a delivery system or something that [00:37:00] can facilitate nitric oxide in the brain?

Dr. Bryan: No. I mean, nitric oxide, is a guess, right? It diffuses right through the blood brain barrier.  It’s a guess that diffuses across cell membranes. But, you know, if you’ve got Alzheimer’s or vascular dementia, it’s not a unique disease to the vascular bed of the brain. It’s a systemic disease, right? So you’ve got microvascular dysfunction and insulin resistance in every vascular bed in the body and the hearts the sex organs, the, and so if you look at all the risk factors that accelerate and put people more prone to Alzheimer’s, it’s diabetes, it’s hypertension, it’s erectile dysfunction, it’s insulin res, I mean.  All of that are, all those are symptoms of nitric oxide deficiency. So people just disease manifests differently in different organ systems, in different people based on, you know, genetic predispositions, their diet, their lifestyle, and that’s what, how it manifests.

Dr. Weitz: So, you don’t think there would be benefit to some route of getting the nitric oxide to be [00:38:00] produced directly in the brain?

Dr. Bryan: No, I don’t because what we try to do as a drug company is recapitulate physiology. Okay. I don’t wanna disrupt what the body’s nor trying to do. It’s just lost its ability to do. Okay. When we develop drug therapy or product technology, I wanna deliver a certain amount of nitric oxide for a certain period of time.  And I wanna control and dictate the metabolic fate of where nitric oxide goes, what it becomes, and how it signals to basically recapitulate what it would naturally do if that patient was able to make nitric oxide. That’s why the technology we’ve developed is so unique and innovative because it’s basically mimicking what the body normally does.  And so, you know, we’re a drug company. We call it biotech company, but we don’t employ pharmacology. Pharmacology is a synthetic compound that inhibits a biochemical reaction to which there’s always side effects to what we try to, what I’ve tried to do over the past 30 years is understand the mechanism of disease to the extent that you can start to develop rational therapy.  And fortunately for us, we know how ni oxides made, at [00:39:00] what rate it’s produced, its natural flux. And so we call this restorative physiology, and that’s the medicines that we’re trying to produce because we wanna mimic physiology, overcome the body’s deficiencies, give the body what it needs, and let the body do its job.

Dr. Weitz: So that’s really a nutraceutical versus a drug where I’ve heard you use the term nitraceutical.

Dr. Bryan: A nitraceutical. Yeah. I coined that term years ago, and we trademarked it because it was a way to differentiate our products from all these other. Nitric oxide products that don’t work and can’t work.  So yeah, we have nutraceutical, our nutraceuticals on the market, but what we’re doing through our drug company is developing drug therapy. You know, so we’re taking what we call a supplemental dose is kind of giving. So we have to do some simple arithmetic, right? And give a supplemental dose. And so the analogy I use is vitamin D.  If you’ve got a vitamin D level of 30, then we can dose till we get you to 80 or optimal, right? So in nitric oxide, because we can’t measure it, we’ve gotta look at kind of normal dietary patterns in the nitric oxide production radio labeled [00:40:00] isotopes from arginine to citruline, and then we get ’em number.

So we have to supplement what’s missing in a normal dietary pattern and we can’t go above that. That’s, those are FDA guidelines for dietary supplements. Now for drug therapy, what do we have to do? We have to demonstrate safety and we have to demonstrate efficacy. And so we have, we can increase the dose that’s still safe.  The dose that’s of nitric oxide that’s needed to treat a patient with ischemic heart disease or Alzheimer’s or heart failure is much different than what’s needed to supplement people that are asymptomatic, that are, is restorative. And so that’s what we’re doing in terms of our drug therapies, increasing the dose for specific indication that we can show safety and efficacy, and then we’ll have our drugs approved that on the market.

Dr. Weitz: Interesting. So nitric oxide plays a role in sexual function for both men and women? Absolutely.

Dr. Bryan: And that’s the, you know, that’s the mechanism of action of the drugs like Viagra and the PD five inhibitors. [00:41:00]

Dr. Weitz: Right. So would it be better to take those drugs and to use supplements to increase nitric oxide?

Dr. Bryan: No, absolutely. Not just scientifically, but clinically because. Those drugs. They were approved in 1998. They’ve been on the market now for, was it 27 years? They only work in 50% of the men, right? So 50% of the men that have prescribed Viagra, Cialis, these PD five inhibitors respond with better erections. And why do 50% of the people don’t res not respond?  It’s because they’re not making enough nitric oxide in the endothelial cells to activate guanylate cyclase to increase cyclic GP. So nitric oxide is produced, increases cyclic GP, these PD five inhibitors degrade cyclic GP, and then the signal goes away. But if you give a PD five inhibitor, nitric oxides produce cyclic GMP increases, you prevent the breakdown of cyclic GMP.  And that’s why. Sometimes there’s a four hour erection, which isn’t a good thing. Right? Right. You [00:42:00] get the process, your organ will die. Yeah. So if we, if to answer your question, if we in the non-responders, if we improve nitric oxide production through our supplemental dose, we activate guamate cyclase. Now these non-responders respond to PD five inhibitor therapy, and you can actually lower the dose, making these drugs safer, more effective, because they’re dependent.  So erectile dysfunction is a symptom of nitric oxide deficiency. Right. And if we improve nitric oxide production, we improve vasodilation, we improve sexual performance, we improve cognitive performance. We improve athletic performance, we 

Dr. Weitz:  So let me just summarize what you just said. These drugs like Viagra and Cialis, they inhibit the breakdown of the nitric oxide formation enzymes, right.

Dr. Bryan: Now what they do is they prevent the breakdown of cyclic GMP. Okay. So nitric oxide cyclic. GP is a second messenger. Oh, okay. It’s dependent upon nitric oxide. Okay. Okay. So if you make nitric oxide, you increase cyclic [00:43:00] GP. Okay. And cyclic GMP is degraded. You lose the vasodilation, the signal turns off. I see.  So they the breakdown. Yeah. Then you potentiate that signal. And that’s why you get sustained vasodilation. And look, these drugs have been, you, they were first developed for a pulmonary hypertension or coronary art disease. And now there’s data showing that people who are on low dose Cialis have a, you know, lower incidence of Alzheimer’s.  ’cause we’re improving cerebral blood flow. We’re potentiating the signaling aspects of nitric oxide. But to answer your question, again, understanding physiology and Sure. Employ these principles of restorative physiology. Let’s there’s not a condition of overactive phospho d racing enzyme. So if you just improve nitric oxide production, let the signaling cascade in second messenger system take care of itself.  You get adequate vasodilation, you can get an adequate erection in both men and women and overcome sexual dysfunction.

Dr. Weitz: Yeah, I feel the same way about like the S-S-R-R-I drugs for depression. You’re, you’ve got a drug that’s keeping [00:44:00] serotonin around, but if the body’s not making enough serotonin to begin with, it’s less likely to be effective

Dr. Bryan: for

Dr. Weitz: sure.

Dr. Bryan: And when you inhibit a, you know, an enzyme that’s normally active in the human body, there’s always consequences. And you look at the side effects of SSRIs, I mean, it’s a laundry list. But again, it’s always risk benefit. What benefit is it providing and at what risk?

Dr. Weitz: Why does nitric oxide production decline as we age?

Dr. Bryan: Well, I think it’s the American lifestyle. It’s the food we eat. It’s the lack of physical exercise. It’s the, you know, complete eradication of the oral and gut microbiome causing dysbiosis. It’s an inflammatory diet. You know, glyphosate on the food completely shuts down. Nitric oxide production kills the bacteria, disrupts the enzyme, you know, now data showing that certain frequencies like 5G, you know, provide a frequency of energy that completely disrupts the flow of electrons through the NOS enzyme and can lead the nos deficiency.

Dr. Weitz: [00:45:00] Let’s see. I heard you talk about the seed oil controversy. Yeah.  So, you know, that’s, I mean, look, this is much debated, you know, in the nutrition world, seed oils and these oils, basically vegetable oils that were promoted originally to have us stop using butter and saturated fats to try to reduce heart disease. And and now they’ve gotten to a point where we, a lot of people feel that they’re really bad for health.  But not all the data really shows it, they’re all that bad for health. And of course they’re all different. They’re made in different ways and and some people say they’re bad because they have omega six, because omega six is inflammatory and Omega-3 is anti-inflammatory. But, you know, it’s not that simple.  And there’s benefits to omega six is too. So it’s kind of a complicated situation, even though we love to reduce it to one hrase that you can put on a billboard.

Dr. Bryan: Yeah, look it’s never that simple. But look, the, let’s go back, the premise for doing that was flawed. Number one, cholesterol and fat does not cause heart disease.  So eliminating it and trying to provide an alternative was the wrong premise, and they were chasing the wrong target. But if you just look at regular cell biology, right? The cell membrane is made up of fat and cholesterol, and it’s a phospholipid bt and there has to be fluidity to that cell membrane.  So when we a cell reacts to its external environment and it binds to receptors on the outside, which then initiate, most of the time it’s a seven transmembrane receptor that starts an intracellular signaling cascade. But if you would get your cholesterol too low, or you’ve got these inflammatory CILs in there, you lose that intracellular signaling.

The other thing is this is like a capacitance or capacit. ’cause the inside of a cell is usually minus 25 millivolts with respect to [00:47:00] the outside of the cell. And if you lose that electrical compa capacitance, then you lose the electrical potential of the cell. Then the other thing is you completely disrupt intracellular signaling.

And so that’s why we have to focus on, you know, providing the body with good fats. It can make good phospholipids that maintain some membrane fluidity and cholesterol is part of that equation. And when you disrupt that and put these inflammatory, you know, fats and lipids in there, then you completely change the cell biology.  You completely change the cell potential and you lose intracellular signaling. And that’s, you know, sets the cell up to become dysfunctional. If that cell becomes dysfunctional, the tissue becomes dysfunctional, the organ becomes dysfunctional. And there you go.

Dr. Weitz: Now the argument is made that saturated fats are inflammatory and increase heart disease because they increase LDL particle number increase.  They increase the risk of heart disease. They’re [00:48:00] not the only thing involved. You have to have inflammation, oxidation, things like that. But that’s the argument for reducing saturated fats.

Dr. Bryan: Yeah, well, that’s a flawed argument I gotta do is look at the science. I mean, you can look at the epidemiological data from lowering cholesterol and lowering LDL.  There’s no benefit in primary, secondary, tertiary prevention trials in tens of thousands of patients. And so, you know, if cholesterol doesn’t cause heart disease, lowering cholesterol will not affect heart disease. And that’s exactly what we’ve seen over the past 30 years. In fact the rate and incidence of heart disease has increased with the use of statin therapy.  Yet, you know, there’s some cardiologists who still, they wanna put statins in drinking water and get everybody’s cholesterol below 200. So you can’t make vitamin D, you become immuno. No compromise. You can’t, men can’t make testosterone. Women can’t make estrogen. And it’s the perfect recipe for being dependent upon drug therapy for the rest of your life, which is the [00:49:00] golden 

Dr. Weitz:  I think the way it’s seen is even by, say, more modern thinkers, is you need two things to happen.  You have to have a lot of LDL and you have to have inflammation and oxidation. So if we reduce the oxidation, inflammation and we reduce the LDL, aren’t we better off?

Dr. Bryan: Well, no, for sure. Look, it’s the inflammation, oxidative stress, and immune dysfunction, right? That cause chronic disease, right? So yeah, if you’ve got naloxone oxidative stress, I would argue that the body increases cholesterol in response to inflammation.  People who inflame typically have higher cholesterols. But that’s a protective mechanism. And that would be like blaming firetruck on the fire, right? Because firetruck always show up at the fire. But did the fire trucks cause the fire? Right. I mean, it’s a misinterpretation, it’s a gross misinterpretation of data.  You know, I spent 25 years in academia, published over a hundred peer reviewed papers, and I reviewed thousands of [00:50:00] papers that people were trying to publish. And I never argue with the data because the data are the data. The problem is the misinterpretation of that data. And that’s the dangerous proposition that we deal with in the published literature.  ’cause today you can find whatever you want to in the public literature.

Dr. Weitz: What are some of the other lifestyle factors that increase nitric oxide production–say exercise?

Dr. Bryan: Yeah, for sure. Exercise. I mean, that’s why exercise is medicine because it stimulates and activates nitric oxide production. You know, sunlight, 20, 30 minutes of sunlight exposure both on.  Both ends of the kinda the visible spectrum. You know, UV radiation can cleave nitric oxide down to cystine ths, the infrared full infrared spectrum. Certain wavelengths can release nitric oxide that will spin bound to metals and liberate that nitric oxide for vasso relaxation and vasodilation.  What else? Elimination of sugar from your diet. Okay. That’s kind of the biggest culprit because anything that leads to an increase in blood sugar, [00:51:00] you know, sugar’s sticky glucose is sticky and it sticks to proteins and, you know, locks it in the white causation. Of course, what hemoglobin A1C is, it’s the, you’re quantifying how much sugar is stuck to hemoglobin.  Right. And it sticks to nitric oxide synthase. And, you know, and when I see, you know, all these bead products out there that are, you know, got four grams of sugar and all this added sugar in these hydrated gel matrix and trying to, I mean, it’s, it would be comical if it wasn’t dangerous.

Dr. Weitz: What’s a hydrated gel matrix?

Dr. Bryan: You know, you see these things that are advertised on TV with these beets and you know, I see it all the time. It’s made of seed oil and sugar. They’re putting beets in seed oil and sugar, and I cannot think of a worse idea.

Dr. Weitz: Is any fermented beet product better or only if the beets are really grown in high nitrogen soil?

Dr. Bryan: Well, no, if, I mean, if you [00:52:00] focus on, you gotta have a substrate or starting material to ferment, to concentrate those metabolites. If there’s no nitrate in that beet product to start with, you can add starter cultures of bacteria all day long, but there’s nothing to convert.

Dr. Weitz: Right. So the beets have to be grown in soil that’s higher in nitrogen. Exactly. But some nitrogenous fertilizers are not necessarily healthy either. Right? They’re very,

Dr. Bryan: well, look, what you have to do is, and. You know, you have to do a soil analysis, right? There’s data showing from the 1940s to the 2010s.  There’s 78% less basic micronutrients in the soil in America, the farm America’s farmlands. And so what we have to do is we have to do a soil analysis when we grow our vegetables and figure out what’s, what are the basic missing nutrients from that soul? And then you gotta replete it. You have to fertilize.  If it’s deficient nitrogen or phosphorus, or potash, or we’ve gotta put it back in there. If the soul is too acidic, we gotta add lime to [00:53:00] it. If it’s doesn’t have, you know, selenium, chromium, and the right bacteria to these nitrogen fixing bacteria, then you gotta, you know, add these bugs to the soil. But, you know, that’s a whole field of agronomy that we, that’s, you know, very complex science.  But, you know, soil need nitrogen. So, for instance, I have 800 acres out here in Texas. We raise our own beef and we grow our own vegetables. But every couple of years, I’ll take a soil sample, take it to the USDA office. They’ll tell me what my soil sample needs, what it is and what it’s missing. And then I make a custom fertilizer and I add it to the soil.  But it’s nitrogen based fertilizers. Typically it’s a, you know, 28, 14 7, 3 and a half with this three and a half being sulfur. And then that provides the nutrients that it needs. But the vegetables that I grow and eat personally are not considered organic. ’cause we’ve had nitrogen based fertilizers to it.  But there are no herbicides, there are no pesticides. So what we grow is a nutrient rich, nutrient dense, pesticide, herbicide free vegetable, which [00:54:00] is exactly what you want, but it’s not organic.

Dr. Weitz: Ah. So you can’t do that with organic..

Dr. Bryan: no organic to get an organic label. In the US you can’t add herbicides or pesticides, but they don’t allow you to add nitrogen based fertilizers to the soil.  I mean, you need nitrogen to assimilate most nutrients in the soil.

Dr. Weitz: Is there any way to naturally add it? If you’re an organic farmer?

Dr. Bryan: No, you can, you add manure, right? Whether you add compost right. Or you add, you know, chicken litter or, you know, cow manure, which is

Dr. Weitz: probably what organic farmers are doing anyway, right?

Dr. Bryan: Yeah. But again, there’s no standardization,

Dr. Weitz: right.

Dr. Bryan: That, is there enough nitrogen in that compost to lead to, you know, any as assimilation and accumulation in the soil? ’cause it’s not measured.

Dr. Weitz: Right. Interesting. Should we take a probiotic for the mouth to increase the healthier microbiome of the mouth?

Dr. Bryan: You know, the answer is yes, but the the reality is there’s not an oral [00:55:00] probiotic available, commercially available that’s designed to restore this flora. You know, we discovered this back probably 10 or 12 years ago. I filed a number of patents because we identified the bacteria. They were necessary and sufficient for adequate nitric oxide production.  And then I went to the FDA because we were going to develop this as a prebiotic or probiotic. Okay. In the FDA’s infinite wisdom at the time, they says, look, you need long-term safety studies on these non-pathogenic commensal bacteria before you bring it to market. Maybe I called it a vaccine. And then they wouldn’t want safety data.

Dr. Weitz: We won’t go there. The games people play. Great. So there’s been a fascinating discussion. How can listeners and viewers find out more about your products and what you’re up to?

Dr. Bryan: Well, I try to direct everybody to the, my latest book, the Secret of Nitric Oxide, bring The Science to Life. ’cause this really tells the 30 year [00:56:00] journey in nitric oxide field, what it is, what it does, how it’s produced, and what you may be doing to disrupt it naturally.

Dr. Weitz: When was that book published?

Dr. Bryan: I launched this, I believe in February or March. I was on Fox and Friends, we did Oh, okay. Media tour on it. So it’s a new book, you know, probably six months old now. Cool. And then I refer people to my YouTube channel, you know, subscribe. Nate, Dr. Nathan S. Bryan, Nitric Oxide on YouTube.  I’m on Instagram. Dr. Nathan, s Bryan, LinkedIn. And then for those interested in the product technology, word, n one oh one.com, that’s the letter n number one, letter o number one.com.

Dr. Weitz:  Now, is this a product that practitioners can carry as well?

Dr. Bryan:  Yeah we have a direct to consumer business, but we also you know, support our medical practitioners, whether they get a wholesale and then they can resell it to their patients at a price that’s reduced from what the consumer can buy direct from us.  So we incentivize, you know, patients to go to their provider and because they can get the product cheaper from them than they can coming direct to [00:57:00] us.

Dr. Weitz: Is it available on Fullscript?

Dr. Bryan: Not yet. We’re working on full script, but we’re trying to get this and make it simple for practitioners to have, for the patients to have easy access to the product.

Right.

Dr. Weitz: That’s great. So you, once again, the name of your product is N 1 0 1. Yes.

Dr. Bryan: It’s N one oh one.com. So for nitric oxide, one nitrogen. One oxygen nitric oxide.

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

Dr. Bryan:  Thank you, Ben. Good seeing me.

____________________________________________________________________________________________________________________________________

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 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.

Jared St. Clair discusses How to Enhance Your Vitality with Proper Nutrition and Lifestyle Changes 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

Navigating Nutritional Supplements, Gut Health, and Endocrine Disruptors with Jared St. Clair
In this episode of the Rational Wellness Podcast, Dr. Ben White speaks with Jared St. Clair, a seasoned herbalist and natural supplement formulator with over 30 years of experience running Vitality Nutrition. They discuss the current state of health in the U.S., the importance of individuals taking charge of their own health, and the role of nutritional supplements in addressing chronic health issues like IBS and SIBO. St. Clair emphasizes a holistic approach to health, focusing on gut health and the critical impact of endocrine disruptors. The episode delves into strategies for improving gut health, types of probiotics, effective detox protocols for endocrine disruptors, and guidance on evaluating the quality of nutritional supplements. The conversation aims to empower listeners with practical advice for enhancing their health naturally.
00:30 Meet Jared St. Clair: Herbalist and Supplement Expert
01:28 The State of Health in America
02:49 The Importance of Taking Charge of Your Own Health
04:05 Challenges and Successes of Running a Health Food Store
06:29 Gut Health: IBS and SIBO
10:49 The Gut-Brain Connection and Mental Health
17:28 Strategies for Managing IBS
21:22 The Role of Digestive Enzymes
26:38 Understanding Probiotics
31:22 The Role of Lysed Bacteria in Gut Health
31:52 Understanding Postbiotics
32:49 Prebiotics vs. Probiotics vs. Postbiotics
34:16 The Benefits of Prebiotic Foods
35:40 Evaluating Nutritional Supplements
38:30 Identifying Quality Supplement Brands
45:43 The Impact of Endocrine Disruptors
50:19 Detoxifying Endocrine Disruptors
58:01 Final Thoughts and Contact Information
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Jared St. Clair is an herbalist and and expert natural supplement formulator with over 30 years of hands-on experience running Vitality Nutrition, a health food store in Utah and the host of the Vitality Radio Podcast.  His website is VitalityNutrition.com.

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

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Podcast Transcript

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

Hello, Rational Wellness Podcasters. Today we’ll be having a discussion on nutritional supplements and health with a herbalist and expert natural supplement formulator Jared St. Clair. Jared has over 30 years hands-on experience running Vitality Nutrition, a well-known health food store in Utah, and he also consults with clients privately.  He’s known for his Vital Five essential supplements.  He’s crafted highly effective formulas and protocols for health concerns from digestive issues and hormone imbalances to immune support and emotional wellness. As the host of the Vitality Radio podcast, Jared educates listeners on mastering nutritional supplements to thrive without pharmaceuticals.  Jared, thank you so much for joining us today.

Jared: Hey, I’m excited to be here. Thanks for the invite.

Dr. Weitz: That’s great. So perhaps we could start this discussion by giving us your opinion of where we are in terms of the health of our country. Are things getting worse, better? I’ll just tell you my own impression is that chronic diseases continue to increase, obesity rates continue to increase, though maybe GLP one agonist drugs are here to save us.  But certainly the standard American diet does not seem to be improving as ultra processed foods seem to proliferate. And as costs go up, people consume even more of these ultra processed foods.

Jared: Yeah, I, well, I think you’re you’re pretty much on the same page as I am. I do think, you know, I always like to have a positive outlook on life as much as possible.  I think that’s actually one of the biggest keys to optimal health. So I’m always looking at the silver lining of what’s going on out there. Right. And it’s kind of an interesting thing because. As we see our health degrading as a country and to some extent as in this entire, you know, on this entire planet.  But I think it’s, I think America’s uniquely not so great. Yes.

Dr. Weitz: We lead the way in bad. Exactly.

Jared: So go USA, right? But as we see that we also see people getting to the point of so much frustration with what they’ve been doing that hasn’t been working, that they are looking for [00:03:00] alternatives and they’re looking for options.  And I believe we actually are in a bit of a kind of a renaissance period where people are really digging in and trying to understand their health and more and more people taking charge of their own health. You know, one of the things I say on my show a lot. Is that, I think one of the biggest mistakes that’s happened in our culture in America is that we’ve essentially been taught to turn our health over to some kind of an expert.  Whether that’s a guy in a white coat or a guy in a health store, or a chiropractor, or a functional medicine doctor, or whoever it is. I really think that’s a mistake, period. I think we need to be in charge of our own health, and then we use those people as you know, sounding boards for advice, for recommendations.  But to just go into an appointment and do as you’re told and kind of offload that responsibility onto somebody else, I think is a really slippery slope into pretty bad health.

Dr. Weitz: Yeah. I love that sign behind you that everybody’s entitled to your opinion.

Jared: Not everybody wants it, but they’re all entitled.

Dr. Weitz:  So on a personal level, how’s your health food store doing?

Jared: Well, you know, my store’s doing great actually. It’s interesting ’cause we are an independent mom and pop health food store. We still have one location. We’ve had one location for 48 years. Actually this week as we’re recording, we’re preparing for our 48th birthday sale at the end of this week.  Wow. So it’s been going a long time. I’m 53. So I was five when my parents opened the place. My son has been working with me now for about 10 or 11 years. So we’re fully into that you know, third generation. And it’s interesting ’cause stores like mine are kind of a dying breed for sure. There’s more and more independent stores that were started by, you know, really good.

Well-meaning people that have just not been able to survive. You know, the Amazon age you know, every big box store in the world has vitamins and herbs now. Right. You know, Costco, one of their biggest categories is supplementation. And that just wasn’t a thing when we started. Heck when we started, supplements were barely a thing.

Back in 1977. So it has been difficult, but what I’ve found is [00:05:00] that education is what people are really starving for. People really want to understand if they’re going to put something in their body, they wanna understand why they’re putting it in there, what to expect when it gets there, and how to tell if it’s working or not working.  And there’s a lot of questions about how in the heck do I tell just looking at a bottle if it’s a good product or not. And so I spend a lot of my time trying to help people figure that stuff out.

Dr. Weitz: Well, that’s good because you’re definitely not getting anybody to help educate you at Costco.

Jared: Well, yeah.  Yeah. They want in and out. Nobody gets hurt over at Costco. Right. And really, I mean, that’s even the case with the big, to a large degree with the big supplement stores, you know, your Whole Foods and Natural Grocers and rab. Yeah. There’s not a lot of education there. 

Dr. Weitz: No, absolutely.  It’s very hard to get anybody who has any clue in Whole Foods. Yeah, so that’s great. So that’s one of the keys is providing education and personal service.

Jared: Yeah, I think that is the key to what we’ve done here. We’ve always taken that very seriously and [00:06:00] we’ve gotten a nice little group of people that support us locally.  And then our website, vitality nutrition.com, which launched about close to four years ago now we have a chat feature on there where people ask questions, and we’re right there to answer those questions and people can call us even if they’re, you know, not in Utah, where we’re located. You can call our phone number and we’re happy to help you with questions over the phone as well.  Our big focus is education and really trying to help you understand and make decisions that make sense when it comes to your supplementation.

Dr. Weitz: That’s great. So, let’s talk a little bit about gut health, which is one of my favorite topics. Sure. Why don’t we start with IBS or sibo? What’s your take on that?  What sorts of strategies have you found to be effective?

Jared: Sure. So, you know, IBS of course, as you probably know, and I would imagine a lot of your listeners know is a bit of a catchall diagnosis, right? Right. People get chronic diarrhea or constipation or cramping, or by, 

Dr. Weitz:  By the way, for those who don’t know, IBS stands for Irritable Bowel syndrome.

Jared: Right?  So it’s like kind of a disease state, I guess, but it’s all over the place. And there’s even categories within IBS, right? IBS-C, which people that lean more towards constipation, IBS-D people that lean more towards diarrhea and there’s a bunch of stuff in the middle that is kind of IBS too.  But the problem with IBS is there isn’t really a medical answer to it at all. Some doctors will recommend things like a low FODMAP diet you know, that sort of thing. But other than that, you know, they might recommend Tums after a meal or, you know, Mylanta or that kind of stuff. They really don’t have a lot of answers.  And I guess to some degree that’s modern medicine in a nutshell.

Dr. Weitz: Well, I’ll be honest with you, for a lot of years, one of the most common recommendations for IBS, especially considering that the overwhelming majority of IBS suffers are women, are antidepressants.

Jared: Yeah. And still is a major category of prescribing.  You’re right. And [00:08:00] you know that initially when I very first heard that, I thought. I don’t even understand what they’re thinking there. But then as I started digging into this is years ago now, 

Dr. Weitz: I think they were thinking anti-stress related disorder.

Jared: Well, yeah, it, it started making sense as to why it might help, because we know that the gut brain connection is this really strong connection.  There’s more you know, what’s the word communication, going up and down that vagus nerve from gut to brain to gut than any other nerve system in the body. Any other highway, if you wanna call it in the body. And, you know, SSRIs, which are what’s typically prescribed the selective serotonin reuptake inhibitors like Prozac or Zoloft, have been recommended.  Initially, I thought, well, they’re. Trying to get people to, you know, feel better, have less stress, less, and maybe they’ll have less gut issues. But we also know now that like 90% of the serotonin that’s made in the body is made in the gut and then shoveled up to the brain. And so it made sense to me that at least that prescribing, which I think is a terrible idea.  ’cause it doesn’t [00:09:00] answer, it doesn’t fix the problem at all. And it comes with a load of potential side effects. I just did a whole show on SSRIs last week talking about that. But it at least made sense what the thought process was once I kind of dug into it.

Dr. Weitz: Well, it turns out that the prescribers had no idea about this, but it’s actually the case that there are a huge amount of serotonin receptors in the gut, right?  A big part of IBS is a lack of motility problems. And it turns out that stimulating the serotonin in the gut stimulates those serotonin receptors, which actually improves gut motility.

Jared: Yeah. 

Dr. Weitz:  And so, and that’s why you’ll see five HTP in some pro motility natural supplements.

Jared: Right. Yeah. So there was a rhyme or reason to it at least.  I mean, it’s technically off-label prescribing, you know, those drugs were never made for that. But some people did get relief with it. And, but what’s interesting is if you start to kind of [00:10:00] dial backwards from that thought process, you start to recognize maybe that it isn’t the brain or serotonin in the brain that’s actually creating a lot of these depression and anxiety issues.  It’s actually the gut that isn’t able to produce the hormones that are needed to be produced and the levels that they’re need needing to be produced. And so then if we’re trying to. Resolve it by just making more serotonin. You’re not gonna resolve anything. You may feel better at least in the short term, but there’s no real resolution if the problem actually started in the gut and we’re giving a drug that really primarily acts in the brain.  So when you, so when people come into me and they say, I’ve got IBS or I’ve got Crohn’s, or I’ve got ulcerative colitis, or SIBO, or whatever the first thing I actually o okay, let me back that up. I started that wrong. If people say I’ve got depression or anxiety, the first thing I think is gut.

And then I ask them about IBS and SIBO and some of these other things and ask ’em if they actually have gut issues. ’cause they know they don’t feel good, [00:11:00] right? They’re depressed, they’re anxious whatever it is. And I’m telling you, maybe eight times outta 10 when I ask that question, they say, oh yeah, I struggle in that area too.  My gut isn’t, you know, I don’t feel good after I eat. I have chronic diarrhea or constipation or whatever. And the studies actually play that out. That is a connection that’s extremely common. I’m gonna give you. A number based on memory. And I might be wrong on this, so don’t get don’t hold me to the exact number, but I think it’s like 65%, if I remember correctly, of women who have been diagnosed with MDD, major Depressive Order are also diagnosed with IBS.  And so there’s a really strong correlation there. And to me that means the gut is where it starts and the brain is kind of where it ends. And we really need to look at the gut first.

Dr. Weitz: Sure. And then of course we have SIBO, which we now know is a major cause of IBS problems

Jared: For sure. And it’s interesting too because now that’s kind of new, right?  I think a lot of people listening to shows like, like your show and my show [00:12:00] maybe haven’t even heard of SIBO before. I don’t know how much you talk about it. I’ve recently started talking about a lot because they have a lot more people asking me about it. Yeah. 

Dr. Weitz:  We’ve been talking about SIBO a lot, have you?  Yeah. Years. Yeah. But you know, I’ve had Dr. Pimentel on a number of times, and he’s the guy who really has done a lot of primary research proving that SIBO is the main cause of IBS.

Jared: Yeah. And I’m starting to lean that way too. And I used to really put most of my focus on what’s going on in the colon which of course is, you know, at the bottom of the digestive tract.  And I wasn’t paying much attention into what might be going on up above that in the small intestine. Right. But as you start to recognize that the small intestine is. Very I’ll say vulnerable, maybe more in the American in the way that we do things with the American diet and with antibiotics and with PPIs in America we have some real problems.  You know, we put people who have reflux on proton pump inhibitors, and that reduces stomach acid. And [00:13:00] stomach acid is supposed to help us digest our food. But not just that. It’s also one of the primary protectors of bacteria not making it into the small intestinal tract where it can create problems, right?  So a lot of people that have issues, you know, in the esophagus and the stomach up, and then that drug is creating issues from the esophagus down, right? And so. Just exacerbating things and making people worse, not better.

Dr. Weitz: Absolutely. Yeah. So a, as you’re talking about hydrochloric acid produced in the stomach is one of the things that keeps bacteria from building up in the small intestine Right.  As well as digestive enzymes, as well as the normal cleansing ways from our motility. Do you ever do testing for things like SIBO or gut testing? Stool testing?

Jared: So, at our place, because we’re, we don’t have any doctors on staff. Right. Okay. Or practitioners. We don’t do that. We do often refer people out for that.  Right, right. And we will recommend a lot of what I do initially [00:14:00] is just help people see what the problem might be. Right. Ask a lot of questions get a lot of feedback from the client to see, okay, what, what might be going on. And then in many cases you can kind of, you know. Put the dots together and recognize, you know, what probably is going on.  Right? And there are some things that are relatively universal. You mentioned digestive enzymes, right? I think that’s something that way too few people are talking about. That’s such a critical component, especially once we get into our thirties and forties and on up. Everybody talks about probiotics.

Probiotics are great, but very few people are talking about digestive enzymes. And one thing that I’m talking a lot more about recently, well I don’t know recently, probably for the last 10 years, is boosting up that stomach acid. You know, whether it’s things like apple cider vinegar or taking HCL when that makes sense.

And then of course, helping people as much as possible, because I actually dealt with this as a younger man. When I was 26 years old, I had really severe acid [00:15:00] reflux really bad case of it. My doctor that did a scope on me, said it. I was one of the worst cases he’d ever seen, and he did 800 of those scopes a year.

So, and that was when I was much younger, much dumber probably than I am, hopefully than I am now. And really just wasn’t listening to the advice that my parents had been giving me as a child and was eating all kinds of junk and was under a lot of stress and all that stuff. But because I was able to shut down acid reflux, I haven’t had that issue in 26 years, 27 years now.

Dr. Weitz: What was the key to you overcoming your acid reflux?

Jared: Well, one thing was diet change. You know, I definitely beefed up the natural and reduced the you know, hyper processed foods and all that kind of stuff. But the, but primarily what I did was adjusted supplementation. I did go on key probiotics back then.  I started using significant doses of digestive enzymes, which frankly, someone at 25, 26 years old back then, 26 years ago, in most cases, would probably have enough digestive enzymes that they’re producing. But [00:16:00] what I recognized. That I didn’t recognize then ’cause I just wasn’t as educated then as I am now.  Is that one of my biggest issues? Probably my very biggest issue was I had two businesses back then. I had the supplement store that I still have now, vitality, nutrition, and then as a young and you know, kind of starry-eyed kid, I also bought another business and thought I could run them together and be successful and I created myself just a massive amount of excess stress.

What was your other business? No, I was just a advertising franchise. I was going into little businesses like mine and trying to sell ’em advertising. I see. I got snookered big time. The person that sold me the business lied to me about all the stuff. I lost a couple hundred thousand dollars in the first year and a half of doing that business.

I didn’t have that money to lose. I was broke at the time already. So that was all death that I created and I was eating out a lot ’cause I was on the road a lot. So I was eating out. I was eating under stress. That’s one thing that, I don’t know if you talk about this on your show, but I talk about it a lot on mine.  We’ve got to learn to slow down when [00:17:00] we eat and put ourselves into a rest and digest state before we eat so that our body’s digestive capacity is optimized. I recognize now that I was probably working on 10 or 20% of my digestive capacity because I was always eating in a hurry and I was always eating under stress.  Right. And that’s, I think what created it more than anything.

Dr. Weitz: Absolutely. You gotta try to get into that parasympathetic state. Yeah. What about IBS? What are some of the strategies you use for IBS?

Jared: So with IBS because again, it’s kind of a general term and there’s different things, I will quiz people a little bit more about, you know, where they’re at on that kind of spectrum, I guess, of IBS.  And so I’ll make recommendations a little bit different.

Dr. Weitz: Let’s say you have somebody with constipation and they have bloating and abdominal pain.

Jared: Okay, so I actually, based on my experience with acid reflux about 15 years ago, I developed a formula that we call back on track. And it’s a combination of digestive [00:18:00] enzymes.  It has peppermint, ginger and fennel in there as well, which are nice na natural anti-inflammatory herbs for the gut. And then it’s got some key spore probiotics one called bacillus coagulants, another one Bacillus subtilis and bacillus quasi. And for people that aren’t familiar with spore probiotics, these are not human strains that are naturally found in the human digestive tract, but they are found in our environment and most of us have them in our gut at some point ’cause we’re breathing them in, getting ’em in on food and, you know, from our fingers and all kinds of things.

And these spores are incredibly beneficial to the human gut in terms of helping to eliminate excess bacteria, you know, overload and other issues like that, parasitic things and things like that. As well as helping to create an environment that is conducive to the replication and production of our good bacteria.

And what I recommend, number one, with anybody with IBS is that formula with every meal, because they almost always are getting [00:19:00] less enzymes than they need. They almost always have been on too many antibiotics or other things that have wiped out their gut. And so they need the probiotics. And in every case, I think just about someone with IBS is dealing with inflammation in the gut, right?

So that at least addresses. As much as I could comprehensively in one capsule. You know, a pretty wide range of things. And then depending on what else is going on, if it’s constipation, oftentimes I’ll recommend aloe vera juice, a good whole leaf aloe vera juice. I’m a huge believer in that ’cause it’s very anti-inflammatory to gut.

It tends to help with gut motility as you were talking about. I sometimes will recommend various different herbal supplements to kind of help with gut motility and that depends on the individual and their level of sensitivity and things like that. But sometimes I tend to like to do this in for short term, but sometimes I’ll recommend cascara sagrata to get things moving.  I always ask if somebody’s on magnesium

Dr. Weitz:  Cascara for people who don’t know, it’s an herbal laxative.

Jared: Yeah. And I don’t love it long [00:20:00] term because I do think your body can kind of build up a bit of a tolerance to it and have more of a need for it over time. But in the short term, I think it’s very effective and very safe.  And then the other thing that I really will. Ask people about is besides the IBS I’ll ask how I, sorry. Besides general IBSI guess is a good way to say it, right? I’ll ask, how long after a meal do you tend to start feeling discomfort? Is it pretty immediate or is it like 30, 35, 40 minutes later?  And based on that, that gives me a lot of information. ’cause if it’s pretty immediate, then I’ll make a pretty good educated guess that they probably are low on stomach acid. They’re actually just having a hard time actually breaking down that meal right there in the stomach. And then I’ll recommend sometimes apple cider vinegar capsules, sometimes bane Hydrochloride capsules.  I actually lean towards vinegar over beam because it’s a little more gentle and it tends to work really well. It’s also pretty economical and pretty easy on the stomach. And then they’ll, I’ll add that with the back on track and that makes a lot of sense for most people. If they’re [00:21:00] having the issue a little bit later then I’ll sometimes re.

Additional levels of digestive enzymes, or I will start that conversation about sibo. I’ll pretty much always ask about SIBO now, which, like I say, up until, you know, several years ago I really wasn’t talking about SIBO much, and I was almost never having anybody ask me about sibo. And now lots of people are discovering that yeah, this is a real,

Dr. Weitz: so when it comes to digestive enzymes is actually a big category of different products.  

Jared: Sure.

Dr. Weitz:  So we have pancreatic enzymes, which come from animals. We have plant-based actually enzymes, right. From fermented. We have, we have brush border enzymes. We have specialized enzymes to break down cellulose, to break down lactose, to break down gluten. We even have FODMAP enzymes, so there’s a huge amount of specialty enzymes.  What do you think is, when do we want to use which of [00:22:00] these products?

Jared: Well, I think it’s really good for people to and this is where I kind of go back to what I first said when we first started this conversation about, you know, being your own best doctor to a large degree, you really have to pay attention to what it is that you’re doing that creates those issues.  So, you know, after your meal if you start to have issues and, you know, let’s just say for instance, it’s cramping and bloating or gassiness you know, take, keep a little food diary for a month or two and write down, okay, what did I eat and how did that affect me? And how badly did it affect me?

Was it a nine outta 10 on the discomfort scale or a two out of 10? Or was there no effect at all? And pay attention to that and see where you’re at because that can help you determine if. You’ve got a lactose issue or you’ve got a gluten issue, it can help you determine if you’re struggling more to digest fibrous foods like veggies and things like that, or you’re struggling more with high protein foods.

Paying attention to that is really big. Now, you can do something that’s. Pretty comprehensive. I [00:23:00] mentioned the back on track formula. It covers those bases pretty well. It doesn’t have anything specific for people that are dealing with like real issues with gluten, but it covers lactose, it covers cellulose and or sorry, cellulose and you know, protein and sugars and carbohydrates, starches, you know, all that kind of stuff.

Lipase for fats. I’ll also always ask if there’s a gallbladder present because lots of us have had those removed and I just did another show about the problems with that because no gallbladder, you know, then I’ll ask. Yeah, I

Dr. Weitz: actually listened to that show. Oh, did you? Yeah.

Jared: Yeah. So I, I don’t know how close we are to the same page on that one, but it’s a real problem for a lot of people.  Yeah. And so I always ask that question too, and I’m shocked, frankly, still, even though I know the truth about it at how many people don’t have a gallbladder anymore. It’s yeah, that’s, you know, that’s a real important component. Just like you, my wife had her gallbladder out. Yeah. Yeah, so it’s, you know, that’s a problem.

So I ask about that, and then if that’s an issue, then we’ll, [00:24:00] I’ll talk about lipase as an enzyme and bile salts, you know, as a, another option there, particularly with high fat meals, right? So the big thing is. I believe the ultimate wild card in health is the individual that we’re talking about.

Right. And so, you know, whatever I were to recommend to you might not be why I’d take my myself. You know, based on how you might answer the question that I’m asking you, there is not a one size fits all. And when it comes to digestion, again, IBS is a pretty broad category of different symptoms. And so, but I’m.

Comfortable saying that if I get enough feedback that over time we can get people to a point where they’re not experiencing those issues anymore and with less issues in the gut. You know this, and I think inherently most people recognize this, A lot of other things upstream and downstream are doing a lot better too.

When we start addressing people’s IBS issues, their depression and anxiety almost always improves because again, the gut and the [00:25:00] brain are, you know, inextricably connected. And if the gut’s not doing well, the brain doesn’t do too great either.

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Dr. Weitz:  So when it comes to probiotics, another huge category of nutrients, and interestingly, a lot of times when people talk about probiotics, they sort of talk about as it’s one thing, like, what about probiotics?  Do you recommend probiotics? And you know, as you talked about spore based, we have. [00:27:00] A huge number of specific strains that have been shown in specific studies to have different benefits, right? We have categories, we have lactobacillus strains, we have bifido strains, we have we have Croce, ardi and healthy Yeast there.  There’s a huge number of supplements, and now we have specialty products like Akkermansia on the market. So when do you wanna recommend which types of probiotics?

Jared: That’s a great question and it’s a deep question and I know you know that there’s a lot to talk about in this topic, so I’ll try and keep it, you know, somewhat surface level, but you know, feel free to ask any questions you want.  So I am a believer generally speaking, that the spore probiotics are. Probably the most universally beneficial in terms of actually really rebuilding and strengthening the gut biome. And there’s a couple of reasons for that. One is that human strain probiotics are very they don’t have a high level of resiliency [00:28:00] once they’re removed from the gut.  And so, you know, they’re used to a very specific temperature, a very specific acid level, a very specific oxygen level and moisture level and all these things. And when they’re pulled out as most people know, most probiotics are found in fri well, a lot of probiotics anyway are found in the refrigerator ’cause they’re not particularly shelf stable.

We just talked about that acid in the stomach. It’s by design there to help us prevent getting poisoning from things like say e coli or salmonella or something like that. Which means that acid is designed to kill bacteria. So when we take a human probiotic, which is bacteria, that acid in many cases will break that down as well.

I’m not opposed to human trained probiotics and to make sure that people are clear on this. Again, spores are environmental. They’re found in our environment and human strain would be found native to the human gut. We need those bacteria, they’re really important. And antibiotics and cesarean section births and not enough, you know, long enough time breastfeeding or not breastfeeding.  These are all things [00:29:00] along with glyphosate. There’s so many things that are attacking our gut and our microbiome right now. So we need those guys. But it’s pretty hard to get those guys back in the gut in the form of a capsule or something like that because of the stomach acid,

Dr. Weitz: and by the way, spore based or sometimes known as soil based.  Sure. And they start with names like Bacillus subtilis, bacillus, et cetera. They’re usually of the bacillus. Family. Right?

Jared: Yeah. And that gets a little confusing too because you mentioned lactobacillus, right? So if you’re looking right if you’re listening to this show and you’re looking at your probiotic bottle, if you see lacto at the beginning, that’s a human strain.  If you see bifido, that’s a human strain. If it just says bacillus, not lactobacillus, then it’s a spore strain. That’s probably the most, the easiest way to try and determine what you’re looking at, whether or not it’s a spore or a soil-based probiotic. But I love human strains for symptom relief. If somebody’s really struggling, you know, you mentioned constipation.  I’ll say even more so on the diarrhea side of [00:30:00] things. If someone’s really struggling with chronic diarrhea, I’ll give ’em a human strain probiotic that’s very specifically high in kind of colon specific bacteria that has a high activity in the colon. And when you take a probiotic like that, you almost always will get symptom relief.

What you usually don’t get, unfortunately, is enough colonization of those strains to actually solve the problem long term. But in many cases, you’ll feel better in a day or two or three, and that matters, right? We gotta slow down, slow things down. In that case. What I’ll tell people is I’ll tell people to get on a spore probiotic.

We have our back on track formula. I have another spore product called Vital Spores. Get on one of those right now, but don’t necessarily expect to see significant benefit in the first day or two or three. It takes a little bit of time, in most cases, for the spores to really kind of kick in and do their thing.

So I usually recommend a minimum of like three months to six months, but I do expect people to feel better in the first 30 days at least, you know, somewhat better. And if they’re struggling [00:31:00] with, you know, here and now issues, then I will recommend a human strain probiotic because what happens with the human strains when they hit the stomach acid or when they’re exposed to too much heat is they are what’s called lysed.

They’re not technically. Killed. It’s kind of like the Princess Bride for people that remember that movie where, you know, he was mostly dead, right? These strains are kind of like that. They get lysed, which means that they’re no longer able to colonize in our gut, but they can deliver benefit because as they’re moving through the gut, the micro DNA that’s in that bacteria will actually speak to the bacteria that’s in our gut and essentially deliver marching orders, for lack of a better term.

There’s a lot of support there, and life’s bacteria can be extremely good for symptom relief. It’s just not that great for actually rebuilding and recolonizing, and that’s where the spores come in. So, really depends on what people are looking at. We also, we hear the term post biotic a lot. Now. That’s another term that nobody was talking about a few years ago, and now everybody’s talking about right.[00:32:00]  Postbiotics are for the most part, just lyed bacteria. They’re bacteria that can’t actually deliver a you know, colonization, but they can in many cases deliver benefits. Akkermansia you mentioned is usually in the form of a post biotic as opposed to a probiotic, even though technically if it was living, it would be a probiotic.

Dr. Weitz: Right. I think you can get it refrigerated and living.

Jared: Yeah. You know what’s interesting though? I don’t know if you’ve read this research, so they’ve done studies on living akkermansia versus what they call heat.

Dr. Weitz: I know there’s one study that shows that killed akkermansia was more effective.

Jared: Yeah.  Isn’t that interesting? Yeah. Like significantly more effective. So, yeah. So it’s not a bad thing to have a life bacteria have a post biotic. In fact, it’s a very good thing, but that won’t be what recolonize your gut.

Dr. Weitz: Right. So what about prebiotics versus postbiotics a as well as pro probiotics?

Jared: Yeah, so prebiotics I think are one of the better ways to actually [00:33:00] help to recolonize the gut. Now, it is interesting because I get this question a lot because I’m such a big fan of spore probiotics. Spore probiotics are not postbiotics and they’re not prebiotics and they’re not traditional.  Probiotics. Either they’re kind of their own little animal. But what they do when they get into the gut is they actually release a bunch of d different natural antibiotics. These are antibiotics that are going after pathogenic bacteria and parasites and things like that in the gut, mold, Yeast, fungus, those kind of things.  And they’re very effective at helping to kind of kill off the bad guys while they’re in there. The other thing that spores do is they actually create an environment of a high level of lactic acid, which. Is essentially food for the good bacteria. So while it’s not exactly a prebiotic, it does have some prebiotic properties.  And so in many cases spores will kind of cover the base of a prebiotic, but they don’t necessarily feed the good bacteria in the way that [00:34:00] a prebiotic does. So I think using prebio makes a lot of sense. I personally am more of a fan of trying to include those in your diet as opposed to supplementing with them.  I believe that’s how we were meant to get them anyway. And if we can include good quality prebiotic food in our diet.

Dr. Weitz: So what are your favorite prebiotic foods that you like to include?

Jared: Well, I think any type of good quality fiber is generally, and I guess I shouldn’t say any type.  Some are better than others, but most good fibrous foods make a lot of sense there.

Dr. Weitz: So what are some of your favorites?

Jared: I really like, the fruit and vegetable fibers. Specifically. I’m a big fan of cruciferous vegetables in that area. Okay. ’cause you get some really good prebiotic fiber in cruciferous vegetables, but you also get the, this really cool side benefit of the dim and the indu three carbon.  All that help with hormone balancing and detoxifying, endocrine, the endocrine system. So that’s a kind of a, you know, a win-win plus, they’re really nutrient dense. So that’s one that I try and include in my diet a lot. I also am a huge [00:35:00] fan of mushrooms in that category. Mushrooms are another one that’s this really cool dual benefit.  Lots of people know about lion’s mane mushroom, for instance. Right now it’s probably the most relevant mushroom out there. Great for your brain. Has all kinds of benefits in kind of the neutropic area, but all of the fiber in that mushroom is prebiotic in nature too. So you get a really nice dual benefit there and it’s really good for the immune system.  So I, when I look at food. I look at foods that have, you know, kind of a wide range of benefits as opposed to just eating for one, one result optimally, maybe we can get two or three benefits or more, you know, out of that food. So those are some of my most favorites.

Dr. Weitz: So I, you’ve written about you wrote a blog post about the other ingredients and how do we tell when we look at a nutritional supplement, whether it’s a quality product, whether it has a bunch of stuff in there that we don’t really want.  Maybe we could talk about that.

Jared: Sure. Yeah. And that’s another one [00:36:00] that is, there’s a lot here. I’ll give you some of the high level stuff that I think is most useful. The first thing is. There is not a universal way to tell if you’ve got a high quality supplement or you don’t, that there just isn’t.  So you do have to get you know, you, you gotta educate yourself on certain things. Particularly if you’re looking at specific nutrients, like let’s just take a multivitamin for instance. That one’s a tough one. ’cause there’s gonna be 30, 40, 50, 60 different ingredients in there. And you gotta be pretty well versed to try and figure out, you know, what the ingredients list looks like.  But let’s say for instance, you’re looking at a vitamin B complex a little bit more simple. Maybe you’re gonna have 10 or 11 ingredients in there, and you can look at those specific ingredients and there are ways that you can tell if it’s going to be a higher quality, more highly absorbed form than another form of that B complex.  And so if you walk into a store like mine. You know, a health store in your local community or a Whole Foods or wherever you’re going to get your vitamins you’re gonna see different options. I always say, look [00:37:00] for specifically if you’re looking at anything that has B vitamins in it, look for what form of folate is in there what form of B12 is in there, and what form of B six is in there.  Now there’s other things that you can look at too, but those are probably the big three for me. Sure. And you’re gonna wanna look at a methylated form typically of folate or B12, or, there are two other forms of B12 that I really like. One’s called hydroxyl cobalamin, another one’s called Adenylcobalamine.  The methylated form is called methylcobalamin. What you really wanna avoid is probably cyanacobalamin. I’m not like anti salam, but it’s just the worst of the bunch. And it’s the one that your body has to do the most work to actually absorb. If you happen to fall into the category of M-T-H-F-R for people that know what that is, you’re not making methylcobalamin out of cyanacobalamin because genetically that mutation is gonna prevent you from doing that. Folic acid is easy to get in our diet. We’re getting lots of it. That’s the synthetic form of folate. And if you’re M-T-H-F-R, it actually can act like a [00:38:00] neurotoxin in your body and you’re not going to convert it. So we wanna look at a methylated form of folate, or another form is called folinic acid.  And that’s a superior form that most people can manage pretty well as well. And then in B six, rather than purine, HCL is the one that will show up. You wanna look for one that’s called P five P that’s gonna be a cell ready form of b B six. A lot of times on the front of the bottle, it’ll say that it’s methylated or it’ll say that it’s a co-enzyme form.

The, that’s good language to look for. But one of the things that’s more high level that I think is really important is when you’re just looking at the brand itself and you’re trying to figure out, is this a brand that I trust? And there’s a couple of tips that I can give people on that. I always say, use Google, or if you’re an AI person, use chat GPT and just ask who owns this brand?  So let’s just say for instance, it’s, I’ll pick up a brand Garden of Life that’s a pretty well known supplement brand out there. Who owns this brand? If you throw that into Google or you throw that into chat GPT, it’s gonna tell you that [00:39:00] Nestle owns that company. I personally am not a big fan of the Nestle Corporation.  I still trust them for a lot of reasons. And if you want to Google around on why that might be, feel free. We’ll find some things. I don’t wanna give them my vitamin money, even if they’re making good vitamins. I don’t want to give ’em my vitamin money, and I’m not convinced that they’re gonna make good vitamins.  Now, at one point, Garden of Life was an awesome brand. They got sold multiple times. Now Nestle owns ’em. And so I am looking for brands that are optimally not owned by some drug company or MegaFood company, or someone like Clorox that owns a lot of vitamin brands now, or Proctor and Gamble that owns a lot of brands.  Now, I’m not interested in that. I want I’m optimally looking at supplement companies that are supplement companies, not drug companies, not chemical companies and I’m gonna say not food companies or at least not high, big processed food companies because I just don’t think they’re that concerned about my health.  So like that’s a big thing for me. Right? [00:40:00]

Dr. Weitz: I get it. I do think that some of those companies that have been purchased by these bigger corporations or by drug companies I am, I’m pretty sure that some of ’em are still sort of being run by a group of ethical people and and a bigger company is basically letting them do that as long as they’re profitable.

Jared: Yeah. And I agree with that. And in many cases, I think the product’s just as good probably as it was prior to the purchase, at least for some period of time. Yeah. So then at that point, you use the word ethical and that’s the word I use when I say. If I’m just looking at where I want to spend my money and who I want, sure.  I get it from an ethical standpoint, I just wanna support better companies, is really what it boils down. Right. I get it. Companies that I think are gonna do better things with the money and optimally, and this is my own bias. I’ll just be the first to admit it. I’m a guy who was raised in a health food store by people that were really into this stuff.  Right. And all of the brands in this industry back then [00:41:00] were little mom and pop brands that were in it because they were passionate about it. Right. They wanted to help people, but that’s what the industry was. ’cause nobody was making very much money. Absolutely. And so I look now and to some degree anyway, the smaller the company, the more likely I think especially if it’s like a little independent family owned company, they are to probably be that same type of person.  They probably got into that business. Right. ’cause they were excited about the same reason your podcast and I have mine, right? Yeah. It’s not just a bottom line thing. And how can we serve our corporate masters with, you know, how much money we can.

Dr. Weitz: So outside of who owns the company, what are some of the other things we wanna look at for a quality supplement?

Jared: So I always look at the other ingredients. So if you’re looking at a vitamin bottle while you’re listening to this show and don’t do this if you’re driving down the street, but if you’re looking at the vitamin bottle and you look at the back, there’s always what’s called the supplement fax panel.  The supplement fax panel is the most revealing part of a vitamin bottle. It tells you, you know, all [00:42:00] the ingredients, the amount of milligrams the type of ingredient, like for instance, the type of B12 or B six like I was just talking about. But then underneath the supplement fax panel is a little spot right under the bottom line that says other ingredients.

And that’s when you find out what the capsule’s made of what kind of filler or flow agent or stabilizer or whatever is in the capsule or tablet. And the first thing I look at is number of ingredients in the other ingredients. If the other ingredients has 6, 7, 8, 9 different things in it, there’s a relatively good chance that some of those things aren’t.

Aren’t great. Now, you can specifically, and I recommend you do this anybody listening to this show, look at the other ingredients on one of your supplements that you’ve got there on your kitchen counter or wherever, and just look at what microcrystalline cellulose is or what silicon dioxide is or what what’s another one?

Magnesium steroid is, or steric acid. There’s a whole bunch of them. I don’t [00:43:00] necessarily think that most of those things are bad. In fact, I think most of the things that are added to supplements are. They’re fine. They’re kind of neutral. There’s some companies that are pushing the idea that like magnesium steroid in a supplement is bad.

It reduces absorption. There’s literally no evidence of that. I don’t use magnesium steroid because I don’t know that there’s not a problem in my supplements. And so I’m more on the kind of better safe than sorry approach to that. But I also don’t, you know, shun those products and think, oh, those are terrible ’cause of this.

But there are a lot of things in those supplements that might surprise you. And this is usually gonna happen in your big box store Supplements, the number one vitamin DI think at least it used to be. In America is made by Kirkland Costco and their vitamin D. Last I checked, and this could have changed, I don’t know, had artificial color in it, caramel color, and it’s like, well, why would I want artificial color in my vitamin D?

It makes absolutely no sense. And the oil that is, that the vitamin D is stabilized in is soybean [00:44:00] oil, which is almost definitely genetically modified. Soybean oil has a hundred other problems with it. It’s a seed oil, and so it’s, you know, more inflammatory in nature. It’s highly processed, and so if I’m taking a supplement to get something good like vitamin D, why would I want an artificial color and a seed oil that’s highly processed and probably genetically modified?

As a companion to it. And so those types of things, be a more aware consumer and recognize that those things matter. Those other ingredients matter. And again, you know, if we had five hours, I could go through every single in other ingredient and we could talk about, and I have, but I’ve done that blog post has some information.

I’ve got some shows like that too. But just not taking the bullet points on the front of the bottle as the all you need to know about that supplement. There’s a lot more there.

Dr. Weitz: And by the way, that same thing about the other ingredients is even worse when you look at most prescription drugs. Oh my gosh, it’s amazing how many [00:45:00] prescription drugs have talcum powder in it.  Yeah. Which is, we know, is highly carcinogenic and, you know, was taken out of out of baby powder and yet it’s in there because it’s a flow agent. Yeah. 

Jared: And it’s cheap, you know, and it keeps things dry. So there’s there there’s utility to it. There’s a reason why they use it, but they could use something else and create the same benefit without the negatives.  And, but it’s industry again, it’s if the most important thing is the bottom line, you’re gonna cut the most corners that you can to get to that bottom line. And that’s why I’m always looking for brands that I think have more of an ethical approach to how they’re producing their products and a little bit more passion behind it.  Not just, you know, what are we gonna do for our bottom line?

Dr. Weitz: Right. One of the things that’s common in our environment and there’s obviously a huge amount of environmental toxins. We have plastics, we have a lot of these chemicals end up being endocrine disruptors. Yeah. So they affect our [00:46:00] hormones.  A lot of ’em are estrogenic, but they could also affect testosterone as well. And so what do we do about endocrine disruptors, which are some of the ones we wanna be most concerned about? And interestingly, some of the testing companies now are including especially the companies that test hormones by urine are including endocrine disruptors in their testing.

Y,

Jared: which is awesome. Right. I mean, the more information we’ve got, that’s great. And in fact I’d be curious do you order blood tests for your clients? We do, yes. Okay. I’d actually be curious we can talk about an hour after the show, but I’d be curious, what are, what you think are the be best tests that are showing for that?

Right.

Dr. Weitz: Well, my brain has a a urine test that includes, it’s called the Hormone Zoomer. That, what’s the name of the company? Fibrin America. Okay. Yeah. It’s one of the premier, functional medicine testing companies, and they pretty [00:47:00] much have, offer everything, all the standard tests, most of the specialized tests, they got a great micronutrient test.  They have testing for Lyme, they have testing for, they have gut testing, and they have a urine hormone tests that includes endocrine disruptors that they came out. I love it. I’m gonna, I’m gonna look into that. I appreciate it.

Jared: Yeah that’s very cool. And way past due really, because this is a big problem.

Dr. Weitz:  If you’re trying to balance someone’s hormones or you giving them hormones and their hormones are all messed up by these endocrine disrupting substances.

Jared: Yeah. Well I think it’s an interesting thing because you know, I’ve been doing this a long time and one of the things that I do a lot of is just kind of observing.  Observing how things have changed since I was a little kid versus now that I’m in my fifties and just talking to people coming into my store, I never used to see guys in their twenties coming in with low testosterone that just wasn’t even a thing 20 or 30 years ago. Right. And I know you see it [00:48:00] all the time, guys in their twenties and thirties.

Dr. Weitz:  Yeah, it’s crazy. Guys in their twenties or thirties with the testosterone of 150.

Jared: Yeah, exactly. I mean, I talk to guys in their twenties that have half the testosterone I’ve got at 53. Yeah. And I just it’s just kind of mind blowing. And then women that are coming in with testosterone that’s like zero or near zero on the free testosterone test, you know, that kind of thing.

Dr. Weitz:  And by the way, for men as opposed to women, as we get older, our testosterone doesn’t necessarily drop off a cliff like women’s does. Yeah.

Jared: It doesn’t have to, but it often does. Right.

Dr. Weitz: It often does. But if you keep yourself healthy, like myself, I’m 67, my total testosterone is 900.

Jared: Yeah. Yeah. And because very simply you’re taking care of yourself.  Right, right. And that’s the key because I believe at this point that the biggest, I don’t know what the word is under the radar. Major health concern in America is [00:49:00] the endocrine disrupting chemicals and how they’re impacting our endocrine systems because we all know about heart disease, we all know about diabetes, we all know about cancer.  We know about these different things and we talk about these things a lot. But nobody really talks a lot. I shouldn’t say nobody, but you’re not hearing a lot Okay. About what’s going on at the endocrine system level. I mean, it’s really just functional medicine doctors that are talking about it. Yeah. We talking about it a lot and not even all functional medicine doctors are paying a lot of attention to it.

Okay. Some more than others for sure. Right. But it’s a big problem. Oh yeah. And so we need to be aware of this and not just aware of it. Like, okay, well my testosterone’s low, so I need to go get something to boost my testosterone. But the question I have to ask is always, okay, well why is it low and what can we do to address that?

Because yes, it might make sense for someone to go on bioidentical hormones to increase their testosterone, and I don’t have a problem with that if that’s, you know, what makes sense in that individual case based on all of the information that’s [00:50:00] there. But if that person has not looked into detoxifying their body of these endocrine disruptors and detoxifying their home of the things that are creating endocrine disruption and detoxifying their diet of the things that are creating endocrine disruption, then they’re really missing a huge piece of that puzzle.

For about the last year, my wife and I have actually been working on an endocrine disruptor detox protocol. That we’ve been spending hours and hours because. This is what I’ve seen. And I’ll be curious, Ben, what you’re seeing in your world. I see a lot of people educating on what the endocrine disruptors are like.  Avoid scented candles. Don’t use glade plugins. Switch your laundry detergent. You know, don’t use perfume and

Dr. Weitz: e eat. Or organic.

Jared: Yeah,

Dr. Weitz: don’t, yeah.

Jared: And all of that’s really important. Don’t use plastic water bottles. Don’t use delon pans. Exactly. And all of that’s important. ’cause avoidance is the biggest thing.  But we know, based on some [00:51:00] multiple studies that I’ve read now, that if you clean up your act entirely, your home is basically chemical free. You’re storing everything in glass instead of plastic. You’re drinking outta stainless or glass instead of plastic and all these different things that you can do, you’re gonna eliminate maybe 60 to 65% of these chemicals, and the rest of ’em are airborne.

We’re gonna get ’em when we walk into somebody else’s house or business. You know, I, you go to a restaurant and you have to run to the bathroom, and you walk in the bathroom. I dunno if you’ve ever had this happen and you hear this as they spray some disinfectant, stinky chemical and the air, that then you have to breathe for the next few minutes.

You know, I mean, you’re not avoiding all of them, even if you’re avoiding them. As much as you can in the environment that you can control, right? So we always have to be aware that our body is consistently under attack with these things, and so we have to put our defenses up and just avoiding them is not enough.

So I mentioned earlier my big love of cruciferous vegetables because they have a couple of [00:52:00] compounds, indu, three carbinol and dim, that help to actually metabolize these things. And basically, if you look at it in really simple terms, essentially if your body makes a hormone and it goes to the cell receptor to deliver the message to that hormone naturally delivers.

Then it’s naturally metabolized and it moves through the liver and then out through, you know, either the urine or through the bowel. That’s how it’s supposed to work. Endocrine disrupting chemicals. They go and they make an attachment at the same receptor site that your progesterone, your estrogen, your testosterone would normally attach to, but they’re like an unwanted house guest that won’t leave after Thanksgiving, or your year old son who won’t move out of the basement or whatever it is that that you’re, that you can, you know, make a metaphor for in life, right?

And they just hang out there and they need to be pulled from the system. And the way that we do that is we open up our detox pathways, make sure that our liver is working well using liver detox herbs like dandelion and milk thistle and artichoke and [00:53:00] things like that can be really effective.  I developed a formula as part of this protocol we’re working on called Liver Vitality. For that purpose, we need to make sure that the bowel is moving consistently you know, once or twice a day, a good bowel movement, at least to make sure things are moving through like they should. Because we have to make sure that once we’ve.

Metabolize these toxins, they’re able to get out of the body. But these key elements, the dim and the Indo three carbinol, and another one’s called calcium derate, these are what kind of unlock that bond and pull them outta the cell so the body can then get rid of them. And if you think about your cell receptor like you would think of an ear, if there’s something in that ear that’s not delivering a message which these fake hormones don’t deliver, right?

Then when your hormones come knocking on the door, it’s like you got your ears plugged and the cell can’t get the message right. And the body’s constantly trying to figure out what hormones to produce, what hormones not to produce. Am I rot? Am I throttling things up, or throttling things down? And if there’s a bunch of these chemicals in those cell receptors, then [00:54:00] the body doesn’t know what to produce.  And that is endocrine disruption or endocrine noise, you could call it. Something’s in the way and the body is trying to figure out what the heck to do. I’ve had so much success over the years recommending supplements. Just to detoxify endocrine disruptors and having men increase their testosterone by one or 200 points within a couple. 

Dr. Weitz:  So what’s the protocol for detoxing, endocrine disruptors?

Jared: Well, the two most important things, the first thing is making sure your bowels are moving consistently. So if you’re constipated, you gotta get that going. Yeah. You can’t detox anything if you’re not pooping. That’s right. So that has to be happening.  And if it’s not, then you know, there are a lot of things that you can look at for that. But make sure that’s happening first. Then I recommend a good liver detox supplement. Like I say, the one that I make is called Liver Vitality, but there are a lot of good ones on the market. I recommend that for a minimum of 30 to 60 days.  I don’t recommend it daily. I don’t think liver detox, especially with things like milk thistle are that are strong herbs makes sense every single day. Although I do like dandelion can be taken daily, [00:55:00] NAC can be taken daily. These are good things to help with your liver. But make sure you do a nice detox of the liver so that the pathway out is open.

Then I recommend we have a formula called endo cleanse. And Endo cleanse has the dim the endo, three carbinol calcium ate. It has a couple of gentle liver detoxing herbs to make sure that process is still happening like it should and it has. Other supportive herbs for the endocrine system. And what I based this on is years of recommending these individual ingredients on their own or other brands formulas that I liked and Endo Cleanse came from, I’d say probably about 15 years of just really consistent experience trying to help people detoxify their endocrine system and seeing really good results.  ’cause as I was saying. I’ve seen men just doing this a month of liver detoxification with a couple of months of endocrine detoxification, increase their free testosterone by as much as a couple hundred points. And that’s not adding any [00:56:00] testosterone to the system or even anything that stimulates testosterone.

It’s just clearing the path and letting the body do what the body wants to do. Right, right. So I’m a huge believer in at least three months, a year of a good liver and endocrine disrupting, or sorry, endocrine detoxification program. And again, the one that I make is Liver vitality and endo cleanse, but there are other good ones out there as well.

And see what that does first because. My feeling is always, there’s basically two things that are have to be addressed for optimal health physically. Now I think there’s a lot of mental, emotional there too, but physically, there’s two things you gotta get rid of. Whatever’s in the body that is damning up the process, in the case of endocrine disrupting chemicals, it’s that the things that are getting in the way of the body doing its normal work.

And then you’ve got to ride nutrition to the body so that the body can make what it’s supposed to make. And so if you get rid of the roadblocks and you create you know, put the fuel in for lack of a better term, [00:57:00] then the car drives pretty good. And then you see where you’re at. So if you’re, you know, going into a place like yours where they can get all these tests and figure out what their levels are and you know, you got a 40-year-old guy that’s at 2 89 or whatever on his total testosterone, which I bet you see all the time.

Absolutely right. Then, you know, we know where he is. We know what his baseline on his free testosterone. You’re probably testing for his total, or sorry. Total as well as free testosterone. You know, where things are, do a three month detox, like what I’m recommending, and go back and get another test and see where you’re at.

I’m, I’ll guarantee you in just about every case, there’s gonna be significant improvement. It’s probably still makes sense at that point for a lot of men and women to still do something in addition to that, whether it’s herbal or nutrient based, testosterone boosting, or some sort of a bioidentical program.  But if you don’t clear the path first and let the body do its best to get there, then I think you’ve missed a huge piece of the puzzle

Dr. Weitz: that, that sounds [00:58:00] great. So I think we’ve had a really good discussion for the last hour or so, Jaron. I appreciate that.

Jared: No, it’s been a lot of fun. I appreciate it.

Dr. Weitz: Yeah.  So give us some final thoughts and your contact information for people who want to get in touch with you.

Jared: Well, my, yeah, as far as final thoughts go, I’ll say this. I believe that there is always hope for better health. And a lot of people I know that come into your office and plenty of people that come into my store are pretty darn frustrated with their health when they first walk in those doors, right?  Sure. And sometimes I know I’ve heard this from my clients. I’m like, their last resort, they’ve already tried this and that and this, and somebody recommended they come down and see me and they’re like, man, I’m just fed up. I don’t even know what to do. But there’s always hope. There’s always hope and there’s always a way to optimize your health and improve your health.  So don’t ever give up. Be willing to do some, you know, real experimentation with natural things that are. [00:59:00] Pretty hard to harm yourself with and can create a lot of benefits and try to do your best if you’re already, if you’re still a little stuck in what I consider to be kind of a broken system when it comes to modern medicine and you find yourself on four or five or six prescriptions and you don’t feel good, then I think that’s telling you something and there are other ways that you can go.

So those would be my final thoughts. But as far as reaching me. My podcast is the best way. If you know, enjoyed what you heard today, I do a lot of this on my podcast. I will give you kind of the the intro to what I do on my podcast. And I say that Vitality Radio is the podcast where we help you master natural supplements, enhance emotional vitality and thrive without the use of pharma drugs.  And that’s pretty much what I talk about those three things. And that’s Vitality Radio Podcast. My store is in Bountiful, Utah. So if you happen to have listeners in Utah, I’m sure you do. We’d love to see you in person. You can call us no matter where you’re at. We’re happy to have a conversation with you.  If you have questions about supplements, 801-292-6662. Our website is vitality nutrition.com. And we have a chat feature there. And if you are an Instagram person that’s our biggest presence online as far as social media, and it’s just at Vitality Nutrition, bountiful.

Dr. Weitz: That’s great. By the way. I love the fact that you’re standing and you’re using great use of your hands.  I love it. You’re really good at that. I don’t know how to talk without my hands. Me too. Okay. Thank you, Jared. Thank you.

 

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

Dr. Dipti Sagar discusses Gastroesophageal Reflux with Dr. Ben Weitz.

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

 

Podcast Highlights

Understanding Gastroesophageal Reflux Disease (GERD): Insights from Dr. Dipti Sagar
In this episode of the Rational Wellness Podcast, Dr. Ben Weitz hosts Dr. Dipti Sagar, an integrative gastroenterologist, to discuss gastroesophageal reflux disease (GERD). They cover the common symptoms like heartburn and its underlying causes, including the dysfunction of the lower esophageal sphincter and impaired motility. Dr. Segar highlights the potential drawbacks of long-term use of proton pump inhibitors (PPIs) and the importance of lifestyle changes for managing reflux. The conversation delves into the role of dietary habits, stress management, and natural treatments like herbal remedies and dietary modifications. Additionally, they explore related conditions such as small intestinal bacterial overgrowth (SIBO), H. pylori infection, and the impact of medications like GLP-1 agonists and bisphosphonates. The episode concludes with Dr. Sagar providing resources for those seeking more personalized advice on gut health and reflux management.
00:30 Understanding Gastroesophageal Reflux Disorder (GERD)
01:35 Symptoms and Causes of Reflux
02:23 Defining Reflux, GERD, and Heartburn
03:18 Normal Reflux vs. GERD
05:27 Treatment with Acid Blocking Medications
07:21 The Role of Hydrochloric Acid in Digestion
09:36 Motility Disorders and Reflux
11:36 Alternative Treatments and Lifestyle Changes
21:28 Foods and Medications Affecting Reflux
23:11 Improving Esophageal Motility
25:27 Managing Stress to Reduce Inflammation
25:41 Introducing the Apollo Wearable
27:13 Understanding H. Pylori and GERD
29:28 Natural vs. Conventional Treatments for H. Pylori
33:51 Hypermobility Syndrome and Gut Health
37:38 Impact of Weight Loss Drugs on GI Health
40:40 Diet and Food Sensitivities in Acid Reflux
43:11 Oral Health and Its Connection to Gut Health
46:50 Conclusion and Contact Information
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Dr. Dipti Sagar is an Integrative Gastroenterologist who practices in Century City as an associate of Dr. Farshid Rahbar and reflux is one of the many GI conditions that she treats regularly in patients. Her website is LAIntegrativeGI.com.

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

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Podcast Transcript

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

Hello, Rational Wellness podcasters. Today we’ll be speaking with Dr. Dipti Sagar about gastroesophageal reflux disorder, which is a very common gastrointestinal condition. Heartburn is the main symptom in reflux and is often described as a discomfort or a burning pain felt in the chest or throat.  It occurs at least once a week in about 30% of Americans, and up to two [00:01:00] thirds of those with irritable bowel syndrome. Heartburn can be caused by a reflux of the gastrointestinal contents up into the throat or esophagus, or it can occur without reflux. Gastro. Esophageal reflux means that the stomach contents have moved up.  Into the esophagus, and this can damage the esophageal lining, especially if there is acid or bile, and this eventually can increase the risk of esophageal cancer. Other symptoms of reflux besides heartburn include regurgitation, chronic cough, sore throat, vomiting, hoarseness, chronic throat clearing. Dr.  Dipti Sagar is an integrative gastroenterologist and I would say one of the few in the country who practices in [00:02:00] Century City as an associate of Dr. Sam
Rahbar and reflux is one of the many conditions that she treats regularly. So Dr. Sagar, so thank you so much for joining us.

Dr. Sagar: It’s been a pleasure.  Thank you so much for having me and for the lovely introduction. I would say you made my presentation very easy because you summarized it so well.

Dr. Weitz: So, maybe we can start by defining some terms. Sure. So what is reflux? What is GERD or gastroesophageal reflux? And what is heartburn? And sometimes they’re used interchangeably.  Let’s make sure we know what we’re talking about.

Dr. Sagar: Yeah, that’s great because a lot of times we use GERD for acid reflux and reflux for heartburn, right? So let’s make it very simple. Reflux is simply the fact that the stomach contents are moving up into your esophagus. That’s simply reflux, right?  Heartburn is the symptom that happens because of this. It could be a burning sensation in the chest or in the throat. GERD, which is gastroesophageal reflux disease and is when that reflux happens frequently or causes complications like esophagitis or stricture or Barrett’s esophagus.

Dr. Weitz: Okay. Isn’t a small amount of reflux normal and usually this doesn’t even create symptoms, right?

Dr. Sagar: Absolutely. It’s very normal to have sm occasional small reflux episodes and they’re asymptomatic. The reason why we don’t have symptoms is because our esophagus have protective mechanism. For example, the saliva that we produce, so we produce like 1.2 liters of saliva every day. And what stimulates saliva production is reflux.  So every time there is acid in the lower esophageal in the lower part of the esophagus, which is like 20 centimeters. The, it stimulates production of saliva, so that protects you. The second is the bicarb, which is again a protective [00:04:00] mechanism and the clearance mechanism of the esophagus, which is the peristalsis.  That itself helps to neutralize the small amount of assets that comes up into the esophagus. It becomes good when the balance tips towards injury or towards symptoms. So you’re right, a small amount is normal, but we have in our ability to clear it by ourselves.

Dr. Weitz: Right. And essentially it’s when the lower esophageal sphincter opens, which happens every time you eat and once it’s open, a little bit of the contents moving up is part of the normal balance, right?

Dr. Sagar: Right, so I’m glad that you brought this. So whenever we are swallowing there, it’s always associated with peristalsis. So as you mentioned, when we are eating the lower ral sphincter relaxes, it opens, but remember it’s always followed by peristalsis, so that clears the acid. But there is something called transient relaxation of the lower feal sphincter, which [00:05:00] is different from the regular swallow induced, relaxation because that one, first of all is longer. It’s more than 10 seconds. It’s not followed by peristalsis. So that’s different. And in people who have reflux disease, the transient relaxation of the lower is vi, sphincter and motility is probably what causes it.

Dr. Weitz: Right? So essentially it’s a motility disorder, but yeah.  Correct. The main treatment is using acid blocking medications like Prilosec, for example, which is a proton pump inhibitor, also known as omeprazole. That decreases the hydrochloric acid, but this is not treating the cause. It’s not affecting motility.

Dr. Sagar: That is exactly correct, and the irony is like, you won’t hear this from a gastroenterologist, but I have to say it out loud, that most acid drift flu patients who have good, they usually have normal acid.  And this is something that I see in my practice like every day because I do, but I do an endoscopy. What I do is I collect the gastric juice and check the pH for all patients. And this is not regularly done by a gastroenterologist when they’re doing the endoscopy. I have seen so many times patients with acid reflux and they are on omeprazole and they say, I have heard heart bone, and I’m, I just have so much of acid reflux.  I just did a endoscopy yesterday on this patient for acid reflux, and when I did the pH testing, it was actually two, so the normal pH of our stomach of the gastric juice is zero to one. So if it’s two. That’s like hypochlorhydria, right? Like it’s not too much acid. So the main issue is the dysfunction, as you mentioned about the lower esophageal sphincter and impaired motility, what PPI does, it reduces the acid so it can relieve some of the symptoms, but they don’t fix the underlying mortality disorder.  And the reason why they’re the main first line of treatment is because they’re [00:07:00] effective for short-term relief, but they do not address the underlying cause. The underlying issue of it, and that’s why I’m completely, I’m not in a favor of like giving PPIs to patient. Now, in the short term, when you have esophagitis or complications from acid reflux, yes, you can give it for like eight weeks, but long-term use really don’t have any benefit.

Dr. Weitz: In fact, couldn’t it harm because it’s gonna decrease the ability of us to break down our food. We need that hydrochloric acid to break down our proteins and other components in the food. And so if the patient has normal or even decreased hydrochloric acid secretion and now we’re decreasing it even more and if you’re not properly digesting your food.  Unfortunately, this is fairly common in our society. Partially ’cause everybody’s eating so quickly, they’re eating on a run. They’re eating foods that they can hold in their hand, in the [00:08:00] car while they’re at their computer at work, et cetera, et cetera. And people often don’t chew enough. They’re not getting enough hydrochloric acid, digestive enzymes to break down the food.  So now decreasing that hydrochloric acid may actually make the situation worse.

Dr. Sagar: Absolutely, and I actually can talk on this topic for odds and that’s why I didn’t bring it up. But the thing is, we need acid, right? Like there is a reason why there is acid in our stomach, right? So first of all, it helps with the absorption of food.  As you said. If you don’t have enough acid, there will be malabsorption. Second of all, acid is important for absorption of minerals and vitamins like vitamin B12, zinc, magnesium, vitamin D, calcium. So if you are, if you don’t have enough acid, you will be deficient in all this micronutrients. Other important thing is the acid in your stomach is actually protecting you from the bad bacteria in the gut.

So [00:09:00] if you have low acid, some of those bacteria will escape because there is not enough acid to kill them, and that changes your gut microbiome as well. And as you know, like the more we learn about the gut microbiome, we know that every. All disease actually arises from the microbiome. So just by decreasing the acid in your stomach, you’re setting yourself up for malabsorption, disease, inflammation, and chronic conditions.

Dr. Weitz: Including small intestinal bacterial overgrowth which is something that can lead to gerd.

Dr. Sagar: Exactly. So that is a big thing that people miss. We talk about motility. So the motility, I’m not just talking about the lower residual sphincter, but there are two other concepts with motility. First is delayed gastric empty, which is delay in the passing of the food and contents of the stomach into the deum.  So if you have delayed gastric ending again, which is a mortality problem, can cause acid reflux. The other one, which I’m passionate about, I wanna bring more awareness. It’s the al [00:10:00] gastric reflux, which is basically the stomach. The contents move from your stomach to your small bowel, so that’s the direction of flow.  But when you have dysbiosis in your small intestine, like just you mentioned small intestinal bacterial overgrowth or fungal overgrowth or any kind of dysbiosis, even parasites, it causes increased intraabdominal pressure. So now there is backflow of contents or bile. From the Odum into the stomach.

So it’s like opposite. And this is a very important concept because as I mentioned, this person I did an endoscopy on yesterday. They had a gastric pH of two. But you know what was more interesting? Like as soon as I went into the stomach. As a gastroenterologist, you’re supposed to see clear gastric juice because the gastric juice is clear.  There is no color to it, but what I saw was just yellow bile in the stomach. So there is no reason for you to have bile in your stomach. So why is bile coming in your stomach? It’s, it should be going down, [00:11:00] right? Like it’s a downward flow. That is a clear indication that it’s a. Dear neuro gastric reflux, that means bile is coming into your small bowel.  And when that happens, remember there is dilution. So the gastric acid, which has a pH of zero to one, is now diluted with bile, and probably that’s why the pH is now two. So again, this causes malabsorption. And I would say this happens because of what is in simple language is a dirty gut involvement. So whenever there is dysbiosis in your small bowel because of parasites or fungus or bacteria, this is what causes the backflow of bile.

So, yeah.

Dr. Weitz: So, instead of prescribing PPIs, do you ever actually recommend hydrochloric acid and or digestive enzymes and or herbal bitters to improve digestion?

Dr. Sagar: Very good question. So everything should be evidence-based. So in patients you have already confirmed that they have a hypochlorhydria, like when I do the pH testing, like this guy who had a pH of [00:12:00] two, then yes, you could gently support them with hand et c.

Dr. Weitz: So when you do your endoscopy, you take a sample of the juice from the stomach, and then you measure the pH in it.

Dr. Sagar: Yes.

Dr. Weitz: That’s

Dr. Sagar: exactly it.

Dr. Weitz: Now there’s another test that I understand is not being done that I think that you were doing previously, the Heidelberg test. Yes. What’s the status on that?  I understand they might be bringing it back in a different form or.

Dr. Sagar: Yeah, unfortunately the, we don’t have those pills anymore. I think we just have like two of them left. They stopped making and they can measure the acid, but it’s not available unfortunately.

Dr. Weitz: So yeah, I think they’re gonna bring it back in, in a slightly different form.

Dr. Sagar: Yeah. So, but we don’t have that available now.

Dr. Weitz: Right. Okay.

Dr. Sagar: Coming. So in the meantime, we could do the pH impedance testing or any patients who are undergoing endoscopy. It’s very easy where you just suction the juice and the pH testing strip is available on Amazon. [00:13:00] You know, so like anybody can get it.

Like, I mean, last week they ran out of it. So I bought it from Amazon for only like $10 and it just, so this

Dr. Weitz: is one of the reasons why doing a upper endoscopy is an important part of a workup for patients with reflux.

Dr. Sagar: That’s one part. So checking the pH, but also important to see if there is any mucus cell damage.

Right, because then treatment is different. So when I do endoscopy for acid reflux and I see esophagitis and Barretts, then the treatment is different because then I know that they would respond to an acid medicine like PBI. However, majority of the patients,

Dr. Weitz: by by the way, for those who don’t know, Barrett’s esophagus means there’s a certain amount of damage to the esophageal mucosal cells.

Dr. Sagar: Yeah, so it’s intestinal metaplasia, which is it shouldn’t be in the esophagus. So the mucosa in the esophagus changes to that of the stomach, which is abnormal. So that’s what Barr’s esophagus is, right? So, yeah, to answer your question here, to look at the mucosal [00:14:00] damage, to look at if there is no muc cell damage, is there bile in the stomach, if there is gastritis, all of that information is helpful in.

Deciding how you will manage this patients. So yes, definitely. And in our practice we do something very special called Al Aspiration, which is not done in any other endoscopy center. So what is that? Basically when I go in, when like in this patient, when I see there’s a problem with the bile, we go in the small bowel and we just suction the.

Which is in the small bowel, and then brush the mucosa of the small bowel and send that for pathology, just like GI Map or culture, that gives us information as to what kind of dysbiosis is this. Because if there is a proximal dysbiosis, a lot of time that’s not picked up in the breath test, and you’ll be surprised that the breath test is normal.  But the patient is having all these symptoms, which is very specific for sibo. So it picks up proximal dysbiosis. Like from CAPA or strep? Pneumo. Pseudomonas. So if you see [00:15:00] all that in the bile, then you would know that this is proximal dysbiosis. Also, candida is a big issue

Dr. Weitz: And by the way, one of the advantages of this is then you can treat the SIBO or you can treat the candida and then that will help to I improve the underlying cause of the reflux.

Dr. Sagar: Exactly. Rather than having them on PPI for life. That’s correct.

Dr. Weitz: You know, PPIs, if you look at the description inside the containers say that they should only be used for short periods of time. And yet, as you said, some patients are on ’em for years and for life. So when you get a patient who’s on PPIs and you decide that it it’s not helping them it’s difficult to get ’em off. Correct. How do you get ’em off?

Dr. Sagar: Very good question. So first you can give them instructions, but I think that here’s where motivational interviewing comes into picture, and we as physicians have this role to kind of talk to our patients exactly.  As you mentioned, it’s so much easier to [00:16:00] buy a fast food burger and eat it while you’re driving and then just go home and take a PPI that does not involve, that does not require any change from your side. Right? It’s so, so much easier. So if you now tell the patients that you have to sit with your food and chew your food, it takes a lot of effort on their end.

So instead of saying like, you have to do this, we as physicians should be very efficient and motivational interviewing. And that’s where we have to kind of like really tell them. Lifestyle is important. Like when we are eating the food, we have to chew the food at least 15 times, you know, like from the front of the mouth because we are producing saliva, and saliva has important enzymes like amylase, which is so important for digestion of protein.

Okay. And also. When you’re eating a chew food and chewing it swa slowly you are increasing your mind gut brain connection, right? The mind body connection, and you’re like really being present with the food that really helps. Not drinking cold water, you know, when you’re eating [00:17:00] your food is also important because when you drink cold water, you’re shutting down the blood circulation because cold water.

It’s gonna do vasoconstriction, so there will be decreased blood circulation in your stomach and that’s not very helpful for digestion of your food. You need more blood. So drinking warm bottle really helps. And obviously at nighttime don’t eat or drink two to four hours before bedtime. And many times people say that, oh, half my dinner at six and I go to bed at 10 and I don’t eat anything.

But in between that period, between six to 10, they’re drinking tea, they’re drinking this, they’re drinking that. So. We also have to let them know that even a sip of water can stimulate the acid. So no eating or drinking even water for at least two to three hours before bedtime. Those are some important or lifestyle changes that you know, we have to incorporate.

And as of course, as you know, a lot of food will relax the lower oph, which sphincter, so we have to avoid those food items and some food items like,

Dr. Weitz: and let me just point out also that [00:18:00] one of the reasons why. People tend to drink a lot of water when they eat is ’cause they’re not chewing properly. So the food won’t go down.

If it’s properly chewed and it’s broken down into, you know, the proper consistency, then you don’t need water to swallow it. But when you’re trying to swallow the food whole, because you’ve only chewed it once or twice then you need a lot more water.

Dr. Sagar: I think you’re making a great point there because a lot of time, you know, when we do as a gastroenterologist, we do the endoscopy and people come with like stuck steak in their throat.

Like, how did that steak get in your throat? Like, it’s because we don’t chew, you know? Right. So I always say, Hey, chew your food. We are meant to chew your food and like really not swallow it. So you made an excellent point. And in terms of like decreasing, how do I taper them off the PPI. So I don’t take it off immediately.

And this is something that we all need to understand if you are on PPI. And if you just stop it, it means that you are going to [00:19:00] have a rebound hyperemia because. All of a sudden you’re taking away the medication that has stopped the acid production, so your heartburn and acid reflux will worsen. So what are usually the doing ‘

Dr. Weitz: cause because when you decrease the hydrochloric acid secretion, the body secretes more gastro.  That tells the stomach to make more hydrochloric acid. So then when you stop the PPI, you’ve got all this gastrin and you get this big increase in acid production.

Dr. Sagar: Yeah, and then the patient will be like, oh my gosh, I feel so worse, and I’m going back on the PPI. Right? Right.

Dr. Weitz: So

Dr. Sagar: that’s why we have to taper it very slowly.  So for example, if you’re on 40, you would go back on 20 and then to 10 and then every other day. So I taper it over the course of like two to four weeks rather than just topping it all of a sudden.

Dr. Weitz: Right. I’ve also heard doctors use a different acid medication on an interim basis.

Dr. Sagar: Yes.

Dr. Weitz: A non PPI say,

Dr. Sagar: yeah.

So [00:20:00] we can use something like H two blockers in the interim, right. Along with the lifestyle changes, I talked about stress management, right? We can also combine some hopes, which is helpful for acid for help for acid reflux, which is DGL or alora or marshmallow, and you can kind of bridge that until you know you are completely off the acid medicine.

Dr. Weitz: What do you think are the most effective herbs? I know some people have talked about using slippery elm. I’ve actually had some of the patients make kind of a paste at a slippery elm and use it to sort of coat their throat. Yeah.

Dr. Sagar: Slippery elm is great. My favorite is DGL. Okay. Slippery m sometimes I use in combination DGL and Slippery m Avera is another one, but be careful with Avera because it’s a little, a bit of a irritant so it can give you diarrhea, so you don’t want to have like diarrhea instead of acid flux.  So we have to be careful with that. [00:21:00] And then I also like marshmallow and zinc carnosine because they have kind of a very anti-inflammatory effect, especially the zinc carnosine for the gut. So that helps. 

Dr. Weitz:  What do you think about melatonin?  I’ve seen some papers on melatonin having a beneficial effect.

Dr. Sagar: Yeah, I definitely use that too. Especially if there is with issues with sleep and usually in combination therapy in a very low dose, like three milligram, that helps as well.

Dr. Weitz: Yeah. Okay. So, let’s see. There, there’s certain foods that we need to consider them not eating that can increase reflux.  And that’s because they can say, decrease the pressure on the lower esophageal sphincter, or because they decrease motility.

Dr. Sagar: Yes. So anything that decreases your lower fial sphincter pressure will increase the reflux. This include chocolate, you know, peppermint or fatty food, alcohol, carbonated beverages, even medications, [00:22:00] which are commonly used for high blood pressure, like calcium channel blockers.  A lot of patients are on benzodiazepine. NSAIDs, SSRIs. So knowing these will allow our patients to have to make targeted lifestyle changes. Remember peppermint is used a lot of times for IDS, but it also, yeah, is the enteric

Dr. Weitz: coated peppermint oil.

Dr. Sagar: Yeah, but be careful because a lot of times that will relax the lower esophageal sphincter and now you are dealing with the acid reflux problem, so remove that.

The first thing. So important to look at the herbs too, like what the patients are taking. If you’re taking a lot of peppermint, we have to stop that

Dr. Weitz: now in terms of motility. We talk a lot of times in the, when we’re talking about gut problems, about the motility of the intestines and the migrating motor complex.

And and then we have motil pro kinetic agents that we know work to improve that motility. But the motility of the [00:23:00] esophics esophagus is different. What do we know about? Promoting motility of the esophagus.

Dr. Sagar: Good question. So, as I said, every time that there is acid in your stomach, there is persis. So there’s there’s motility.

But what you could also help with, which I didn’t mention before, how we can use saliva for this, like for removing the acid, because that’s like a normal alkaline solution, right? So. After your meals, what I recommend is chewing some kind of gum, and that doesn’t have to be like a sugarcoated gum, because as you know, a sugar will have its own issue.

So we could use like a xylitol based gum. And when you chew that for 10 minutes after your meals, what’s happening? So after your meal, the stomach is full of acid. Some of it might be coming up if the immortality of the esophagus is not very good, or if there is some problem with dysfunction. So when you choose a gum, it’s producing the saliva and the pH of [00:24:00] that saliva is between 6.8 to 7.4.

And when you swallow that saliva, it neutralizes the acid in your stomach, so it’s your body’s natural anti-acid. Without the use of PPI. So Heidi, if you have a motility problem where you’re there is a delayed gastric emptying or esophagus is not clearing very well, chewing the gum after every meal, like breakfast, lunch, and dinner, does so much good.

Like you, it’s like your own natural anti acid, as I said.

Dr. Weitz: Now, do we know if any of the. Say pro kinetic either drugs like procal pride or nutritional supplements, like we use ginger and artichoke and five HTP and things like that. Do we and then we have strategies like trying to stimulate the vagal nerve.

Do we know if those strategies work for esophagus motility?

Dr. Sagar: Absolutely it does. Because the stress management is [00:25:00] important. So remember, there are for the antireflux, the body’s natural way to prevent reflux is three three layers to it. First is the pre epithelial factors, and that is like saliva, mucus bico.

And then the epithelial factors, which is your, the tissue resistance, you know, the epithelial cells resistance. And then there is the post epithelial factors, which is improved blood flow. Now that improved blood flow is de is decreased when you have inflammation. And that inflammation could be from stress.

So whenever we work through stress management, decreasing the cortisol, that in turn will decrease inflammation. That in turn will improve blood circulation. So it definitely works.

Dr. Weitz: Okay.

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Dr. Weitz:  H pylori is a bacteria that grows in the stomach and this can sometimes be a player in gerd.  What should we think about h pylori? Should we test for h pylori regularly? Should we eradicate it? I think conventional gastroenterology my understanding is if you see h pylori, you definitely need to get rid of it no matter what. Yet there’s some controversy over what tests are even accurate for h pylori, whether stool testing that shows DNA of h Pylori or whether there’s stool antigen or a breath test.  And then there’s an argument that h pylori is actually protective. 

Dr. Sagar:  It seems to be.

Dr. Weitz:   Potentially correlated with decreased esophageal cancer. There’s an argument to be made that this is a microbe that is important and we shouldn’t get rid of it even though most of us don’t have it anymore.  What should we think about h pylori?

Dr. Sagar: Very good. That’s a very important topic to discuss because it’s a little complicated. So just to make it simpler in terms ofmy and the physiology of how Hval works, is that, so Hval could be in your antrum, which is the distal part of your stomach, or it could be like in the fundus, which is the upper part of your stomach.  So when you have h Bori, which is an predominant. You re it’s gonna actually, and you remove it, then it’s going to improve the acid reflux. But a lot of time the h pylori has migrated to the fundus and the proximal side. And if you actually, and that is actually protective against esophageal cancer.

And if you try to remove it. It’s actually going to make the [00:29:00] acid reflux even worse. So the best way to kind of do this is when you’re doing the endoscopy, I take different biopsies, one in the antrum and then one in the fundus. So if there is an anally predominant h pylori, I know that the acid reflux will improve after this.

But if it’s more fundus. Then I do tell the patient that, hey, we can treat it, but it can bring back acid reflux. Now if you don’t have acid reflux, then you can go ahead and treat it, but we have to educate the patients that, you know, it can make your acid reflux worse. Now, in terms of treatment, and I understand what you’re saying, so I take a very individualized approach.

If by the way,

Dr. Weitz: What do you tend to use for diagnosis? What testing do you think is most helpful?

Dr. Sagar: Good question. Accurate if they’re doing an endoscopy biopsy is great, but if not, then either the stool antigen testing or the ure breath test, both of them checks for the antigen. There are some problems with that, like, you know, if they have been on antibiotics or PPI or you know, like, red meat, that all of [00:30:00] that can affect the way the hval.

Will show up. The antibody testing is not a very sensitive testing because it’s a blood test. If you have ever had an HP, even if it’s not active, it will come back positive. The most sensitive is the biopsy because it’s not affected with all of these. And you can also know like where in the stomach the HP.

Well

Dr. Weitz: what about the stool? DNA testing.

Dr. Sagar: Yeah. Good. Very good. So the, that one, like especially if you do the integrative labs, you know, the stool testing like GI Map or you know, through Vibrant, the problem is those it has to benefit and disadvantage. The benefit is it’ll tell you the virulence factor.

Which is very helpful and the problem is that the titer is not very sensitive because it’s going to pick up another other type species of helicobacter, which are not h pylori. So if I see that the titers are very high, but the Vance factor is negative, and patient is young and has no family history of gastric [00:31:00] cancer and have no symptoms, which is specific for H ery, I tend not to treat it.

Because I think the treatment has more harm than any benefits, you know, giving them antibiotics. It’s not very good.

Dr. Weitz: What about using the natural treatment, say like masum?

Dr. Sagar: Yeah, I was coming to that a lot of time. The esophageal cancer that we are concerned about, and sorry, the stomach cancer is because of the viral, the bacterial load.

That means the more the bacteria there is the higher chance of having the cancer. So antibiotic will completely eradicate it, but it has its own complication. But natural therapies like master gum, they reduce the bacterial RO load without total eradication. That really helps with preventing the complication as well as help with symptoms.

But as I said, the decision has to be very individualized based on family history patient preference, patients cofactors, all of that.

Dr. Weitz: Right. That’s interesting. Now it’s been my thought. I, that’s the number of [00:32:00] gastroenterologists and they’ve all said, oh no, the natural treatments don’t work.  You have to use the. Quadruple. And now it’s a quadruple antibiotic therapy. So we and those of us who study the microbiome know that using broad spectrum antibiotics, especially multiple ones, is caught putting the microbiome at risk and would rather not do that.

Dr. Sagar: Yeah, that’s, so if you treat a patient with quadruple antibiotics, how many of them come back again after a month or so, or maybe six months with, again, H pari positive, right.  Right. Yeah. So that’s the problem. And I agree that it the natural therapies are not very good with eradication, but they’re very good in decreasing your bacterial load and that’s all you need.

Dr. Weitz: Yeah. And I’ve seen that consistently in a number of my patients, so that’s why I was kind of skeptical about.

[00:33:00] Hearing that they, they don’t do anything because I think you’re right. They’re looking at, you haven’t completely eradicated it, so you haven’t done anything. But it’s more a question of the balance, which it is for so many things.

Dr. Sagar: Right. And as you know, how does Hval transmit it’s fecal oral route, right?  So if somebody has hval in the house, right, and you’d give them antibiotics, I’m sure the people who are sharing the plate sharing bathroom, you know, living in the same household, it’s cross contamination. And that’s why a lot of times it’s difficult to eradicate, you know, especially in endemic areas because everybody in the family has it.

So you have to give antibiotics at the same time for everyone, and may work for somebody may not work for someone else. So it’s tricky. So we have to find that balance, as you’re saying the most the least side effect and the most effective. And I think natural therapy is the way to go.

Dr. Weitz: Now, one category of patients that I’ve run into several times is patients who have hypermobility syndrome, [00:34:00] like LERs Danlos syndrome, and these patients often have other gut problems like SIBO and because of this hypermobility, meaning their ligaments are kind of loose. These are people who are like hyper flexible, their arm hyper stands et cetera. So, which means that some of the connections in their gut, like the valves tend not to be as tight. And same thing with the lower esophageal sphincter, as well as some of the other valves.

Have you run across these patients? I’m sure you have. And are there some strategies that can help?

Dr. Sagar: Absolutely. So the simple answer is, the way it works in patients with EDS or AL Syndrome is that the mu everything is hypermobile, right? So there is a weakened lower phial sphincter tone. So we have to understand the physiopathology first, then we don’t, we do the treatment.

So they have the tone of the lower phial [00:35:00] sphincter is weakened and that’s why they have this issue. So I would do the same things that I talked about, how to clear the acid from the esophagus. If you have a lower, so it’s all about lifestyle. Chewing your food, you know, saliva production after eating, not drinking water avoiding the food or medication that’s going to lower this FTA tone even more.

A combination of all this natural supplements like DGL. So it has, it’s more like a teamwork, working with the patient to see what works, what not. But that’s what I do usually in these cases.

Dr. Weitz: Oh, you know what? Now it occurs to me melatonin, one of its benefits not related to sleep is it seems to increase the protective factors in the mucosa,

Dr. Sagar: right?

So, yes, that is correct. The other hers that you could use, which helps with that, it is sodium alginate. Right. That also helps protective thing, melatonin. And then I am also a big fan of artichoke and [00:36:00] ginger because they’re like pro motility. So those are some of the things that we can use in combination.

Dr. Weitz: Okay. Now, one category of drugs that really tends to sometimes damage the esophagus are the osteoporosis drugs that bisphosphonates like Fosamax. Can you talk about these and what can we do about this?

Dr. Sagar: So they work differently. The bisphosphonate, they cause direct mucus cell damage. So it’s not about the motility, it’s just that they go and stick with the mucosa.

They create ulcers and damage so that, because again, if you understand the pathology, you would understand the treatment. So the treatment is simple. Do not let them stick to the esophagus. That means whenever you are drinking or having a pill, which is bisphosphonate, drink a lot of water, like a whole glass of water so that it goes into your stomach, and then you have to stay upright for like 30 to 60 minutes.

Because if you lie down again, it might come back in esophagus. So understanding pathology [00:37:00] helps with treatment. So it’s a direct MCO cell injury, and you prevent it by not causing direct contact with the mucosa by drinking a lot of water.

Dr. Weitz: Have you ever had the patient do the heel drop thing? You haven’t drank all this water, and then they drop down and the idea is it kind of pulls the stomach down.

Dr. Sagar: Yeah. So don’t do that together all. So he drop very well. I really recommend, but you have to do it correctly. So you have to kind of lift up and then drop certainly, and

Dr. Weitz: right.

Dr. Sagar: People do it just one or two times, but no, you have to do it like 10 times. Right. And obviously at least two to three times in the day.

Dr. Weitz: Right?

Dr. Sagar: Yeah.

Dr. Weitz: And right now in this country, the. Most popular new drugs are the weight loss drugs, the GLP one agonist drugs. And these drugs work by slowing down GI motility. Are you starting to see an increase in patients with [00:38:00] reflux because of these medications?

Dr. Sagar: Yes, and I’m glad you asked this question because I

Dr. Weitz: by the way these are drugs that we’ve all heard about that everybody’s taken for weight loss that started out as diabetes drugs.

Dr. Sagar: That is correct and a lot of people are using it. It’s funny you say that because I launched my online platform and I do like live sessions in it, like every couple of weeks and this last Friday I had this gentleman who took GLP one for type T and now they’re dealing with acid reflux and constipation.  You know, so I talk about natural ways to kind of lose weight and these things in my platform. So we had like a two hour discussion on this. So this is, I’m passionate about this. So first of all, we have to understand that losing weight is not the same as being healthy. You can lose weight by just drinking water or eating like a little bit of chicken throughout the day.

But does that mean that you’re healthy? The answer is no, because it has a lot of biochemicals that comes into play [00:39:00] with the GLP one. How does they help you lose weight? They decrease your mortality, right? So you’re not feeling that hungry, but that in turn also changes your gut microbiome, so we have to understand that concept as well.

So to answer your question, yes, a lot of patients with GLP one will have acid reflux. The problem happens that we don’t take those things into consideration before starting. So I think it’s important to have that dialogue with our patients that, hey, this is going to decrease your mortality so it can worse in your acid reflux it worse in your constipation.  And also it is not a magic pill because once you come off it, you are going to gain all that weight back.

Dr. Weitz: Right.

Dr. Sagar: Are you willing to. Be dependent on a chemical for all your life, because ultimately you have to change your lifestyle, right. In the weight loss, you know? Right. So that and

Dr. Weitz: these drugs, like Ozempic is one of the most popular ones.

You’re right. People tend to gain the weight back. Not only that, but there’s a tendency when people lose weight to [00:40:00] lose muscle, which means your metabolic rate is slowed and it’s gonna be even harder to keep the weight off.

Dr. Sagar: Yes. And remember, once you are overweight. The chemicals in our body alters in such a way that your mind and body will try to maintain that weight.  So you have to remember this because that’s why it’s easy to lose weight, but maintain it is difficult because now you’re kind of fighting against all these chemicals. So training, how to kind of reduce that, you know, that fight. And then setting a new baseline. For chemicals for your system is more important and that’s the way to sustain the weight loss rather than through the help of these chemicals.

Dr. Weitz: You’ve talked about some specific foods like coffee and Mint to avoid, but is there a sort of general diet that’s beneficial?

Dr. Sagar: Very good question. Nutrition, I love that because I think food is medicine for acid reflux. I would say that a [00:41:00] whole food-based anti-inflammatory diet with emphasis on mindful eating, as we mentioned, chewing the food thoroughly.  Having smaller portions throughout the day and avoiding those trigger is key. There has been some benefit of low FODMAP diet or low acid approaches. And if somebody is interested, they could look into that, but I believe it adding more food items rather than removing. So eating everything but more like whole foods non-processed that’s the way to go.

Dr. Weitz: What about food allergies?

Dr. Sagar: Good question. So yes, food sensitivities or

Dr. Weitz: food sensitivities, yeah.

Dr. Sagar: Yeah. So the food sensitivities can trigger inflammation and motility changes, and that can worsen your acid reflux. So, if you have been tested for food allergies and if you are allergic or sensitive to something, you could start with a elimination diet.  But as I said in my practice, I have seen that it’s never the food, which is the problem. ’cause if somebody, if you [00:42:00] do the food allergy testing on ports on a person who has a lot of GI issues, they will come back positive for like 50 different food items. But it’s usually not the food. It’s because there is something going on in your gut, like there is a dysbiosis or there’s a leaky gut which is causing all this allergies.

So that needs to be addressed,

Dr. Weitz: right? Some patients with gut problems have histamine intolerance. Or elevated histamine levels. Can this also be a factor?

Dr. Sagar: Absolutely. So high histamine levels from diet or from mast cell activation or poor breakdown of histamine can increase the the acid secretion and it can also worse in the reflux.  So you have to support the histamine metabolism and reduce the food items that has histamine. And I also feel like it’s kind of a vicious cycle because if you have dysbiosis, gut issues, then the histamine is produced every time you eat the food. So rather than just suppressing the histamine, addressing the root causes of why you have [00:43:00] elevated histamine is also important.

Dr. Weitz: Okay. I think I, those are the main questions that I had. Any other things you want to tell us about?

Dr. Sagar: Yeah, I think the, in patients with acid reflux, a lot of time we just think about the digestive track, right? The esophagus. But you have to understand that if the a traditional approaches have not worked out, then we have to have a more multidisciplinary approach.

And what we, I’m really talking about. Sometimes acid reflux can give you atypical symptoms like bad dreams or headaches or sinusitis. And when you have a patient who has not improved with conventional treatment, we have to look beyond the digestive track and things like oral cavity. So if you have infection in your mouth because of root canal or poor dental hygiene, remember the microbiome in your oral cavity is not separate from that in the gut, right?

It’s all connected. Swallow that. So you have to look in [00:44:00] your MI oral cavity and probably refer them to a holistic dentist who can actually clear up the infection in the mouth so that they can have a better microbiome and symptoms. Sometimes that helps with acid reflux.

Dr. Weitz: Right? I understand. If you have, say, an increase in p gingivalis in the oral cavity, that’ll lead to a more acidic pH in the mouth.

Dr. Sagar: Yes, exactly. That’s that’s absolutely true. The other thing that we missed is I had a patient actually who had very refractory acid reflux and, you know, she was losing weight and then she had IBS and we did all these endoscopies and different testing. Ultimately I referred her to an ENT specialist and what she really had was a deviated nasal septum, and she went under the surgery to kind of correct the septum and her acid reflux improved.  So looking at the sinuses to see if there is infection there because they’re all interconnected. So just to keep in the back of the mind that sometimes [00:45:00] it’s really not the stomach or esophagus, but it could be the sinuses, it could be your oral cavity. So we have to have like, like this whole person approach to this.

Dr. Weitz: Yeah, that’s a really good point. I think it, the oral cavity can play a role in almost any GI can condition, including, it could be a factor in IBS, SIBO and dysbiosis and we often don’t really pay much attention to it and we really need to.

Dr. Sagar: Yes, we do. And I think we don’t ask this question to our patients, but we should ask them like at night, do you breathe from your nose or from your mouth?  Right. This is important question that we miss as you know, physicians, primary care doctors, because if they’re breathing from their mouth, then it’s kind of like just changing your microbiome, not just in the mouth, but also in the gut. And really the answer is very simple. You just tape your mouth so that you breathe from your nose.  Obviously, your nos, your nostril need to be clear. But this is from habit. Some people breathe from their mouth and that can affect your gut health [00:46:00] also. So please ask, start asking this question to your patients going forward.

Dr. Weitz: And address your oral hygiene with flossing. Do you like things like oil pulling?

Dr. Sagar: Well, I feel like if you, your sinuses and nostrils need to be open. Okay. And whatever helps with that. I’m a big believer in breath work and meditation. Okay. I teach a lot of that in my platform as well. So there is something called alone below, which is kind of a breath work where you close one of your nostril.

And you breathe in from this one, and then you close this one and breathe out from the other one. That’s, if you do that practice every day, it’ll help to open up your sinuses and nostrils. So, simple things. You don’t really have to go to ENT if you can just do this and open up your nervous nostrils.

That, that would be very helpful. That’s

Dr. Weitz: great. So how can listeners and viewers find out more about you, get in contact with you, your website, et cetera?

Dr. Sagar: [00:47:00] So that’s the QR code. Okay. You just like to do this and it’ll take you directly to my online platform. And yeah, once you join, you’ll have access to self-paced modules gut health, root cause all of that.

I do live q and a sessions. We did one session with how to remove subconscious blocks for healing and the during the live q and a sessions. It’s so much fun. It’s a sense of community, a lot. Patients are there and they kind of, we support each other for healing. Now

Dr. Weitz: not everybody is gonna be looking at this.

If you’re listening on your phone, you can go to my White’s Chiro YouTube page and you can pull this up. And this’ll be towards the end. Or if they just want to type in your your URL code to go to your website where would they go? Would they use this code here?

Dr. Sagar: Yes, you can use your phone to kind of scan this, if not the u U RL is on the top, so you, we can just like, put that,

Dr. Weitz: You wanna read it out real quick?

Yes. So, yeah,

Dr. Sagar: sure. [00:48:00] So it’s www.school SKOO l.com. And then there is like a

Slash and guta, so G-U-T-V-A-N-A slash about A-B-O-U-T. And also, if you guys follow me on Instagram, I have the link on the Instagram. So that’s another way to kind of get the link.

Dr. Weitz: What’s your Instagram handle?

Dr. Sagar: It’s Dr.

Dipti. That’s it.

Dr. Weitz: That’s great.

Dr. Sagar: Yeah, it’s all together. There are no dashes. All smalls. Yeah.

Dr. Weitz: Thank you Dr. Segar.

Dr. Sagar: Thank you so much Dr. Wise. It was such a pleasure.

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

Dr. Marc Ryan discusses Hashimoto’s Thyroiditis with Dr. Ben Weitz.

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

 

Podcast Highlights

In this episode of the Rational Wellness Podcast, Dr. Ben Weitz hosts Dr. Mark Ryan, a licensed acupuncturist, herbalist, and functional medicine practitioner, to discuss Hashimoto’s Thyroiditis, the most common autoimmune condition in the US. Dr. Ryan shares his personal journey with Hashimoto’s and his path towards specializing in its treatment. They delve into the causes, symptoms, and the complexities of managing this condition, emphasizing the importance of a holistic approach. They also discuss the nuances of various thyroid medications, the impact of diet, and the role of supplements. The episode provides insights into functional and traditional Chinese medicine approaches to treating Hashimoto’s, stressing the need for comprehensive testing and individualized care.
00:30 Meet Dr. Mark Ryan: Expert on Hashimoto’s Thyroiditis
00:59 Understanding Hashimoto’s Thyroiditis
02:52 Dr. Ryan’s Personal Journey with Hashimoto’s
05:45 Common Symptoms of Hashimoto’s
07:11 Conventional vs. Functional Medicine Approaches
07:46 The Role of Thyroid Hormones
12:59 Autoimmunity and the Immune System
16:33 Comprehensive Testing for Hashimoto’s
20:13 Addressing Adrenal Dysfunction
21:28 Managing Blood Sugar Levels
24:14 Product Break: Apollo Wearable
25:45 Hypothyroidism and Its Effects on the Body
25:56 Understanding Hypothyroidism and Kidney Function
28:23 The Impact of Testosterone on Kidney Health
30:16 Thyroid Hormone and Heart Disease Risk
31:41 Nutritional Supplementation for Hashimoto’s
31:47 The Controversy of Iodine in Thyroid Health
37:30 Balancing Thyroid Medication
38:52 Dietary Recommendations for Hashimoto’s Patients
43:51 Final Thoughts and Contact Information
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Dr. Marc Ryan is a licensed acupuncturist, herbalist, and Functional Medicine practitioner.  He’s written two books about Hashimoto’s thyroiditis, How to Heal Hashimoto’s and The Hashimoto’s Healing Diet. He teaches at YoSan Acupuncture College, and his practice is devoted to treating patients with Hashimoto’s.  His website is HashimotosHealing.com.

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

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Podcast Transcript

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

Hello, rational Wellness podcasters. Today we’ll be having a discussion with Dr. Mark Ryan about Hashimoto’s Thyroiditis. Dr. Mark Ryan is a licensed acupuncturist, herbalist, and functional medicine practitioner. And we’ll be discussing Hashimoto’s thyroiditis, which is the most common autoimmune condition in the us and I’m just going to talk for a few minutes about Hashimoto’s to give us a little background about this condition.  So, while the prevalence of Hashimoto’s thyroiditis occurs in about one to 2% of the population, up to 20% of the population have positive thyroid antibodies. Women are affected five to eight times more frequently than men. Over 90% of those in the US with hypothyroidism have Hashimoto’s, meaning that their low thyroid is autoimmune in origin rather than a rising from an iodine deficiency called goiter.  Prior to 1924 in the United States, the main cause of hypothyroid was iodine deficiency. Especially across the northern part of this country and in Appalachia where the soil was iodine deficient, and this area was known as the goer belt. Iodine deficiency leads to enlargement of the thyroid knowns, goer, and in extreme cases can lead to [00:02:00] impaired neurological, stunted growth, physical deformities.  But starting in 1924, we instituted iodized salt. When this happened, rates of goiter dropped to very low levels, but rates of Hashimoto’s soared. A similar pattern has occurred in other countries around the world that have instituted iodine supplementation.

So, as I mentioned, Dr. Mark Ryan is a licensed acupuncturist, herbalist, and functional medicine practitioner.  He’s written two books about Hashimoto’s thyroiditis, how to Heal Hashimoto’s. The Hashimoto’s Healing Diet. He teaches at Yoan Acupuncture College, and his practice is devoted to treating patients with Hashimoto’s. Dr. Ryan, thank you so much for joining us today.

Dr. Ryan: Oh, thank you for having me.

Dr. Weitz: Great. Let’s start by talking about your story with Hashimoto’s.

Dr. Ryan: Yeah, so I, you know, I think like many [00:03:00] acupuncturists, I started out as a generalist and you know, worked for many years in, in a number of different other people’s practices. And then opened my own practice in San Pedro. Had a big multidisciplinary practice there for several years and I kind of, it was a big thing.  I kind of crashed and burned and got burned out and, you know, I was working like. You know, I’m sure you know, 12, 15 hour days doing long hours. And I just like burned the candle at both ends. And through that process, I ended up closing that practice and decided I wanted to, like, reimagine myself and what I was going to do with my career.  And I went and got some business training and one of the things that they said was you have to choose a niche. Like if you wanna be successful, you need a niche. So I was like, well, and I was thinking about my patient population. I thought maybe I’ll do thyroid stuff. You know, I always, I seem to have a lot of thyroid patients, even at that time for some reason.

And so I chose, [00:04:00] originally hypo, just hypothyroidism as the niche. And then six months later I was diagnosed with Hashimoto’s. Huh. And then, so that pro, you know, obviously it became not just a professional choice, it became a personal you know, mission. Because my experience with it, and this is experience I’ve had with lots of patients over the years, is I went, I had a good friend who was an MD.  He did all the testing. We did ultrasound, you know, found nodules. We found that my TPO was quite elevated. It was really high. I was at 1200. But all my other numbers were normal. And so it was basically, it was like, well, yep, you have Hashimoto’s, but there’s nothing we can do about it right now.  We’re just gonna keep an eye on it. And once it gets bad enough, which means, you know, that translates to once your thyroid’s sufficiently destroyed, we’ll put you on Synthroid and then you know, it’ll be fine. So it was at that point I realized like. Holy crap. Like they have nothing to offer in the Western medical model.  There’s really nothing for people who don’t have advanced [00:05:00] destruction of their thyroid with Hashimoto’s. So that really be kind of started my whole journey of learning and research and studying and working with people to try to find solutions for things that. You know, we have

Dr. Weitz: before it gets that bad.

And by the way, this is also the reason why most medical doctors, even endocrinologists, rarely test for thyroid antibodies. And if they do test, they’ll never test again because there’s nothing they can do about it.

Dr. Ryan: Correct. They don’t, it doesn’t change their treatment strategy. One iota. If they find the person has, you know, antibodies if the antibodies are a hundred or if they’re 3000, you know, it does, they do not do anything differently.  Yeah.

Dr. Weitz: So, what are some of the most common symptoms that somebody with Hashimoto’s can have? Which, what symptoms did you have?

Dr. Ryan: Yeah, I mean, it’s, three of the most common are fatigue brain fog and weight issues, [00:06:00] usually trouble losing weight, although there’s a whole. You know, sort of subpopulation that has trouble gaining weight.  Those are the common, most, three common symptoms. Hair loss is another one, which is particularly troubling for women sometimes. Dry skin, usually some sort of gut. Dysbiosis or leaky gut or some gut prop. Food sensitivities are also very common. Joint pain is quite common. But the top three are brain fog fatigue and, weight gain. I didn’t have any weight issues really, about my top symptoms were brain fog and fatigue. I had pretty severe brain fog. I remember one day I, a patient came out I had for 12 years and I could not remember their name, and I was like, oh, so’s in my brain right now.

Dr. Weitz: Yeah. I, by the way I also have Hashimoto’s and have never Oh, really?  I didn’t know that. Yeah. I’ve never taken thyroid medication and I’ve been dealing with it using a functional medicine approach as well.

Dr. Ryan: Yeah.

Dr. Weitz: I’ve actually to my knowledge, never [00:07:00] had any symptoms. My TPO antibodies are, you know, around a hundred, 150, so it seems to be a lower level, but I’ve certainly been working on managing it.  So, what a patient sees a conventional medical doctor with Hashimoto’s, how did they get treated?

Dr. Ryan: Yeah. If you go to see a conventional medical doctor, usually the first line of treatment, if they see. Some imbalance in your numbers. If they see elevated TSH or some Usually they just test TSH and maybe Right.  TSH is really the one number they really focus on. Right. So they find that the TSH is elevated out of range. They will usually prescribe Synthroid.

Dr. Weitz: Right. Which is essentially synthetic T4.

Dr. Ryan:  Correct.

Dr. Weitz:  Can you explain what T4 and T3 are and what TSH is?

Dr. Ryan: So, TSH is produced by the pituitary–Thyroid Stimulating Hormone, and basically it’s, your brain gets signals from the body, [00:08:00] and then there the, through the HPT axis, the hypothyroid, pituitary, and thyroid axis, it signals the thyroid.  And tells the thyroid to either produce more thyroid hormone or less. And in the body produces naturally about 12 parts, T4 to one part T3, and that T4 has to be converted into T3 for it to be biologically functional and most of that happens in the liver. About 60% in the liver.  Another 20% of that conversion happens in the gut with good bacteria, and then the final 20% happens in the peripheral tissue. So the body has to go through that process of conversion and then also it has to then absorb the thyroid hormone properly. All, you know, all the cells in the body have thyroid hormone receptors.  But there can be problems, and I think this is where we come in as natural functional medicine practitioners. There can be problems with conversion, there can be problems with absorption you know, all along the way there. So [00:09:00] just taking medication doesn’t always guarantee that it’s gonna function properly in the body because of that whole process.  Right.

Dr. Weitz: And can you explain what T4 and T3 are?

Dr. Ryan: Yeah, so T4, as I said, body produces mostly T4. It’s not the biologically active form, although it does do some things within the body, but by and large it has to be converted to T3, which is the biologically potent form of T3, that works on the cells and causes the metabolic changes that it does.  And T3 is so active. That your body actually has mechanisms for turning it off. There’s something called reverse T3, which also happens in the liver, where if you’re under times of stress if your adrenals are too taxed or if you’re iron deficient. Then the body will take that T3 and make it inactive just because it, it’s so metabolically potent [00:10:00] and, you know, can cause stress and other things.

Dr. Weitz: And if in case there’s some lay persons listening to this who might not understand how important thyroid hormone is, can you explain why thyroid hormone is such an important hormone?

Dr. Ryan: Yeah, I mean, in Chinese medicine we sort of view it as a v. The personification, if you will, of kidney yong, which is your body’s metabolic fuel in a sense.  Every cell in the body has thyroid hormone receptors. It is what powers the, you know, it’s like the engine that powers the function in your body. So whenever you are hypothyroid, whenever you are, if you aren’t absorbing it probably, or your body’s not utilizing it properly, it can affect every system of the body.

One example is the liver. Like when someone’s hypothyroid it’s everything. All the processes in the liver slow down. So often you’ll get elevated cholesterol and other problems as a result, just because that [00:11:00] metabolic energy that fuel. It is not being processed and utilized properly and everything slows down.

Dr. Weitz: Essentially, the thyroid is the master regulator for every cell in the body.

Dr. Ryan:  That’s exactly right.

Dr. Weitz:  Every tissue in organ. So let’s go into proper testing. Yep. When you wanna assess the thyroid besides looking at the whole person and their symptoms, et cetera, what lab tests should ideally be run?

Dr. Ryan: Yeah. So I mean, for me it’s always important to do as complete a thyroid panel as possible, particularly if it’s the first time that person’s being tested or if it’s someone who has not been tested for some time. So that would be the TSH I would. Order the total T three and the total T four.  That’s the amount of T four and T three that are, is both free in the body and it’s bound to proteins. And then I would also order the free T four and the free T three. These are the free fractions. What is bioavailable? I like to also look at the [00:12:00] reverse T three. Most MDs will not. Order that test. But I like to look at that test ’cause that can tell us something about conversion.  If you look at the ratio between free T three and the reverse T three and then the two antibodies which tell us I, is there an autoimmune process going on that’s TPO or thyroid peroxidase and TGAB, which is a thyroid globulin antibody. So a complete thyroid panel would include all of that so that we can really assess how the thyroid is functioning.  And whether or not the autoimmunity is part of the equation. 

Dr. Weitz:  So, autoimmunity in the conventional medical world is either ignored as in cases of thyroid autoimmunity, or in other forms of autoimmunity. There are medications that suppress some or all of the immune system. In the functional medicine and traditional Chinese medicine world, how do we address autoimmunity?

Dr. Ryan: Yeah. So what, [00:13:00] first of all, what is autoimmunity? Autoimmunity is like the body has lost the ability to recognize itself in a sense, right? It’s, you, your immune system has flagged your own tissue as an invader and is attacking it. So. What we wanna try to assess is how is that imbalance occurring within your body?  Are there different parts to the immune system? What we call t th one, TH two, TH three, TH 17. These are all th stands for T helper cell. One of the things we do in functional medicine is we assess, well, what is this relative balance of these different parts of the immune system and where it may it be overzealous.

You know, at first there were theories about Hashimoto’s being a th one dominant condition. I think OO over time research has shown this, that maybe it was an oversimplification, but there’s usually some kind of imbalance there in, in the th one or th two aspect of the immune [00:14:00] system. And then th three is, so see, let’s explain what those are.

Th one is kinda like the frontline of attack the immune cells that, that do the actual tacking of pathogens. TH two is the antibody system. I think of that sort of as like military intelligence, if you were to use it thing that your immune system is flagging certain parts of that certain parts of the, of your own body with autoimmunity, but other.

Pathogens when it’s, you know, fighting a virus or bacteria. And then th three is sort of the command and control structure. This is the part of the immune system that is overall balancing this process. And so we wanna try to assess that and calm down the attackers, you know, quiet that portion of the immune system and strengthen that.

Command and control structure, which is what Vitamin D and glutathione are both very helpful for. Right.

Dr. Weitz: So what are, what how do we understand how our body gets dysregulated? You know what, [00:15:00] why would our immune system start attacking our own cells?

Dr. Ryan: That’s a great question. There are a number of different theories for that.

You know, some, there’s a theory called molecular mimicry. Correct. Where the, you know, immune system sees you know, your own cells as similar to a pathogen, I think sometimes. And I

Dr. Weitz: think that’s one of the most,

Dr. Ryan: Dominant thoughts in this

Dr. Weitz: world, right?

Dr. Ryan: Right. Yeah. It’s one of the top theories on it.

You know, I think autoimmunity itself is a perfect storm. There’s a, there’s usually a genetic component. There’s usually exposure of some kind of pathogen, like Epstein Barr for example. You know, in that case, you know, Epstein Barr can attach to thyroid tissue, and then you kinda get this hybrid of your own tissue and Epstein Barr and all combined and the immune system just flags that.

And you know, your own cells are kind of, you know, the. The residual victims of that. There’s [00:16:00] also usually, you know, stresses is definitely a big component to the onset pregnancy for women is sometimes an onset. And usually some kind of gut dysbiosis or, you know, problem in the gut too.

So it’s usually it’s definitely a, not a single cause I don’t think. I think it’s really a perfect storm of all these things. So,

Dr. Weitz: let’s see. We talked a little bit about testing, so, let’s go into how we handle patients with Hashimoto’s and what’s the first thing you like to look at?

Dr. Ryan: Well, I’ll definitely do a thyroid panel, but I like to do also a more, much more complete panel just to see what other systems are being impacted and how, so we want to, you know, do a lipid panel. We want to look at the liver, do a lip, a liver panel, look at the kidneys, how they’re functioning to a renal panel, you know, comprehensive metabolic panel.

We wanna look at red and white blood cell counts, you know, how’s that being impacted? We wanna check [00:17:00] to see are they anemic? So we do an iron panel as well. And look at ferritin. It’s very important since this is not just a thyroid problem, it’s really a systemic problem because of the influence of thyroid hormone.

We really need to assess the entire body and see what’s going on. So we’ll look at all those things. Look at blood sugar metabolism, how that’s you know. In the person. I also, you know, I like to think in terms of this, the endocrine triangle, that’s the thyroid, the adrenals, the blood sugar, the pancreas all is one system really.

So we, we want to check and see how that is all being impacted. And then, you know, we have to treat, we have to prioritize what we find in that process and you know, treat the patient holistically in their entire body. Do you look at food sensitivities when you do your testing? I do, sometimes I do.

Yeah. I mean, it depends, you know, that’s part of the intake process we wanna see, you know, are they having [00:18:00] food reactions generally, you know, even if I don’t do testing, I generally advise people to get off of gluten and dairy just because it can have such immune stimulating effects that can make your auto autoimmunity worse.

And people often do have food sensitivities, but it’s not usually the first thing that I will test. I generally do just the blood tests first to. To assess how the system is right,

Dr. Weitz: so when you book, you address how you explain how adrenal stress has an effect and reduces the conversion of T four to T three.

So that, that’s why talk about the adrenals and how that affects the thyroid.

Dr. Ryan: Yeah. So that’s why it’s important that we assess that, that triangle that I was just alluding to. The and that’s the stress piece, I think too. Right? That’s the there’s, has a huge the adrenals it’s interesting.

In Western medical model, the adrenals are not really

Dr. Weitz: Yeah. Unless there is Cushing syndrome. Exactly. Unless it’s super advanced, really extreme. They don’t recognize any other [00:19:00] adrenal problems. And I think part of that’s because of the way they test for it.

Dr. Ryan: Oh, right, exactly. Because they’re.

What is testing for the adrenals in West Medical in A CTH, which is the equivalent of TSH in the adrenals. Yeah, so it, and it’s serum cortisol, right? And right and cortisol in the bloodstream. What I do like to test is do to do a saliva test the four point cortisol saliva test, which we take samples of saliva four times throughout the day and actually look at the circadian rhythm and how the body is processing.

Cortisol and how that’s impacting everything. But yeah, I think the point that you brought up is very important and that is that stress and too much cortisol being produced and adrenal dysfunction has a huge impact on the thyroid. And I think one of the main reasons is there’s that communication system between the brain, between the hypothalamus pituitary.

And these glands is so much the same, right? There’s the [00:20:00] HPA axis, there’s the HPT axis, it’s the same communication pathways. And once they’re disruptive in the adrenals, they’re gonna be disrupted in the thyroid as well. So that it’s super important that we evaluate that.

Dr. Weitz: When you see a dysfunction with the adrenals, how do you address that?

Dr. Ryan: Depends what it is, but generally we wanna, we want to you know, really look at their circadian rhythm, what’s going on, how are they, what’s their sleep hygiene like, you know, how is their sleep? What is their blood sugar, you know, balance. Like are they hypoglycemic, are they insulin resistant? Like where are they in that?  ’cause those two things are also very much intertwined. So, you know, part of the first thing to assess is, okay, how. How are, how is your sleep? How is your circadian rhythm? Are you know, taking care of that piece? And then often we’ll do things to try and reestablish that communication between the hypothalamus and pituitary by using app adaptogenic herbs perhaps.  [00:21:00] Or you know, in Chinese medicine we’ll do an approach where we’ll work on that kidney yang and kidney in balance. There. But I think, yeah it’s all, again, the holistic approach is it looks at blood sugar stability, get that communication from the brain and trying to establish and rebalance those.

Dr. Weitz:  So, why is blood sugar such a common problem and how do we properly assess blood sugar?

Dr. Ryan: Yeah, so blood sugar issues are maybe the most, and when I say

Dr. Weitz: blood sugar we really mean insulin resistance is probably right, the main problem.

Dr. Ryan: But even, I mean, we see both things.

We see both types of dysfunction, like hypoglycemia is also a major problem. For people with Hashimoto’s. Yeah. It’s just the other end of the spectrum. It’s just the, that bloodstream mouth, but Right. So let’s explain what those two are. So hypoglycemia means you have too little sugar in the blood.

That, those are the type of people who you know, they can’t skip meals. They get really like lightheaded or [00:22:00] hangry. Often we’ll also see, you know, low triglycerides, which are sugar stored as fat, like they have no sugar reserves. So, you know, these type of people are really vulnerable to their blood sugar crashing.

And that has an entire impact on the thyroid in the system. And those people usually on

Dr. Weitz: their way to high blood sugar.

Dr. Ryan: Correct. Right. That’s usually earlier on in the progression that, that imbalance. And then the other side of that is insulin resistance, which is also called metabolic syndrome, which is you know, pre-diabetes that, that pathway towards becoming a type two diabetic, which is, you know, an incredibly common problem we have in our culture because I think a lot of processed foods have so much sugar and.

Whatnot. And so that’s the opposite problem, where you have too much sugar in the blood and then that can lead like to things like, you know, elevated ferritin where you can’t access iron either until you get this like double. You know, [00:23:00] fatigue problem because of that imbalance. So, w with that, we really wanna assess, we wanna look at their fasting glucose, look at their hemoglobin A1C, look at their lipid panel, look to see how they’re processing sugar and how it’s being utilized in their body.

And try to, you know, get people to be conscious about. Stopping these huge spikes and crashes of sugar in their daily life and create more balance throughout the day. How do they do that? Well, generally, again, we have to figure out where they are on the spectrum, but we, you know, that first starts of the, you know, it’s not really an old wives tale, but having a good breakfast is actually a critically important thing where you have you know, ellos, frosted flakes, starting the day with sugar is a recipe for disaster because you, that’s exactly what happened to you.

Like you’re sure. Hits this roof and then you crash a couple hours later and then the rest of your day is trying to make up that. So yeah, we wanna start the day with a good protein, a good fat [00:24:00] balance making sure then from there on making sure we’re, you know, wherever you are on that spectrum, you’re eating frequently enough throughout the day so your sugar doesn’t crash and you’re not, you know, binging too much on carbs and sugar along the way there.

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So go to Apollo Neuro and use the promo code Whites today. And now back to our discussion. In your book you talk about how hypothyroidism can lead to decreased blood flow to the kidneys, increased uric acid, even high blood pressure. Can you talk about [00:26:00] that?

Dr. Ryan: Yeah, so. Again because of thyroid hormone is so influential on so many different systems.

Whenever you’re hypothyroid or something, I call functionally hypothyroid. If you, sometimes we’ll have enough thyroid hormone in our system, but because of thyroid receptors being blocked or just systemic inflammation or this blood sugar stuff that we’re talking about that can lead to.

Other systems being impacted and not functioning properly. So we can see that with the with blood pressure and the kidneys usually it it starts as low blood pressure, but over time it, it can kinda snowball into a problem where you actually end up with high blood pressure.

Dr. Weitz: Yeah. And we, you know, I see a lot of patients who do a lot of labs.

Who are trending towards having kidney problems. And I think it’s often unrecognized when we look at kidney function tests that a lot of times we’ll use [00:27:00] aerial filtration rate EGFR. Yeah. And on the labs it says anything over 60 is fine. Right. The reality is. When you get below 60, you’re actually at grade three.

Kidney failure, right. Precise. One and two are much higher than that. So 60 really should not be the cutoff for assessing thi kidney function.

Dr. Ryan: Right. Exactly. I mean, funny brings up, I had a couple patients last week, like two opposite issues resulting in, in kidney damage in the decline of the EGFR and that’s explain that.

CGFR is blood flow in the kidneys. It’s actually how your kidneys are processing blood and therefore how everything is working through them. And you’re right. What. In the Western medical model, there are five stages of chronic kidney disease and after stage three a, it’s a really big problem.[00:28:00]

Like the, you know, that’s where you’re

Dr. Weitz: and stage three starts at below 60. Right. So, so somebody comes in with 65, they’re already at stage two kidney failure.

Dr. Ryan: Correct. So like that’s why it’s so, but the labs say normal. That’s why it’s so important for us to check and evaluate this. So over the last week, I had a couple different patients.

These weren’t Hashimoto’s patients, but it was very interesting to see. One of them was this elderly man who’s, you know, this is in vogue right now where people are being put on, you know, large amounts of thyroid hormone replace, not thyroid of hormone replacement. This elderly man who’s 81 years old, was put on like huge doses of testosterone.

How are a dosage. His testosterone was over a thousand. Okay. On the blood test. Okay. I don’t remember what the exact dosage was, but anyway, they brought me in like four years worth of lab work, and you could see this steady decline of EGFR. So it went from, you know, like [00:29:00] in the eighties to the forties.

Right and through, as it was charting it, you could see when he was aggressively dosed testosterone, just like the absolute immediate decline of kidney function. And basically what was happening was he was, they were, you know, causing intrinsic kidney damage with this aggressive supplementing, you know, so this is one of those things where, yeah, thank God they.

Hey, thank God that came to me, and we could figure out what the problem was and stop it so that it doesn’t have further kidney decline. And b, that, you know, like there’s consequences to doing things.

Dr. Weitz: Like, hey, everything should be in some sense of balance. Some sense of balance, yes. Yeah. Not that hormone replacement is bad, but.

Dr. Ryan: No, it’s, it could be appropriate. Yeah. But you gotta be paying attention to how it’s impacting the rest of the system. And then the other case was interesting, got sort of opposite problem. The person who had pretty [00:30:00] significant B12 deficiency and that ended up causing like high elevations of homocysteine, which is inflammatory mark and causes inflammation in the arteries.

And that was, you know, impacting blood flow to the kidney. And he was also experiencing decline. In kidney function, EGFR as a result. So,

Dr. Weitz: Can point now, hypothyroidism increases risk of heart disease. You mentioned in your book it can increase cholesterol, which you just mentioned. I think a lot of people are somewhat aware of that, but it can also increase homocysteine levels, right?

C-reactive

Dr. Ryan: protein. Right. So, so again, because of the influence of thyroid hormone on all the systems. We see, like I said it’s very, when you’re hypothyroid, it’s very common to see elevations in cholesterol and the other lipids. Also, one thing that there’s definitely been an established link to is the M-T-H-F-R gene mutation and Hashimoto’s.

And that can lead in and of [00:31:00] itself to elevated homocysteine. In fact, like, you know, I teach my students one of the poor man’s tests for elevated homocysteine or sorry, EZ test for M-T-H-F-R mutation is elevated, cysteine over 15. So that basically what you have is this combination of risk factors that increase the possibility and the probability of some kind of heart disease and heart problem.

You get those elevated lipids, you get the high homocysteine, which is impacts blood flow and causes inflammation in the arteries. You get just general inflammation, which we see with the C-reactive protein. You get this, again, another sort of like vicious cycle or perfect storm. Of risk factors that can lead to more problems.

Dr. Weitz: So let’s talk about the potential benefits of nutritional supplementation for patients with Hashimoto’s. And let’s first start with the most controversial nutrient, which is iodine.

Dr. Ryan: Yeah. So Ida this is like one of those areas

Dr. Weitz: where there’s by the way, let me throw an anecdote in there.[00:32:00]

So I have Hashimoto’s and my TSH has been for a lot of years between around seven and eight. Then one year it went up to nine. I decided I would try the high dose iodine. I took 12 and a half milligrams and my TSH went up to 25. So stop that. Exactly. So eating anything that had iodine in it, like seaweed.

Figured out what else I needed. I was really low on zinc. I have a gene that can’t absorb zinc, really ramped up the zinc supplementation as well as the vitamin D, as well as selenium. And then I got my TSH to between four and five.

Dr. Ryan: So perfect antidote because that is exactly what happens with Hashimoto’s patients, who, in my experience, who do high dose iodine.

I I think that’s really the problem, is it’s just excessive amounts. Like we, the reality, we, our body does not need that much iodine for [00:33:00] thyroid function. It’s very important. But the amount we actually need is relatively small, right? So, so if you’re gonna, you know, having seaweed occasionally is actually sufficient.

And I take a multi that

Dr. Weitz: has 150 MCG, and that’s fine.

Dr. Ryan: Right, right. So I think the controversy and the problem really is with excessive iodine, right? Supplementing and that can cause, you know, the, your autoimmunity to flare too. So, particularly I iodine salt is also problematic for autoimmunity.

And when you combine those two in relatively high doses, that’s a real recipe for disaster for the someone with thyroid autoimmunity.

Dr. Weitz: Now, why is iodine salt worse than, say, supplements iodine or eating seaweed?

Dr. Ryan: It’s because salt. It can also you know, amplify the autoimmune process.

Just the sodium itself? Yes.

Dr. Weitz: Yeah. Okay. So what other supplements can be helpful [00:34:00] depending upon the patient? Well, yeah, of course.

Dr. Ryan: And do you test for nutrients? There’s a wide variety. I mean, I do test for some nutrients. You know, all common minerals. We wanna look at the things that are most important for thyroid function, like selenium and zinc like iron you know, so those are the most common ones I’ll look at.

Sometimes I’ll look at B12 and folate as well. Right. But, the, I think we were talking earlier about the different parts of the immune system. We wanna test vitamin D levels too as well to see, ’cause that’s gonna give us a sense of, you know, how do they have enough vitamin D to, to help strengthen that regulatory part of the immune system.

I think glutathione is a very helpful, supplement as well. It’s a Mastro antioxidant. I think in general, you know, we were talking about how a lot of thyroid hormone conversion happens in the liver. You know, so one of the things I see often too is with patients is that the, there will be [00:35:00] some reason that their thyroid hormone is not functioning as well, whether there’s thyroid hormone resistance or the systemic inflammation or what have you.

And then the doctors are just gonna keep increasing the dose and increasing the dose and increasing the dose, whereas and that in and of itself can cause other problems. So what I look at first is, okay, what. Where can we just improve this process by improving these other areas? So let’s maximize liver function.

Let’s make sure that we’re getting, you know, the liver’s detoxing properly, that it’s being supported properly. Let’s look at the gut and see is there any kind of dysbiosis there? Can we support the good bacteria and the microbiome and the gut? Let’s look at the systemic the rest of the body where we’re.

This inflammation, the systemic you know, in this peripheral tissue can cause problems. So, so let’s look at things that are anti-inflammatory, like, like turmeric or resveratrol or things like that. So, you know, I think we get a lot more, we have a lot more success clinically when we think that way.

Dr. Weitz: And I do [00:36:00] think that there is a relatively small sig, but. Significant percentage of practitioners who have adopted a philosophy that when it comes to thyroid. You supplement with thyroid hormone, if the patient doesn’t feel really well, you just keep increasing that dosage. And I’ve had a number of patients come in my office and they’re actually in hyperthyroid from pushing that dosage up so high and granted there may be a few cases, maybe with a history of thyroid cancer where you.

It may be justified, but just for the sake of managing symptoms, pushing that TSH so low with such an aggressive level of thyroid hormone potentially, I think is damaging to the body. And you’re suggesting other ways to try to bring the BA body into balance and address those other symptoms besides simply pushing the thyroid hormone higher and higher in the [00:37:00] body.

Dr. Ryan: And yeah, I think the danger of overmedicating, like we know. That it can lead, particularly in women that can lead to osteoporosis. If you’re too aggressive with thyroid hormone supplementation. The heart itself is very sensitive to T three and to thyroid hormone, so you can do damage to your heart by overmedicating.  There are, again, there are, you know, we were talking about the testosterone supplementation. There are consequences to overall supplementing, right? So we always wanna be looking at balance. Right.

Dr. Weitz: What about thyroid medication? Do you have an opinion about that?

Dr. Ryan: Well, I mean, I. I don’t really like have, people always ask me what’s the best medication?  Like, I, right. You know, so

Dr. Weitz: people say, oh, you should take Tyrosint. It’s better absorbed. You should use, right. You should use armor, you know, it’s natural. It has some T three you should use exactly. Synthetic T four with synthetic T three.

Dr. Ryan: Exactly the problem with that is I’ve seen basically every permutation of it and that it doesn’t always [00:38:00] work for people in the same way.

Like some people actually really do better with synthetic T four. Right? And then other people do need that additional T three that you get with armor or nature. Thyroid, and then, yeah, tyrosine. It can be a great choice because it comes in gel. There’s no filler, so we can eliminate that variable.

But, you know, I think there’s no like magic bullet way of figuring it out. You have to like experiment and you have to pay attention to what’s going on there. And you know, I’ve seen people on the flip side who have reacted to natural thyroid as though it was their own thyroid hormone and actually flared up their autoimmunity.

So, you know, that’s a very complicated, difficult question and often it’s just trial and error to we find the right mix for that person.

Dr. Weitz: So what type of diet is best for patients with Hashimoto’s hypothyroid, and should they stop eating [00:39:00] broccoli? Great question. I mentioned broccoli ’cause broccoli’s in a category of foods known as goergen.

Dr. Ryan: As goergen. Yeah. I’ll start with that. So I think. I liked your little history at the beginning talking about the, you know, the history of Appalachian, the goiter belt, and the fact that we didn’t have, you know, at that point in our history iodized salt and that’s impact that, that is ancient history for us, so, right.

The whole goitrogen. I think, you know, myth is part of that ancient history. It’s no longer an issue and I think the health benefits of broccoli and other, you know, those cruciferous vegetables far outweigh any problem that, that they may have caused. So I think that’s a complete non even.

Dr. Weitz: Just explain what this concept of greater gens is.

Dr. Ryan: Yeah. So the. These vegetables like broccoli, cauliflower, kale, the things of that family I. Can [00:40:00] potentially lead to more increase in, in goiter and nodules in the thyroid, which by the way are very common. The vast majority are benign, but you know, almost everyone will develop some sort of thyroid.  Growth, you know, before they die. So in, in large quantities in the absence of sufficient eye, by the way, how

Dr. Weitz: are they alleged to do that?

Dr. Ryan: The pro I, that’s a good question. Okay. Sorry. I don’t remember

Dr. Weitz: how they okay. Sorry, I didn’t mean to put you on the spot. So, but we have these gor units that are known to I, I think they’re supposed to block the conversion of T 40 T three.

Dr. Ryan: Right, right, right, right. Yes.

Dr. Weitz: And so they,

Dr. Ryan: right. They’re involved in that, but it’s usually, again, in the absence of sufficient amount of iodine. Right. That, that, that happens.

Dr. Weitz: Oh, so it’s a myth that e eating foods like [00:41:00] broccoli aren’t gonna make your thyroid function worse?

Dr. Ryan: I believe so. I believe so.

Again I think it’s the benefit far outweighs the negative of those because they’re very productive against cancer and thyroid cancer in particular. So just diet in general. I think this is a really interesting topic because I went through process for a while. You know, it was, there was a diet that was.

Super pop. It’s not so popular anymore, but it was called the Autoimmune Paleo Diet. Correct? Yeah. It’s I mean, generally I still am in favor of it but I learned something the hard way. Basically it’s a diet where it’s essentially the paleo diet where you’re, you know, minimizing carbs.

It’s just taken to the next level where you’re cutting out every, anything that’s potentially inflammatory. So you’re cutting out carbs, you’re cutting out dairy, you’re cutting out nuts and seeds. You’re cutting out legumes. So it’s a pretty restrictive diet, mostly you know, protein and vegetables.

But one of the things I discovered the hard way was that you can’t stay on that [00:42:00] restrictive a diet for too long because you end up degrading is known in the body as oral tolerance and oral tolerance is our capacity to adapt to different foods. And the only way we can do that is to be exposed to them.

So again, back to balance. You know, I often advocate people go on some sort of, you know, restrictive diet initially to just to calm the immune system. And so we can work on the gut, but it’s critically important that they don’t stay on that super restricted diet for too long because that in and of itself can cause problems.

Dr. Weitz: So, which is the best super restrictive diet to start on? Is it the autoimmune paleo?

Dr. Ryan: I like the autoimmune paleo. Yeah, I think that’s a, I think that’s a good approach. Yeah. So for, but like for 30, 30 to 60 days only, don’t go more than that.

Dr. Weitz: Right? Okay. So you can look that up. Basically, you avoid dairy, you avoid gluten, you avoid all grains, you avoid legumes.

You also avoid nuts and seeds, correct?

Dr. Ryan: Correct. All those different things and nightshades too. [00:43:00] For Right. For people. So it’s anything that’s potentially inflammatory. Right. And it works wonders in terms of calming down the immune system. Just again, you. We can’t stand it for too long,

Dr. Weitz: right?

Because it’s gonna lead to nutritional deficiencies and those foods you’re eliminating that can cause a little bit of inflammation. Also have many benefits that outweigh that. And having a little bit of inflammation means that you have a properly functioning immune system. Anyway.

Dr. Ryan: Right. Exactly.

Yeah. Our immune system is not meant to be completely shut off. It does good

Dr. Weitz: work for us. Absolutely. Which is one of the problems with medicating to suppress your immune system, right. Helps you fight you off infections, cancer pathogens, et cetera. Yeah, exactly. Yeah. Alright, great. Any, anything we haven’t covered that you wanna explain?

Dr. Ryan: Not really. This has been a great discussion. We, I think we’ve touched on a lot of [00:44:00] important things. I just think overall for people, you know, if you’re new to this, you’ve just been recently diagnosed with Hashimoto’s and you’re feeling lost or you’re struggling, just know that there’s a lot that we have to offer.

In the functional medicine, Chinese medical world for you if you’re feeling abandoned or you know, not that supported by your md. There, there’s a lot that we can do. And it’s generally pretty well and easily managed if it’s done properly,

Dr. Weitz: right? So simply taking Synthroid should not be the end of the story, and if you’re not feeling great after that.

You should really seek out a functional medicine practitioner like myself, like Dr. Ryan. How can listeners and viewers get in touch with you?

Dr. Ryan: Yeah, I’m, I have a couple social media accounts. I’m on Facebook and Instagram. I currently teach what’s your tag on Instagram?

Instagram is at Hashimoto’s Healer. Okay. And I currently am a professor and clinical [00:45:00] supervisor at Yoan University where I’m teaching students how to practice you know, functional medicine as we discussed and I do see patients there as well. And

Dr. Weitz: if they want to get ahold of you directly, what’s your website?  Phone number, contact? Yeah, my website’s,

Dr. Ryan: ha hashimoto’s healing.com. You can reach out to me through there or message me, you know, via social media.

Dr. Weitz: Great. And your books are available on Barnes and Noble, Amazon,

Dr. Ryan: et cetera,

Dr. Weitz: correct?

Dr. Ryan: Well, there, but books are published by Hay House. Actually just approached me, they’re gonna do an audio version of my first book, how To Heal Hashimoto’s.  We’re in the process of doing that right now. They were gonna clone my voice and have ai

Dr. Weitz: and you said, no way. Let’s bring on the real thing.

Dr. Ryan: Yeah, it was like, yeah, I dunno. We’re in discussions with that right now, so I will read the book happily. They wanna replace me with a robot, but yeah,

Dr. Weitz: that’s the world we live in.  That’s the world we live in. Does the [00:46:00] robot have Hashimoto’s?  Okay, thank you, mark.

Dr. Ryan:  My pleasure.

Dr. Weitz:  Great talking with you.

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Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple 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 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 [00:47:00] consultation for functional medicine and I will talk to everybody next week.

Dr. Andrea McBeth discusses how Stool-derived Postbiotics can restore gut health with Dr. Ben Weitz.

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

 

Podcast Highlights

In this episode of the Rational Wellness Podcast, host Dr. Ben Weitz discusses postbiotics with Dr. Andrea McBeth, a naturopathic clinician and expert in functional gastroenterology and the microbiome. Dr. McBeth shares insights into her work with fecal microbial transplants and her development of the pheno-biotic supplement made from sterilized fecal matter. The conversation dives into the benefits of postbiotics for various gastrointestinal conditions and overall gut health, the complexities of bile acids and their roles in the body, and the emerging understanding of the microbiome’s impact on brain and immune function. Dr. McBeth also highlights the stringent criteria for selecting stool donors for her supplements and announces an innovative partnership for clinical trials to gather more data on the effectiveness of postbiotics.
00:29 Meet Dr. Andrea Mcbeth: Expert in Functional Gastroenterology
01:26 The Science and Benefits of Fecal Microbial Transplants
04:50 Exploring Bile Acids and Their Clinical Importance
10:02 Understanding Prebiotics, Probiotics, and Postbiotics
12:28 The Development and Benefits of Sterilized Postbiotic Products
14:36 The Apollo Wearable: Managing Stress and Improving Sleep
16:07 How Postbiotics Enhance Gut Health and Overall Wellbeing
28:01 The Role of the Microbiome in Immune Education
29:02 Postbiotics and Their Complementary Role
31:51 Clinical Trials and Data Collection
32:58 Dosage Recommendations and Usage
35:52 Probiotics vs. Fecal Microbiota Transplantation (FMT)
42:20 Misconceptions About the Gut Microbiome
48:19 Sourcing and Criteria for Donor Stool
50:04 Conclusion and Final Thoughts
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Dr. Andrea McBeth is the founder and CEO of Thaena, a pioneering microbiome therapeutics company. She has a Bachelor’s in Biochemistry, focusing on molecular biology, and a Doctorate in Naturopathic Medicine. Early in her career, Andrea directed her ND clinical practice toward functional GI disorders and autoimmunity, launching one of the first stool banks for fecal microbiota transplantation to treat Clostridioides difficile infections.  Driven by the interface between gut microbes and human health, Andrea invented ThaenaBiotic, the first human-derived postbiotic supplement. The website is Thaena.com.

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

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Podcast Transcript

 

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

Today we’ll be speaking to Dr. Andrea Macbeth about postbiotics. Dr. Andrea Macbeth is a naturopathic clinician who has been focusing on functional gastroenterology and the microbiome since 2015. She became an expert at using fecal microbial transplants as a form of therapy, especially for c diff infections, and she started a stool bank.  She is now the founder and CEO of Thaena, Inc. And she has developed a breakthrough fecal-derived postbiotic nutritional supplement, phenobiotic, made from sterilized poop that enhances the health of the gut and overall health. And that will be a focus of our discussion today. So Dr. McBeth, thank you so much for joining us.

Dr. McBeth: Thank you so much for having me. It’s my pleasure to be here.

Dr. Weitz: Great. So tell us how you got involved with fecal microbial transplants.

Dr. McBeth: Yeah, I was, I like to joke, I’m a researcher, scientist that like fell out of academia, fell down the hill to become a naturopath. Okay. So I’m a naturopathic provider.  I was a molecular biochemist, kind of focused before that in my academic career.  I didn’t finish my PhD.  I left to focus on taking care of a family member who had cancer.  And then in that process found the journey and desire to do more preventative medicine, and so became a naturopathic provider.  Got really involved in the gastro, GI, autoimmune, kind of focused naturopathic community, right? And worked with a doc named Mark Davis, who sort of pioneered fecal transplants in Portland, Oregon in the early days when it was being introduced in Boston and other parts of the US healthcare system for the treatment of a disease called c diff.  So fecal transplant is what it sounds like. It’s the delivery of healthy donors stool to a recipient, and it’s super effective at treating an infectious GI bug called C Diff. And yeah I was really enamored with the microbiome. I found it fascinating. It was a great bridge for me between my old life as an academic and I, my understanding of why all these tools we use are so important.

Dr. Weitz: And my understanding is there’s emerging evidence of fecal microbial transplants being beneficial for ulcerative colitis and Crohn’s and maybe a bunch of other conditions. I’ve heard Dr. David Perlmutter talk about using it for neurological conditions.

Dr. McBeth: Yeah. So what is really cool and sort of unique is in medicine in particular in the US healthcare system, we normally start with a theory or that pharma starts with a theory, they create a drug and they test it in a disease.  And very rarely do we see something like fecal transplant that sort of works backwards. It’s an ancient therapy that’s mentioned in Chinese literature. It’s standard amendment. Of medicine and veterinary medicine and was reintroduced after being used in the fifties for this antibiotic resistant pathogen.  And what that did is challenge what we think we knew about the microbiome and open a doorway to clinical trials. Hundreds of [00:04:00] them for everything from liver disease, neuroinflammation, autism, Parkinson’s, immunotherapy responses, post bone marrow transplant, graft versus host disease. They use it…They looked at it in pediatric diseases. I mean, kind of anything you can imagine and in mice as well for basic science. And what it did is say. We have no idea how it works, but clearly the microbiome impacts the brain and the immune system and our metabolic system in ways we never even thought possible before.  And so it, it opened a whole, it challenged neurologists to rethink how they think about the gut in ways that I think functionally we do that. But it’s really cool to see that sort of adopted and challenged on a 10 year timeframe in the US.

Dr. Weitz: Cool. I noticed that among your studies, you spent some time studying bile acids.  And I’m just curious if you have any clinical pearls about bile specifically because it’s starting now to be an add-on to some of the stool tests. Diagnostic Solutions now has an add-on to measure bile acids and short chain fatty acids. And I’ve been thinking more about bile acids. I have a few patients with bile acid malabsorption and I, yeah.  I know that bile acids are one of the players, and I wonder if you have any thoughts about how clinicians can think about bile?

Dr. McBeth: Yeah, so again, similarly really interesting story. We thought bile acids. In traditional biology, there’s four of them, right? And they get conjugated and de conjugated, and it’s the cycle back and forth between the liver and the gut microbiome.  And they’re thought of as the, these four bile acids get used to excrete stuff, right? That’s sort of our traditional biology understanding in a really simplified way. But it turns out that with the [00:06:00] microbiome research, there are thousands of versions of bile acids and. Different bacteria can conjugate different molecules to bile acids.  And what we are now starting to appreciate is that bile acids aren’t just this thing that helps us excrete fat. It’s actually a signaling transporter molecule that brings, in theory, nutrients are small molecules to all different parts of our body. And they’re the really interesting researcher at UCSD in San Diego named Peter Dorsen.  And all he does is study bile acids from the perspective of how microbiome bacteria make them. And he uses mass spec to sort of look at the molecules. And then he has done really interesting work tracking where they go in a mouse, for example.  And there are specific bile acids that go just to the frontal lobe or the cortex of the mouse brain, and they have very specific [00:07:00] conjugates with them.

And so what we are now starting to think about when we think about bile acids is that they actually may be important nail male delivery systems for nutrients to distal tissues and. Adding complexity to the importance of the microbiome in our bile, but also just emphasizing how crucial having these core functions working.  Because if we, I mean, I think about people who get their gallbladder and appendix removed a lot, right? And I understand that saves people’s lives sometimes, but the cost of that. When we start to think about what happens when people lose functionality of making these foundational transporter molecules is probably more far reaching than we appreciated.  And when you see patients with bile acid malabsorption or [00:08:00] other dysbiotic associated issues with this. You know, I just am reminded that it’s such a critical orchestra–mouth to anus–with our vagus nerve and how central appropriate functionality of our nervous system and expression of all these, whether it’s digestive enzymes, or bile acids or pancreatic enzymes.  They impact the environment and then having a healthy microbiome is central to being able to take those things and redistribute and put them in the places they need to be. That’s probably more than you wanted about bile acids, but I just think no I, it’s so fascinating.

Dr. Weitz: I’m trying to figure out how to think about bile acids and what seeing bile acids come up on a stool test means and what role that’s playing in patients.  Is it, you know, when a patient has like breakthrough diarrhea, is that a bile thing?  How do you know, and you know…

Dr. McBeth: I think we know a lot less than we think we do, but the patterns are important and I wouldn’t negate the importance of having, if, you know people’s bile acids are out of whack, right. That is potentially impacting their brain, for example.  And so it is something we should pay attention to and make sure it’s hard to know what is health, right? We still don’t actually have a good definition of a lot of these biomarkers and stool testing even. But what we do know is if it is out of balance and it is out of whack, it has far region consequences.  And so doing what we can to sort of re equilibrate probably has benefit and. I don’t know the right answer of how to do that, but we have pretty good tools for bile acid malabsorption and nervous system patterning. And you know, those people that you see that just everything’s outta whack ’cause they’re in fight or flight versus people that have just one thing wrong.

Dr. Weitz: So I, I mentioned post biotic. I’m wondering for helping listeners understand what we’re talking about. Could you maybe give us a brief definition of what a prebiotic, a probiotic, and a postbiotic are?

Dr. McBeth: Yeah, so I, I caveat this with, there’s scientific definitions that are sort of like firm in the sand.  And then there’s marketing definitions that we’ve developed to help people understand things and or supplement companies have developed to help sell things.  And prebiotics and probiotics and postbiotics are definitely the latter.  They’re marketing terms, I think, more than scientific terms. And there isn’t true consensus on what they mean.  There is a organization called ISAP that has defined a probiotic to be a. Studied strain of bacteria that’s been shown in clinical trials to have health benefits. But we all think about probiotics as like all the good bacteria that come on fermented foods. And even some of the time we think about just the good gut bugs we have in our gut as probiotics, right?  The live material. And I think it’s fair to just put all probiotics into the. A live bug that can live in our gut and or on our skin or in our ecosystem of our body and provides benefit. And that’s loosely my definition. Okay. And that helps anchor what a prebiotic and a prebiotic is.

And a prebiotic is the food or nutrients or something that bug metabolizes or eats.  Then the thing that it produces when it eats that prebiotic is a post biotic. And I think of it as like a broccoli comes in, it gets digested. We have good bugs in our gut. They, those probiotics break down that broccoli into a post biotic, which may be butyrate, for example.

Dr. Weitz:  Right. Short chain fatty [00:12:00] acids that are produced by the bacteria in our gut.

Dr. McBeth: Yeah.  And the Isop definition is a little different and sometimes people call, you know, the lactobacillus you buy at the grocery store that’s been heat killed a post biotic. I think the most clear definition and the way that I like to think of it is it’s the thing that the probiotics make and it’s not alive.  It’s a small molecule or the dead parts after it’s been heat killed.

Dr. Weitz: Right. So why did you de decide to sterilize the poop in making your post biotic product?

Dr. McBeth: Yeah, so fecal transplant had all this early research, it’s like 90 plus percent effective at treating c diff. It was really cool to work with, right?  And I really loved having patients come in and have a tool that I knew could turn them from, you know, in and out of the hospital or really acutely ill to. Totally better in 24 hours. It’s like one of the coolest things I’ve [00:13:00] ever worked with. I love all of the naturopathic stuff, but fecal transplant was really cool.

Dr. Weitz: And by addition, how are most fecal transplants done these days

Dr. McBeth: either oral capsule, there’s two companies that made pharmaceutical versions. So there’s an oral capsule company and there’s an enema or like colonoscopy delivery version. Okay. And they both work, which is cool. And so we were working with it and the barrier was infectious disease risk.  We don’t know what we don’t know, and COVID came along just like other things of, in the history of using, you know, blood is a good analogy, right? Like blood donation, we can’t make synthetic blood. It’s too complicated. The same thing’s true for poop and. But you don’t know what you don’t know with blood.  And so the HIV epidemic really changed the way the regulators thought about human derived products for [00:14:00] good reason, right? And so when stool came along, they were concerned about the same kind of hypothetical, and then COVID happened and it was like, well, we don’t know if COVID could be in the stool and if it can be transmitted that way.  And so we had already been thinking about looking at a sterilized version of. FMT and that sort of was the catalyst to get there to say, okay, well we don’t have a way to test for infectious disease, so let’s just heat kill it, know it’s good, and then have a sterile version from there. And that actually ended up being really beneficial and working.

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

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Dr. Weitz:  Let’s talk about your product and what kinds of benefits can be derived from this post biotic sterilized poop. And how it can promote health and improve the microbiome and what other benefits?

Dr. McBeth: Yeah, so it, it has a bunch of short chain fatty acids, like we mentioned bile acids.  The magic is probably in a lot of, a little bit of, a little bit of a lot of things. So tens of thousands of small molecules that go into it. And we think they’re working synergistically to bind immune receptors, modulate the oxidative stress of the gut. We know now that there’s little neuronal cells that stick into our gut and these small molecules bind them and trigger responses that mediate our brain.

Dr. Weitz: Yeah, I saw where you wrote something about those neuronal cells. What are those called?

Dr. McBeth: Neuropod cells. I love em. Oh yeah. Terrine that. Okay.

Dr. Weitz: That’s fascinating. I’d never heard of that before.

Dr. McBeth: We just like just discovered them. Right? Like science just discovered that there’s neuronal cells sticking into the microbiome Miu like 10 years ago.

Dr. Weitz: Wow.

Dr. McBeth: I know. And they can trace ’em. So they do this cool stuff and. Neurobiology where they use a rabies virus that has a green floor for on it. So it’s like neon green and you can inject it into a nerve like in the gut. And the way the rabies virus is it transmits and travels back to the brain. And so you can actually trace a nerve from the gut back to the part of the brain that it’s connected to.  And they do this in mice and rats, and they can see these neuro pod cells are going to all different parts of our brain.

Dr. Weitz: So these nerve cells are like receptors.

Dr. McBeth: They’re activated by like calcium channel receptors. And these postbiotics are what? Like turn the light switch on. Turn the [00:18:00] light signal on.

Dr. Weitz: Really? Wow. Are those playing a role in motility?

Dr. McBeth: Yeah, they’re playing a role in how we make decisions in our prefrontal cortex and wow, how our nervous system is patterned. And you know, really, it really goes a long way to challenge like, who’s in charge here?

Dr. Weitz: So it maybe sort of helps explain things that we’ve been saying.  Oh, well, it’s because of the vagal nerve. And it may be really the neuro pods that, you know, we’re seeing some of these benefits of probiotics and gut bacteria. Definitely careful akkermansia affecting blood sugar and maybe through these neuro pots

Dr. McBeth: partly. And then the other place that. This is really interesting is, you know, our gut microbiome and our liver are constantly communicating.  We have this really tight SAS link between the liver and a lot of that [00:19:00] metabolic impact that we see from like pendulum and amania and even bile acids can go to the liver. Educate T cells there, or impact our insulin or our ghrelin. I mean, even, I think just the fact that GLP one now with Ozempic and all this, we are familiar with the concept of a GLP one agonist.  GLP one agonist drugs are just a longer life version of what we naturally make in the gut from these receptor. Relationships. So our gut’s constantly making GLP one, but like on an hourly basis from tryptophan binding receptors or bile acids, binding receptors. And then our gut cells are enteric. Colon lining is making GLP one.  So there’s all kinds of stuff going on there that Wow. Kind of at like the very tip of the iceberg on understanding.

Dr. Weitz: So what kinds of GI conditions can these [00:20:00] postbiotics that the antibiotic help, is it beneficial for sibo, I-B-S-I-B-D, et cetera?

Dr. McBeth: Yeah, so we, we have the luck and the curse of being the first people to use this, right?  And like completely new to the market, right? And. Part of the advantage of that is so obviously

Dr. Weitz: there’s no randomized control trials, right. With thousands of patients. Right? Right,

Dr. McBeth: right. And so what we’re doing is piggybacking off theory from work that’s been done in small molecules like butyrate and sine and stuff.  But our product is in smaller concentrations, and so we’re not a hundred percent sure. And then we have all this fecal transplant data. We think there’s some parallel to that mechanistically, and then we’ve been using it clinically for several years and we have observational anecdotes that show it’s really great if your gut is like moving too slow or too fast, right?

What’s interesting is it can [00:21:00] help with people who are having too many bowel movements, but it also can help with people that haven’t had bowel movements and increased motility in like a couple days. It works in a way that seems to be like a buffer, like a pH buffer, right? Like so whatever direction you’re out of balance from SIBO or whatever, it brings you back to that homeostasis probably because it’s 14,000 different molecules and whatever.  You’re out of balance and it’s sort of nudging you back to that center.

Dr. Weitz: Have you started trying to figure out exactly what the composition is with all these different molecules?

Dr. McBeth: Yeah, we actually bought a mass spec like two days ago. Okay. From an auction. It’s like a very fancy piece of equipment to look at ’em.  We’ve like paid other people to do it before, you know? Right. But I think of it as like the new gold rush. Like really there’s so many important molecules in our poop and nobody has, like, we just haven’t looked [00:22:00] for it before. Right. So we have run a lot of metabolomics. I have like Excel sheets of lists of stuff.  And I put it into chat JBT and ask it to tell me what it thinks. And we’re sort of at this very early stage of exploration, but we have a, we have an r and d arm of the company that will work on kind of parsing out what is doing what, if we can, you know, there’s a lot there, but. I think it’s the future.

I, so here’s another anecdote I like to use is traditional pharmaceuticals in our medicine. We’ve like traveled to the jungles and looked at the bottom of the ocean and we’ve, like, we’ve skipped, we’ve looked all over the world for molecules, right? That do something. And a lot of our really important medicines come from plants and places, but.  We have been co-evolving with these molecules in our gut since the beginning of time, so they don’t [00:23:00] have acute toxicity, but they still functionally do really important jobs. And so if we can start to understand what postbiotics are, the ones that hit that nerve, that tells me to chill, you know, to not have anxiety, I think we’re gonna have a lot better tools to help people in the future from this gut.

Dr. Weitz: I watched a YouTube video where you were talking about the postbiotics potentially being beneficial in reducing visceral hypersensitivity, which is something that we often see in IBS patients. Can you talk about that?

Dr. McBeth: Yeah. So, we. I mean, the visceral hypersensitive is really cool, right? Like what we are learning about it and the way that our nervous system patterning Well,

Dr. Weitz: it’s really, I think, common and often, maybe over often overlooked and yeah, not really sure how to address it.  We use curcumin, we try different things, but [00:24:00]

Dr. McBeth: yeah, and it’s like imagine that the fire alarm has just been going off and that patterning has gotten reinforced so much that. You know, the underlying mechanism probably is a combination of oxidative stress and inflammation based on some basic science. Okay.  And nervous system patterning. Right. But the reason we think this might be helpful for that is it kind of lays a blanket over that fire in a different way than just maybe like curcumin does. Right. It turns down that signaling through this sort of multimodal interface of oxidative stress and immune and nervous system, like those neuro pod cells are cool, right?  Because they can bind and send a signal and tell us to chill. But if you don’t have receptors and it. Is a sad neuro pod cell because you’ve had malnutrition or malabsorption or you know, chronic IBS or whatever reason, antibiotics, a [00:25:00] lifetime of preservatives and just whatever that neuro pod cell, maybe it doesn’t work all the way.

Or like the little mitochondria that bring the calcium to turn on that switch doesn’t are sad, right? Our MIT mitochondria gets sad because we’re sort of poisoned, right? So if we can repair that by putting in the nutrients that a healthy microbiome represents from a healthy person, we can start to repair that damage and rebuild that mitochondria.  We did preliminary early work in a model system, a little like worm, and what was really interesting is the antibiotic. Impacts a lot of mitochondrial genes and oxidative stress genes, though it’s sort of like the housekeeper of turning on that like baseline rest and repair that we lose when we see hypersensitivity or chronic dysbiosis.  However you wanna kind of define. [00:26:00] 

Dr. Weitz:  So are, define that, are these neuro pods part of the mucosal lining? Yeah. Are they involved with leaky gut in some way?

Dr. McBeth: I mean, I think. I mean the, one of the things I’ve thought about doing just for fun is like teaching a class on all the different types of cells that line our gut because we’re learning new ones all the time in the same way we like know very little about the microbiome itself.  You know, our human cellular biology is really complicated and in you imagine the bottom of the VI is this stem cell, right? And the stem cell can turn into a goblet cell, it can turn into a neuro pod cell, it can turn into a regular like endothelial cell. It can turn into, there’s all kinds of things that can like turn into, and then you get this lining.  And the amount of goblet cells that make mucus versus the amount of immune cells that are coming in. Dendritic cells versus the amount of neuro pod cells is all variable depending on the environment and how that set [00:27:00] that stem cell kind of core growth comes. And I just think. Well, so some of the best preliminary research I’ve seen is looking at goblet cells in our mucus layer and goblet cells.  You have to have enough of them to make the mucus and then you have to have your vagus nerve telling them to make mucus to have a healthy gut lining. And the same thing’s probably true. I don’t know as much about the enteric endocrine cells or haven’t read about their maturation the same way, but the all of this biology is kind of has that core.  We need the cells, we need enough of them and we need the signals to turn them on to be effective.

Dr. Weitz: And do these postbiotics enhance the gut immune system?

Dr. McBeth: Right? Yeah. So the axis I think about is the neuronal. We know gut brainin is like super strong, the gut immune cells. That’s why so many immune cells are.  [00:28:00] Are focused in the gut, right? The pyres patch lives there because so much of our immune education comes from the microbiome. And the microbiome is really like our first. Interface to the environment to tell us how to be responding. It’s one of its core functions as an organ really is adapting and telling us what’s going on in the world outside of us.  And then it, the third arm is the metabolic arm. So how we respond with insulin and process energy and fast and get satiety and all that stuff. And on the immune side. So much of us are walking around with like, again, a different kind of fire alarm of inflammatory cytokines and overregulated towards, you know, TH one or TH two.  And what we really need is the T regulatory calm down signals. And it turns out that the microbiome is really central into turning those on and these [00:29:00] postbiotics in particular

Dr. Weitz: interesting. So right now a lot of us are using immunoglobulins as part of our treatment protocols. How we using this post biotic, interact with that?

Dr. McBeth: It compliments it. It’s a really good tool to add with IgG. I think it’s a really good tool to add with glutamine or nutrient powders or. Antimicrobials. It’s a good compliment for SIBO treatments. It’s a good compliment for mold and Lyme treatments, right? Because you’re repairing some of the die off or the kill.  The other thing I really like it with is N-acetylcysteine. ’cause N-acetylcysteine is sort of a detox and a biofilm disruptor, and this is complimenting that as well.

Dr. Weitz: So for those of us who have different phases of care, is there one phase of care that this would be better for or,

Dr. McBeth: yeah, towards like the end of the kill and toward [00:30:00] into the repair.  Okay. Like it’s very much a part of the repair and tolerance and right support phase. Right. And I also just say, now it makes sense. It tends to help people like the sicker they are, the more likely it is to benefit them, like the more screwed up their gut is. 

Dr. Weitz:  Right now there’s one of these immune products that we use partially because it’s been shown to bind some of the endotoxins.  I wonder if that’s something that this product does as well.

Dr. McBeth: I don’t think it’s overtly binding. I mean. Some of the classes of things we know this product is doing is it is, it does have anti-microbial properties, it does have bacteria sins and Okay. Things that would be, you think about all the different things microbes make to modulate their environment.  And so they’re making anti what we call bacteria sins, which are kind of like their own [00:31:00] antibiotics to compete against their neighbors. They’re an making antifungals to create, to like fight against their fungal neighbors. And then they’re making antivirals.

Dr. Weitz: Right. And you have bacterial phages from the viruses in the gut, right?

Dr. McBeth: Yeah. And then, you know, so there’s an a component of this that’s like anti. Specific things that the healthy gut didn’t want or was trying to compete. And then there’s a bunch of nutrients there. And I think of it kind of as like the loss micronutrient vitamins, like the bile acids or the brain that I can’t make.  ’cause I was a C-section baby and I have so many antibiotics at my life and I’m on. I have autoimmune disease and all these things, right. So like I probably don’t make the special prefrontal anti-anxiety, but

Dr. Weitz: Interesting. So do you have research currently underway on this product?

Dr. McBeth: Yeah, and I would, I mean, this is the first time I’ve done a podcast where I get a.[00:32:00]  Announce. We have this really cool partnership with a clinical trial company called People Science. And they ran decentralized clinical trials for pharma for a long time, and then they pivoted to the supplement space. And so we now, anybody can go to our website@thena.com and buy the product and anybody can.  Sign up for the Chloe app, which people science built and opt in to share their data. And it’s really just a way for us to collect all this anecdotal data in a meaningful way. Like, did you poop today? Did you take your, the antibiotic? How was your anxiety? How was your diarrhea, constipation, or whatever it is that you are sort of co-managing.  The app is gonna give us. Hopefully a few hundred people to really say, this is what we should do an RCT on a clinical trial.

Dr. Weitz: Right? Sure. Randomized clinical trial. So what is the [00:33:00] dosage that usually recommend?

Dr. McBeth: Yeah, the dosage is,

Dr. Weitz: and are there are different strengths or is it just one strength or?

Dr. McBeth: It’s just one strength at a hundred milligrams, and you can either buy a sample pack to see if it helps a seven cap pack. There’s a 30 bottle, 30 cap bottle, which I recommend generally for people as a one month, roughly one cap a day, and then there’s a 90 cap bottle for people just as the most cost, cost effective, but for dosing.  One CAPA day is our base recommendation, but it’s unique in that you can kind of use it when you need it or use it when you’re outta sorts, and you can taper up on it and you can just. You could use like four caps a day and then not any, so you don’t have to taper off of it. We recommend people start with one cap and then add another and go up if they’re gonna increase dosing, but you don’t have to worry about weaning off of it.  And it can be really great for acute [00:34:00] GI stuff and you can just decide to use it when you want to eat cheese because cheese doesn’t agree with you. But this kind of like. Gives you a break, right? Or

Dr. Weitz: anything? Is there best time of day to take it? Is it better with meals? Apart from meals?

Dr. McBeth: I think with meals in the evening is my general baseline recommendation, but again, there’s not, it’s.  We see very few side effects. So pe if people wanna take it in the morning and it’s easier for them and they don’t eat breakfast, totally fine. Are based there certain

Dr. Weitz: supplements you shouldn’t take it with.

Dr. McBeth: Not that we have found. I mean, I’d say the only place to be cautious is it does seem to turn on that orchestra, right?  Motility, stomach acid, pancreatic. And this is anecdotal, but if you’re taking a whole bunch of beane HCL digestive enzymes, I would just be cautious to not take too much. ’cause it might turn back on your stomach [00:35:00] acid. So, you know, use this as a tool to kind of wean one way or the other. If you are on a bunch of stomach acid, just kind of pay attention.

Dr. Weitz: Right. Are there any contraindications.

Dr. McBeth: No, I mean, stomach acid is the one that in the early days, people theoretically were concerned about. We haven’t really had adverse event reporting. Sometimes it does help heart like acid, but the only. I mean, again, it seems to help people that are out of sorts, right?  And then it, or if it does nothing, it’s worth trying a sample pack to see. It can help you with your bowel movements in 24 hours. So you should know if it’s gonna help you,

Dr. Weitz: Pretty quick. Do we know how f and t works? No. Okay. So. Once again, [00:36:00] the thought with probiotics and of course FMT, is that we have this damaged microbiome, and now we’re gonna, you know, basically reseed our guts with a new microbiome.  You know, we’re laying down sod and now we have a new beautiful lawn. But perhaps that’s not what’s happening. And I noticed in one of your, one of the articles you talked about how. We’ve learned that in some cases dead probiotics are as effective or even more effective than live probiotics.

Dr. McBeth: Yeah, we spent a lot of money, or like the industry spent a lot of money on marketing to say, probiotics need to be alive.  And our, the fanciest marketing was like the most CFUs of live bacteria and the best way to get it, and turns out that they just don’t en graft. That’s not how the biology works.

Dr. Weitz: So they’re basically [00:37:00] probiotics and maybe even FMT is. Do we think FMT is different? Does it reason there’s some take hold in your microbiome?

Dr. McBeth: There’s some evidence that fecal transplant and grafts, and that’s probably a component, especially in really sick people, right? So if you have an ecosystem microbiome that’s super healthy, you’re, nothing’s gonna eng graft, nothing’s gonna outcompete the guys that you already have there. But if you’re really sick, you have c diff, you took a bunch of antibiotics, you do have room for something else to come in.

Probably and in fecal transplant they see some, but there’s a washout period like fecal transplant. You do it, you feel better, but it’ll go kind of rebound back to your previous in six months to a year, you know? So I think it depends on, we all have a set point of our immune system that we. We established a set point with our [00:38:00] microbiome, like by the age of three, and our immune system similar to our metabolic set point.

It’s really hard to change that for any reason. You know, taking your appendix out would impact it. But taking antibiotics, you know, we’re all always gonna come back to that homeostasis. And so you can get yourself out of an acute dysbiosis or acute bad space, but you’re. You are not gonna be able to out engineer that set point very easily without really concerted effort of continuous dietary changes or, you know, input from something like a, the antibiotic.

And that’s part of the reason fecal transplant I think has not been, I think fecal transplant would’ve done better in conventional medicine in terms of. Applications and other diseases if it had been dosed more because c diff is a very specific [00:39:00] circumstance that’s different than most of the chronic diseases we deal with.

Dr. Weitz: Right. I think you mentioned that this could be used in cases of a flare. Like what about a patient, like with Crohn’s who’s having an acute flare? Is this something that you would think by itself or in combination could be beneficial?

Dr. McBeth: We don’t have any clinical research on IBD, but there’s research in fecal transplant that’s really strong for ulcerative colitis.  That’s interesting. I don’t think we’re gonna replace conventional treatment, but I think it’s a great tool for a flare and a compliment. And I actually think if antibiotics gonna help people, you’re more likely to help somebody when they’re in an acute phase rather than their baseline. And so without, you know, going too far into saying we know something we don’t.  Anecdotally it seems to support people in a flare. And I would love [00:40:00] to see more research looking at. Role because I think, again, where fecal transplant fell short was the way that they were dosing it in a lot of these IBD clinical studies. And that’s where it got like some preliminary good data, but the metadata is not great.  And I think just the clinical design, it’s weren’t very good.

Dr. Weitz: Yeah. And this

Dr. McBeth: is way safer because it’s failed.

Dr. Weitz: Right. Do you know Dr. Rebar? He’s a in integrative gastroenterologist in Los Angeles. And he does a lot of scoping and stuff like that. You should probably talk to him. He might be interested in maybe even getting involved in some of the research.

Dr. McBeth: Yeah, we have a collaboration with, a group at Vanderbilt looking at it and people who have had colectomy, so their whole or portions of colons or pouchitis, you know, where stuff that’s really hard and it’s just observational, they’re introducing it with their other stuff. But it makes total sense [00:41:00] that it would help people that are missing a colon.  Right, right. Because that’s like the whole thing. Yeah, is all these small molecules are made in a healthy ecosystem.

Dr. Weitz: I’ve always been amazed at that whole concept. You know, we, there’s just unbelievable amount of research on the benefits of the microbiome, and now basically you’re taking patients who don’t have any colon and you’re taking a huge part of their microbiome and it’s just not there.  And yet. There’s a fair amount of ’em that continue to thrive and do reasonably well for long periods of time.

Dr. McBeth: I mean, the human body is very resilient. We’ve seen anything, you

Dr. Weitz: wonder if it’s creating a new microbiome out of the small intestine. Yeah. Elsewhere.

Dr. McBeth: I mean, I’m sure if, and again, they we’re just like, haven’t done a lot of research into this, but like.  We know so little. Yeah. And the amount of sampling we’ve done and what we’ve looked at with taxonomic [00:42:00] sequencing, like and lacking functional information from that data. I mean, I wouldn’t be surprised if the small intestine microbiome is way more important than we think it is. You know? And compensatory too for when we have issues with the colon.

Dr. Weitz: Yeah. Are there some misconceptions about the gut microbiome that you think need to be corrected?

Dr. McBeth: The microbiome is used in marketing, and I am guilty of this too, right? Because I have a supplement company and I market shit literally okay. On the internet. But I just really wanna caution that we know so little.  It’s an organ we right. We only discovered it 20 years ago, and it’s not like our brain or our heart that you can see when you cut the body open. It’s literally been invisible, and so it’s [00:43:00] also. What makes us individually resilient? I love it because it’s a very empowering paradigm to introduce to patients and providers because each person has the ability to adapt in our individual and everything we think we know about standards.  Right. And algorithm medicine. This is where it diverts. And this is why some people respond to some things and some people respond to others. And so we know nothing except that we know we’re all special and unique. And you have to be your own scientist in everything you’re approaching, whether it’s herbs or diet or supplements or whatever.  And I really like that. That’s. A way for us to frame that individuality without making people feel crazy. ’cause they’re like, you know what? It’s like, why doesn’t this thing that worked for everybody else work for me?

Dr. Weitz: So let’s say you are a [00:44:00] clinician and you decide to use the antibiotic on a patient who’s maybe got IBD and is having an acute flare.  What would you think would be. A reasonable dosage that if you wanted to push it a little bit, that you could go up to?

Dr. McBeth: Yeah. I mean, so one capsule is loosely equivalent to a half a gram of pooled stool, but a half a gram of stool.

Dr. Weitz: If they threw an FMT, how much stool are you getting?

Dr. McBeth: 50 grams, 25 gram to 50 grams.  

Dr. Weitz: Wow. Okay. So that would be a hundred capsules, right?

Dr. McBeth: And I think part of the reason I really like the antibiotic and I liked making it, is it’s very much a low dose, very safe, gentle nudge. I think it’s totally fine to, to taper up patients in acute phase. I had food poisoning yesterday and I just like pop a handful kinda.  Okay. But I’ve been doing that for a long time. Right. And I’m [00:45:00] comfortable with that. But starting with one and then going to like two, twice a day, you know, or up to. Two, three times a day. I don’t think you need a lot more. You definitely don’t need a hundred or 30 or whatever. I don’t think it’s gonna hurt you, but I just don’t think it’s necessary and it’s not cost effective.

But I, again, individual people, it’s reasonable to sort of test out that tapering up and down and sort of see where in acute phase people respond, verse. At a baseline, kind of a maintenance or you know, honestly, what’s interesting and we didn’t expect is sometimes this really helps people, but then it kind of like the effect of it kind of tapers off and it actually works better if you post dose it.  So you give people whatever they tolerate, two, four caps a day for three or four days, and then you wait a week and then you do it again. And so everybody’s a little bit different there too. [00:46:00]

Dr. Weitz: Interesting.

Dr. McBeth: Don’t ask me why we know nothing fascinating. It shouldn’t do anything. Right. Yeah. That was what I was told when I first started this, but it definitely seems to be a safe tool, a gentle tool to help people when they’re in a tough spot and other things don’t seem to be working.

Dr. Weitz: Right. Is there any smell or taste?

Dr. McBeth: I don’t think so. There’s like a, maybe a musky undertone. Okay. It’s not poopy. Right. Like we actually have just finished doing a very. Diligent, we’re gonna put like a desiccant pack that’s very non-toxic and very, you know, top of the line that has like a little bit of citrus or mint.  We’re deciding between those two just because it’s an IIC factor. People and you know, the other thing I tell people is if you’re anxious, you don’t know if you should take this. You’re uncertain. Don’t just don’t do it right. Don’t do it. Be, I like, we all have agency, so don’t be peer pressured, but.[00:47:00]  You know, email me and I’ll send you why I think it’s safe, if you want that information.

Dr. Weitz: Where can practitioners or patients find out about ordering it?

Dr. McBeth: Yeah, so we have a website thena.com. And

Dr. Weitz: can you spell Thaena?

Dr. McBeth: T-H-A-E-N-A. So it’s the Greek spelling.

Dr. Weitz: Oh, it’s the Greek spelling.

Dr. McBeth: Okay.  Yeah. ’cause microbes, and, you know. The domain was available if you spell it funny, you know. And yeah, and then we sell it through our website. And so there’s a provider wholesale cost, so I recommend definitely if you’re a provider, sign up, it’s half price, wholesale. And then direct to consumer. A 30 cap is 1 99.  And a 90 cap is 4 99. But also if you’re a patient of a provider, you get a URL and you get a discount. If you sign up for data tracking with our Chloe app and contribute, you get 30% off. So we have lots of ways to incentivize and try to make it accessible, but still maintain the integrity of the science and the sourcing because, you know, these are really healthy people.  They’re hard to find. It’s not simple to find a vaginally born, breastfed, fully organic. Never been sick. 

Dr. Weitz: Oh wait, you know, I don’t think we really explained that. So the patients that are donating the stool have to meet certain criteria.

Dr. McBeth: Yeah. Our super poopers, we’ve been recruiting them for poopers a long time.

Dr. Weitz: Okay. Okay. So go through real quickly what exactly characteristics they have to meet for their poop to qualify.

Dr. McBeth: Yeah, so they’re, they’ve never been chronically ill, they’ve never been prescribed, you know, Adderall or antidepressants or heart disease medicine, or, you know, they’ve never had cancer, they’ve never had autoimmune disease.  They’ve never really been sick besides like the flu or acute stuff. That’s normal. They’ve had [00:49:00] less than five antibiotics in rounds in their lifetime. They were vaginally born, breastfed. We do a very exhaustive interview about their environmental risks. We talk to them about what their job was and how they grew up and what food they ate as kids and did they have pets and you know, everything we can think of that we know about the microbiome.  And then we have them do a diet diary and we look at their food and we really care that they have good quality ingredients and not ultra processed foods, that they’re healthy in exercise. And their BMI is in a good range and they’ve never yo-yo dieted and they have a good relationship with food and they’re not allergic to anything.  And then we do theorem and stool testing for infectious disease and we back check them on, you know, all the important things.

Dr. Weitz: Wow. So this is good poop.

Dr. McBeth: Yeah. I mean, as good as you can get in America in 2025.

Dr. Weitz: Alright. Thank you so much for joining us today.

Dr. McBeth: Yeah. Thank you for having me. It was lovely.

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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.

Dr. Nasha Winters discusses The Metabolic Theory of Cancer with Dr. Ben Weitz.

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

 

Podcast Highlights

In this episode of the Rational Wellness Podcast, hosted by Dr. Ben Weitz, the guest is Dr. Nasha Winters, a naturopathic doctor and integrative oncology specialist. The discussion centers around the integrative approach to cancer, including Dr. Winters’ personal journey with ovarian cancer and her insights on the metabolic theory of cancer as opposed to the somatic mutation theory. They explore various factors influencing cancer, such as diet, environmental toxins, and mental health. Dr. Winters also shares information on innovative diagnostic tools, the importance of metabolic health, and her work in educating the public and healthcare providers. The conversation emphasizes that individual treatments should be tailored to the patient’s unique metabolic and epigenetic profile.
00:26 Guest Introduction: Dr. Nasha Winters
01:55 Current State of Cancer Worldwide
03:56 Historical Context of Cancer and Health
12:07 Advancements in Cancer Diagnostics
20:30 Dr. Nasha Winters’ Personal Health Journey
29:28 The Metabolic Theory of Cancer
36:24 Reevaluating Cancer Theories
38:20 Metabolic Approach to Cancer
39:08 Impact of Diet and Environment
40:23 Microbiome and Immune System
42:37 Radiation and Metabolic Health
52:12 Supplements and Immune Support
59:00 Personalized Cancer Treatment
01:07:10 Integrative Oncology and Future Directions
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Dr. Nasha Winters is a licensed Naturopathic Doctor and an Integrative oncology specialist.  She is the host of the Metabolic Matters podcast and Executive Director of the nonprofit organization, the Metabolic Terrain Institute of Health.  And she is also a cancer survivor herself.  Dr. Winters has a vision to open a residential integrative oncology hospital and research institute and she recently opened a metabolic research lab. She offers the Terrain Advocate program and the Metabolic Approach to Cancer practitioner master course. Dr. Nasha is a co-author of the best-selling books “The Metabolic Approach to Cancer” and Mistletoe and the Emerging Future of Integrative Oncology.  Her website is DrNasha.com.

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

 

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Podcast Transcript

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

The Topic for today is an integrative Approach to Cancer with Dr. Nasha Winters. Dr. Nasha Winters is a licensed naturopathic doctor and an integrative oncology specialist. She’s host of the Metabolic Matters podcast, executive director of the nonprofit organization, the Metabolic Terrain Institute of Health.  She’s also a cancer survivor herself. She has a vision to open a residential. She’s working on opening a residential integrative oncology hospital and research institute, and she recently opened a metabolic research lab. She offers the Terrain Advocate Program and the metabolic approach to cancer practitioner master courses.  Dr. Nasha is the co-author of the bestselling books, the Metabolic Approach to Cancer, which is one of the few books we have all sorts of highlights and tear backs. Your book and Lisa Alschuler’s book in the cancer realm are the two books you have to have and also the Missiletoe book. In the emerging future of integrative oncology, Dr. Nasha is on a mission to educate and empower the nearly 50% of the population expected to have cancer in their lifetime, and prevention is the only cure. Thank you so much for joining us.

Dr. Winters:  It is an absolute honor to be back with you, Ben. Thank you so much.

Dr. Weitz:  Absolutely. So before I ask you about your personal journey with cancer and we dive into the metabolic theory of cancer and your approach to managing the terrain for cancer, I want to ask you, where are we in the nationwide, or perhaps worldwide… (I don’t know why we limit ourselves to our nation) fight against cancer? While cancer mortality continues to decrease, cancer incidence has not really decreased that much and there’s been an significant increase in certain types of cancer in young people. So what do you think is going on?

Dr. Winters: Wow, such a great launch into this conversation.  So we actually just got an update on the statistics, the World Health Organization statistics on cancer. And so just for your listeners to know,

Dr. Weitz:  oh, World Health Organization, that’s fake news…

Dr. Winters:  I know. Maybe we won’t totally trust that it’s pretty compelling information and that today in the United States alone, 1700 people will die of cancer just today.  Wow. Okay. Globally, 26,000 people will die of cancer today. Wow. Wow. That’s a lot. That’s a lot. That’s talk about a, an epidemic, right? Like that’s a big one. A hundred percent. Exactly. We also now, you know, really it has driven home that 50% of us, as you mentioned, we might be living longer with cancer, but we are certainly meeting the diagnosis more often.  And now one of two of us are expected to meet this diagnosis in our lifetime. And then to your point, we’ve had a 36%. increase in cancer diagnoses under the age of 40. And in, you know, peer reviewed journals such as nature and whatnot, they’re scratching their heads and saying, gosh, I don’t know why.  Maybe it’s something genetic, which I’m just sit there and think to myself, are we still having that conversation?

Dr. Weitz:  Massive change in our genes in the last 10 years…

Dr. Winters:  My goodness gracious. So it’s like we just, we are, you know, we look at this like process. So I think how I look at it is this didn’t happen overnight.  Right? So, you know, you and I think have had this conversation before, and I want to give a little context to your listeners that when we think about the world, you know, if we look at a clock and we imagine the world on that clock, that basically we are about six minutes old. We’re about six minutes into this like worldwide.  And so when we look at all the changes that have happened in the world, the majority of them have happened in the past 150 years. Like, it’s like the biggest input of change in our, in, in our environment, which then impacts our internal environment has happened since the industrial food. You know, the industrial Revolution kicked in the 1800s.  So prior to that, we were, you know, primarily for the first, you know, I don’t know, just tens of thousands of years, we were all hunter gatherers. 11,000 years ago, we moved into the neolithic farming era, where we started to literally put down some roots in the whole kind of Mediterranean region known as the Fertile Crescent.  And that’s when we first started the introduction of the gene, HLA, which is the human leukocyte [00:05:00] antigen. So we actually changed our immune systems by changing the way we re you know. Sought our food, our resources, right? And so that was one change, which also HLAs what increase your response, your risk of other autoimmune conditions and immune, like viral sensitivities, mold sensitivities, environmental sensitivities.  That’s what the HLA kind of brought to the table of new kind of diseases, right? Then we really saw the next biggest change in the industrial revolution in the 18 hundreds. So we were cruising along for about 11,000 years, you know, and then suddenly another big change. That change was significant. And then even people like Western a price.  And Dr. Pottinger were commenting in the late 18 hundreds saying, wow, something’s changing. We’re seeing changes in dentition. We’re seeing changes in health expression thanks to this industrialization of our food. So we started milling sugar, flour, and salt. We started having more accessibility to these things.  Refrigeration began, and suddenly we had more [00:06:00] access to foods and ability to start to factorized our food sources.

By World War II, we made another big change. We had leftover ammunition from two major world wars, and we decided to invest that into big Ag and big pharma. And so in that world, we started to change things even quicker.  So basically those folks born before World War II had a little bit of a stronger foundation, you know, genetically epigene, genetically, they had a little bit stronger foundation that maybe they had some new exposures. But it didn’t really pick up momentum until after World War ii. It was also in the 1940s to 1960s, we started introducing hormones into our food systems.  We started giving women, basically, if you were a mother in 1940s, fifties, and into the early sixties, you had a very high chance of being given DES just prophylactically to prevent miscarriage. So we started introducing hormones and that level, we started [00:07:00] introducing hormones into the feedlots, you know, that started factory farming animals to, you know, feed the masses.  And so things started changing. And so we also then saw that with that change, that started to have a ripple effect in diagnoses of other health conditions. So, I say this so people understand that it’s not like we went to bed one night with no concerns and woke up the next day with a problem.  It’s been insidious. These changes have accumulated over time. But the changes in the last 50 to 70 years have been. Even bigger. And so when you say what is the cause, why now? Well, we, you know, even the good old World Health Organization in I think 2012 stated that those born after 1980 are not likely to have the same longevity as their parents.  Right? So we started noting difference in longevity. We’ve also noted the trend in longevity in United States, that we’re the only developed country in the world that is actually [00:08:00] either everywhere else they’re either stable or improving on their longevity. And we, even prior to the pandemic, we’re losing longevity on an annual basis.

Dr. Weitz: Right?

Dr. Winters: And so we were sounding the alarm for some time that, oh, something’s weird here, but it’s picked up momentum. And there’s a lot of reasons for that. I mean, some scientists would say we are in the era of despair because the things that have affected our longevity in the US are suicide and drug overdose. So when we look at the pandemic, one of the biggest fallouts of that was the mental health fallout, right, of isolation and whatnot.  That took an already vulnerable population of, you know, pain mentally and emotionally, and amplified that. So that might have some impact. But we’ve also seen an incredible spike in young people with cancer. Like when I left medical school, the average age of cancer in the 1990s was 68 years old.  Cancer used to be considered a disease of the aged. Today’s the average age is 48 years old. So in just a 30 year period of time, we’ve seen a 20 year different gap difference.

Dr. Weitz: We also, during the pandemic we saw a sedentary, overweight population gain 30 pounds and do a lot less activity.

Dr. Winters: Well, you know, and it’s interesting that in that 2018 Chapel Hill, North Carolina Chapel Hill study that came out, that showed, this is 2018, mind you, that showed that less than 12% of Americans were considered metabolically healthy.  Right there, when you think about metabolic dysfunction.  That is all cause mortality, right? That’s your top killers at that time was cardiovascular disease, followed by cancer, followed by, diseases around obesity, which led to like cardiovascular disease, diabetes, kidney dysfunction, the neural neurological disorders, including Alzheimer’s, you know, dis dementia and properly prescribed pharmaceuticals.  So the proper prescribed pharmaceuticals was the number five killer. Now it’s the number three [00:10:00] killer. So those were the things that were happening in 2018. With this 12% of our population being metabolically healthy, that’s a problem. And instead of us saying, what are we gonna do about it? Let’s lean in and get curious and do something about it.

Then the pandemic happened and we went from, well, here’s another crazy study. So in 2022, a study was published that led up to 2020. So just as things were getting started that showed that actually less than 6.8% of us are metabolically healthy. Wow. So we were already seeing within a two year period of time, we dropped that by another 50%.

Dr. Weitz: And then I saw the CEO of Kellogg’s on TV during the pandemic talking about how great it was that so many people were eating boxed cereal for dinner.

Dr. Winters: Yeah, fabulous. Because talk about job security for doctors and cancer, but you know, like, because this is what’s so crazy is we’re looking at data from 2020 and before, which was already put in the writing on the wall.  We’ve not lifted up the corner [00:11:00] of the rug to look underneath to see what the reality is. But I would say we are probably way less than 6.8% metabolically healthy in this country today. And that reaches beyond our borders as well. I mean, we see now we have rates of cancer and diabetes overtaking the US rates in places like India, in places like Mexico.  You know, places like the UK and Canada are right close with us in our stats as well. And so no one’s asking why Ben, and this is where, you know, we may not be able to say one cause because this is what standard of care likes they want one cause in one case, of course.

Dr. Weitz: Yeah.

Dr. Winters: Right. But cancer itself is, even the American Cancer Society says it’s a collection of hundreds of diseases.  And when we can look at those diseases and we can look at the health of our nation and our entire global family and realize we are getting sicker and sicker by the year we aren’t asking the right questions and we weren’t bringing together the right solutions. [00:12:00] And that’s where my passion and purpose lies in all of this, and why I’m excited that we get to have this conversation.

Dr. Weitz: That’s great. One more question in this realm, which is what do you think about some of the ways to test for early signs of cancer.  Do you like the Grail test and the full body MRI?

Dr. Winters:  So I, you know, it’s interesting ’cause I’ve been on this journey for myself for over 34 year, well, it’ll be 34 years in September for my own cancer journey, as well as helped tens of thousands of patients directly and hundreds of thousands indirectly for decades now, my biggest wish during this last 30 years was to find a non-toxic, so non-contrast dye toxicity, such as gadolinium, and a non radiation toxicity, known ion ionizing radiation, known carcinogen, right way of evaluating someone’s.  You know, insides, you know, in, in a profound way. So we’ve leaned on things like ultrasounds, x-rays, PET scans, [00:13:00] CT scans, even mammograms, and DEXA scans. Those are what we had. But those all come with shortcomings and they also come with a lot of toxicity. ’cause almost all of the devices use some form of radiation and almost all of the imaging uses some type of contrast dye.  So, just to give an example, five CT scans in your lifetime is equivalent to exposures of Hiroshima or Nagasaki, radiation wise, right? 

Dr. Weitz: Yeah. I think that’s amazing. Most people don’t realize that they, their doctor says Get a CT scan. They get a CT scan. That’s actually the equivalent of between 30 and 50 x-rays.

Dr. Winters:  Exactly, and we’re now doing this, like for even the biohackers, like, oh, I wanna go and take a look at my body fat content with a CT scan. I’m like, please don’t, you know. So when I heard on Peter Attias podcast in 2019, an interview at Dr. Attariwala from Prenuvo, from that time in Vancouver, BC, you know, Vancouver, bc, [00:14:00] a complete unknown in the United States, I immediately got on the horn and said, how can I get patients to you right now?  To get this imaging, which is using no contrast dye and using no radiation in a high resolution, high sensitivity, high precision repurposed MRI, which this amazing brilliant MD who’s a radiation oncologist, who also had a, like a chemical engineering brain, like a PhD in that realized he could rebuild and repurpose the MRI to make it more effective.  Now since then, we have others that have come to market. Simon one, Ezra, Prenuvo, you know, all of those are out there, 

Dr. Weitz:  So you’re a fan of the full body MRI?

Dr. Winters:   Huge. Huge because we, so just when that started coming out, I started sending patients up to get them in Canada. Then they opened up an office in San Francisco and then started moving all over the us and now beyond that.  We were probably their first customers. Like really it was like why they came into the US is because my community was looking for a non-toxic approach because data is really powerful and [00:15:00] compelling. And then we started seeing things like we were able to start diagnosing things that were missed for years in people.  We were able to catch things super early, like I can’t even tell you how many early stage brain cancers, thyroid cancers, breast cancers that were picked up accidentally incidentally, of people who thought they were healthy, right. So powerful. That’s great. So powerful. So I’m a huge fan because, I mean, first of all, I think it should be standard of care.  I think it should replace all of the conventional MRIs that are out there. Those who still argue that gadolinium is a must in evaluation, need to read the book more than meets the MRI specific to gadolinium toxicity, to realize that the the benefits you get from adding that gadolinium are so minimal, but the risks are kind of lifelong.  I personally am a lifelong gadolinium poisoned patient. My kidneys are destroyed from that. I still deal with the fallout of that over 30 years later. Wow. People will likely take that to my grave. And so, you know, it’s  This is not something 

Dr. Weitz: And the FDA has a warning against gadolinium because it builds up in the brain.

Dr. Winters: Exactly. So here’s what do we do with patients with a brain tumor. We are having this scan every three months with gadolinium. So suddenly, are we actually looking at brain tumor pathology, or are we looking at gadolinium pathology, or are we looking at gadolinium driven pathology? Right. So suddenly it’s like we’re clouding the picture, literally and figuratively.  So to your point, the imaging has come a long way. I’m very excited about that. I hope it becomes standard because it’s still outta the price point of a lot of people. And that’s part of what our work in our nonprofit is about trying to raise funds for until these become standard of care. How do we help people finance the right way to do their healthcare?  And then specific to the early diagnostics testing. Gosh, Ben, I’ve been at this for so long that I’ve watched many companies come and go in the early diagnostic space from videssa, which was a test that used to be able to evaluate if a breast lesion was [00:17:00] cancerous or non-cancerous. We were very excited about that.  They’re no longer on the market. We were excited about ONCOblot, which was checking for a specific protein, an enox protein, which is an early sort of fingerprint. Cancer and even to the point where you could identify the source of the cancer, the tissue that it was arising from that was pulled off the market gallery, you know, finally a few years ago, gallery came out and everyone was really excited, myself included.  But it has a lot of false positives and false negatives, you know, so there’s a huge, there’s a lot of room for error. I still think that it’s worthwhile, but people need to take it into context, you know? Right. Don’t just put all your eggs in that basket, that you’re either all good or all bad. Get more information to round it out.

Dr. Weitz: So if you’re going to do one test for cancer prevention, it would be the full body MRI.

Dr. Winters: I like that. And then I do my version of testing, which tells me of course, lot information. Right, right. And we can dig into that next, but I wanna speak to a test that was out on the market that was FDA approved the same price [00:18:00] range as gallery that had a much higher sensitivity and specificity by the company DeTar. They’re coming back online by end of this year, is what the rumor on the street is to be an early diagnostic. There’ll be about $300 more expensive because they are they have a few more steps to their methodology to Val for validation to create that precision, but for about 1200 US dollars.  Last I was told DeTar will be available for early diagnostics and. Again, it was already out on the market. And FDA approved gallery is not, I don’t believe gallery is FDA approved. I could be wrong. So gallery folks, I, if I’m mistaken, please correct me. But it’s, it is still an available direct to consumer test for early diagnostics.  It’s not you know, a hundred percent, but it’s still something. So yes to imaging that’s non-toxic, yes to early diagnostics. I believe this is a field that will continue to explode. There’s really cool tests in the, in research right now, like breath tests. There’s already tests like you can test [00:19:00] for pancreatic and lung cancer through breath.

You can test for breast cancer through tears. There’s already a lot of early diagnostics that are approved and that are out there. You just have to know about ’em. And that’s, I think the key here is accessibility. A lot of people have no idea of what you and I are talking about, that these things exist.  Why are these not made known? Because you don’t make money from capturing a smoldering ember in the basement. You make money when the entire house is engulfed in flames. Right, right. So it’s not financially appropriate for the big pharma or the big radiology departments. If you’re catching things either preventative, like early diagnostics, it doesn’t, you don’t make as much money from prevention or early diagnostics.  And, you know, I sound like a conspiracy theorist, but man, I’ve been in this for so long. My husband was a cancer drug design for crying out loud as his vocation and worked for Merck for years to tell you that there was no interest. [00:20:00] In trying to change the outcomes or actually prevent cancer, that’s not where the money lands.  So, you know, as, as awful as that sounds, anybody who’s worked in that industry will tell you that this is an accurate assessment and it’s just the way of the world. It’s, we have

Dr. Weitz: a profit driven healthcare system, and if it, that provides positives and negatives and that’s the bottom line. We,

?: yeah.

Dr. Weitz: Maybe at some point want to ask, do we want to have a profit driven healthcare system? Yeah. So now’s the time. Tell us a little bit about your personal health journey with ovarian cancer.

Dr. Winters:  Sure. So, golly, I don’t even know if I was ever knew what health was. But I’ll tell you as someone who you know, was born in 1971, no one was breastfeeding.  That was not in vogue. And so, you know, my mom was trying to find which formula worked best for me ’cause I was sick on all of them. So the pediatrician tried everything. They finally settled on soy formula, which that probably is where a lot of my problems [00:21:00] began. I also, it was normalized, my pediatrician normalized my pooping once a month as a toddler.  Once a month. Once a month because it was my pattern. So as an infant and a toddler and all the way up through my teen, only imagine what your microbiome looked like. Exactly. And they put me on basically baby gas X at that time. ’cause my belly was constantly extended. I was in excruciating pain. All these issues like.  But normalized, it was just normal. So just give her this, that will, that’ll take care of it. By the time I was nine, I started menstruating. No one questioned that. Wow. This is 1980 for crying out loud, right? Not normal, not common today, unfortunately, common still not normal. But no one was questioning the why of that.

By the time I was 11, I was put on birth control pills for endometriosis and polycystic syndrome. Wow. 11, 11. By the time I was 14, I had my first bout of cervical dysplasia. 16. The second bout you just like on and on it was diagnosed with juvenile, rheumatoid arthritis. By the time I was 16, no one, myself included, thought I was unhealthy.  There was just a pill for that. You just got the birth control pill when you were nine. You would just take an antibiotic. If you had an yeast, you know this, then you’d take a yeast, a anti-yeast drug. When you got a yeast infection because of the antibiotic. It was just. That was just normal, right? By the time I was 19, everyone thought my symptoms that were, that was showing up in the ER every single week almost for the six months leading up to my official diagnosis in the fall of 20 of 1991, they just said, oh, it’s just your IBS flaring.  It’s just your RA flaring. It’s just your, you know, PCOS flaring or just your endometriosis flaring. So it was again, normalized until I landed in the ER with a hundred percent bowel blockage, a grapefruit size tumor in my right ovary, lesions throughout my liver, my entire abdomen, a belly full of fluid, known as malignant ascites.

Pulse oximetry. My oxygen levels at room were in the low eighties, high seventies. Wow. I wasn’t able to eat or drink anything for days on end ’cause it was excruciating pain and coming back up. ’cause I didn’t know I had [00:23:00] a blockage, like just everything. They finally looked under the hood. Right.  So I was put into that category of a histrionic teenager, just drug seeking. And yet I kept telling ’em, I don’t respond to the pain meds. I get really sick on them. I don’t like these drugs. No one, they just thought I was there to like, get another drug and they would just write a script and write me off at the same time.  So that’s where I landed in, in the er and a different doctor on staff that night who took one look at me and realized, oh shit, you know, I just was extremely cachectic and I had this big drum belly. And he did a proper workup and realized, oh, something really bad here. So, fast forward, it took a couple weeks to get the official diagnosis, but he saw the, they, I got an MRI at that time, that’s what was available to me in my tiny little mountain town.  They pulled the ascites fluid. It was bloody so they knew it was malignant at that time. They, you know, all these things were happening. They realized they had the bowel blockage and they sent me home to die. Yeah, that was just, they’re like, you’re too sick, you’re in, your organs are in [00:24:00] failure. You’ve got this blockage, it will absolutely kill you with a single dose of chemotherapy.

So from that fast forward, I couldn’t eat. And so for the next two and a half months, then I didn’t. So I deeply fasted, not on purpose, not intentionally, I just out of necessity and that started to slow down my need to have the ascites drained every few days to maybe once a week to just every couple of weeks for the first two and a half months.  By the end of that two and a half months of fasting, I resolved the bowel blockage, I resolved the ascites, and I just sort of stabilized the fallout that was happening. Now, they didn’t know what to do with me ’cause I was still alive and they didn’t expect that. I didn’t expect that I wasn’t fighting it.  I just wanted to understand it. And that’s what’s led me to where I am today. I wanted to understand why a 19, soon to be 20-year-old was dying of what was considered a disease of the aged that had been missed. Four years that no one questioned my extremely high doses. ’cause all liter literature at that time said, oh, birth control pill is protective against ovarian [00:25:00] cancer.

Oh, it’s not at all if you’re given a dose as high as I was given. Right. In the 1980s. Right. And all the way through it also, no one understood until a few years after my diagnosis would be another five years when I learned that I had the BRCA mutation. So some people think of that as a death sentence.  But really it’s just a methylation problem. Right. And ’cause I’d also been a self-proclaimed vegan since I was 16 years old. I was severely malnourished and I had none of the co-factors for methylation. I also am missing, I would be another. Eight years beyond 19. So in the early two thousands, I also had my genes tested, my SNPs tested and realized I’m missing the Gstp one.  The GSTM one. So I was missing single nucleotide polymorphisms that helped me detoxify. So all those years of medications, all of those years of birth control pills, all those years of living near four EPA Superfund sites, all of those years of eating a very toxic diet for myself, a [00:26:00] very highly processed vegan diet, because I thought I was doing things right by taking care of the animals, but I wasn’t taking care of this animal.

I was doing all the things wrong, right? But I was living like the outside world looked like I was the uber athlete. I was student body president, I was head of my volleyball team. I was, you know, like all the things on the outside world. I looked like the picture of health. And the picture of success, but inside it was rapidly dying.  Wow. Now I’m a sophomore in college pre-med and literally given months to live, and so that’s what has led to my entire career. Ben is starting to learn about, like in the early months of my diagnosis, I started to go to the library and there was no Dr. Google. There was literally, there was a Dewey decimal system and microfiche where I could do my research on and started to understand.

I started running across the work of people like Otto Warberg and the me, the mitochondrial metabolic dysfunction of cancer versus the genetic mutation theory of cancer. I started to run across the work of Dr. Mina Bissell, who was one of the originators of the studies of the terrain, the extracellular matrix and the tumor microenvironment.  And I started to run across the work of Robert Aler and excuse me, Robert Ader and Candace Pert, and at that time an unknown cell molecular biologist by the name of Bruce Lipton, who were all talking about the epigenetics and the impact of trauma and the impact of emotional impact on your immune system.  It would still be another 20 years before Bruce Lipton’s book came out.

Dr. Weitz:  The Biology of Belief, right?

Dr. Winters:  But in 1991, I was reading his research and so these were the people that started informing my understanding that my biography definitely had impact on my biology. My environment outside of me definitely had an impact on the environment inside of me, and I started to wanna understand it and wanted to start to learn ways to resolve it.

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Dr. Weitz:  Let’s talk about the metabolic theory of cancer, which contrasts with the more mainstream somatic, or. DNA mutation theory of cancer. And I’d like to start this part of discussion with a quote from your book, which I thought was very well said.  Cancer is not a disease of our genes. It’s a disease caused by what we are feeding them.

Dr. Winters: Beautiful. Do we need even need to say more? I love it, but Well, and I love it you brought that up because in 1914, Dr. Theodore Bovary coined the concept of somatic mutation theory of cancer, saying that cancer is simply bad luck of genes that are broken and gone rogue and now can’t stop and actually accelerates the proliferation of cancer cells.  That has been where we have put all of our resources of research and treatment basically ever since. Now, there was a little window though, ’cause in the early 1920s, another character came along a bit controversial. Dr. Otto Warberg, who was the biochemist saying, this isn’t a genetic issue, this is a biochemical issue.  And started to realize that the mitochondria, those little powerhouses of our cells looked different and were less in number in cancer tissue. And he started saying, I think that this is happening more upstream. And then the genes come later. And so actually for a chunk of time, he even won a Nobel Prize for this.  But from about the mid, you know, early to mid 1920s until the mid 1950s, [00:31:00] his theory dominated over the somatic mutation theory and lots of accolades. The world of cancer was all tied up in the biochemistry and in the study of that, and that’s where the energy was. But then Watson and Crick, actually a woman that Watson and Crick took credit for, found the DNA helix.  And we pendulum back over to saying, oops, let’s throw the baby out with the bathwater of the mitochondrial theory, metabolic theory, and go back to mutation of genetic theory. And that’s where we’ve been ever since, including, you know, claiming the war on cancer in 1971. Basically flatlined of our overall survival rate since then.

You know, no real, really impactful, impressive changes in this sense then. And the best part is that this somatic mutation theory has actually been disproven. Thousands of times over the, and all over the globe. And that if this was truly a genetic disease, the little organelles within our cells called nuclei are like the [00:32:00] big biggest organs within our cells are where we house our genetic material.  That is the genetic hard drive of our cells. If this was a genetic disease, if you removed that genetic hard drive, the nuclei of a cancer cell and you replaced the nuclei of a healthy cell, you should turn that into a cancer cell. And the opposite is true. If you removed the nuclei, the healthy cell and you replaced it of a cancer cell, you should turn that into a healthy cell.  That doesn’t happen. Never happened, never will happen. ’cause that’s not where it starts. So good old auto was right. It starts upstream from that. Your DNA is protected by the health and wealth of your mitochondria, which is another little organ within the cell that is doing a lot more than just producing your energy.  It is to me, the mitochondria do three major thi things. So yes, at the end of the day the output is energy and an energy exchange. That is life, you guys. That is just the way it is. We live and die by the function of the energy produced from our [00:33:00] mitochondria. But what the mitochondria do before that energy production is three things.

Number one, it takes in information, lots of information. It is a receiver. Okay. And so when I mentioned earlier about what’s happened in the past, you know, 170,000 years where mitochondria began as bacterium. Of which they today make up upwards of 20% of our mass. So think about that for a moment. You know, we’re kind of mostly a bacteria.

That should probably be a clue that, hey, we’ve brought a lot of things like antibiotics and glyphosate, which is a massive antibiotic into our systems. That should probably be a clue of some problems. But we also have brought in, as I mentioned, all the changes after going from hunter gathered and Neolithic farmer to industrial food to post World War.

Lots of new information coming at those mitochondria. So first is they take in everything in, on and around them, including people, places, and things. That’s all. Second big job. They are translators of that information. So, [00:34:00] you know, sometimes when you guys try and use like your Google translate, sometimes it doesn’t translate well, right?

Sometimes like the system is off. Well, that can happen with our mitochondria as well. Like sometimes it’s not translating as well, or it’s so overwhelmed by the input of information, it can’t translate it fast enough or correctly enough. So we’re also the result of how we translate that data. And then the third job of the mitochondria is to signal out, to communicate to the surrounding cytoplasm, to the surrounding organelles, to the surrounding cells, tissues, organs, structure, et cetera.

That is when you have good information in, you have good information out, but if you get crap information in, you get crap information out, or if you get good information in, but poor translation, that can impact. So now you’re likely realizing that there’s a lot of places where things can go wrong within the mitochondria and all of our conditions today.

Cardiovascular disease to diabetes, to dementias, [00:35:00] to autoimmune conditions, to cancer are all based on our mitochondrial function. And earlier you and I talked about the 6.8% or less of us being metabolically healthy, what that really means is that there’s less than 6.8% of us who have well-functioning mitochondria.

And so that is where, and what’s really cool at the time of our discussion been is about, my gosh, maybe six months, eight weeks or six weeks, eight weeks ago, a study came out in I believe nature that literally asks the question or makes the statement that the somatic mutation theory is dead. Oh, really?

And that the metabolic mitochondrial theory is actually the most dominant theory of cancer today. Wow. So I’m hopeful. ’cause I never expected, I mean I’ve been at this for over 30 years, right? Even though I was reading about this all those years, people thought I was knuck and Butts. Even reading like Mina Bissell, who’s been this [00:36:00] amazing researcher, you know, since the eighties, people just di completely dismissing her.

When Tom Creed’s book came out in 2011 claiming that cancer is a metabolic disease, everyone dissed him. When Travis Kristofferson’s book came out, I believe 2014 or 15 on Tripping Over the Truth, which was a consolidation of Tom’s book along with Shar Ji’s book, the Biography Biology, or excuse me, the Biography of Cancer.  And of all Maldi suddenly conversations around this started happening and basically the last 15 years, right? Just conversations despite us being able to disprove the somatic mutation theory for decades. Finally, people are starting to lean into saying, well, maybe we should start actually evaluating for studying and considering more wholeheartedly the work that Otto Warburg started in taking it to the next level, which started to make us look more at these metabolic mitochondrial underpinnings that this is actually what’s running the show.  Not the good old gene. 

Dr. Weitz: Still wonder though, if metabolism, the metabolic health, blood sugar, all that insulin, if this still isn’t only one of the causes, and wouldn’t we actually be better talking about the terrain theory of cancer?

Dr. Winters: Well, and that’s how my brain sees it, so, okay. The metabolic mitochondrial, that’s still, to me, it’s still the expression of what the terrain is being exposed to.  Right. So, for instance, been like most people now, like we started out with the six hallmarks of cancer, Hanahan and et al in, I think 2006 came out with the six hallmarks, and then we, I think in 2010 or 11 we’re like, oh, now it’s 10 hallmarks and we’re up to like 16 now. Right? We have all these hallmarks, but no one’s saying, but what makes those hallmarks express?  Right? It’s the same thing like, well, what makes the mitochondria not work? No one. So I, that’s my passion, is to say, well, what is contributing [00:38:00] to the dysfunction and the lack of number and the lack of vitality of the mitochondria. So even my colleagues in the metabolic oncology space who are focused in, they’re still focused on the tumor and the tumor metabolism and the tumor cell, and not why that metabolism went amuck.

Dr. Weitz: Right.

Dr. Winters: And so that’s what I speak about in the book. The metabolic approach to cancer are sort of my 10 drivers, of which there are likely more, but even some of those drivers collect a few things. So things like your epigenetics, the blueprint of your genes that were handed down from generations that make you vulnerable to certain expressions depending on input of data, right?  Input of food, light water, emotions, stressors, chemicals, toxins, et cetera. That is your the input is let’s see, you like fielded by or filtered by your blueprint, your genetic blueprint. And so they’re not set in stone. They’re [00:39:00] dynamic, and you can change the expression of, or the silencing of those genes with your day-to-day dietary and lifestyle choices and an even standard of care.

We will tell you today that upwards of 90 to 95% of all cancers are absolutely diet and lifestyle impacted. So it’s not what I’m saying. It’s like, we know this, we say this, but we don’t do anything about it, right? In standard care. So that’s one of the big drops in the bucket. The second big drop in the bucket is what do you eat or don’t eat, or when do you eat, right?

So the fuel, what are you fueling those cells with, right? Everyone’s trying to give like, oh, the blue zones, or, oh, the Mediterranean diet, or, oh, the keto, or, oh, the carnivore. Oh, the vegan, or, oh, the raw. It’s like, no it’s the raw material. What raw materials are you giving your body, and how does it meet your DNA, your genetic history and your needs in this moment at any given time.

So maybe what you need today will be different than what you need next season. Right. So that’s another piece. And the third drop in the [00:40:00] bucket, the environmental, I mean, my gosh, we have 80 to a hundred thousand new chemicals that have come out into the market since the 1960s, and yet less than a thousand of them have been properly tested.

And we’ve virtually done no testing on how they interact with each other. So suddenly talk about all that information coming in. We don’t even understand, beginning to understand what we’re being exposed to and how our bodies are dealing with it. And then we look at the microbiome, which was completely ignored until we can monetize it basically with really expensive shit.

And so we, you know, that’s, you know, that’s just what is what it is because as nature passes, as Chinese medicine practitioners, Ayurvedic practitioners, so 5,000 year old medicine and beyond we’re saying it all starts in the gut. We didn’t quite understand what. In the gut, but we certainly do now. And so for instance, the microbiome.

Now, we almost wanna put those two together, the microbiome and the immune system, because they’re almost impossible to separate. And so with that being said the [00:41:00] microbiome determines your immune system. It determines what nutrients you absorb. It determines what nutrients you convert to make them bioavailable.

Right? It determines what your how you’re going to respond to other medications, to other treatments. For instance, if you are missing certain things like Akkermansia for instance, you may not respond to immune therapies, right? There are certain chemotherapies that if you don’t have the right meta mi microbiome, it just falls flat.  It does nothing. We actually, 

Dr. Weitz: has anybody tested adding akkermansia supplements to immune therapy?

Dr. Winters: Yes, they have. There’s actually multiple studies on this and oh wow. You go to PubMed and say microbiome and checkpoint inhibitors. Let’s just give you a really simple one. Improvements with supplementation, right?  Or changes if you to pull, like, or detriment when you pull out those particular nutrients or those particular organisms. There’s plenty of studies, in fact I mean, I was trying to think the [00:42:00] last time I took note. I think there’s over 600 studies in this globally right now. On adding Akkermansia or just specific like, and Akkermansia is just one, but that’s like one example.  But there are certain, there’s other organisms that are important for response to certain therapies. I see. Okay. But like Akkermansia has become really well known with specifics to icis, which are the immune checkpoint inhibitor drugs. And so that’s one that you’ll see a lot of data on. And

Dr. Weitz: by the way, Akkermansia has a huge effect on blood sugar and insulin.

Dr. Winters: Exactly.  It’s a, it’s nature’s GLP one inhibitor.

Dr. Weitz: Exactly

Dr. Winters: right. And so here’s where it comes back again to the metabolic drivers like you. Here’s the, you know, like your client, your patient, your listeners may not know this, but like radiation, yes. Is radiation effective in treating cancer? Absolutely.  But it’s also effective at causing cancer. So how do you wanna make it work for you and not against you? One of the most important ways to make it work for you is to sensitize the cancer [00:43:00] cells to the radiation, which then protects the healthy cells from it. And you cannot sensitize cancer cells to radiation.  If your system is full of insulin and glucose, you desensitize the cancer cells. So basically they are impermeable to the radiation when your insulin is high. We know this, we’ve known this for ages, and yet what radiation oncologist is telling, there’s a few Dr. Brian Lunda. You know, is one that comes to mind.  There’s a few radiation oncologists out there. Dr. Christie Kesslering comes to mind to understand this and understand this well, that if they can get their patients metabolically healthy, metabolically flexible, insulin depleted, glucose depleted, their patients have much better outcomes on the radiation.

Less side effects. Their immune systems don’t tank, and they maintain you know, a pushback of the cancer, you know, and even into remission. You also don’t get those patients if you are, you know, not potentiating them. Like if they’re blood sugars are high, that’s a problem. But also [00:44:00] you can protect their cells by giving them things like high dose melatonin, which will potentiate, sensitizes those cancer cells further while simultaneously protecting the healthy cells.  Why is this not standard of care? These are not expensive interventions, and they’re not difficult interventions, and they’re, I guess if you

Dr. Weitz: were to say something to a radiation oncologist about using almost any supplement, one of the responses would be, under no circumstances should you ever take antioxidants.  Right. And, you know, I we have that famous rant from Dr. James Watson, who you mentioned, Watson and Crick.

?: Yeah.

Dr. Weitz: Talking about why would anybody ever take an antioxidant, right. At the same time, knowing that eating fruits and vegetables that are rich in antioxidants are one of the healthiest things you could do.

Dr. Winters: Really, the ORAC score of a blueberry, for instance, far outweighs most things you would take as a supplement. Right. And yet no one’s telling them to avoid blueberries. Right. So, but, and the other side of this is that

Dr. Weitz: can you just talk for a minute about this topic? Yeah. Can taking a vitamin C uncouple the effects of radiation or conventional chemo, or, in my opinion, it’s more like saying if I bring this plastic shield onto the battlefield against you know, rocket fire, am I pretend, am I gonna.

Dr. Winters: Really, if you were looking at a truly antioxidant free diet to support the claim of the radiation oncology team, people would have to be drinking distilled water and eating cardboard. I mean, that’s just the reality, right? And that’s just not possible. Right? Here’s what’s very interesting. I will say that we do, as clinicians want to, if we’re going to use an oxidative cytotoxic therapy, we want to have that effect.  Right. [00:46:00] We do not want to quench that effect. Sure. But we wanna be prepared to quench it. After the half-life is down, we want to come in and clean up the environment as quickly as possible. So for instance, the other thing about radiation oncologists is they do not understand anything about redox chemistry, which is knuck thoughts because there is no such thing as like purely pro-oxidant or purely antioxidant.  There’s sort of these gray areas of we move in different arenas. So for instance, low dose oral vitamin C. Two grams, four grams, six grams a day, and split doses is actually antioxidant. We actually do advise our patients on the day of radiation or the day of chemo at least four to six hours around it to avoid things like vitamin E, selenium, zinc you know, vitamin C in the oral forms, just so we can harness as much of that oxidative stress as possible.

We call it the kill phase. We wanna take full advantage of that, but [00:47:00] like day after you’re going to town on those things you need to clean up and scavenge that reactive oxygen species as much as you can so you don’t further overwhelm those mitochondria. Right. So that is a really big strategy. The other thing is, the strategy is we can potentiate those oxidative therapies like radiation by giving the patient a bump, a hit of oxygen, whether it’s from HBO t insufflation, or even nasal blow by prior to going into their radiation.  You actually open up the pores, for lack of a better word, of the tumor to make it penetrable because radiation is very difficult to penetrate what we call cold tumors or really cloaked tumors. And so the rate, the oxygen therapy adds a level of oxidative stress that actually opens it up more and makes it more penetrable by the radiation.  So we might enhance the radiation effect and, but simultaneously that. So would you do that the day before the radiation or? I do it, I like it within an hour to two hours before the Oh, really? That’s my ference

Dr. Weitz: now. So, so when you [00:48:00] say su fla sulfation, if everybody’s not familiar with that, you’re talking about using ozone?

Dr. Winters: You were using ozone nasal cannula. Well, actually not nasal can. It’s too vulnerable there. But like rectally vaginally, you can do that before going in for a radiation therapy, especially if it’s like a colorectal cancer. We definitely wanna get the oxygen right to that region, you know? So those are the things, if it’s like head and neck cancer, just regular nasal cannula of oxygen, if it’s sort of something more diffuse or in the abdomen, we might put somebody in a chamber.  We want to potentiate that, which will help the healthy cells and focus on the cancer cells simultaneously. That’s one example. The other example is ketone bodies. So therapeutic ketosis mean ketone bodies of above millimoles above three actually increase oxidative stress. So it potentiates your chemo, it potentiates your radiation, but simultaneously protects the healthy same things like hyperthermia, and same things like high dose IV vitamin C, high dose iv, vitamin C above 25 grams intravenous is pro-oxidant. It will fact in like fully impact and synergize the oxidative kill phase effect of those things. So when a radiation oncologist tells a doctor or tells a patient, Nope, no way are you doing my IBC because that is an antioxidant. They’re fucking idiots. I mean, excuse me. But it’s like that is the most pro oxidative therapy out there.  We’re making your work better.

Dr. Weitz: That’s, well, when your lab, you should do a study having patients get IV vitamin C along with their radiation or chemo, then

Dr. Winters: those studies exist. They’re already published. They do. Okay. And they’re already, and they’re favorable. You will potentiate. So not just for radiation, but also for chemotherapy.  So some of those really toxic chemotherapies, it will potentiate the effect of that and protect the marrow simultaneously.

?: And then

Dr. Winters: you come in with your antioxidants [00:50:00] around it, like the day before your treatments the, you know, day after, depending on the half life of the treatment. Then you clean up and scavenge that, what’s still running around the system causing chaos where it doesn’t need to.  That’s where we bring, this is why integration. Right. This is how it rounds it out. And so, this is where, so we were just talking about like the microbiome and we’re kind of heading out to the other drops. So really quickly, the other big drop, the immune system talk about harnessing that inflammation circulation and oxygenation.  Hormone modulation circadian rhythm, stress response. This is such a big one in the cancer world and mental emotional. So these are the 10 major drivers. So for instance, if someone’s willing to eat the right diet, do all the right pills and potions get the right standard of care treatment, but they’re not, like for instance, going to bed before 11:00 PM and they’re on screen till two in the morning, that’s completely disrupting their entire terrain, right?

You know, that insulin [00:51:00] growth factor wiping out the ability to detoxify, which is the time our bodies do that in the middle of the night. You know, things like that. But if they’re also not dealing, say with the skeletons in the closet of their mental emotional resilience and their traumas, they also are less responsive to therapies.

So folks, for instance, with high ACE scores, adverse childhood events. They have a much, they’re wired differently. Their, the nervous systems are wired differently. Their immune systems are wired differently. So until they basically rewire that, reprogram themselves and resolve that trauma, they’re gonna continue to be playing that record.

And it will mean that their treatments don’t land as effectively, whatever they are. And if you’re in a state of constant fight or flight, if you’re in a sympathetic nervous system, we don’t heal and sympathetic. So being afraid, so living in fear, which are com, our complete culture like seems to thrive on and seems to perpetuate the money machine on.

If you’re living in a state of [00:52:00] fear, you can’t receive, no matter how good the treatment is from standard of care, from alternative care, from healers. If you’re in a constant fight or flight, you can’t even receive that healing.

Dr. Weitz: What are your what are a couple of your favorite supplements for patients?  You, you were talking about immune system function. Yeah. When you have a patient and they have low white blood cells or low lymphocytes and you know, they need some boost to their immune system what are some of your favorite strategies?

Dr. Winters: Well, one of my favorite strategies is that there’s a kind of common denominator of deficiencies within patients that are dealing with a cancer diagnosis, but also and so I’ll just start with that.  So they’re really simple. You’re missing you’re missing the fat solubles typically very common. So a DK, right? Those are the main ones. You’re missing major minerals. So zinc, selenium, magnesium are the big ones you’re missing the kind of co the the big, like the B12, the big methylator.  You’re missing that, those are your big ones. So magnesium, zinc, vitamin D, vitamin A, vitamin K, and B12 are the ones that are classically missing across every patient I’ve ever run labs on. Right? Both from functional labs to conventional labs. It’s missing, right? And so we know those are all the important co-factors for immune function, right?

And for lots of cell, like you, like magnesium alone pulls like 200 different genetic levers. And vitamin D alone has major epigenetic, you know, liver pulling and packed as well. Vitamin A is pretty much your entire immune system, right? And K like we so downplay these and we’ve gotten so fat phobic and we avoid the things that those come from.

And we give people synthetic forms and we give folks plant-based forms. So in fact, the studies that show that things like vitamin A and E can cause cancer, it’s because those are the plant-based forms. Right that are misunderstood and misappropriated. So betacarotene, we don’t, we don’t ever give our patients betacarotene, right?  We don’t ever give our patients cyan cabal forms of B12. We don’t ever give our patients [00:54:00] so, solen, methionine forms of selenium. Like we know we need to use certain nutrients that are depleted in our cells. So when we deal with those, if I get those foundational ones, I’m not

Dr. Weitz: sure if everybody knows what the issue is with seleno-methionine.

Ah,

Dr. Winters: so the methionine aspect in

Dr. Weitz: a person who’s dealing with cancer, who’s acting cancer,

Dr. Winters: okay. 

Dr. Weitz: The idea of that high methionine might promote cancer?

Dr. Winters: Yes. And we can tell very sur. I mean, first of all, you can get testing now to actually know which metabolic pathways are deranged. But we can surrogate tests with a homocysteine level.  And so the homocysteine level is elevated and we do what we call a homocysteine challenge. So we give some of those co-factors, you know, high dose for a couple days and we retest the homocysteine. If the homocysteine comes down, drops significantly, we know that was just a methylation problem. But if the homocysteine barely drops or stays the same or even goes up, we know we have a methionine driving the cancer process.  So you don’t want to take supplements that contain the methionine form. And [00:55:00] selin methionine is the most common form of selenium. Interesting. And sodium is a very powerful PTP 53 tumor suppressor support. It’s really great for methylation support, but if you’re using the wrong form, it can backfire.

So we, we want to use the right form. So because I’m a clinician who’s had to piecemeal all of these things together, we actually created a formula. And this is not to mean a shameless plug. It’s that I needed it, it didn’t exist, so I created it. That’s sort of the story of my life, you guys. So it’s like these tests didn’t exist.

So I created, these courses didn’t exist. So I created, this hospital didn’t exist. So we’re creating like it’s, instead of me waiting for somebody else to do it, my personality is just. Do it, like get outta the way and we’ll just do it ourselves. So we created a company called Mito Vita. So the life of the mitochondria and one of our sort of flagship pro products is this Nutra master, which are those replaced or those repleted sub, you know, nutrients I just mentioned are all in one place.

And so that’s kinda like my form of a [00:56:00] multivitamin. ’cause multivitamins otherwise are crap. I don’t ever recommend ’em for anybody. They have too many things that are not therapeutic enough, but they also have too many things that are actually could be drivers and somebody dealing with cancer. And so I just wanna avoid those.

It’s very difficult to find good quality ones. So for years we just had patients take these things individually. Now they take it in one. One pill versus Yeah. My,

Dr. Weitz: I don’t, I’m sure you must be aware of it, but Integrative therapeutics has least s Yeah. Thrive multivitamin.

Dr. Winters: Yep. Yep. And so, but you know, for me, I don’t want anything that contains calcium, boron, iodine, iron non methylated B vitamins.  Sure. Still has a few of those things. And so I love Lisa. I think she’s stinking brilliant, but it’s not a supplement. I personally recommend for my patients on that. But if you’re not cancering, I think it’s perfect. But if you are cancering, there’s. Too many things we’re learning that we have to be pretty careful and pretty thoughtful on.  But when you talk about the immune system, I know there’s a lot of people out there who think that supplementation of vitamin D is [00:57:00] controversial, but the reality is that we’ve all used detergents on our skin to break down the ability to absorb our vitamin D three. We are all terrified of the sun.

So we’re not getting our 10,000 units minimum just to prevent rickets a day exposure to vitamin D from the sun. Perfect world. If you could lay out naked every day for an hour, we’d all be fine. Right? But no one’s doing that except for a few biohackers, right? So at the end of the day, one of my most compelling, you know, levers, especially if people have single nucleotide polymorphisms that make vitamin D absorption difficult, whether it comes from natural sources or supplements, we do need to bring on a supplement for these patients.  It pulls so many levers. It’s a really important one to optimize. Another one that we like to use that really optimizes the entirety of the immune system, the entirety of the metabolic system, the entirety of the like hormonal modulation and DNA protection is high dose melatonin, right?

Again, your like, probably the most studied outside of missile toe [00:58:00] alternative cancer therapy out there. Hundreds if not thousands of white papers on it. If people wanna go, people like Dr. Dr. Ri Ryder Russell Ryder famous researcher in melatonin chemistry, because everyone’s always like, oh, it’s gonna replace your function.

It doesn’t. It doesn’t. That’s a myth. And so there are ways that we can harness the power of high dose melatonin like I potentiate. I give somebody like, you know, 500 mil, you know, IU or 500 milligrams of for going to radiation therapy or getting an X-ray or a CT scan to both potentiate the impact of the radiation where you want it to go, but also to protect the healthy cells.

It’s a TP 53 protector as well. And so these are some of the tools we can be using that brings us back to this conversation and need for integration that it shouldn’t be either or. It should absolutely be an and. Absolutely.

Dr. Weitz: I have a million more questions, but running outta time. I’m sure you are too.  I’d like to get one more particular [00:59:00] question. There’s a particular issue that has come up that is a peeve of mine and that is there’s at least one prominent ca researcher who also has researched cancer and recommends a low protein diet, particularly because. According to him and some data that higher protein diets, meaning including animal protein raises IGF one levels.  And in your book you point out how IGF one levels are raised by insulin being produced by eating a higher carb diet. So therefore, eating a lower protein vegetarian diet is automatically gonna be a higher carb diet. And so we measure IGF one levels in all our patients, and I do not see uniformly that our patients following a healthy diet with even [01:00:00] three times a day of animal protein.  We, I do not see a big increase in IGF one levels. And so I’ve always been very skeptical about that. So should. Patients who wanna prevent cancer follow a lower protein diet because of the fear of raising IGF one? Or is the concern more about eating sugar and high glycemic carbohydrates?

Dr. Winters: So, couple, there’s a couple places to unpack here.  So biggest prevention is going to be carb restriction, right? That’s because 70%, some research shows upwards of 90%, but let’s just be conservative. So let’s say 70% of all cancers are very heavily driven by insulin. All I would say a hundred percent are to some degree, but 70%, it’s pretty much the main driver, right?  Right. That other 30%, it’s a driver, but there’s usually other players such as glutamine. Methionine cystine, right? Loose arginine, [01:01:00] right? Somebody’s so what you’ll notice is those are proteins, right? So this is where the conversation gets confusing to people. Healthy metabolism of healthy cells and metabolism of cancer cells are two different animals, and they’re happening simultaneously.  So when you look at, does sugar alone cause the cancer process it doesn’t it. So what you have to have a metabolic derangement that then switches and says, I want to utilize glucose as my primary fuel. That doesn’t start that way. It’s a response to something stressed in the environment that allows that ship to happen.

Similar to the protein question. So let’s talk about this for a moment, because IGF one is definitely a problem, but it’s a problem once the metabolism is switched over, right? And so absolutely too much protein will drive IGF one, [01:02:00] but it is far less common to see that than it is to see IGF one being caused by too many carbohydrates.

Also, people always forget too much steroid, which they give every freaking patient who’s on chemotherapy, which even in Dr Balter Longo’s newest book in the first few chapters says this should be pulled, which I’ve been saying for 30 years from every patient. It’s like peeing in the wind when you give a patient a steroid for with going through cancer treatment.

And then the other side is, so she’s talking about corticosteroids like prednisone, which are often included in the protocol to reduce inflammation. All included. It’s a, it’s an, it’s a CYA. But I tell folks that even if you get the CYA of the pre the preload drugs, if you’re going to have a reaction, you’re gonna have a reaction.

And you’re in that chair with a lot of people close by that are gonna give you the proper drugs like histamine, antihistamines, and even more steroids if you do have a reaction. So why don’t we already know they’re there? Just keep those things on hand to give them those drugs right away because the patient’s still doing [01:03:00] CYA drugs are going to have that reaction that are going to have it, right?

So it’s like we’re preempting things that we actually can treat if it shows up in immediately and deal with it immediately. But the other things that drive up insulin growth factor stress. So cortisol drives up IGF one

?: right

Dr. Winters: over exercising. ’cause it drives up insulin, it drives up cortisol. Okay. And sleep.

Lack of sleep. So two nights of bad sleep, just two nights of bad sleep will impact your IGF one levels. So we may be blaming the wrong things for IGF one. I see interesting other drivers for it. But if I have a patient who’s actively cancering and their IGF one is elevated, we’re gonna go after all of those things.

We’re gonna see, well, is this stress? Is this sleep? Is this too many carbs? Is this too much protein? And we will adjust accordingly. We will get back the data and we will be able to know what was the driver for that patient. And so to me, that’s what’s really exciting is we don’t have to [01:04:00] guess, right?

You’re modulating

Dr. Weitz: nurturing and you’re testing to see what’s happening with that individual patient. And that’s how you provide individualized, personalized care.

Dr. Winters: And so, Ben, when someone says. It’s always bad or it’s always good, you need to kind of run from it. We know across the board carbohydrates are the driver.  Too many carbs and too many processed carbs in particular are the driver of many of our chronic illnesses today. We all do not expend enough energy, right, to utilize the carb intake we have. And then because of the things like altered metabolism from light exposures in the wrong times of day because of the endocrine disruption, we are completely swimming in from the chemicals in our environment to the exogenous hormones we take to the plastics we’re exposed to the glyphosate drenching our entire planet.  Today, that impacts the way we metabolize things. Like we have to become aware of everything we put in on and around us, including people, places, and [01:05:00] things, which is where we started our conversation today. And the simplest place to start is just to be aware of when you eat. And what you’re eating. Like that’s the thing that’s like your base camp.  And to start to realize that we’re all leaning towards way more carbs than ever before, right? And that some of us can tolerate more than others based on our epigenetics. So you can even take that information in. So even the question about IGF one, my husband would love to be carnivore, but he has a PA two snips.  He has a CSL one snips. He’s got snips that when he eats red meat, he can get by with a little bit, but if he eats too much, his glucose and insulin go up and his ketones drop.

?: Wow. His

Dr. Winters: body thinks it’s a candy bar. But there other people who have like the seven oh gosh, I can’t believe I just forgot it.  The seven FL 7 22. Ugh. I cannot believe I just completely lost this one. There’s another SNP TCF seven L two, which is for those folks who wanna be like a vegetarian or vegan. They’re, they are [01:06:00] so predisposed to diabetes and the issue is they don’t have the enough amylase to break down all the carbohydrate.  So the point is that there’s a time and a place to be more, you know, higher protein, more higher carbohydrate based on our biochemical individuality and our single nucleotide polymorphisms. And in, if we’re even then using a clinical application, we may wanna pulse things like maybe we need to restrict.  This is why I’m such a huge fan of fasting and intermittent fasting, because you basically starve all of the potential drivers, glucose, fats, and proteins that could potentially be causing a problem. So if you pull that out for a little bit of time, you make those cancer cells a little more vulnerable, and then you pair that with some other pushing therapies such as oxidative therapies of some sort, standard of care or otherwise, you completely change outcomes.  Right. So we might get caught up in these dogma wars of which is the best diet or which is the best foods to avoid [01:07:00] or to take. But really some of our most compelling data is when we’re not eating and how to layer that in more strategically with some of these therapeutic interventions.

Dr. Weitz: Oh, so let’s wrap here.  It’s another continuing conversation. Tell everybody about your programs, your training programs for practitioners and whatever other contacts you want everybody to have.

Dr. Winters: Thanks, Ben. Well, first of all, folks can start by following me at drnasha.com, D-R-N-A-S-H a.com. That will probably take you to all the things that we’re up to.  That’ll take you into the nonprofit land of MTIH, which is Metabolic Training of Health, where we’re doing research and innovation, but we’re also doing patient grants to get access to this type of care. And then also working on funding for a really powerful hospital that we hope to build on this model, around this model.  And then you can also learn about the product line that we’ve developed is very specific to the metabolic health and metabolic oncology space. So we’ve been using it internally in our community for some [01:08:00] time, but that’s where it’s been tough because there’s no, there’s a lot of stuff on the market that doesn’t quite fit what we need for our particular population.

We also have a data platform that’s a clinical decision making tool, our MT that is about to launch to the public, which is a really powerful way to. Make this approach more available and scalable by clinicians. ’cause it takes a lot. We’re about a thousand strong now in 46 countries of clinicians and allied health professionals who’ve come through my training program.  But this requires a lot of time and energy to master this information and to apply it. And so we’re creating tools to make this more accessible and scalable by clinicians globally. And so you can learn about my book, the Metabolic Approach to Cancer, all the things that Ben and I talked about really go into greater detail about this.

And then the book, the Metabolic missile toe and the future of integrative oncology is kind of like the next gen. This is actually written for clinicians as a kind of a toolbox for them to access in the integrative oncology space. But ultimately, you know, if you go to [01:09:00] Dr. Nayha or mth.org, you can sign up for our newsletter to keep abreast of all the conferences and all the podcasts I do where I’m guests or I have guests on.

And then I think the final thing I want your listeners to hear is we’re doing a really amazing event. I hope this comes out in time for that. In October 10 10, by the way, October 10th is our Health Day on the calendar, right? So for the last couple years we’ve been doing some events, just kind of one day virtual things on 10 10.  But this year we’ve had such a demand. We’re actually creating a conference and we’re bringing together all the things that personally for me. Are about how we impact the terrain being in the best of metabolic health and metabolic, you know, like regenerative health with region farming and soil mitigation and environmental medicine all under one roof.

So if you go and Google Metabolic Health Day conference, and we’ll give a link to this you will see that. E any one of our keynotes would fill a stadium on their own. Really unbelievably brilliant people that I’m really proud to have on board. Plus 30 other well-known, high, [01:10:00] highly followed, highly influential clinicians and influencers out there in the world making, making a difference in health as we know it a healthier planet for healthier people.  So I’m excited about that because it’s bringing a lot of these voices together that are impacting policy, impacting planetary health and impacting people health. So is that in person? It is. There’s an option for in-person in Tucson, but there’s also an option for virtual live streamed as well as recorded if you can’t be, take part in the livestream aspect.  So we want this to be a toolbox for creating a better future.

Dr. Weitz: Great. Feel free to post a notice on my functional medicine discussion group of Santa Monica closed Facebook page.

Dr. Winters: That would be amazing. Thank you for that opportunity. 

Dr. Weitz: You’re welcome. Yeah. Thank you so much Nasha. Another amazing discussion.

Dr. Winters: Thanks, Ben. You’re the best. Appreciate you so much. Thank you.

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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 want to promote longevity. Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.

Dr. Peter Kozlowski discusses Improving Fertility with DNA Testing and Functional Medicine with Dr. Ben Weitz.

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

 

Podcast Highlights

Genetics and Fertility: An In-Depth Discussion with Dr. Peter Kozlowski
In this episode of the Rational Wellness Podcast, host Dr. Ben Weitz engages in a comprehensive discussion with Dr. Peter Kozlowski, a leading functional medicine practitioner, about the role of genetics in fertility. Dr. Kozlowski, with over a decade of expertise, delves into how genetic testing and a functional medicine approach can optimize fertility treatments. He shares insights on various genetic polymorphisms, such as MTHFR and FSHR, and their impact on fertility, alongside preventive measures and treatment strategies. Additionally, he emphasizes the importance of mitigating environmental toxins, optimizing mitochondrial function, and the role of both partners in addressing fertility issues. Dr. Kozlowski also introduces his advanced AI-powered platform designed to support practitioners in applying functional medicine effectively.
00:28 Guest Introduction: Dr. Peter Kozlowski
02:12 The Importance of Genomic Analysis in Fertility Care
02:58 Genetic Testing Advancements and Personal Stories
04:23 Preventative Use of Genetic Testing
08:30 Environmental Toxins and Infertility
12:52 Personal Infertility Journey and Genetic Factors
14:42 Key Genetic Factors in Fertility
19:22 The Role of Resveratrol in Fertility
22:53 Promotional Break: Apollo Wearable
24:24 Additional Important Genes in Fertility
27:58 Genetic Factors in Nutrient Status and Fertility
28:18 Vitamin A: Importance and Testing Challenges
29:10 Micronutrient Testing and Deficiencies
31:10 CoQ10 and Fertility
31:40 Genetics and Personalized Interventions
33:04 Detoxification: Genes and Controversies
33:51 Approaches to Detoxification
40:10 Mitochondrial Health and Genetic Risks
43:56 Genomic Testing for Fertility
46:00 Men’s Role in Fertility
48:14 Conclusion and Contact Information
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Dr. Peter Kozlowski is a leading Functional Medicine practitioner with over a decade of experience dedicated to transforming healthcare.  He is the creator of Root Cause Practice Pro, an advanced AI-powered platform designed to empower both functional Medicine practitioners and individuals seeking answers to chronic health issues. Dr. Kozlowski has written two books, Unfunc Your Gut and Get the Func Out. He lectures for the Institute of Functional Medicine about fertility and how using a Functional Medicine approach that includes looking at genetic SNPs, that is a very compelling way to help patients.  His website is doc-koz.com.

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

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Podcast Transcript

 

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

Hello, Rational Wellness podcasters. Today I’m excited to be having a discussion about genetics and fertility with Dr. Peter Kozlowski. He’s a leading functional medicine practitioner with over a decade of experience. Helping to transform healthcare.  He’s a creator of Root Cause practice Pro and advanced AI powered platform designed to empower practitioners and individuals seeking answers to chronic health problems. He’s written two books, Unfunk Your Gut and Get the Funk Out. I heard Dr. Kozlowski lecture for IFM about fertility and how using a functional medicine approach that includes looking at genetic polymorphisms is a very compelling way to help patients.  And I thought it was really a. Fascinating. And I also appreciate the way Dr. Kozlowski is able to blend DNA testing with the overall approach especially when it correlates with testing because there’s genetic testing out there, but a lot of times it’s hard to correlate it. And I have found personally in practice, when you’re trying to take all this genetic data and blend it with lab data and everything else, and do it in a reasonable amount of time, is definitely a challenge. So while Dr. Kozlowski is dedicated to transforming he, his healthcare, his proudest achievements are family related, being a father to his daughter Sawyer, a husband to his wife Mackenzie, and a soon to be father of a baby boy. So Dr. Kozlowski, thanks for joining us today.

Dr. Kozlowski:  It’s an honor. Thank you so much for having me.

Dr. Weitz:  So why is it important to include a genomic analysis and fertility care from a functional medicine perspective?

Dr. Kozlowski: Yeah, I think, honestly, I think it’s the most important thing to include, and this is coming from somebody for that for 12 years, told people not to do genetic testing.  Because I, as you you heard me at IFM, but the gene when I first started training that everybody talked about was M-T-H-F-R which one of my patients famously called the mother EER gene. Right. And because when you read about it, it was like it was. The root cause. It was the root cause of everything.  Right? Right. If you had M-T-H-F-R, it would cause heart disease, infertility, inability to detox. And when I dug into it, it just didn’t make sense to me that one gene could explain everything. And over my [00:03:00] years of telling people not to do genomics, not to do genetic testing, genetic labs got. Way more advanced.  We know a lot more about genetics and now the testing is incredible. When we order a genetic profile, you can get hundreds of SNPs that are related to your ability to detox your risk for dementia, your risk for what kind of diet you should follow, r regards to your weight whether you’re at risk for heart disease, diabetes, clotting.

My own personal story is anxiety and depression. I, that, those, that’s how I ended up in functional medicine. And I found that genetically I don’t make serotonin. And I was able to use my genes to then optimize, like my supplement protocol to help my body make serotonin. And I feel like it’s really helped balance my body people’s ability to absorb vitamin D, magnesium.  There’s B12 and then, you know, not just M-T-H-F-R, the full methylation pathways. Autism is something I work with that I have not yet tested a child with autism that didn’t have significant predisposition to autism. So the reason for testing is to opt. You know, unfortunately in my practice, everybody I’m seeing is already with.  Disease. So 99% of my patients have a chronic disease and I’m like their last hope for reversing it before they’re out of meds or surgeries or things like that. Ideally, genetics to me should be used preventatively, right? So we did a full genomic panel on our daughter when she was two months and. I have an idea of what she’s set up for.

So I have a strategy that I’d like to take as she’s growing up to hopefully prevent disease. Right. So, right. We know she doesn’t detox well, so you can put her on binders in certain situations. You can upregulate phase one and phase two detox. Whether it’s deciding how to supplement, right?

I think that’s one of the hardest things is like determining which supplements what people should be on. And I was always a minimalist. It was like, [00:05:00] well, let’s test what’s wrong with you. Let’s get it rebalanced and then you don’t need any supplements. And then I found for myself, like I don’t absorb magnesium at all.

So I’ve now on a magnesium three and eight, which I think has totally changed my life. So I would love to use genetics as preventative medicine, but I’m using it with my families that, you know, the kids have autism and we’re optimizing. Do they need high dose folate? Do they need oxytocin for infertility, endometriosis?

How do we down regulate it? How do we optimize hormone balance? How do we optimize detox? For patients who have a family history of dementia, you know, are you at risk? Right? Do you have the genetic predispositions? What we know about dementia is the changes in the brain happen start 20 years before disease starts.

So using it that way. So there’s so many different ways. So the way I use it now is typically to, you know, with, again, to optimize a condition that we’re treating, whether it’s optimizing [00:06:00] a mold detox or cardiovascular care, or dementia prevention or autism or detox or whatever. But. I would love to use it primarily just as prevention to let people know what they’re at risk for and how we could prevent that.

Dr. Weitz: Yeah. It’s interesting how many of the common chronic diseases today, particularly neurodegenerative diseases, actually start to present some of the early signs. 20 years earlier, the Parkinson’s, same thing. You know, patients get constipation. They have certain symptoms that are very characteristic, that they have a higher risk in 20 years of ending up with Parkinson’s.  Let’s intervene. Then. Let’s not wait until the person is officially diagnosed.

Dr. Kozlowski: Yes, exactly.

Dr. Weitz: And the same thing with autoimmune diseases. You know, these things gradually, slowly, you have this chronic inflammatory situation where the immune system’s attacking the body. And let’s not wait until there’s enough damage where you are now officially diagnosed with the disease.

Dr. Kozlowski: There’s so many genes related to like the immune system and inflammation and certain people are just way more prone to autoimmune conditions, right? So again, it’s whether that’s, if it’s already developed, you kind of optimize an anti-inflammatory plan or you do what you can to prevent it right.  I really think, like, you know, when I, as I was trained with the Institute of Functional Medicine, it was all about like personalized medicine, right? Like, that’s what makes us different as, right? Like practitioners, like this is like we focus on personalized medicine. Well, genetics like truly makes it personalized, right?  Right. You treat the same condition differently. Like, I have a heavy metal detox protocol or a mold protocol or a glyphosate protocol, but when I know somebody’s genetics. It completely can change based on what that

Dr. Weitz: person needs. In your presentation at IFM, you showed some statistics about the [00:08:00] rising rates of infertility from, you know, less than 1% to over 19% in the us over 40 years.  Over 40 years. Yeah. Still, that’s a shocking number. 

Dr. Kozlowski: That’s insane. There’s not many diseases that go from less than 1% to 20% in 40 years.

Dr. Weitz:  Right. So what do you think are some of the contributors?

Dr. Kozlowski:  I think the argument that the genetic haters will say is, well, our genes haven’t changed. Right?  So why do you talk about genetics? When you talk about infertility, what, why I think the rate has gone so crazy is our environment. And. Our environment is way more toxic. And the books that I wrote, one of them get the funk out is it’s the whole point of the book is how our hormones are being damaged by the environment, right?  And it all comes down to mitochondrial dysfunction. I really think most chronic disease is based in mitochondrial dysfunction. There is nothing more [00:09:00] damaging to our mitochondria than environmental toxins. And so when I say toxins, I mean there’s lots of ’em, right? There’s millions of them.

Unfortunately, right now there’s only a few that we can really test. We can test heavy metals, we can test mold, we could test levels of glyphosate we can test herbicides and pesticides and plastics. So there flame retardants there. You know, there’s a lot we can test. There’s still a lot we cannot but, you know, over the course, if you look at, you know, again, the rate of infertility in 1990 being less than 1%, and now, 19%. There’s not like a causation study, but when you look at the correlation of the amount of toxins being released into our environment you know, it’s a straight up curve with the correlation of what’s happened. So it, you know, my, my theory of why it’s so out of control now is. We have an increasingly toxic environment.

We have more stress. Our guts are in worse shape, right? So most people are familiar with that term, leaky gut. Our gut is a barrier to keep the outside world out, just like our skin is a barrier, just like our lungs are a barrier. Because we have these leaky guts, because we’re putting all these chemicals on our skin because we’re spraying our foods with all these chemicals we’re breathing in this stuff.

There’s gateways of that outside world that’s way more toxic to get inside. Toxins are fat soluble. They look for fatty places to get stored. When our detox is overwhelmed, every cell in your body is surrounded by a membrane that’s made up of 50% fat. Right, and particularly one of their favorite place to go.

Those toxins are our reproductive organs. So for men it’s the testes. For women, it’s the ovaries. Thyroid disease is the most common autoimmune disease. So toxins surround these reproductive glands. Our hormone glands create mitochondrial dysfunction. Those glands don’t work the [00:11:00] way that they used to, and now you have an infertility problem.

Right. And I do believe it’s very multifactorial. It’s not just one thing, it’s all of these things. The bigger picture, creating this toxic world inside of us that is, you know, different people affecting different things. But one of the things that’s really affecting is people’s ability to reproduce now.

Dr. Weitz: Yeah, and those of us who are paying attention to what’s happening in the environment, it’s clear that there’s all these increases in toxins. I’m living here in Santa Monica, in Los Angeles, and we live through these horrific fires, and there’s all this data about how particulate matter from smoke. Leads to all sorts of damage to the body.  We have all these floods and hurricanes and that inevitably leads to mold buildup afterwards. And the way we build our homes that are airtight leads to increased mold. And [00:12:00] there’s so many reasons why we are. We’re hearing about microplastics and the brain and the other organs. It’s clear that we live in a very toxic environment and that those toxins are getting their way into our bodies.

Dr. Kozlowski: And so, and unfortunately there’s not causation studies yet. But you know, like I said that you perfectly explained the correlation, right? We know that this is getting worse and worse. They’ll admit it when there’s fires. They don’t admit it from our day-to-day exposure, but.

You know, what we do see is the infertility rate was less than 1%. It’s now one in five couples. Right. Right. So it, you know, we could just say, we have no clue what’s going on. Or we could say, Hey, we know these things are getting into our bodies at way higher rates. We know these things once they’re in their body damage or mitochondria, we know mitochondrial damage leads to infertility.  Right, right. 

Dr. Weitz: So, yeah.

Dr. Kozlowski: And it, I mean. So the reason I became so passionate about this subject is my wife and I had to go through infertility [00:13:00] treatment. My wife had stage four endometriosis for seven years, had pelvic pain going to the doctors saying that she had pelvic pain, that she thought she had endometriosis, and they kept telling her, no, you don’t.  No you don’t. Finally, the last OB told her to go to a physical therapist. For pelvic floor exercises. Right. It wasn’t until she saw an IVF doctor that they did a tubal study and her tubes were so scarred that they had to remove them.

Dr. Weitz: Yeah, that’s sad.

Dr. Kozlowski: And she, when we went back and did her, because I didn’t get to do her genetics until she was pregnant, but when we did her genetics, what we, well, I knew the whole time when she was 20, she had moved into a moldy building, worked at an airport.  She had really nasty environmental toxin exposure. We did her genetics. We found out she doesn’t detox well, specifically the chemicals that are present at airports, and that’s where she worked. We saw she had four different [00:14:00] genes that gave her anywhere from like a two to five times risk of endometriosis.  We know endometriosis is a mitochondrial disease, so, you know, that was, you know, that story is kind of what got me so passionate about getting into infertility. ’cause it was, you know, it was, it’s a, it’s our story and it took us four year, three years of trying before we actually got pregnant and we have a daughter now.  But the, and I guess why I wanted to get started on that is like, this is something with the one in five, like. Everybody knows somebody now going through IVF, right? Whether it’s a family member or a friend. Like you know, the, at 19% we all know someone affected by this issue, right?

Dr. Weitz:  So let’s go through some of the genetic factors.  One of the factors is the project progesterone receptor gene, which can contribute to miscarriage or infertility.

Dr. Kozlowski: Yeah, so there are a lot of genes, [00:15:00] right, that are connected, and so the, there’s not like one specific one that I would just focus on. Of course, like when we do the. Like a, we, what I, what it’s called is a female health panel.  Right? And so then we start looking at ways, how can we optimize a woman’s fertility? And what you’re talking about the progess, PGR when women have a snip, which is a polymorphism maybe that, you know, I don’t know if everybody, every listener is totally familiar with. 

Dr. Weitz:  Sure. Why don’t you explain what a single nucleotide polymorphism is?

Dr. Kozlowski: Yeah, to keep it I like to keep things super simple. We have about 23,000 genes. There’s what’s, what most of the population has, and you get one copy from each parent. So, when it comes to looking at a gene, you can have what’s typical. You could have one variant, or you could have two variants, meaning that you have a variant from mom, you have a variant from dad, or you have both.  Sometimes having two variants from the, what’s [00:16:00] most common is good. Most of the time it’s. Bad. So when you look at a genetic, to me, when I look at a genetic report, what I look at first is what is the prevalence? What percent of the population has that combo? Right? So what percent of the population has zero copies?

What percent has one or two copies? And now what the research has where the research is basically when you have one copy, what does that increase your risk for? When you have two copies, what does that increase your risk for? And then what? The most important step of all of it is how can you intervene on that gene?

Right? So that’s probably the most important thing to understand is if you have a gene, the importance of knowing is what can you do about it? So, for example, somebody with the progesterone receptor gene has an increased risk of infertility. Basically, they need more progesterone to bind up their receptor and.

So if you’re, if you have the PGR [00:17:00] gene. Your receptors don’t bind, the progesterone doesn’t bind as well, so you need more progesterone. You’re gonna be more predisposed to having problems with too much estrogen. And so somebody with that, the first thing I would do is I always test for estrogen dominance, right?

So if I test someone for estrogen dominance, I’m looking at their progesterone levels in the second half of their cycle to see if their progesterone’s high enough. Somebody with the PGR receptor is gonna need higher levels of progesterone. Progesterone is your first pregnancy hormone, so there’s a lot of women who can get pregnant, but then they miscarry, and after a couple miscarriages, the doctor will then be like, well, let’s put you on progesterone now to maintain your pregnancy.  There’s probably. People listening that it was either them themselves or their husbands listening. It’s like, yeah, my wife needed to go on progesterone after we had a couple miscarriages. The benefit of knowing a gene like that is, is, and I’ve had patients who have this, who have not yet started their [00:18:00] fertility journey.

But they can take that to their OB doctor and be like, listen, I need extra progesterone when I get pregnant. So if they find out they’re pregnant, they could go on progesterone early and maybe prevent a miscarriage.

Dr. Weitz: So, and that’s because progesterone helps get the uterus ready and helps prepare for implantation and.

It’s the main hormone

Dr. Kozlowski: During the luteal phase. After ovulation, exactly right. So progesterone is what gets exactly like you said, gets the uterus ready. And then once there is actual fertilization and there’s pregnancy, that hormone skyrockets before the woman starts making HCG. So it’s a vital hormone right at the beginning to get pregnant and to maintain a pregnancy early on.  Right. So that’s a great example of a gene that it’s be very beneficial for a woman to know whether she has it early on, so she knows. And then, you know, that gets into the whole discussion also of estrogen dominance where, [00:19:00] you know, the classic symptoms of PMS, bloating, anxiety, insomnia in the two in, during the ltil phase you would be more, I would be more aggressive as a physician.  To treat the estrogen dominance early on in more natural ways through like detox through supplements to help keep that balanced.

Dr. Weitz: Yeah. One of the supplements you mentioned in your discussion, which I looked up subsequently, and it’s an amazing amount of data around resveratrol. Yeah. Talk a little bit about the impact of resveratrol and how that can impact fertility and how it can modulate some of the hormones involved.

Dr. Kozlowski: Yeah, I mean, resveratrol when they say drink one glass of wine a day, right? That’s, that, the point of it is resveratrol, right? So obviously if you’re working on pregnant, I mean. One glass of wine, I guess would be okay. You don’t wanna overdo it if you’re [00:20:00] trying to get pregnant with wine.  Right. In general. Yeah. I usually don’t tell people to start drinking wine to get resveratrol, but it’s a, it’s an amazing anti-inflammatory. Right, right. And and really the way to think about. Estrogen progesterone for me as a functional medicine doctor when I’m working with a woman is estrogen can be very inflammatory if it’s not balanced right.  Too much. It’s just kinda like that thing of, too much of anything is a problem. So too much estrogen is a problem when it’s not balanced by progesterone. So we try to do things to lower the inflammation related to that, and resveratrol is a way to do that.

Dr. Weitz: You mentioned variants in the FSHR and the FSHB genes that affect hormonal regulation affect endometriosis.  And then I think you mentioned resveratrol is something that can help regulate in that regard.

Dr. Kozlowski: Yeah. So [00:21:00] FSH stimulus follow helps the eggs mature and. Women who have this FSHR gene, the follicle stimulating hormone receptor, have been found to have a lower number of healthy eggs, right?  And so that’s another gene where my kind of argument is to protect the egg production or to optimize the egg production. One of the things resveratrol has been shown to do is to basically, downregulate that gene, so it’s not as much of a problem. So a woman makes a healthy amount of eggs, right?

An example I gave during the discussion is I have a woman right now, a patient going through IVF therapy that she’s young and she can’t get. A lot of eggs, right? When you go through IVF, the first, one of the first steps is to get the eggs out of the woman. And she’s not getting them. And they can’t really figure out why.

Well, she has this gene that [00:22:00] kind of predisposed her to not making enough eggs. She also has extremely high levels of glyphosate that we’ve tested for, and she can’t detox it. Well, these are all things that we’ve found out kind of too late, right? It’s already, she’s already too late in the process. Now we’re using that to hopefully lower inflammation, to hopefully down regulate it.  But it’s hard, right? Like, you know, with any disease, once it’s started it’s hard to reverse it. And so the goal would be to prevent things like this. So when a woman with this gene is definitely like at a young age, can go on a resveratrol to help protect

Dr. Weitz: her eggs in such a situation, what’s a range of dosage that you might use for resveratrol?  Typically like a hundred, 150 milligrams is what I would go with. Oh, really? That’s a pretty low dosage.

Dr. Kozlowski: Yeah, I’m, I mean, I try to be conservative

Dr. Weitz: usually. Oh, okay. Yeah.

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Dr. Weitz:  So let’s talk about a few other, what are some of the other important genes, whichever ones you want to highlight.

Dr. Kozlowski: Yeah, I mean, the one that I kind of made fun of that you know, that everybody knows MTH ffr, it is connected to infertility, right? But both men and women,

Dr. Weitz: right?

Dr. Kozlowski: The a 1298 C mutation is particularly a problem in men. It can affect their sperm production. So, for example, a young man right now or that gets their genetics done and he has them THFR.  That’s an important one to know. I just think it was overstated, but [00:25:00] that’s something he can go on. A daily methylation support, which every nutraceutical company makes to basically help support his sperm production right now in a woman. The C 6 77 T mutation was found to be a problem with implantation failure lower ovarian responsiveness.

So again, a very simple. Affordable supplement you get on methylation support if you know you have this to again for a man’s support is sperm for a woman to support the fertility cycle and support like the. Embryo implanting into the end endometrium. So M-T-H-F-R is an important one. I think one of the most interesting genes that I’ve found that is almost, it should be called the m mothereffer, is factor five laden.

Okay. Which we traditionally, you know, think of factor V [00:26:00] laden for like blood clots, right? It’s people with factor V laden clot really easily. So that’s somebody that could get a blood clot in their leg when they’re flying or if it’s worse, it can go to their lungs. And that’s called a pulmonary embolism.

And those people take medications typically to decrease clotting. There’s also supplements you can use. I really got into the factor V in regards to heart disease. I’ve had a few patients with Factor V where we’ve done scans of their coronary vessels and they actually have significant coronary artery disease.

But then the interesting thing was, is that one of the patients with this, she’s a woman in in, in her sixties, but I asked her, I’m like, when you were younger, did you ever have a miscarriage? And she’s like, yeah, I had three before I got pregnant. And it, there’s studies that show having factor five can be associated with it.

Two to four times risk of recurrent fetal loss. And that’s something that if she [00:27:00] had known that as a kid, she could have been on something like Olol, which comes from pine bark or Nattokinase as like a natural anticoagulant. And maybe she wouldn’t have had those, you know, multiple miscarriages when she was trying to get pregnant.

Right, right. So that’s like factor five. I just connected it in a couple seconds to clotting, to heart disease and infertility. Right. So that’s a bad one. That if you know it, it’s very easy

Dr. Weitz: to manage. Right. And is the mechanism for affecting fertility related to clotting as well? Yeah.

Hypercoagulability. Yeah. Okay.

Dr. Kozlowski: Yeah. Yeah. What is, that’s where another, like other, you know, again, people listening to this might be like, well, oh yeah, when I was trying to get pregnant, I was having miscarriages and my doctor put me on aspirin. Right. Right. And so that’s a common one that’s known in the OB world.  It’s like, oh yeah, multiple miscarriages give the patient aspirin. They don’t really know why, when there’s actually could be a genetic component to it.

Dr. Weitz: Right. What are some of the other genes [00:28:00] related to nutrient status that can affect fertility?

Dr. Kozlowski: Vitamin A beta carotene, oxygenase is the name of the gene.  That one is also one that affects men and women. You need vitamin A for healthy sperm production. You also as a woman, need it to regulate ovulation? Vitamin A is something that I, in my opinion, is difficult to test for. I don’t really fully trust any of the lab tests to measure someone’s vitamin A levels.  I mean, you can measure a toxicity, I think. A deficiency is harder to find. So that’s something when I have a patient with that gene, I will put them on 10,000 IUs of vitamin A daily for a man again for sperm. For a woman to regulate ovulation, vitamin A is one that I would be very careful with though, because it is teratogenic, so Right.  A woman, you know, that does, if she’s on it, she, I mean, vi to me 10,000 units should be a safe dose. If I have a woman on it, I’m gonna just check her [00:29:00] levels to just track it to make sure. Typically, like for it to be teratogenic you, you’d have to be on over a hundred thousand units a day or more. But I’d be

Dr. Weitz: cautious with it.

Why are you skeptical of the testing for Vitamin A and which tests for vitamins have you done? Have you done some of the micronutrient panels like vibrate or some of the others?

Dr. Kozlowski: Yeah, so I’ve done the urine testing, I just think, you know, I haven’t as had as much time to dive into the validity

Dr. Weitz: of those tests as I would, you should look at the vibrant micronutrient tests because they do serum and then they do white or red blood cells, so you got shorter, longer term, and they have a pretty robust panel that I have found really helpful.  Does it measure a specifically. It measures, yes, it measures a, it measures many different nutrients. Offhand, did you remember if you found any people with deficiencies? Yeah. I’m working with a woman right now who’s pregnant and she [00:30:00] has that gene that doesn’t allow her to convert betacarotene ol, so we put her on a prenatal.

Yeah, with retinol in it directly, because when you look at prenatal, some of them only have betacarotene. Some of them have retinol, some of them have both. And so yes, I, we found that helpful. And then we found out she, she needs even more. Yeah. Nice. Yeah. I’ll look. And then we’ve been testing at the beginning and then halfway through the pregnancy because the nutritional status tends to change during pregnancy.  Right? Yeah. You typically need to up things. So you’ve seen her levels normalize? Well, they improve when we put her on re retinol, but then during the second half it’s starting to go down again. Okay. She needs even more.

Dr. Kozlowski: Yeah. Yeah. Yeah. That’s definitely, it’s obviously ’cause they’re growing another human, so they’re gonna need more nutrients.  Right. Yeah. I, yeah, I’ll take a look at that test. I mean, that’s, I guess that’s the thing is like, I like to see consistency with my labs is like, yeah, [00:31:00] I find a deficiency, I treat it, the levels go up. And I guess I haven’t felt fully confident in that, but I’ll take a look at that.

Dr. Weitz: Yeah. What are some of the other nutrient status genes?  Coq 10. Okay. A gene is called

Dr. Kozlowski: coq two. Okay. Individuals with that have lower coq 10 production. Men, coq 10 improves sperm motility in women coq 10 I think, through the mechanism of protecting the mitochondria, but can protect against oxidative stress. And then there’s studies that suggest it could thicken the uterine lining.

Dr. Weitz: So coq 10, some fertility experts are

Dr. Kozlowski: just recommending coq 10 now. Yeah, exactly. Right. And so that’s the, I think that’s been like the beauty of using genetics is there’s these, you know, something like that. Like it’s being recommended and it doesn’t work for everybody. Right. And now with genetics, you at least that’s what I’ve found is like, it makes sense now why certain interventions work in certain people, right. And

Dr. Weitz: [00:32:00] then Right. You get somebody 5,000 units of vitamin D and their vitamin D goes up a little bit. Yes. Not in range. Somebody else goes to 120. Exactly.

Dr. Kozlowski: So that’s where like, yeah. That there’s, you know, there like you’ve been in this field even longer than me and it’s, you know, there’s certain interventions that we know that work for a specific condition, but it’s like they don’t work in everybody. And that, I think genetics is kind of putting the ribbon on that of like, okay, now I get it. Right. Yeah. I would rather do genetics before I’m working with a woman going into, you know, optimizing fertility or like, again, a, a family with a boy with, or a girl with autism like.  I know how to then target my high yield interventions based on the individual and success is faster. Instead of like, listen, like we’re gonna try these high yield things first, and then if these aren’t working, then these are kind of usually the second tier of things I would try. But now it’s like we could just jump to, these are all the best things for you because [00:33:00] we know your genetics

Dr. Weitz: right.

And what are some of the more common genes that affect detoxification and how do we deal with toxins? And and then this whole question of toxins and detoxification for some reason has been extremely controversial.

Dr. Kozlowski: Yeah. I’ve tried to, that that in general, I think that’s a good comment is just like, why is the discussion of detox so controversial?

You know, my, my career trajectory was like I was a family practice doctor. And then I went straight into a functional medicine practice on my own. And I had no problem doing like nutrients. I had no problem doing diets and gut, but I was like scared to do detox. I, and I don’t even understand really why like, why I was cautious to go into that field.

My approach to detox in general has always been let’s test your level of toxins. Right? Right. So, I like anything I do, I [00:34:00] like to do it objectively. And so that’s where I personally with that, like, you know, I would do the glyphosate test. I do pre and post urine chelation testing. I would do mold testing if someone has exposure history.

And for me, my, my exposure questionnaire, well, my exposure question is, have you ever lived in a building that had water damage? I don’t like to ask people whether they have mold exposure, because most people will say, most people I tell that I treat for mold. Well, adamantly tell me they don’t have mold exposure.

And so I just ask them, did you ever live in a water damaged building? Right. And then like I use Mosaic personally for the toxin testing. And so they have the tox detect panel which has the phthalates and the plasticizers and the herbicides and the pesticides and. So that for me, I would start with that personally.

Right? Like I would like to get the phenotypical expression are, do you have toxins? Right? Sure. [00:35:00] Well, at the meantime, I want to get your detox genetics. And I don’t think I’m going to be able to name all the genes related to detox. There’s hundreds of them, right? Yeah. So that’s where a genetic report, you know, when you get one back.

There’s a section labeled detox or toxins. Right?

Dr. Weitz: Not to mention that we have this whole family of P four 50. Yes. Detoxification, enzymes, and even apart from genes, there’s all these other things, even foods that can upregulate or downregulate these different enzymes and that can all affect your ability to detoxify various toxins, drugs, et cetera.

Dr. Kozlowski: Exactly. So, well, the way I handle it is I’ll get the toxin testing if we have a positive result, then I go to the genetics and I’m like, whi, which genes are deficient? A pretty common one actually, that you see is inability, in inability or a reduced ability to make [00:36:00] glutathione. Right, which is a huge problem, right?

Because glutathione is our master antioxidant. Like if correct, if I could pick one thing personally to give someone for detox, I would use liposomal glutathione, right? And because when we, when you look at phase one and phase two of detox, glutathione is the only thing that affects both pathways, right?

Right. You can’t find another nutrient that affects phase one and phase two. So that, I think that’s why it’s so effective. And it’s been shocking since I’ve started doing genetics. How many people have reduced ability to make it or recycle it. And so that, you know. You can debate going on a higher dose.

Right. I think there’s typically I wonder what your opinion is. A lot of people like to use NAC n acetylcysteine, which is, you know, what you use to make glutathione. Yeah. That’s a precursor. Right. And so I’ve personally, like I’ve always been, I’ve always chosen glutathione over NAC because I’m like, [00:37:00] what’s the point of giving the precursor if we could go straight to the source?

But I do think a lot of people like to use nac. And so you can make those kind of decisions genetically how to optimize. Sulforaphane is something that I’ve started using a lot more since seeing people’s genetics. You know, you can focus. You always need to balance, I think, phase one and phase two.

So I’d cautious to overdo like, support for either phase and then. Obviously phase three of detox is actually getting the stuff out, peeing, pooping, right. Sweating. So I don’t ever like to, like, if I have a patient who comes in with constipation issues, we are not going to go through detox.

Right, right. You’ve gotta get them, I gotta fix the cut

Dr. Weitz: first.

Dr. Kozlowski: Yeah. So that’s the overall approach I take towards toxins. I don’t, how about yourself? Is there anything that you kind of

Dr. Weitz: do very differently? I mean, I definitely, I am a big believer that you gotta fix the gut if you can’t excrete and you don’t wanna [00:38:00] detox.

So I totally agree with that. I tend to find glutathione more effective than NAC, though sometimes we use both. Some people, claim that they’re getting side effects from glutathione and they can only handle NAC. It’s tricky to find out if the side effects are really coming from glutathione or not, but, you know, if they’re convinced that they are, then I’ll go along with that.

Yeah, absolutely. Yeah. It is funny though that it’s so common they’ll be talking to a patient and one day they’ll have a symptom and it could be. They got a headache. Yeah. And they just happened to start taking vitamin C, so obviously the vitamin C caused a headache. But yeah, it’s not easy.

Right? Yeah. Well, I try to ask ’em to stop taking vitamin C. Give it a few days, try it again. If it keeps happening over and over, then there must be something about their body. But a lot of times you just. Have, you know, some [00:39:00] some symptom that day that really probably had nothing to do with it, but anyway.

Dr. Kozlowski: It’s a good reminder too, ’cause like when I, if I take somebody through a detox, right? Like I was just doing this yesterday for a woman that’s got a lot of mercury plus glyphosate. Right. And, but she’s known that she typically can be pretty sensitive to adding new things. Right? So So you gotta do a little bit one at a time.

Exactly. We did the same thing. Yeah. Yeah, so you kind of do one, add in one new thing every few days or one a week and right. And lower the dosage. It sucks when you

Dr. Weitz: maybe do like, you know, one spray once

Dr. Kozlowski: a day and, yeah. It’s frustrating when you start someone on a full plan and it’s like, well, three days later they have a complaint and it’s like, well, which thing do I stop?

And it’s like, you know, we probably should have done this one at a time. And that, yeah. The

Dr. Weitz: tricky thing though is here you are saying, do I want this patient to take months and months to get this stuff out, or do we wanna Yes. Hit ’em with the full program and they [00:40:00] tolerate it and a few months later they’re feeling great, you know, so, yeah.

Dr. Kozlowski: Yeah.

Dr. Weitz: You gotta make that call. Exactly. What else, what are some of the other genetic factors? You talk a lot about mitochondria. How do you like to assess mitochondria?

Dr. Kozlowski: I typically, you know, as far as phenotypically, you know, I think mitochondria is another thing that’s hard to test. I mean, I use an organic acid test Okay.  To look at the kreb cycle. Okay. I think to me, that’s the best test I know of to, to assess mitochondrial function. Right. I do think there’s lots of people with mitochondrial dysfunction that can still test normal on an organic acid test. So the way now I like to approach the mitochondria, that’s one where I think really looking at the genetics makes a lot of sense.

It’s amazing. The amount of people now I’ve tested who have like specifically like either like infertility issues or chronic neurological issues that seem to be the [00:41:00] people who have genes that predispose them to mitochondrial dysfunction. Right? Right. The, I think the tricky part is, and I think different practitioners would take a different approach is, so let’s say you have a patient who’s predisposed and that’s another one where there’s a number of genes that could predispose you to mitochondrial dysfunction.

But let’s say you do have that genetic risk. Is the strategy to go straight on supplements, right? To support the mitochondria, which coq 10 we talked about is pretty famous. You can use alpha lipoic acid, you could use B vitamins. There’s different ways to glutathione could support the mitochondria.

  1. When I see mitochondrial risk in the genetics, I do then want to go back to my root cause Functional medicine approach is what’s the thing that’s going to be affecting your mitochondria the most? And that is toxins. And those toxins, again, could be the environmental ones, but also they could be food [00:42:00] sensitivities.

Right? Right. It could be dysbiosis, it could be candida, it could be sibo you know. A leaky gut with a standard American inflammatory diet. So when, if I, ’cause I don’t typically like to just order every test for every person. Right? Like if you’re, if you have no history of mold exposure, I’m not gonna do a mold test.

If your gut. Is balanced. Like you’re moving your bowels every day, you don’t have symptoms. I’ll do a microbiome test ’cause someone could have dysbiosis and not have symptoms, but I might not do like a full SIBO test, anode test and all those things. But if you are someone that. Tests for mitochondrial dysfunction, genetics.

To me, I would recommend you then really, you probably need the full gauntlet of tests. Like you don’t want to be messing around because because of the fact, there’s not like to, in my opinion, the perfect way to test, are you expressing this right, because I right. With any [00:43:00] gene I want is the, my first thought is there a way to test for expression, right?

So again, for me, I would do an oat test to see if they, that’s indicating mitochondrial dysfunction. But like I said, I do think there’s lots of people who are normal on that test and still might have it. So then my best next step for phenotypic expression is do you have diseases that could create inflammation in your body?

And so I’m gonna, then at that point, I’m gonna be like, we need to test you for food sensitivities. We need to do a full look at your gut. We need to do a full gut look at your environmental toxins. We should, we need to look at your hormones. We, you, if you are gen genetically pre. Exposed to mitochondrial dysfunction.

I think the best thing you need to do is really make sure your body is as balanced as possible. ’cause to me, those people are the ones that are really susceptible for the chronic diseases that you just don’t want to be dealing with.

Dr. Weitz: Which genomic testing platform [00:44:00] or panels do you like to use for fertility?

Dr. Kozlowski: So I use, personally, I use the women’s health panel with Telex, DNA. The lab is based outta Austin, Texas. Okay. That’s the main lab I’ve used. They, we have a conference coming up, I don’t know when this is coming out, but end of July there will there’s a full three day weekend talking about all the different panels that in Inte X has.

So that’s the, typically, specifically for like women’s health, they’ve designed like a custom panel that all my women are getting that are whether. Hopefully before they’ve started their fertility journey or if they’re in the middle of it, we’ll do the women’s health panel with Inte X. ’cause it’s very targeted at exactly what a woman needs to know about her mitochondria, about her hormones about mitochondrial dysfunction, about nutrients.

So it’s very targeted exactly what that person needs. What’s your favorite prenatal vitamin? My wife has taken the plus one from Metagenics. Okay. [00:45:00] Yeah I know there’s a lot of good ones out there. I don’t even know why, honestly, that’s just one historically that I was introduced to many years ago.

And yeah,

Dr. Weitz: one thing it has is extra L-carnitine, which can be very helpful and I think mitochondrial support often overlooked. Yeah. Do you have one that you like? I’ve been toying with different ones. We’ve been using the Designs for Health one, but it’s hard to find the perfect one and we always have to add stuff to it

Dr. Kozlowski: That’s exactly kind of what we’re, because my wife is actively pregnant right now.  She’s doing plus one, and then we’re optimizing it a little bit based on her genome, so Right. That I mean, I, we’re definitely in, in agreement there on that plan. I, you know, most of the good nutraceutical companies make a good product and it, you know, you kind of pick one that’s worked for you. I mean, we have the healthiest daughter in the world, so I don’t want to change anything.

So that’s what worked for us the first time and we’re sticking to it this time. Right.

Dr. Weitz: Good. [00:46:00]

Dr. Kozlowski: Yeah.

Dr. Weitz: You know, we’ve been talking a lot about women, but the role of men in fertility is super important and I think often overlooked.

Dr. Kozlowski: Yeah. Yeah, it’s typically right, we go straight to the woman. But yeah, I mean there’s a large percentage of the infertility stories that are related to men and that’s why with the genes specifically that I could mention that, that do have an association with male fertility.

I try to mention it ’cause it’s not just the women you know, for. The mechanism is basically the same for us as the environmental toxins are destroying our testes. And you know, when the testes are surrounded by toxins, we’re not gonna produce sperm as well, or the sper sperm we produce are not gonna be as modal.

Right. And so it, it’s. You know, if you do a genetic panel on a man and it’s like he does need more vitamin A, he does need methylation support, he does know need coq 10. And that’s again where genetics has kind of changed my life. Personally and with my patients. ’cause [00:47:00] I would typically say, well, you know, until there’s a problem, you know, it’s, again, I don’t fully, I guess, you know, if you have a micronutrient test, you can, you trust you can run that.

But for me, like, I would do the genetics and be like, well listen, like we are gonna get you on, you know, 200, 300 milligrams of coq 10, we are gonna put you on 10,000 units of vitamin A. ’cause your genetics are saying you need it and let’s optimize your sperm. At the same time I, you know, if we do the genetics and the mitochondria at risk, then we know the sperm are at risk.

So let’s, that’s again, that’s getting you into, let’s get you on mitochondrial support, but most importantly, let’s protect your mitochondria. So the, I think luckily the mechanism is the same. And I, like I said, I think the biggest variable in all of this is our environment. So that’s where. Our genes have not changed, but our gene, we are more susceptible to these genes being activated because of our [00:48:00] environment, right?

Our mitochondria weren’t as risk the way they used to be to the way they are now. How nobody’s ever come out

Dr. Weitz: with a men’s prenatal. I think that could be your product. There you go. Yeah. So, thanks Peter. This has been a good discussion. Thank you. What are your contacts for people?

Dr. Kozlowski: Yeah, so my website is the best way to get ahold of me doc cause.com.

I don’t do social media. That’s for my own mental health. So, but I have been I do podcasts pretty frequently, so just. Googling my name. There, there’s lots of podcasts that show up. So there’s, I have a couple videos I’ve made on my website but really through just doc cause.com.

My books are on Amazon and everywhere. They’re, so that, that’s the best way. And what

Dr. Weitz: about that AI platform you’re working on?

Dr. Kozlowski: Yeah, so that currently is, designed for practitioners. So if there’s practitioners okay. That are learning how to optimize [00:49:00] applying functional medicine, right, or integrative medicine.

That’s really what my AI agent has been designed to do. I mean, is it currently available? It is. So the website is rcpp ai.com, but there’s a direct link from.cause.com. So, okay. You can sign up and really. The way it’s designed is so that if you have a new practitioner that’s like, I’ve never tested someone’s glyphosate levels before.

I’ve never done an organic acid test before. I’ve never done a microbiome test. You can, you know, type, and that’s the more advanced, I mean, you can type in my patient’s or ribose levels where 105 on their oat, what does that mean? Or their glyphosate levels were this, what does that mean? And then how do I treat it?

So I have. All my protocols in there of how to detox things, how to treat SIBO and mold. And I just think that there’s so many practitioners now that want to get into functional medicine. They’re in the middle of a practice. They go to a conference for a weekend, and then they, you know, try to apply it and it’s very hard.

So, right. [00:50:00] I train my, and then traditional AI is just not trained. The knowledge base is not. Up to date with functional medicine so that I used my books and everything I’ve learned over 13 years to train my own agent. So that’s available. Yeah, it’s through my website. It’s, I’m very excited about it.  It’s so yeah, people can go on there and use it.

Dr. Weitz: Sounds great, Peter. Thank you so much.

Dr. Kozlowski:  Thank you for having me.

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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 Podcasts or Spotify and give us a five star ratings and review.  As you may know. I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity. Please call my Santa Monica Weitz Sports chiropractic and nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.

Mike Feldstein discusses Indoor Air Quality and How to Improve It 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

Improving Indoor Air Quality for Better Health with Mike Feldstein
In this episode of the Rational Wellness Podcast, Dr. Ben Weitz discusses indoor air quality with Mike Feldstein, founder of Jaspr. Mike shares his journey from wildfire and mold restoration to developing a high-quality, quiet air scrubber designed for home use. They explore the impact of poor indoor air quality on health, the limitations of standard air purifiers, and practical tips for improving air quality at home. Mike highlights the importance of clean air, particularly in bedrooms, and offers insights into air filtration, mold detection, and the prevalence of microplastics. The episode emphasizes the need for greater air awareness in the wellness space and introduces Jaspr’s advanced air scrubber as a comprehensive solution.
00:00 Introduction to the Rational Wellness Podcast
00:26 Meet Mike Feldstein: Air Quality Expert
01:37 The Importance of Air Quality
06:09 Challenges in Indoor Air Quality
08:17 Wildfire Impact on Air Quality
14:17 Mold and Indoor Air Quality
24:02 Healthy Homes and Air Filtration
26:46 Cooking and Air Quality
27:30 Wildfire Smoke and Indoor Air Quality
28:11 Range Hood Efficiency Test
29:07 HVAC Systems and Air Circulation
31:33 Microplastics in Indoor Air
34:17 Sources of Microplastics
37:49 Impact of Pets on Indoor Air Quality
39:48 Optimizing Bedroom Air Quality
43:06 Jaspr Air Purifier Features
48:32 Special Offer and Conclusion
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Mike Feldstein is the founder of Jaspr, a high quality air scrubber, and an air quality expert. With a background in wildfire restoration, air quality consulting, and home remediation during some of the biggest natural disasters, Mike started Jaspr to innovate in air science and technology. His goal is to protect air quality and improve human health using the latest air quality science.  You can learn more by going to Jaspr.co.  The cost of Jaspr is normally $1199, but if you use the discount code WEITZ for the next 2 weeks it will only be $799. 

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

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Podcast Transcript

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

Hello, Rational Wellness podcasters. Today I am excited to be having a discussion about indoor air quality with Mike Feldstein.  I believe this is the first detailed discussion we’ve had on this podcast about indoor air quality. Mike Feldstein is the founder of Jaspr, which is a high quality air scrubber, and Mike is an air quality expert. He has a background in wildfire restoration, which is especially significant to those of us living in Los Angeles in 2025. And he was also involved with air quality consult consulting, home remediation during some of the world’s biggest natural disasters.  Mike started Jaspr to innovate in air science and technology. And his goal is to protect air quality and improve human health using the latest air quality science. Mike, thank you so much for joining us.

Mike:  Thanks for having me, man. I’m excited to talk all things air with you.

Dr. Weitz:  So I guess you’re an airhead.

Mike:  Air snob, air snob.

Dr. Weitz:  There you go. Perhaps you can tell us what you were doing for a living and how you became interested in air quality.

Mike:  Yeah, so it’s kind of twofold. The big one was, my background was in wildfire flood and mold restoration. So we weren’t doing it locally, we were traveling. So anywhere where the biggest disaster was in North America, that’s where we were going.  So California wildfires, hurricane Harvey, Canadian wildfires, floods, hailstorms, all that kind of stuff. So it was like really disaster response restoration. And the main thing that you do when you’re remediating anything is you have to clean the surfaces and the air. People think about mold removal, but visually you only think mold remediation has like removing the mold.  But that’s not the case when you remove mold. You’re isolating the environment, you’re removing the physical materials and you’re scrubbing the air inside and outside. So a lot of restoration and environmental cleanup, it’s equal parts air as it is surface cleaning. And we would use these big machines called air scrubbers.  They were huge, loud, they kind it like, like this, like big subwoofer looking things. Very loud, very industrial, but they clean the air incredibly well and. When I started comparing that to air purifiers that you would find out like a big what Walmart Best Buy, home Depot. What people imagine when they think about an air purifier are the scrubber specs versus the purifier specs was almost like 20 to one, and I’m like.

This doesn’t really make much sense because people are buying air purifiers for wildfire smoke all the time, and it’s way too small to get the job done. An analogy I like to use for people is it’s like trying to heat your bathtub with a kettle, using a little air purifier to try to clean your air. It’s tea.  A kettle is fantastic if you’re trying to make a pot of tea, but you cannot heat your bathtub with a kettle because it’s gonna be cooling down faster than you can possibly heat it up. So the. I, and it was frustrating because we would remediate a home after wildfire or smoke, detox it, clean it three weeks later, it would be contaminated again, because often the ambient outdoor environments after a disaster would stay bad for months.

So I’m like, okay, where can I find a. Beautiful air scrubber, a quiet air scrubber that people could leave in their homes [00:04:00] regularly, that wouldn’t sound like a truck, and they didn’t exist. So that’s when I realized that, okay, there’s lots of remediation and restoration companies, but how can there possibly be no product that works like a scrubber, but that is also quiet and beautiful?

So that kind of changed my path from all things restoration to just completely focusing on air. And then the other side of that was when we would, in between disasters, we would do air consulting. So if somebody was sick at home and they didn’t know why, we would come to their home and test everything to figure out if something might be lingering in their environment that’s keeping them sick.  And people generally, water and air and EMF and everything, it’s the normal is not good. So I kind of just. I realized that a lot of people are quite water aware, they’re diet aware, they’re movement aware, but air awareness relative to all these other big health inputs was completely un. You know, it wasn’t getting the time and attention that it needs.  And I started seeing people have a huge be health benefits by improving their air. So I went all in.

Dr. Weitz: It’s definitely the case that those of us in the wellness community are really focused on the food we eat, the what we drink, the water, the pure purity of that. And we focus much less on the air, but yet we breathe a lot more air than we eat food or drink water.

Mike: Yeah. So, to put it into perspective for people. The average person, let’s say, eats two pounds of food a day, two or three pounds of food, drinks a gallon or so of water. But you can, you breathe up to 17,000 liters of air. You can go three weeks without food, three days without water, and only three minutes without air.  Air is the first thing breathing. It’s funny with food, we talk more about the food that than we eat than how we eat it. We talk about the water, not how we drink it, but breath work and breathing gets a lot more conversation. This breath and breathing [00:06:00] gets a lot of attention while we’re ignoring the actual air that we’re breathing.  The air is the fuel that you’re breathing and people are completely ignoring their fuel source.

Dr. Weitz: So what are some of the biggest issues with indoor air quality? And I say this here in Santa Monica, California, right next to Pacific Palisades where we had these horrific fires. And I imagine the stuff being spewed into the air is probably not over.  ’cause first you got the fires, then you got, they’re quite, in a way, they’re digging out the soil. And then we’re gonna have all this massive construction happening soon here.

Mike: So the big picture, the issue is. Roughly since the seventies, homes have been optimized to be airtight boxes, so they’re incredibly tight.  They’re built to be energy efficient, keep the cool in, in the summer, keep the warm air, and in the winter. Now, if you think about a pond, if you think about a moving [00:07:00] stream or a current or a river, generally moving water. Clean water. Right? But when a stagnant pond, that’s where you get algae, bacteria, mosquitoes.  If you can imagine all the things that you see growing when water is stagnant. So outdoor air is free flowing. It’s like the lakes, it’s like the oceans. But we’ve built our homes. Basically our homes are little stagnant ponds. So because there’s no air movement in our homes, this is where everything starts to grow and starts to fester.  Plus, we spend like 95% of our times indoors on average. So there’s a reason why you don’t walk down the street and have mold problems, or have dust problems, or have VOC problems. These are indoor problems. Our homes are incredibly tight, and the greatest air purifier of all time is nature. The UV light from the sun, wind, rain trees, but we’ve trapped all that outside.

We’ve trapped ourselves inside, and then we have thousands of chemicals in our homes from the paints to the flooring, the adhesives, the fire retardants, cooking [00:08:00] pets, and it just can’t breathe. It has no airflow. So generally speaking, the problem is with how we build homes and how we live in a modern society.

That is causing all of these problems, especially like, and then in a wildfire setting, you are absolutely right. So you ha like people ha, when you test the air quality and water quality and soil quality, it can stay bad for a very long time after a fire. And the recent LA fires in January are unique, like one I’ve never seen before because I’ve never seen that many homes burnt in that concentration.

But also. That many electric cars. So I’m very curious like what happens when you burn four, 5,000 lithium batteries? We know, and everyone’s been at a campfire where someone throws the bag of marshmallows in and they’re like, that even looks and feels very toxic. So now imagine scaling that up to like a billion x when you have everything in every home that burnt every can of paint.  The [00:09:00] walls, the floors, the furniture, the chemicals, the cleaning products, the cars, their batteries. So it’s a very toxic soup. And then, yeah, so you have all that, of course, that gets in the soil and it gets in the water, and then every time that the wind blows, the ash kicks up more and more.  And then, yeah, then you’ll have your rebuild phase. It’s a pretty big deal.  

Dr. Weitz: I know every day I would go out to my car after the fires and it would just be covered in soot and then you just think, oh my God, how much of that is getting into my lungs?

Mike: A lot. And it’s a tough situation because, and like a lot of people in LA, because the city is so vast, a lot of homes, it was unclear the amount of damage because.  A lot of you go into your home, and if you don’t. See piles of ash everywhere. You just figure, my home’s fine. Its smelled smoky a couple weeks ago. It’s all good now, but it doesn’t really work that [00:10:00] way. Be if you test anybody who didn’t detox their home in la now if you test their carpets, their couches, their bedding for hexavalent chromium, or polycyclic aromatic hydrocarbons or heavy metals.  If you don’t detox it and pull it out, just think about our bodies, how many years we can hold heavy metals and things if we don’t detox it out. So every porous material in your home is the exact same, and a lot of people don’t remediate and detox their homes because they don’t realize that they need to.

Dr. Weitz: Can you even detox that stuff out? Do you have to just throw out everything that’s porous? The poor stuff is pretty hard to deal with. You’re talking about mattresses and carpets and furniture and stuff, so it depends like

Mike: which way the wind was blowing your proximity to the fire. So that’s why TE testing can be a decent idea for people.  Also, depends if people had good air filtration in their homes beforehand. So. If somebody had significant air filtration in their home, [00:11:00] then likely most of those particulates were being captured before they had a chance to settle on surfaces. But typically, all of the hard surfaces can be cleaned up, but the soft surfaces would be replaced.  But it’s not black and white at all. Actually created on YouTube. Oh, yeah we put it on YouTube recently. If people look on our YouTube and type in like Jasper Smoke course it used to be. Like an email thing, but now it’s just totally free and it’s on YouTube. So after the fire is up, I was chatting with everybody like an hour, several hours a night about their unique situation and 99% of those conversations was, were the exact same.  So I just created a bunch of videos on how to assess your own home, do you, should you go with insurance, how to vet your contractors, how to detox your own home. All that kind of stuff. So people want, if anyone wants to dive deeper into smoke detox, it’s all available on YouTube.

Dr. Weitz: Interesting. And then and then I guess after all that, then detox your body as well [00:12:00] that I don’t

Mike: have experience in, but that’s absolutely a good idea.

You, you’d be the guy for that. Yeah. And if you think about it, like when a lot of people are sick at home, the their aha air moment. Often occurs when they go on a trip or they go camping and then they feel great and then they come home and they’re sick again. And they have this moment, is my home making me sick?

So if you’re not optimizing for the, like your home, that’s your fish tank. And if you think about how would you clean a swimming pool, you use a water filter. You don’t jump in the pool and use a sponge and scrub the sides. You need to filter the water constantly, right? And. In a home, people are spending a lot of time and energy and money on mopping and vacuuming and wiping counters, and that’s all great.

But if you don’t, if you don’t also have a strategy in place to filter your air, you’re just that. You’re just in the swimming pool, scrubbing the sides and not filtering the water. And [00:13:00] guess what happens if you don’t filter that pool of water? It turns green real fast, so people’s indoor air, you cannot see it.

Most of the time, but wow. When we test air, it’s usually off the charts. Typically, we see indoor air that’s five to 10 times dirtier than outdoor air.

Dr. Weitz: So how do you find somebody, what’s the best way to test the inside of your house? You have to have an expert come in and test it. Do they? How do you know?

Mike: You know, so I used to be, that’s what I used to do. Okay. And I can’t tell you a time when I’d ever go into a home where if I tested someone’s air or water, that it was good. Like it just isn’t. Okay. Indoor air is pretty much always bad, so the practical way to test, there’s a few things to look for, but a pr a practical thing, like you could go and pay $1,500 or more for an expert to come into your home, but, and I was that guy, but I did not feel good because the 80 20 like.  They would’ve been better [00:14:00] off just getting the solutions.

Dr. Weitz: Okay.

Mike: Because, you know, just assume your home is toxic. If you want to verify it. And depending on people’s budgets and everything, like if you test your home for mold, indoor and outdoor, there’s always mold. I always tell people, if you ever wanna break a lease, call me.  I’ll come over and I’ll find the mold. 

Dr. Weitz: Well, you need to talk about that a little more because mold’s a big topic in the functional medicine world and we talk a lot about testing your home for mold, testing the body for mold, and there’s a lot of controversy. Oh no, this test is not accurate. It’s showing mold and maybe you don’t really have mold, but I’ve heard you say before, and you just said here, that pretty much everybody has some degree of mold in their home.

Mike: And in their body, like when have you ever done a test and seen zeros? That’s not how it works. It’s,

Dr. Weitz: well, you know, it’s interesting. I think that makes sense because mold is an important constituent of the environment. In fact, it’s in the soil, you know, just like bacteria are. And the goal is not to [00:15:00] rid ourselves of all bacteria and all fungi.

Mike: Yeah, exactly. Yeah. People know what happens if you take too much antibiotics, like you kill your immune system, right? So yeah, it’s, people got this idea that like mold is the big enemy. The problem is you’re, if you think about that piece, that sandwich. Out on the counter, not so bad. You put it in the Tupperware, it starts growing mold, and your home is essentially a big Tupperware box.  So you have mold issues because if you live in a airtight home with no ventilation and no filtration, that’s the real problem here. So typically when you do test for mold indoors, you always want to test outside and you want to test inside. And if you don’t test outside, the test is completely useless.

Because that’s your control sample. So if it rained there, could the spore count is gonna be incredibly high inside and outside. Your indoor air comes from outside. So [00:16:00] if people have a noticeable odor in their home, it smells musty. Or if they’ve had water damage, if they’ve had leaks. Like if you have visible mold in your home, that is a time when you want to get restoration and remediation done.

If it smells really strong of must and mold, that’s when you may want to go and look for it. But I’ve seen a lot of people who, I call it whacka mold because they’re just looking all over, you know, they’re dealing with a little leak here and a little thing there, and they’re cutting open this wall.

Next thing you know, it’s like investigative surgery of your home. And then, you know, next thing you know, you’re living in another home for six months or 12 months and you’re displaced and it costs a fortune. And a lot of people like it’s not a black and white situation. And when I hear people talking about it, it’s like, I’ve got the mold like.

If you take a thousand people and you test everybody’s home and bodies for mold, everybody has some amount of mold. It’s more about like what concentration, what species, and technically you’re not even supposed to [00:17:00] test for mold if it’s rained within two or three days. I can’t remember if it’s 48 or 72 hours.

Nobody, no mold testing company in the world that I’ve ever encountered upholds that standard. How could you imagine on a it, it drizzles that morning you canceled the job. You still have to pay your employees. The customer’s not gonna want to pay you to not come, right? So nobody does that. You just take your control sample inside and outside, but it can dramatically skew results.

But more or less, if you’re living in a really tight home, the VOCs from your furnitures and the paints and the off gassing and the cooking and the mold is a big problem. So it’s not that mo mold does make a lot of people sick, but you could have five people living in a home. Two are sick. One is moderately sick and two are completely fine because people you know, they detox differently and they ha have different severities of allergies to things.

I honestly treat mold not so differently than pollen. Like someone could have their life. [00:18:00] Wrecked havoc from excessive pollen and someone else won’t notice a thing. And I find mold to be very much like that, where for some people it’s a big problem. For others it’s not. But to me, like I preferred filtered water.

My water budget is huge. We get glass bottles of water delivered every couple weeks, like. For me, air and water were like my first two. ’cause those are the two things that I need to survive the most. Right? If I can only live three minutes without air, clearly it’s quite important to me. If I can only live a few days without water, also important.  So where a lot of people are starting from supplements and then food, and then water, and then air. I’ve kind of flipped it a little bit where I’m dealing with the thing that I consume the most of and then branching up from that place.

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Dr. Weitz:  What is the best way if somebody wants to test their home for mold to do it so it’s accurate?

Mike: It’s tough too. So there’s multiple different tests and some skew positive and some skew negative. I mean, there’s the Petri dishes.

Dr. Weitz: We have the IMI test. Is there? Is there? You got the

Mike: aerosols? Yeah. IMI basically is restoration. Companies love IMI because it’s designed to be generally quite alarmist. So with an imi, it’s testing your dust, right?

There was obviously mold at some point in your air, so even if there’s not mold. Today, a lot of it, there was some mold that passed through. So [00:21:00] you test take a dust sample and it’s generally like a, it’s designed to be a fairly alarming test, even the way that the report is kind of designed. It’s a perfect thing for restoration companies.

I’m just looking at financial incentives for restoration. Companies love it because it’s always gonna get the insurance company to approve a reclean. So if Derby’s not the best test, what is the best test? Well, it’s not that. It’s, the thing is it’s a good tool also. Okay. Okay. So if, so, and like, it’s not that it’s a ba and aerosols can also skew negative ’cause they’re just looking at the exact moment of time.

Right. So,

Dr. Weitz: you know, the, so use the Ermi test, but don’t exaggerate the results. The best test

Mike: of all is like the best. If we’re going from best to worst, it’s the, it’s like a mold dog. A mold sniffing dog, you’ll find exactly where the mold is. You can’t beat that. But like once I had tested hundreds of homes for mold, for example.

I, I didn’t really need to do testing anymore [00:22:00] because you can feel it, you can feel it in your lungs immediately. You could between smell, difficulty of breathing in my lungs, I could go into a home. Most people who do indoor environmental testing, they know in the first two or three minutes just ’cause their body tells them what’s going on.

And then the data is just to quantify that for the homeowner or for the patient, like. Your body really knows if, but I mean, mine is more calibrated because I’ve tested a lot before, but I still I like the aerosol test. I also like the imi. It’s a tough one. It’s really, it really depends also if someone has cancer and money.

Just saying like they, they have a severe health issue and a large budget. I would definitely bring in a company to do testing, but that’s not the, so you kind of need to find the balance. Like anything with health, like health isn’t free, so it’s a little bit nuanced to, to give blanket advice is a little bit difficult.

Is

Dr. Weitz: there any benefit to the Petri dishes? [00:23:00]

Mike: If so, when I used to do the Petri dishes, we were supposed to. Get the p like we would do the Petri dish and then instantly give it to the lab and they would culture it in the lab environment. If you kind of let it sit in your home environment pretty much always grows mold mo unless you’re filtering your air.  So like that, like, and that’s really like, or really good ventilation, so that’s why older homes often. Can be good because they’re leaky or new homes are incredibly tight. So people, when I was doing air testing, almost half of the testing work that we were doing was people who just moved into a brand new home because the, it was so tight that it would have humidity issues and off gassing and VOC issues basically right away.  And the problem is. Like the architect and the builder aren’t typically sitting around saying, how do we make the healthiest home for people? Like, [00:24:00] you know, you buy a home. Why?

Dr. Weitz: Why isn’t somebody doing that? Why isn’t somebody saying, we, here’s a design that allows a home to breathe and this is gonna be healthier for you.

So

Mike: on the custom home level, they exist. So if you Google Healthy Home Builder, there’s a handful per city and it’s a growing trend that I believe strongly in using better materials, using better hvac, you know, mold resistant, no off-gassing low VOC, a good ERV system, which basically is a fresh air intake so your home can actually breathe better.  While maintaining its energy efficiency, but if you think about it, when someone typically buys a home, they’ll go get a home inspection and all that home inspection is looking for is there anything in the home that is gonna cost me money? How’s the roof age? How old’s the water heater? Is there cracks in the foundation?

Typically, there’s no prior to that process that says, is this a healthy home for my family to live in? And that’s why, that’s [00:25:00] where the air awareness is more important than any product anybody can create. Because once you start asking the questions, you’re able to kind of navigate and advocate for yourself.

But I’m really. Expecting to see a trend here where we see healthy homes and going beyond custom homes to the developer level. Unfortunately now, the, it used to be clean living and now the term wellness has really got hijacked. Wellness now means like often very edge case biohacking tools, whereas it used to mean like.

Go clean water, clean air, clean diet, go for a walk after your meals, get some sunshine. Go for like, it used to be about healthy living. And then on top of that, how do we layer in our exer, our exercise, our strength training, our supplement, it’s literally called supplements. It’s supposed to be the extra thing to balance you out, but it’s become the.

Pill like people have started to lean on pills, has the primary thing [00:26:00] as opposed to a supplementary thing, and unfortunately until the homeowner and the consumer is made aware, there is no value actually put on. A healthy home, right? The consumer’s not valuing it yet, so therefore neither is the builder, neither is the architect.

It’s, they just wanna say, how fast can we build a home? How many square feet? How cheap do we have? A two garages, you know, if people are looking for a whirlpool and things like that, they’re looking for features, right? Instead of just a home that has great air, great water, really good lighting, right? I feel the movement coming in this direction it just, it takes one breath and one conversation at a time.

Right. And that’s what we’re, that’s what we’re trying to do here.

Dr. Weitz: So how does cooking affect air quality? And I heard you speak about some of the issues even with the range hoods.

Mike: That’s perfect. So we’ll talk cooking and I’ll talk just like I like giving people a bag of tricks, [00:27:00] free tips that they can implement immediately that doesn’t require buying anything at all.  So, but to cooking is a big problem because the way your home is. Built so tight. When you cook, a few things happen. And it doesn’t matter if you’re just, if you’re cooking bacon, you could be making grass fed steak with organic oil and no seed oils and still be heavily polluting your air. So when you take high heat and protein, that creates something called polycyclic air magic aromatic hydrocarbons.

And that’s a cancer causing. Compound that we would test for after wildfire smoke. That was one of the most common things that we would test for. So high heat and protein gonna be a big problem. The particulate themselves, the actual PM 2.5 that gets off gassed is another issue. Then obviously a lot of people also have, gas ranges and most range hoods don’t work. So if the ventilation is working good, we have no problem. Commercial kitchens [00:28:00] tend to have really good range hoods in a in a home environment. There’s a few problems. Number one, they’re typically too high, they’re not powerful enough, and they’re not vented properly.

So, this is the one thing that everybody should do. Take your take a tissue. Hold it up to your range hood and put it on fan speed, one or two and make sure it’s actually sucking it up and pulling it up. 50 50. It doesn’t, so if it’s not even pulling up a tissue, it’s not even bring, it’s not intaking any air.

So that’s the first thing. Then two, check where it’s venting. So a lot of the time it’s venting up into the cabinet. Just above, it’s not going outside. And the whole point of ventilation is to vent outside. So you want to, you want a range hood that can hold up a tissue. You want a range hood that vents outside.

And then ideally, if you can, if you’re like boiling or simmering use the back burners [00:29:00] instead of the front burner, because the back burner captures a lot more particulate than the front burner. And what happens when you cook. It’s not just a localized issue. For example, if you take a 3000 square foot home and you know, Jasper can detect the air in real time.

So if I have a Jasper in my baby’s bedroom and I’m

Dr. Weitz: so, so just for everybody, Jasper is the air purifier that you developed and it also gives you some reading as to the quality of the air, correct?

Mike: Yeah, so it’s reading the particulates in real time. And adjusting its fan speed accordingly. So even if Jasper is in your baby’s bedroom and you’re cooking in the kitchen on the opposite side of the house, within a minute or two, Jasper’s gonna be detecting the poor air quality in the bedroom in every room because you have an HVAC system that’s designed to circulate and mix the air.  So you think of the, like when you walk into someone’s home who’s cooking, you [00:30:00] smell it right away and you smell it because it’s everywhere. And then just like the wildfire smoke we were talking about before, it gets absorbed into the couches, into the chairs, into the clothing, into the all the poorest materials.

So if people have a rangehood that’s not working and the weather permits regardless, like I open my windows big time when I’m cooking. Because you really just don’t want to be offgassing heavily in your home. And then on top of that, I would do the same tissue test in your bathroom. So make sure your bathroom fans can also hold up a Kleenex or a paper towel or something like that.

And then you should check to make sure your bathroom fans are venting outside. A lot of people’s bathroom fans vent directly in the attic. And then of course they have moldy attics because they, if you have a family of four, taking four showers a day, you’re dumping gallons of water into your attic. And of course you’re gonna have mold for sure.

And then, yeah, filtration really helps too. So the way Jasper works is it’s gonna automatically [00:31:00] respond to any cooking in any particulates, so that way it’s silent. You’ll have your green light on, you’ll see a low number, like a four or five. Which is, and we’re looking at PM 2.5, and those are the particles that are small enough to enter your lungs and your bloodstream.

So if we measure the air in a home with no filtration and we cook, the air quality can stay elevated for three or four days, and by that point it’s been absorbed in all your materials. If you have a jas, a couple Jaspers in the home, within 20 minutes, we’re back down to baseline. So it’s a huge difference between filtering your air and not filtering your air.

Right.

Dr. Weitz: What about microplastics? Because there’s been a lot of talk about microplastics and we know that they end up in our brains, but they’re also in our lungs.

Mike: Yeah. So there was a study done in London where they tested a hundred homes and 98% of all samples contained microplastics in them and indoor environments had up to 40 times more microplastics than [00:32:00] outside.

Wow. So. And then they started to work with a lab that was doing biopsies on people’s lung tissue, and almost a hundred, I think a hundred percent of all the lungs that were tested had microplastics in them. Wow. So they say that the humans that live in cities on average are breathing one credit card worth of microplastics per week.

That’s insane. And how does this happen? So you have things like plastic manufacturing, just general plastic breakdown when things decompose over time. They decompose often into the air. If you think about a car, you have to change your tires every few years. The rubber wears thin, like where do you think the rubber goes?

All this stuff goes airborne. And then inhalation is the primary exposure route for microplastics. So it’s kind of interesting that people are thinking about the microplastics in their water. But there’s a very good argument to be made that you could be breathing way more plastics microplastics than you are drinking them.

[00:33:00] So we did a study about two months ago. We contacted the lab and we said, Hey, can we do a microplastic study to show how Jasper, is Jasper effective for microplastics? If so, how effective? And they said, there’s not an exactly a microplastics test because, they’re all different sizes. So they said we can do a latex bead test where they have these microscopic latex beads that they aerosolize that are the size of some of the most common microplastics, and we removed 98% of all of them in one hour.

So the good news here is your indoor, it’s like a good news, bad news. Your indoor air is way worse. Then your outdoor air across the board when it comes to microplastics, mold, dust, even pollen, we get way more pollen inside our homes than outside because it gets trapped in there and it can’t get out. The good news is if you filter your air, it’s not a problem anymore.

So you can turn like, you know, you can’t heal in the place that made you sick, and you can turn this negative that’s making [00:34:00] you sick into a clean air sanctuary. So instead of saying, let me go outside and get a breath of fresh air, how about let me go inside and get a breath of clean air so you can really turn this around very cost

Dr. Weitz: effectively.

Where are all these microplastics in our home actually coming from?

Mike: So, like I said, it’s the plastic manufacturer. It’s out, it’s mostly outdoor sources. Oh, okay. Because our indoor air comes from the outdoor air. So it’s, right. It’s like, it’s the rubber from the tires, it’s the factories. It’s all that stuff.  It’s the plastic products in your home are slowly decaying and decomposing over time. Also a reason why you don’t wanna live near a freeway. It’s a good idea. I actually, when I have tested air by highways, it’s always been less bad than I expected it to be, huh? When it is bad is during Russia like bumper to bumper traffic.

Freeways are bad, like highly congested. Freeways are bad, but freeways that don’t have a lot of traffic that are constantly flowing are much less bad. Okay, because you [00:35:00] don’t have like thousands of cars in one small area constantly running their fumes. So. And there’s also even debates now that plastic kettles could be released.

Like, like things that heat up water in your home could also be aerosolizing like, to me, that makes sense. I can’t say I’ve seen a test on it, but if you think about a plastic kettle with boiling water against plastic, if you can get microplastic we know that we can get microplastics in our food and in our water.

In our water bottles and our Tupperware. So if you think about anything that, that has high heat and plastics and the sun is constantly breaking things down, and then when it breaks down, they go airborne. I

Dr. Weitz: was just reading an article about how a lot of black plastic utensils like you use you know, in the kitchen because they’re made from recycled plastic, that plastic has toxic material from computers or whatever else that gets into it.  And so then that breaks [00:36:00] down.

Mike: Yeah, it makes sense. Like if that, and also if that plastic is touching the high heat, right? Like when you look at that spatula over time, it’s like, it’s smaller. It’s that edge kind of comes down a little bit. It’s like where did it go? So the interesting thing was in London, 100% of homes tested and they would test the dust sample and every single dust sample had microplastics in it.

’cause dust is a collection of things. It’s not just one thing. And a good way to know if you have an indoor air problem. The best way is do you have dust? If you have, does everybody have dust? No.

Dr. Weitz: No. I have no dust that’s just because you dust every day or you’d seen dust ever accumulate No where?

Mike: Well,

Dr. Weitz: think about this

Mike: if you have dust on a coffee table, okay? Did the dust come emerging from the coffee table or did it come from your air? Right? So you’re saying

Dr. Weitz: if your air is clean, you won’t have dust.

Mike: Yeah, of course not. If you filter the air, if you filter the dust from the air, then it [00:37:00] doesn’t land on surfaces because you capture it before it actually lands.

I thought dust,

Dr. Weitz: it was coming off your skin and your pets and everything else, and it just lands there.

Mike: Well, think about it. It can even, it can be on the dustiest place could often be your, the door cells your doorframes and your window sills, places that are actually above your body. So it’s not like it’s just falling off of you on the floor.

I see. The stuff that falls off you is very light, so it gets mixed into your air system very quickly. I see. So it’s all about the air. It dust is. Yeah, like it, it is, dust can be pollen. It’s mold, it’s allergens, it’s the pollution, it’s the VOCs. It’s a combination of all of the things.

And then dust creates a really good vessel for mold spores to hit your ride around your home. Great.

Dr. Weitz: What about pets? I’ve heard you talk about pets not being great for indoor air.

Mike: Pets are also a problem. Yeah. Well, think about this, especially like everybody I know who has a dog [00:38:00] also sleeps with their dog.

So if you think about it, could you ever imagine taking a blanket, going outside with it, rubbing it along? Your neighbor’s glyphosate filled lawn, maybe on some other dog butts, rubbing it on some trees across the road. Then bring it inside and shake it out in your bed. It seems like a crazy idea, but that’s literally most people’s experience every day when you have a dog.

Plus of course you have the pet dander. So yeah, you get all that stuff coming from outside. The pet dander itself. Dogs do contribute to humidity as well. And then cats have two, two issues. They also have allergens, but cat litter can also create a huge problem. If you look at what’s in cat litter, it is not good at all.

And so it, it’s all kind of cumulative, right? Like no. One of the things that we talked about here is gonna be a make or break, but it’s when you have an airtight home with no [00:39:00] ventilation, no filtration, it has cooking, it has pets, it has the allergens. That is a perfect storm for poor health.

Most people nowadays, we’re not ventilating our homes and we’re not filtering our air. So it’s just a constant accumulation over time. People and a lot of people wear their shoes inside, so that brings everything from outside as well. So the pets are definitely an issue, especially if people are allergic to pets.

Dr. Weitz: Yeah, I think I heard you say that there’s like 99% likelihood you’re gonna have fecal matter on your shoes.

Mike: 95% of all shoes tested at fecal matter on them. Wow, because like you go outside and dog shit outside, like it’s not surprising. But the cool, the coolest thing is where to, you know, make it tangible and practical.

The number one place to optimize for by far is your bedroom. Like if you spend one third of your life where you sleep, one third of your life [00:40:00] where you work, and kind of one third miscellaneous out and about taking care of those two thirds. Is very practical and that doesn’t require, you know, it’s very easy with health stuff to get super overwhelmed and you feel like it’s impossible and it’s this big rabbit hole, but it doesn’t have to be that way.

So like I, I just put sleep above everything else. And then what are the ingredients for a good night’s sleep? You need a good bed. Cool clean air. So everybody, thermal comfort is like humans optimize for thermal comfort over everything else. So the cool air is really important, even if that’s moldy, dusty, pollen filled air, a lot of people don’t even notice that.

Fun fact, we did a sleep study last year where we gave 150 people, Jaspers, who were using Ora rings to track their sleep, and the average person slept 25 minutes more per night and 18% deeper sleep. Wow, that’s amazing. So when I go into a bedroom and I use my par, my [00:41:00] particle, like my commercial grade particle counter, let’s say there’s typically a million particles floating around of all sizes.

When we put Jasper in someone’s bedroom within 20, 30 minutes, it’s 95% cleaner. Wow. And then it’s great. So I live in Austin and Jasper’s based in Austin. So whenever anyone buys a Jasper in Austin, we actually deliver it to their home and we test their air. So we go to their home, we go typically first.

Jasper’s gotta be in your bedroom. We do our particle counter, we turn the Jasper on, we talk for five or six minutes. By the time we, we leave their bedroom and to go into their main home, their first breath outside of their bedroom they find that it feels very heavy. Harder to breathe because it’s like if you were drinking tap water your whole life growing up it was just water.

You weren’t paying attention to it. And then if you start drinking filtered water, all of a sudden tap water tastes very chlorinated. You can taste the tap water now. It’s a big difference. That’s why I said I’m more of an air snob because once you start [00:42:00] breathing clean air, it becomes very annoying and difficult.

You go to, all of a sudden the sense and the heaviness is everywhere, but like. In a bedroom, good bed, good sheets, cool air, and clean air. If you sleep in air like that is the thing that you live inside of. So naturally, by cleaning up the environment, it has a profound impact on your sleep. And then when your sleep is good, sleep to me is synonymous with recovery.

So. A lot of people who struggle from seasonal allergies, they go from a lot of allergy attacks to none. People who snore, we’re doing a snore study in a couple months. A lot like my favorite, my, my sister here, literally like, we get this every week, but my sister, her husband’s John, he’s been snoring for five or six years.

Once they put Jasper in their bedroom, he stopped snoring. Now they’re not sleep divorced anymore. You know, John’s back in the bedroom. So it’s [00:43:00] really profound, honestly, the impacts that cleaning up your air in your bedroom can have on one’s life.

Dr. Weitz: How does Jasper work? What makes it better than other air purifiers?

Mike: So the big thing is the size, like. Most air purifiers that you see are made by billion dollar companies that make thousands of products. They make everything under the sun, so it was kind of just another box for them to check in the market, to throw it on Amazon and throw it at Walmart and call it good like.

Think, how crazy is it that the air people Google Air freshener more than air purifier? Everybody’s got an air freshener and all an air freshener is shooting chemicals out to hijack your ability to smell so you don’t smell the garbage anymore instead of just cleaning the air in Allers are toxic. Yeah, so like PE ins, it’s, instead of dealing with the problem, which is dirty air, they’re like, let’s just throw some more chemicals in there.

And that’d be a great way to solve the problem. Last week actually we just got back from our [00:44:00] first hotel trip in Miami. There’s a hotel there called the Caron Hotel, and they’re the first clean air hotel in the country. So they have a Jasper in every single guest suite and Oh wow. All 30 massage therapy rooms as well.

Huh. So if anyone’s in Miami and wants a good night’s sleep, I highly recommend that place. Back to your question though, about what makes it different, so. It’s really designed to be industrial, so it’s like what makes a pickup truck different from a sedan? You know, they both have four wheels, doors, a roof, an engine, but one can like pull a lot of stuff.

It can haul your boat, it can haul your trailer, and one’s just designed to. Haul, take a few people around town. So in, in its nature, Jasper is a lot larger. So it’s moving about five times the air of a traditional air purifier. Our filter is four and a half pounds. Most filters are about half a pound.

So our filter’s about nine to 10 times heavier ’cause we just have more filter media in there a lot. There’s the hepa, there’s the carbon. [00:45:00] So the filter’s just much, much bigger. When you look at most air purifiers, their filter looks like a tissue. It’s not much more than a piece of paper. Ours is like super heavy duty.

We make it outta steel instead of plastic. Going back to microplastics, PLAs polluting plastic. Is horrible for the environment. So to buy a machine that’s supposed to clean your air, that pollutes the environment, seems counterproductive to me. And then also, like the lifespan. So Jasper’s designed to last about 25 years.

Every component in there was designed by my restoration brain saying, how do we make like a restoration grade machine that I would use for mold removal, floods and hurricanes, but with the aesthetic and the design that people would want in their home. So when it’s more powerful. That means it’s more because it’s bigger, it’s very on, its lowest fan speed.

It’s virtually silent in a bedroom setting. You can turn it onto dark mode. It has no wifi, no Bluetooth, no EMF. So if you, the simplest way to think about Jasper is for [00:46:00] every one Jasper, you would need four or five small little machines, and it’d be very unpractical to put four or five little machines in each bedroom of your home.

So we just consolidated it and made, it’s like if there was. Big trucks and sedans, but no SUVs. We kind of have like the only SUV, and that’s why we call it an air scrubber because it’s really designed to be heavy duty, but also designed to be beautiful.

Dr. Weitz: It’s really amazing that it’s designed to last 25 years.

There’s not too many products that are designed to last 25 years. Your car is not designed to last 25 years.

Mike: Dude, I hate planned obsolescence, and I hate, and I hate planned obsolescence and I hate inflation. You’d think as we get more efficient and more productive and more technology, that prices would go down and we would build things to last longer.

But I think a lot of companies, you know, big public companies like. Quarterly revenue. They wanna sell more stuff every three months. Whereas I believe that if you just make a really great product that people can basically keep for a lifetime, [00:47:00] they’ll buy more of them. They’ll tell their friends. So the way our lifetime warranty works is if Jasper breaks.

We ship you a brand new one. You take the new one outta the box, you put the old one back in the box. We give you a prepaid shipping label that we email to you, and then we pay to send UPS to your front porch to pick it up off your doorstep because I can’t tell you how many times I had like a warranty on a product.

They wanted me to send photos, videos, original receipt, get an obscure shape box, go to FedEx and pay a hundred dollars to ship it back. And I just think that’s bullshit. I think if Jasper breaks, that’s Jasper’s problem. That’s Jasper’s fault, and I think it. It. I think companies should really put their money where their mouth is.

Like we don’t even have a sales department here. Everyone here who engages with customers was a former air quality expert, you know, been in thousands of homes. It’s the same people that are going to people’s homes every day. So we just view, we truly view Jasper as an air education company that happened to also make the world’s only air scrubber.[00:48:00]

Designed for your home. But that’s why 90% of what we’re doing is going to functional. Like right after this, in an hour from now, I’m going to a functional medicine clinic to teach them all about air and set them up with Jaspers because they’re detoxing people that are living in moldy, pollen filled environments.

So they’re doing great stuff, but they’re completely missing the most foundational part. So 90% of our time as a company is in education. And then because we only make one. Product it, it allows us to just offer a really good quality of service.

Dr. Weitz: So in order to order Jasper, is it jasper.com? Is that the website?

Mike: I wish it’s jasper.co.

Dr. Weitz: Oh, okay.

Mike: Dot co. And Jasper’s spelled JSPR.co. And ibel I’m seeing my,

Dr. Weitz: yeah I believe there’s a discount code that if our listeners and viewers put in code WEITZ, my last name, W-E-I-T-Z, they’ll get $400 off. [00:49:00]

Mike: Correct. So Jasper’s normally 1199 with your, with Code WEITZ, it’ll be $799.  And what we’re gonna do is, so starting today, the day that the podcast came out. For two weeks, it’ll be valid for $400 off. After that, we’ll leave the code live forever, but it’ll be $200 off. I just know myself as a consumer, I typically only buy things when there’s an opportunity to get a good deal.

So if. That’s also why we don’t sell on Amazon Best Buy or any of these big stores because they would take all the margin and we wouldn’t be able to give big discounts. So our whole philosophy is go speak to health conscious people, educate them as much as we can in an hour or so, give them the best price possible.

And so, yeah, so for the first two weeks, starting today, code WEITZ at JASPR.CO is $400 off. And then after two weeks from now, it’ll be $200 off forever. So, but if you feel so  called and you want to invest in your air, now’s a good time to do it now, one. You can only get one your bedroom a hundred percent, a thousand percent, take care of your clean air and the one in your bedroom.

You should really use fan speed two or fan speed three on dark mode, so you hit the light button so there’d be no ambient light. And it’ll be at a higher fan speed. So it’ll be a gentle white noise scrubbing your air constantly. And then if you’re putting one in your living room, you put that one on smart mode.  So it’s silent all the time, and that’s the one that will automatically adapt to any cooking and cleaning that you’re doing.

Dr. Weitz: So if you were gonna get two of ’em. Bedroom first. Yeah. Second would be the living room or would it be the kitchen?

Mike: So typically most homes, the living room and the kitchen are very close to each other.

Okay. Even though the polluting, polluting happens in the kitchen, it spreads throughout the whole home. So Jasper in your living room is gonna detect it in the kitchen like right away. Anyways, so the idea is you want to have the air [00:51:00] cleaning where you spend the most time. Right. So. That’s why a, a bedroom or a home office or a living space where the whole family’s hanging out in the evening, those are the places that you really want to take care of.

First and foremost.

Dr. Weitz: That’s great. We’re recording this podcast, but it’s gonna get it’s gonna get put up in about six weeks, so

Mike: Well, for everyone’s because we don’t know the exact day. That’s why I’m just saying today,

Dr. Weitz: right. From your perspective.

Mike: The podcast came out today. So yeah, I hope that resonates with someone.

And also, like I said, we don’t have a sales department. Everyone here is an air expert. So if you have any questions, Jasper or know Jasper about your indoor air, your environment, anything, hit us up on Instagram, send us an email. We are here to help. That’s great. Thank you so much, Mike. My pleasure, man.

Thanks for having me.

Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go [00:52:00] 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 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.

Dr. Tom Fabian discusses Measuring Bile Acids and Short Chain Fatty Acids with Dr. Ben Weitz.

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

 

Podcast Highlights

In this episode of the Rational Wellness Podcast, host Dr. Ben Weitz interviews Dr. Tom Fabian, an expert in microbiome science and a clinical education specialist at Diagnostic Solutions Lab. They discuss the new Stool Omics test—an advanced quantitative analysis of bile acids and short-chain fatty acids used in conjunction with the GI Map stool test. The discussion covers the clinical need for this test, the differences between commensals, opportunists, and pathogens, and how bile acids and fiber can impact gut health, motility, and inflammation. The episode also touches on dietary interventions, including fiber and polyphenols, and highlights the complexities of treating conditions like IBS and inflammatory bowel disease.
00:00 Introduction to the Rational Wellness Podcast
00:30 Meet Dr. Tom Fabian: Expert in Microbiome Science
00:54 Understanding the Stool Omics Test
01:21 The Importance of Discussing Gut Health
01:45 Clinical Need for the Stool Omics Test
03:05 Explaining Key Microbial Terms
04:40 Bile Acid Metabolism and Gut Health
07:35 Inflammation and Gut Health
11:10 Bile Acid Malabsorption and Its Effects
11:37 Biofilm and Bile Acid Malabsorption
13:08 Impact of Gallbladder Removal on Bile Regulation
14:51 Addressing SIBO and Dysbiosis
16:05 Role of Dietary Fiber in Gut Health
18:47 Introducing the Apollo Wearable
20:18 Different Forms of Fiber and Their Effects
21:21 Significance of LCA to DCA Ratio
25:13 Strategies for Managing Excess Bile
25:44 Understanding Bile Acid Malabsorption
27:20 The Role of Bile Acids in Gut Health
31:22 Exploring Short Chain Fatty Acids
33:20 Interpreting Stool Test Results
41:53 Balancing Fiber and Protein Intake
47:36 Case Studies and Practical Applications
49:30 Conclusion and Resources
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Dr. Tom Fabian is a Functional Medicine trained PhD, who serves as a clinical education specialist at Diagnostic Solutions Laboratory, which now offers the StoolOMX add on test to their GI Map stool test.

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

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Podcast Transcript

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

I’m your host, Dr. Ben Weitz, and today we have the pleasure of speaking with Dr. Tom Fabian, a functional medicine training PhD, an expert in microbiome science. Tom serves as a clinical education specialist at Diagnostic Solutions Lab, the lab that provides the GI Map stool test that we use regularly in our office.  Today we’ll dive into a powerful new tool for gut health assessment, the Stool omics test, an advanced quantitative analysis of bile acids and short chain fatty acids, designed as an add-on to the GI map. Tom, welcome back.

Dr. Fabian: Thanks so much, Ben. Always a pleasure to be here. And thanks so much for inviting me back again.  Looking forward to the conversation.

Dr. Weitz: I love talking poop. It’s funny how patients come in and a lot of times they’re embarrassed talking about their poop, and I let them know. I talk about poop all day long and don’t feel embarrassed about it. It’s an important biomarker for overall health.  Absolutely. Why don’t we kick things off with the big picture? What clinical need inspired the development of this stool omics test?

Dr. Fabian: That’s a great question. So, as you can imagine with the typical comprehensive stool testing that’s available in functional medicine like [00:02:00] Gmap usually we’re targeting the most clinically relevant organisms, the ones that we know most about.  And so that gives you a window into a lot of these. Really actionable microbes when it comes to commensals pathogens, opportunists. But we also wanted to get a bit of a bigger picture. And there’s also growing research now on the products that they’re producing. So the research shows that it’s important to know not only which microbes are there, of course, pathogens versus opportunists versus commensals, and which commensals, which produce, which products like butyrate.  Ultimately, we want to know kind of at the end of that whole production process in terms of their gene expression and then their metabolic activity. What are they actually producing in the gut in terms of these key products, like short chain fatty acids, bile acids that have now been linked both to promoting health depending on the details and the levels as well as [00:03:00] linkage to a wide variety of chronic diseases and conditions as well as symptoms.

Dr. Weitz: Tom, just for those who might be lay persons who are listening to this podcast who are not functional medicine practitioners, could you just briefly explain what a commensal is? What an opportunist is, what a pathogen is?

Dr. Fabian: Absolutely. Yes. So of course pathogen is I think a lot of people are familiar with that.  Those are these microbes that can cause disease. Usually term as an infectious disease. In the gut. We know that there are a number of different microbes that can cause unpleasant symptoms, sometimes even very serious. For example, if there’s excessive diarrhea that can lead to dehydration there can also be certain microbes that can lead to blood in the stool, et cetera.  So there are some that can be serious. There’s a few that are in between opportunist. Are actually kind of in between a beneficial microbe and a pathogen. So with opportunists, they can be present [00:04:00] in the gut at certain levels. It can be fairly normal to have these opportunistic organisms there. We just don’t wanna see them in excess.  We don’t wanna see them in a certain set of circumstances, especially related to symptoms and diseases where they can actually turn. Into essentially pathogens. So that’s why they’re called opportunistic pathogens typically. Then we have what are called commensals. So commensals is essentially kind of the scientific term for beneficial bacteria or kind of more ge generically bacteria that are just normally found in the gut that usually have neutral to beneficial properties.

Dr. Weitz: Good. So why don’t we start with the bile acid picture. How does bile acid metabolism impact fat digestion, microbiome health, gut motility, inflammation?

Dr. Fabian: So there’s a lot to impact there. So I’ve gotta [00:05:00] start out high level. 

Dr. Weitz:  So we, well maybe start by explaining what a bile acid is.

Dr. Fabian: Okay. So bile acids are basically produced by the liver, so it’s within the category of fats and lipids.  They’re basically formed or produced from cholesterol. So they have kind of, that cholesterol molecule is the basis for the production of bile acids. Their main function, at least in terms of what we recognized for decades since they were discovered is to assist in fat digestion and absorption.  So they’re typically basically transferred from the liver, stored in the gallbladder. And then during a meal when there’s fat content in the meal that basically is detected in the gut sends signals back to the gallbladder to start releasing the bile. So the, basically the bile is released into the small intestine to again, assist with this digestion of fat.

So it’s really a critical component to have [00:06:00] adequate levels of bile. It’s not too high, not too low in the small intestine to assist and really kind of optimize fat digestion. That also includes fat soluble vitamins, like vitamins A, D, and K. You need that bal in order to help us absorb those vitamins as well.

So that’s kind of the traditional view in recent years really in the last two decades. As we’ve learned so much more about the microbiome while these studies have come out, especially in the last five to 10 years, but we now know a lot more about how bal both affects the microbiome in terms of its antimicrobial activity in the small intestine.

But we also know that bile can be acted on by the microbiome in a couple different ways that can influence how bile acids. Then can influence our health. So there’s sort of this whole new category beyond just fat digestion, where bile [00:07:00] acids in their microbiome derivatives can influence in particular intestinal health, particularly the intestinal barrier.

Also immune balance metabolic function. There’s a lot of research, for example, that certain bile acids can potentially stimulate the release of GLP one in the gut. There’s also well known, well established effects on motility. So that’s basically this whole movement of contents through the gut, gastrointestinal, motility.

And then as I mentioned, there’s also influence on the microbiome balance itself.

Dr. Weitz: Okay. So, w why don’t we talk about we, me, we mentioned inflammation in a couple of exchanges we had, and we know that inflammation in the gut is an important factor. It’s found in many. Inflammatory gut condition, especially Crohn’s disease and ulcerative colitis.  And on the GI map we measure fecal calprotectin [00:08:00] and we, there’s another marker, eosinophilic activation protein. So we look for inflammation. And how does bio impact inflammation?

Dr. Fabian: Great question. Yeah, so there’s really kind of two ways you can think of this. And it’s based on the two major types of bile acids that are found in the gut.  So the ones that are released from the liver those are referred to as primary bile acids, meaning that they haven’t yet been acted on or changed by the microbiome. Those are the ones that we know are primarily involved in digestion. In normal physiology, normal healthy physiology. Those bile acids, by and large are.

Reabsorbed at the end of the small intestine in the ileum so they can be reused. Your body doesn’t have to keep remaking them constantly. You can reuse a high percentage of them after each meal through that reabsorption, but unfortunately in some patients, they don’t reabsorb them very [00:09:00] efficiently.

They can have issues in the small intestine that interfere with the reabsorption. Some patients might even have excess production of bile acids, so they’re just not efficiently reabsorbed. So it can be either excess production or just not reabsorbing them in the ileum either way. We can get into some of what’s known about the small intestine and what affects that reabsorption, but once they get into the colon, which normally has a very low percentage of those bile acids in a healthy gut that get into the colon, they’re quickly.

Then converted by the microbiome into what are called secondary bile acids. Secondary bile acids have much different properties, physiological properties compared to the primaries. So basically those secondary bile acids can be anti-inflammatory. They can support a healthy intestinal barrier, but if you’re not converting them very well, and also you’re getting an excess coming in.

Then that’s been shown to [00:10:00] stimulate inflammation. There’s several important studies that just came out in the last year or two demonstrating that basically in various ways, those primary vilas that should not be in the colon in excess when they are, that can stimulate motility. So some patients might actually develop diarrhea that’s referred to as bile acid diarrhea.

They found that actually bile acid diarrhea can be present in IBS patients IBSD diarrhea dominant. Up to 30% of those patients may have this scenario. In IBD inflammatory bowel disease, it’s been shown to be a significant factor now in basically affecting the health of the mucosa. So mucosa are usually damaged to some extent in inflammatory bowel disease.

And then that can also stimulate inflammation. So, there are some, you know, details we can get into as far as sort of what they know about how that happens. But we do know that an excess of those primary bile [00:11:00] acids getting into the colon, along with insufficient secondary bile acids, typically is a contributor to inflammation.

And it’s been documented. So

Dr. Weitz: these primary bile acids, they get secreted into the small intestine where they have an important role in fat digestion. And then they’re supposed to be reabsorbed in the distal ileum, right? And the last part is testing. If they’re not properly absorbed, that’s what we call bile acid malabsorption.  They get into the colon. It’s not a good thing. Exactly.

Dr. Fabian: So what we know from a really interesting study that came out, I’d say probably three, four years ago now out of a group in os Austria they actually found that in a high proportion of IBS patients up to 60% and also in inflammatory bowel disease patients I think it was something like 30 40% had biofilm [00:12:00] build up of biofilm in the ileum.  That was basically the main microbe that was characteristic of the biofilm was an overgrowth of e coli. We know e coli under certain circumstances can be inflammatory.

Dr. Weitz:  It can produce it’s major microbe involved in sibo.

Dr. Fabian: Exactly. So, you know, we know a lot about e coli and then when it’s overgrown in the wrong places it’s not clear exactly why these biofilms develop yet.

They still are studying that. They found that the biofilm was associated with an excess of primary bile acids. So then they found in another study that the excess of primary bile acids then creates an environment in the colon that allows these inflammatory bacteria like e coli to overgrow in the colon as well, particularly in inflammatory bowel disease.

So it seems like these upstream issues that are happening particularly in the small intestine. With biofilm [00:13:00] development in the ileum seems to be related to some of these issues with bile acid, malabsorption, and inflammation.

Dr. Weitz: Now, a lot of people have had their gallbladder removed.  That’s because they get a gallstone or they get gallbladder inflammation or infection and they remove the gallbladder. So without a gallbladder. You don’t have, the body, can’t time the release of bile with that being ingested. So how does that affect this picture?

Dr. Fabian: That’s a good question. So there are a lot of things that can essentially happen as far as complications after surgery like that.

Sometimes there’s some negative effects on that even from the liver when you have the bile coming in not necessarily directly through the gallbladder, but from the liver. There can still be problems with that regulation, but as you mentioned that can be dysregulated. So it’s known from research and we’ve actually [00:14:00] seen some clinical cases already.

Despite the fact this is a fairly new test. We’ve just seen a few of these. But of patients that have had their gallbladder removed, that have persistent symptoms, so they can have a variety of different symptoms, including in some cases ongoing loose stools and diarrhea. For some reason it’s, again, not really clear yet from what’s known in research, but that scenario of removal of the gallbladder and then dysregulation of bile acids seems to be related to the same scenario downstream, where they’re not reabsorbing those bile acids in the ileum de efficiently either.

So there must be some sort of imbalance that causes this dysbiosis, causes this biofilm formation under those circumstances. That can perpetuate these problems for some patients.

Dr. Weitz: Does this indicate another thing we might wanna address when treating a patient with sibo?

Dr. Fabian: I would say [00:15:00] yes. I mean, that seems to be anything that’s happening in the small intestine in terms of overgrowth of opportunists could fall under the umbrella of just generally dysbiosis or sibo.

So if there’s. You know, I would say knowledge from research that suggests what might be going on. It’s a little bit difficult to confirm, and of course we know stool testing is downstream. We can never say for sure, unless the research tells us that a certain organism is only in the small intestine, for example, or only in the stomach like h pylori.

Then we know where it’s coming from even though it’s detected in stool. Some microbes, like e coli, can be small intestine or large intestine or both. We can’t say for sure from a stool test is it really overgrown, but if you’re putting the pieces together and they have bile acid malabsorption, you see an increase on the stool mix in terms of the total bile acids and also the percentage of primary in those scenarios typically.

Then that might suggest that there’s some [00:16:00] upstream issues that you want to further explore in terms of that dysbiosis or sibo.

Dr. Weitz: Now, one of the papers you sent me went into the role of dietary fiber and that how that might play a role in how. Bile acids, increased gut inflammation, and one one of those papers indicated that inulin, which is a common form of fiber, used as a prebiotic.

In fact, many probiotic supplements contain inulin to facilitate the growth of the bacteria. My increased gut inflammation. Can you talk about inulin and what we know about different forms of fiber?

Dr. Fabian: Yeah. Yeah, that’s a really interesting and kind of developing topic. So we know there’s lots of studies showing beneficial effects, especially in terms of short chain fatty acid.

So that’s, you really have to kind of consider, excuse me, the whole gut picture in terms of what [00:17:00] they’re producing, which microbes are there. We certainly wanna also consider the short chain fat. Yes. So they could be compensating. To some extent for some of these issues with bio bile acids. So again, you’re looking at kind of the pros and cons, but this research indicates that inulin under certain circumstances particularly in patients that have inflammatory bowel disease we already know from research and clinical experience that fiber may be a problem for a subset of patients with IBD.

It might make their symptoms worse. So there have been studies to try to figure out why that’s the case and see if we can identify which patients really may be candidates for not not considering inulin fiber, for example. So the studies show that actually what Nulin can do, and of course they’re basically mostly in animal models, so you take it with a grain of.

Although they’re correlating them with what they see in patients in terms of their microbiome, et cetera. But what they found with inulin is that can stimulate [00:18:00] the increase in the bacter bacteria, which are on jmap. So that’s the bact phylum. They are basically capable of metabolizing a wide range of fibers, including inulin.

For reasons that are not fully cleared yet. The inulin seems to especially stimulate those bactes bacteria. They actually produce an enzyme that modifies the bile acids and makes them more damaging in the gut. So that’s what they found in these studies was that the, through the activity of inulin on the bacteria, causing an imbalance, but that then increased the potency of the bile acids.

To cause damage and inflammation in the large intestine.

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Dr. Weitz:  I noticed one of the papers mentioned, or somewhere where they were talking about different forms of fiber. Maybe it was a, maybe it was a webinar on diagnostic solutions lab website.  But they mentioned that whereas inulin in certain cases might cause inflammation, we have partially hydrolyzed gar gum that might decrease inflammation. Do we know why that would be?

Dr. Fabian: Probably because different fibers are acted on by different bacteria, and then they produce a different set of products and they have different effects.  So I’m guessing that with those other fibers, they’re not promoting the tities group that then can make the effects of [00:21:00] primary bile acids worse. So they’re probably. Other microbes that may be their main effect is increasing short chain fatty acids, which actually have an anti-inflammatory effect, particularly butyrate.  So that’s why you really wanna look at the big picture of the microbes, the short chain fatty acids and the vial acids to really put that picture together better.

Dr. Weitz: I noticed the test includes the LCA to DCA ratio. Can you explain the significance of that and how it might affect treatment?

Dr. Fabian: Absolutely, yes.  So it’s basically telling us that there’s an imbalance. So LCA stands for lithocholic acid. That’s one of those major secondary bile acids that are produced by the microbiome. And the DCA is deoxycholic acid. That’s also a major secondary bile acid, also produced by the microbiome. So there are different associations in the research as far as LCA health effects versus DCA [00:22:00] health effects.

So the ratio can, number one, tell us that there’s an imbalance. So even though we might overall have a good level of the secondary bile acids, which is kind of our high level measure of, do things look pretty good? Of when you get into the little bit more granular detail, there can still be imbalances there, and you really wanna have kind of a nice even profile of these secondary bile acids.

As far as, without getting too into the weeds, the imbalance mostly tells us that you wanna look for dysbiosis and try to rebalance the microbiome so you have a more even distribution of products. The con, there’s a little bit of controversy over the health effects. So, LCA, for example, historically has been linked to conditions like colon cancer when it’s in excess.

And I think that still holds up to some extent. It was kind of older research done, you know, a couple decades ago. But now actually to kind of. Flesh out the whole picture. We know that LCA actually for [00:23:00] the most part, unless somebody happens to have, you know, a risk factor for development of colon cancer, it has beneficial effects in many ways.

So it’s, it can be a little bit challenging sometimes to figure out exactly what it means, because there’s research now that shows it promotes a healthy intestinal barrier. LCA has anti-inflammatory activity. And there was a recent study that actually linked LCA to the effects, the positive effects of caloric restriction in aging in an animal model.

So, and there’s lots of links between LCA and LCA related products produced by a diverse microbiome in stimulating the, for example, the GLP one receptor and promoting metabolic health. So it’s really kind of alerting us to. Is there an imbalance? And then what is the presentation of the patient and their risk factors?

Those are always important for [00:24:00] interpretation. Because with a lot of things like hydrogen and sulfide, there’s positive and negative associations, so you want to know what that context is.

Dr. Weitz: It certainly seems like bile is something you want very localized because some patients who have reflux have bile reflux, so if the bile gets too much, bile gets into the colon, that’s a problem.  If it ends up in the esophagus, that’s a problem too.

Dr. Fabian: It is. Yeah. So it’s kind of a, you know, it’s a learning curve in some ways for practitioners who haven’t really necessarily. Focused on assessing bile in their practice. This is giving us a set of information that’s related to what’s happening downstream.  Sometimes it does point to the fact that there may be issues upstream that you want to explore further in terms of liver health, gallbladder, et cetera. So I think it’s another window into giving us some really concrete clues about what’s going on with motility [00:25:00] inflammation, intestinal barrier, et cetera.

More downstream. But again, you wanna look at what are those factors upstream that may be interfering with that process leading to those downstream issues.

Dr. Weitz: Now as functional medicine practitioners, what are some of the strategies we can use if patients have access bile?

Dr. Fabian: Great question. So traditionally, one of the approaches has been to use bile acid binders particularly if patients have bile acid diarrhea.

So I think in gastroenterology that’s still, you know, one of the standard set of tools for consideration in terms of controlling the symptoms. Like

Dr. Weitz: romine on the prescription end.

Dr. Fabian: Exactly.

Dr. Weitz: Yeah.

Dr. Fabian: There’s even some evidence of certain fibers bind to bile acids and may have similar effects in helping to modulate motility.  I think cilium in some cases may do that. I think active HR call, right? So [00:26:00] things that, that basically may help to slow down motility and bind up the bile may be beneficial from a symptom standpoint. So I think there, there’s really gonna be a lot of focus now though on what are these underlying mechanisms causing bile acid malabsorption, such as the biofilm with e coli that I mentioned because of some of the recent studies have shown.

Bile acid binders actually might have a downside that in some patients certainly not all patients, but in patients probably more with the IBD inflammatory bile disease scenario, that it’s bringing in essentially excess bile that’s kind of bound up. But they’ve shown in those studies that somehow that bile still stimulates inflammation.

In some of these patients. So, that may be something just to keep in mind for patients that are not reacting well to bile acid binders or other approaches with fiber, as we just talked about with inulin. Similar effects were shown even with cilium [00:27:00] in terms of the potential, mostly, again, in an IBD scenario, inflammatory bowel disease.

So just some concerns there that practitioners want to be aware of. That even though it might help with symptoms particularly motility in the short term there may be some downsides to consider there and also looking at alternatives.

Dr. Weitz: It’s interesting because we focus a lot on motility in the functional medicine world when we are looking at trying to treat patients with IBS and sibo and generally that condition tends to be more associated with decreased motility, and yet we’re using strategies to increase motility.  So you wonder if. If where bile plays a role in all of this, and you know, patients who are taking pro kinetics, whether they’re prescription or natural it may improve motility, but maybe it increases bile. On the other hand, things that [00:28:00] slow down motility you mentioned GLP one agonist, they slow motility, so they might actually decrease bile, ending up getting into the colon.

Dr. Fabian: So there, there can be some complications there to consider, but overall the research indicates that both for short-chain fatty acids and for bile acids, that usually you’re gonna see, you’re more likely to see a deficiency in both of those because both short-chain fatty acids and bile acids are known probably as far as the microbial metabolites, they’re probably one of the best studied.  As far as their effects on motility and also the mechanisms, right? So understanding the mechanisms is really important. We know both short chain fatty acids and bile acids can interact with receptors in the gut that basically participate in regulating motility. So if you have insufficient levels of both of those.

Or just one category. For some things you might see low bile acids, but normal short [00:29:00] chain fatty acids. If they have constipation, then you may wanna suspect that their lack of bile acids may be a factor in their constipation. So there’s a actually quite a bit of research on bile acids that they can affect motility and essentially promote motility in, in two main ways.

One is acting as a natural prokinetic. That’s one of their main functions. So we’re thinking about, you know, prokinetics are talked about a lot in IBS and placebo field, and we’re usually thinking of supplements, herbals, things like that. Right? We kind of forget that we have these natural factors produced in the gut and modified by the microbiome in a healthy gut.

Of course, that naturally regulate motility, so we would do want to take that into account. And then if of course you have an excess that can cause bile acid malabsorption, bile acid diarrhea.

Dr. Weitz: Now, herbal bitters are often used to enhance digestion, and it’s often said that they stimulate bile [00:30:00] production or bile movement.  First of all, do we, how much do we know that really occurs? Or is that just something we think might occur? And then b might that be some of the benefits? Like I’ve seen herbal bidders in some pro natural, pro motility agents, right?

Dr. Fabian: Yeah. So I’m not, I can’t say that I’m not familiar with the research on herbal prokinetics.  Certainly we know that bitters and other things are pretty well documented to help stimulate the secretory part of digestion. So that’s usually used when there, we suspect that patients may have low pancreatic enzymes, low stomach acid, et cetera. There’s this interaction between secretory activity and also motility.

I don’t, can’t say that it’s all fully understood yet. And that is one of the ways in which bile acids, I mentioned the prokinetic effect, but also bile acids stimulate secretory activity, especially in the colon, [00:31:00] so they can act as a bit of a stool softener. But as far as how the herbals interact, it’s probably somewhat specific to the components that are in each different type of herb.  I’m not really that familiar with exactly how they might stimulate motility in a secretory versus a prokinetic. That both of those can become into play in terms of improving constipation.

Dr. Weitz: Okay, well let’s go into short chain fatty acids and what do short chain fatty acids what important information do they give us and how do they help us to improve our patient’s gut health?

Dr. Fabian: So this one is definitely a bit of a different scenario in terms of interpretation compared to bile acids. So, when we’re talking about production of short chain fatty acids, that’s part of the equation. You want to have good levels, you don’t wanna have insufficient or excessive levels. On stools, we have one of the pieces of information that’s included is the total.  Short chain fatty [00:32:00] acids in absolute terms. So we know basically how much is contained in the stool. What we see in the stool reflects production, which is basically by the, largely by the colon microbiome but also absorption. So that’s unlike bile. Acids are mostly reabsorbed in the ileum. Short chain fatty acids are absorbed actively.  In the colon. So there’s actual transporters in the colon to absorb short chain fatty acids. And that’s how they can have their effects on colon health. For example, we know 70% of the energy of these colon cells, the cells that line the colon, they derive from short chain fatty acids, especially butyrate.

So they need to get across that epithelial lining so they’re continually absorbed. Some of those even continue on. Into the portal circulation that goes to the liver. The liver may metabolize some of those and has metabolic effects where they may sort [00:33:00] of pass them on into systemic circulation, where these short chain fatty acids have effects on the brain, positive effects such as butyrate skin muscle health, et cetera.

So they’re really important for local health in the gut. Also systemic health. But we want to, when we’re interpreting that, we want to consider, it’s not just production. Traditionally in functional medicine, when we see short chain fatty acids on stool test, we’re usually interpreting those in terms of production.

So if we see, oh, butyrate is low, that must mean that butyrate producers are low or they’re just not producing enough butyrate. We also know though, from. Lots of studies that transit time. So in constipation for example, which usually reflects a longer transit time, there’s more time for absorbing those short chain fatty acids.

So you end up with very little in the stool sample. So the two things you want to consider are the production. So you’re looking at the microbes, you’re looking at those [00:34:00] commensals that produce short chain fatty acids, looking at their levels, but you’re also considering the patient’s bowel habits.

Potential transit time. So in constipation, you’re much more likely to see low levels for those patients. So in that case, you know, they might actually have a good level of the short chain fatty acid producers. They might be getting plenty of fiber, so you don’t necessarily need to work on that end of the problem.  You’re working more on the motility side. So if you happen to see the patient also has low bile acids, for example, that could be one of the reasons why motility is low. So you want to focus on. Improving liver, gall bladder health, maybe even considering bile acid supplements.

Dr. Weitz: If we see low levels of short chain fatty acids like butyrate.  What do? What do you think? Obviously it depends on the patient, but what do you think are some of the most effective interventions? Is it better to give prebiotic fibers to feed the [00:35:00] bacteria? Is it better to give specific probiotic strains? Is it better to just give butyrate?

Dr. Fabian: I would say all of the above to consider.  Okay. So studies do show that fiber, for example, can be synergistic with polyphenols in certain probiotics. And we actually summarize that as the, 

Dr. Weitz: and polyphenols a lot of people refer to as postbiotics now,

Dr. Fabian: Poly. So the products the microbiome can produce from some polyphenols like uro, litan a, that uro litan a would be a post biotic because it’s produced by the microbiome from a polyphenol.

So yes, definitely those polyphenols are important for generating some of those postbiotics. And that’s actually one of the four Ps that we talk about. So you have your prebiotics, meaning making sure there’s not just enough fiber, but you wanna make sure there’s the right types of fiber. And Diagnostic Solutions Lab did put out a webinar that’s recorded, so it’s available [00:36:00] through our YouTube channel on our website last fall.

The team put together a great webinar and accompanying resource. As a fiber guide because we always say patients need more fiber when they seem to have a microbiome issue. But the devil’s in the details there as we just talked about. Some patients may not be candidates for inulin at all, for example.

So it’s, it can give you a good guide on what types of fiber may be relevant for constipation, diarrhea, inflammation, et cetera. So there’s a little bit of a learning curve there too, in terms of the fibers. But when it comes to butyrate. So in the context of those four Ps, we have fiber. As far as fiber, we know resistant starch is a well study for helping to promote butyrate production in many people.

I think partially hydrolyzed gure gum also fairly well documented there. There’s one more that I’m forgetting, hopefully that’ll come to me. But so there are definitely specific types of fiber that we know can promote butyrate. And then the second thing would be polyphenols. So we [00:37:00] know that there’s quite a bit of evidence.

Polyphenols can promote not just butyrate producers, but the very bacteria that can help supply those butyrate producers with the precursors they need to make butyrate. So a great example would be bifidobacteria. Bifidobacterium can produce lactate and acetate butyrate. Producers take those other short chain fatty acids and make butyrate.

So again, those prebiotics and the polyphenols can help probiotic bacteria grow that cross feeded the butyrate producers. The third P would be probiotics. So just what we were talking about, lactobacillus, bifidobacterium, and others, even akkermansia. Those can all sort of help promote a healthy ecosystem that supports butyrate producers.

And then there kind, there’s basically butyrate, which is a post biotic. It’s in that category along with Uli a and others. Those are products produced by the microbiome. A growing number of studies shows that [00:38:00] butyrate supplementation has many potential beneficial effects, but especially on helping the entire.

Colon ecosystem potentially to create a better environment for these butyrate producers and other bacteria. And that’s been shown in research to be probably due to the effect that butyrate feeds the colon cells. When the colon cells are fed by butyrate, then the colon cells participate in creating an anaerobic environment in the gut.

Those anaerobes the microbes in the large intestine, the colon are mostly anaerobic. They need an anaerobic environment, meaning lack of oxygen in order to grow. So butyrate actually promotes that anaerobic environment. Right. So I just talked about a lot of information here, so you may have questions or clarification on some of that.

Dr. Weitz: Yeah. I. Yeah, this is a whole new thing. So it’s gonna take a while I think, to really understand [00:39:00] it for most practitioners, including myself. But part of the test reports on branch chain fatty acids. What are the significance of branch chain fatty acids?

Dr. Fabian: Good question. So, we included those because again, there’s a lot of accumulating research now that they help inform us on the state of the colon health, so particularly in relation to the short chains. So you can almost see the short chain fatty acids in the branch chain fatty acids as being antagonistic to each other. So in a healthy gut, we’ve got plenty of fermentable fiber, fermentable carbs of the right kind that can promote short chain fatty acid production.  As you go through the colon, so a lot of that happens in the first part of the colon that fiber fermentation is happening primarily there and into the transverse colon in a typical person. First the microbiome is metabolizing the [00:40:00] fibers that gets depleted eventually, and then towards the end of the colon, microbes start to transition to protein fermentation.

So they’ll basically turn to amino acids for energy when they don’t have enough fiber. And that’s normal to an extent. So you wanna have a little bit of protein fermentation in a healthy gut, but not excessive amounts. Lots of studies show that when you have an excess of these protein fermentation products, that can increase the risk for certain things like it’s been associated with colon cancer, for example.

Some of those products are detected in serum and might be related to poor kidney health, for example. Maybe even issues, gut, brain issues. I think there’s some links, for example, with autism. So you definitely don’t want excessive protein fermentation. The main factor that we know, or I should say factors that increase protein fermentation would be constipation.

So that’s slow motility. You’re exhausting the fiber fermentation kind of early on. [00:41:00] And then because of this smoke slow motility, you’re allowing protein fermentation to happen for a much longer period. Producing more of those products. So you’re more likely to see higher protein fermentation and those various products that are on stools in constipation.

But it can also be due to ex excessive protein intake, which is a concern given the focus on high protein diets for muscle building. As always, in functional medicine, we’re looking at the context of the individual. So you wanna know, is that individual actually handling their protein well? Are they, excuse me, are they digesting and absorbing their protein?

Because if they’re not doing that efficiently, then you’re getting more protein into the colon that can increase this protein fermentation that can have negative effects.

Dr. Weitz: Interesting. So certainly, yeah, I was gonna say, since we do have a lot of focus on [00:42:00] protein intake for building muscle. We also have the popularity among a segment of the functional medicine community that’s using lower carbohydrate diets that are usually higher fat, but also tend to have a little more protein like the ketogenic diet which is being used for brain health, for Alzheimer’s, for all kinds of things.  And and even now the carnivore diet. I’m wondering if. Maybe what we need to think about is for people who want or find those types of dietary approaches helpful, would there be a fiber protein ratio that helps to balance this out?

Dr. Fabian: So research does support that. Now, whether or not there’s sort of a, you know, identifiable ratio I don’t think there’s enough really research yet to say.

A certain amount with a certain [00:43:00] protein. Probably you have to sort of ballpark that and then do some gut testing to see how well you’re doing in that scenario. Again, by looking at your short chains and your branch chain fatty acid production. But there’s a lot of research going back, probably at least a couple decades, showing that adequate fiber intake and adequate polyphenol intake.

Can counteract to a large extent the protein fermentation. So that is probably one of the best well established ways to mitigate the concerns about excess protein. Plus, and this is, I think really interesting research. I’d like to see more research along these lines that we’re always thinking protein for muscle health, muscle building, but it turns out indirectly fiber actually participates in that process.

By promoting these short chain fatty acids that can go into circulation. And as I mentioned earlier, one of the tissues that those short chain fatty acids influence is muscle. [00:44:00] So certain studies recently have shown that these t regulatory cells those are your anti-inflammatory immune cells that are promoted by short chain fatty acids, especially butyrate.

Those can travel from the gut to the muscle. Then help to promote normal regeneration and repair. So say for example you have a hard workout and your muscles are sort of repairing, regenerating after that, building a new muscle indirectly fiber through its effects on the immune balance can affect that process.

Butyrate itself is known to have some effects, positive effects in the muscle. So, you certainly want to think about kind of the bigger picture in terms of overall diet effects. Supporting Muscle health.

Dr. Weitz: This could also be. A negative effect of being on a a lower fiber diet, such as a low [00:45:00] FODMAP diet for a long period of time.  Yes, in the functional medicine world, we often treat patients with a low FODMAP diet. Which we find to be helpful. And then we usually try to broaden the diet and get ’em to have more and more fiber and higher FODMAP foods as tolerated. But there’s a percentage of patients that just find that they can never get back to eating that fiber.  And this is pointing to another potential long-term negative effect of not having a higher fiber diet.

Dr. Fabian: My, my guess based on the research is yes, that there’s likely to be some significant negative effects long term. It’s gonna be somewhat individual. But I suspect that a fair amount of this traces to how individuals actually can handle the carbohydrates and fiber that they’re consuming.  So if you have, for example, various factors contributing to carbohydrate intolerance. [00:46:00] Of course in the short term, you’re likely to feel better when you cut down on those and maybe even switch to a carnivore diet. So from a symptomatic standpoint, we know there’s lots of things that can help with symptoms in the short term, but have long-term negative effects like antibiotics, for example.

Interestingly, there’s research now coming out from a couple different studies showing that fiber, which we think is mostly just active in the colon fiber, actually can also promote small intestinal health. One particular study showed that Klebsiella, which can be one of the bad guys in the small intestine when it’s overgrown is inhibited by fiber even in the small intestine.

They didn’t really work out the mechanism, but this sort of a lot of studies that showed that fiber and the short chain fatty acids that they lead to. Can inhibit the bad guys. These opportunists like Klebsiella e equal citrobacter, proteus, et cetera, that can be particularly overgrown in the small intestine.

So that would be my guess. [00:47:00] And there’s also some evidence that some of these microbes in the small intestine like staphylococcus reus, can actually interfere with the brush border enzymes. And we know deficiency in brush border enzymes with the classic example being lactase leading to lactose intolerance.

When you have a deficiency due to dysbiosis in the small intestine, that might be one of the factors you wanna look at as far as these patients that just seem to not tolerate carbohydrates or fibers very well. So always thinking upstream I think is helpful.

Dr. Weitz: So we need to wrap in the next five minutes or so.  So I’m thinking maybe you could walk us through a case where the stool, all mixed results helped change the clinical approach and then we’ll conclude.

Dr. Fabian: So, because it’s a new test and we do consults on these so far, because it’s only been out for a couple months, I don’t have follow up cases yet.  Okay. That I can speak about. I only [00:48:00] have the primary cases. So the one I had mentioned earlier, we’ve had a few of these examples, whether it’s cholecystectomy, so removal of their gallbladder leading to this increase in the primary bile acids in the colon. And then we see that often associated with inflammatory bacteria.

Recent research shows that there is that connection. Excess primary bile acids in the colon can lead to increase in inflammatory bacteria. So that would suggest, you know, looking at ways to. Reduce some of those inflammatory bacteria using our typical functional medicine tools for dysbiosis, for example.

Even considering biofilm inhibitors, if that seems to be part of the picture. So that’s something that we talked about in the consult is some of these research based insights that might help guide them in which way they want to go. And then. Certainly with inflammatory bowel disease, I’ve probably seen two or three Crohn’s disease cases, similar scenario.

But usually the bile [00:49:00] acid malabsorption was more significant in those cases where the total was quite high and the percent primary was high and the percent secondary was low. And all of those have been linked to potentially worsening scenarios in IBD. Again, that helps the practitioner understand that these are some things they want might wanna look at in terms of supporting and targeting in order to help improve, potentially improve the patient’s situation.

Dr. Weitz: Tom, this has been incredibly informative and I think the stool one makes test looks like a real. Benefit for precision gut health assessment. Where can practitioners go to learn more about it and order the test?

Dr. Fabian: The simplest way is just to go to the diagnostic solutions lab.com website. That’s all just basically one string diagnostic solutions lab.com.  And then you’ll see that there’s the test menu. It’s listed under the GI Maps. If you look at the dropdown menu on our different tests, you’ll see GI Map. And because it’s an add-on stool can’t be ordered alone by itself. It needs to be added on to the GI map. You’ll just see it there and basically when you go to that page, it gives you all the information you need to order the test.

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Dr. Weitz: Okay. And so thank you everybody for joining us and thank you Tom for spreading this information with us. And for those listening, if you find this helpful, please share the episode. Leave us a review on Apple Podcast or Spotify, and we’ll see you next time on the Rational Wellness Podcast.  Thanks so much, Ben. Thanks Tom. Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five star readings and review.  As you may know, I continue to accept a limited number of new patients per month for functional medicine if you would like help. Overcoming a gut or other chronic health condition and want to prevent chronic problems and wanna promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.

Dr. Austin Perlmutter discusses Brain Health 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

The Critical Link Between Brain Longevity and Lifestyle Choices with Dr. Austin Perlmutter
In this episode of Rational Wellness, Dr. Austin Perlmutter, a board-certified internal medicine physician and Chief Science Officer at Big Bold Health, joins the conversation to discuss brain longevity. Dr. Perlmutter emphasizes the critical importance of brain health and explores connections between neurological health, immune health, and lifestyle choices. He delves into the impact of diet, specifically the benefits of a Mediterranean pattern diet rich in polyphenols and omega-3s, as well as the role of sleep and exercise in maintaining brain health. Dr. Perlmutter also highlights the dangers of air pollution and offers practical tips for everyday lifestyle modifications to preserve and enhance brain function for a longer, healthier life.
00:00 Introduction to Dr. Austin Perlmutter
00:38 The Importance of Brain Health
01:48 Personal Motivation and Family History
03:31 Preventing Alzheimer’s and Brain Decline
05:15 Core Systems Influencing Brain Health
06:15 Lifestyle Choices for Brain Health
08:11 The Role of Immunity in Brain Health
11:45 Gut-Brain Axis and Brain Health
17:21 Nutritional Factors for Brain Health
20:21 Mediterranean Diet and Brain Health
23:26 Ketogenic Diet and Brain Metabolism
30:13 Omega-3s and Polyphenols
35:33 The Role of Diet in Cognitive Health
37:19 Importance of Nutrient Testing
39:05 Choline and TMAO Controversy
42:45 Benefits of Polyphenols
49:15 Exercise and Brain Health
53:03 Air Quality and Brain Health
57:29 Essential Oils and Air Fresheners
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Dr. Austin Perlmutter is is a board certified internal medicine physician, New York Times bestselling author, educator, and consultant. He co-wrote Brainwash with Dr. David Perlmutter and he is the Chief Science Officer at Big Bold Health.

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

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Podcast Transcript

Dr. Weitz:  Hello, rational Wellness podcasters. Today I am excited to be having a discussion with Dr. Austin Perlmutter. Dr. Perlmutter is a board certified internal medicine physician, New York Times bestselling author, educator, and consultant. He co-wrote Brainwash with Dr. David Perlmutter and he is the Chief Science Officer at Big Bold Health.  And today we’ll be having a discussion about brain longevity. Dr. Perlmutter, thank you so much for joining us.

Dr. Perlmutter: Thanks for having me.

Dr. Weitz: So, let’s start talking about brain and neurological health and immune health and the connections between all these and longevity.

Dr. Perlmutter: So to start with, the most important thing, I believe the brain health is the only thing that really matters.  And let me contextualize that a little bit. We worry about other problems. So heart disease is certainly the number one killer.  We know that metabolic diseases create all sorts of havoc throughout our bodies.  We know that arthritis, for example, that affects about 54% of people who live to the age of 75 is incredibly debilitating, but why does all of that stuff matter?

It matters because it takes away from your quality of life, the quality of enjoying your life and the ability to enjoy life. To show up each day, to be able to get outta bed and participate in this world and enjoy it for all of its worth is a direct manifestation of what is happening. In that two to three pound organ that we call the brain.

So I realized that if this was the case, then I needed to do a better job of teaching people what to do to keep their brains not only in good health, but in great health across their lifespan. And just for a little bit more background as to why I care about this. So my father is a neurologist. He’s been focused on brain health for his entire life.

His father was a neurosurgeon, was focused on brain health for his [00:02:00] entire life. But in my family, I had two grandfathers with Alzheimer’s disease a disease for which, at least at the time of this recording, there is no meaningful scaled out cure and a disease for which we know we can take amazing steps for prevention.

And that’s just one of the many things that can happen to our brains as we age. So my goal in this conversation is going to be to talk through what we’ve learned about. What causes our brains to age more rapidly and what we can do to help slow the rate of aging and perhaps even reverse certain aspects of that aging process so that we can keep our brains not only basically functional, but working exceptionally well over the course of our lifespan because there really is no value to lifespan without brains span.

I don’t think most people realize this, but there’s not a lot of value to living many years if your brain isn’t coming along with you on the ride in a way that it is healthy. So that’s why brain longevity matters so much, [00:03:00] and I’m excited to get into some of science.

Dr. Weitz: Yeah, I absolutely agree with that.

And I think a lot of people’s worst fears is losing their brain slipping into dementia. And I think that’s one of the reasons why people are so worried about that. And are willing to do whatever it can take to promote better brain health. And certainly when it comes to all these chronic degenerative diseases the treatments for any of ’em are really not that great, and prevention is a much better solution if we can get that started.

Dr. Perlmutter: Yeah, and I’m hopeful that five, 10 years from now, if people listen to this, they’ll say, wow, that was before that amazing cure for Alzheimer’s came out, or before that wonderful new drug came out. I hope that’s the case, but we also need to be truthful about the reality that in 2025, there is no meaningful pharmaceutical way to reverse Alzheimer’s disease or even to slow it too significantly.

So what that means is. For each of us. And Alzheimer’s is just one of the things that we need to be preventing. It’s maybe [00:04:00] the biggest age-related brain decline of any sort of condition, but all of us need to be taking steps right now. If you’re listening to this, if you’re watching this, there is no better time in your life to take steps to protect your brain than today.

I guess yesterday is slightly better, but we don’t really have that opportunity. So today is the day. The steps that we take today can either determine if we are at higher risk for developing Alzheimer’s disease and general brain decline as we age, or at a dramatically lower risk for developing Alzheimer’s disease.

And whether you have an A POE four allele or even two alleles, the reality is that lifestyle modification is the single most important thing we know of that is capable of modulating our risk for developing Alzheimer’s disease. And so this is not just kind of an integrative topic. This is not a functional medicine topic necessarily.

This is just a medicine topic that the best available literature. Is telling us that if our goal is to, and I want to take this one step, it’s not just Alzheimer’s, but if our goal is to [00:05:00] slow the rate of our brain aging so that we can protect our brains over our lifespan so that they are partners with us and not just us kind of being carried along to whatever our brains decide they’re going to be doing.

And they, the years after age 50 or so. These are amazing steps that we can take. What’s super interesting for me and for the research that I’ve been doing is the understanding that there are core systems that modulate the speed with which our brains age. And these systems just to go over a couple are able to influence to a significant degree our overall brain health right now and in years to come.

And the ones that I’ve been most focused on are metabolism. So our brain’s, metabolic health immunity, our brain’s immune health, and then neuroplasticity, which is a technical term for the fact that our brains are perpetually rewiring themselves. And the relative ease and value of those connections has a significant role to play.

In our overall brain health. So these are kind of the neurobiological systems that undergird things like [00:06:00] mental health and cognitive health and importantly, we are able to influence those systems, whether they’re going to be kind of bias towards brain health or bias towards brain disease through the decisions that we make each day, and specifically through our lifestyle choices.

Dr. Weitz: So what are some of the biggest levers we can push when it comes to making these lifestyle choices? I know I’ve heard you speak talking about the fact that one of the biggest things we can do is make sure we optimize our sleep.

Dr. Perlmutter: Yeah. Well, there are many things we can do, and maybe before we get into some of the specific levers, I just wanna make a general disclaimer here because I think that it’s important for people to understand that in this era of sensationalism, the best data that we have for the things that are going to significantly.

Decrease the rate at which our brains age and significantly increase our chances of having a healthy brain into our later years. Our basic lifestyle modification, it’s not extreme diets, it’s not extreme supplements, it’s not extreme biotech [00:07:00] companies that are gonna give you some sort of a device that solves everything.

It’s doing the basics well. That is, again, 2025, the single best data point that we have. So. There’s definitely some value in doing the extreme stuff, but the majority of the value that people will get in terms of protecting their brains is going to be basic stuff. For example, traumatic brain injury is a major preventable driver of brain dysfunction.

Not just mental health issues, but the development of dementia and overall worse brain health. So what can we do to prevent TBI? These are simple things. Wearing a helmet, if you’re on a bicycle, wearing a seatbelt, if you’re in a car being cautious, if you’re an elderly person to take steps to reduce your risk of having a fall.

And I don’t mean this as something that, you know. People are gonna get excited about. This isn’t some sort of an amazing hack, but what I am trying to say is these are the types of steps that the science is clear on. That we can take small steps each day to mitigate in a major way our [00:08:00] risk for developing brain health issues down the line.

Now there are some really exciting aspects of what the science is telling us we can do to act upon these key pathways. And as I’ve alluded to. One of the key pathways that is absolutely vital in determining our brain health right now and in the future is immunity. So, you know, I learned in medical school that the brain is made up of a whole bunch of different cells, but we primarily focused on cells called neurons.

That’s the brain cell that most people are aware of, and it’s a great cell. Don’t get me wrong, you have 80 billion or so neurons in your brain, but there are roughly 80 billion or so other cells called glial cells, which comes from the word for glue. Because initially it was just thought these cells served to hold things together.

It turns out that glial cells play a massive role in mental health and cognitive health and decision making. Even in personality, and one of the most important of the glial cells is a cell called the microglial cell. Microglial cell. Somewhere between 10 [00:09:00] to 15% of all the cells in your brain, something like 20 billion cells in your brain.

What makes it so interesting is that it is an immune cell that lives inside of your brain that changes its function, that changes its physical shape depending on the data that it receives, and based on the way that the microglial cell changes its form and function, it actually influences the way that your neurons work.

So what we’re saying here is your brain has an immune system. It has these microglial cells. These microglial cells are listening to what you do each day, whether you exercise, if you eat a healthy meal, if you had good sleep, if you’re breathing in air pollution, what is the quality of the things that you’re consuming?

And based on that input, they dramatically transform their function. And this has now been determined to be a principle driver of everything from the rate of brain aging to depression to PTSD, as well as to risk for developing dementia and specifically [00:10:00] Alzheimer’s disease. So this brings this concept of immunity, which is generally something people think about, is happening only as a defense system.

You know, you get a cold, you get a flu, you need your immune system to rev up, you wanna make sure you’re topped off on vitamin C. So your immune system works well. Actually, that is such a small part of what the immune system does because the immune system is a principle force translating the outside world into the inside world.

And because your brain, as amazing as it is, doesn’t really have access to the outside world, it relies on signals in part through the immune system. To know how to change itself in order to guide us towards ideally survival, not necessarily thriving, but survival. So immune system in the brain, significantly directing how we think, how we act, how we feel, and being directed by our lifestyle choices, what we consume each day.

Programs, the brain’s immune system. And by doing so, programs, our brain health.

Dr. Weitz: And this is a [00:11:00] new concept because we used to think that there was this impermeable blood brain barrier. So there were no pathogens in the brain, there were no toxins in the brain, and there was no need for it to have a brain immune system.

But we’ve learned that’s not really true.

Dr. Perlmutter: That’s absolutely right, and I think this is still a common misconception. You know, it, it kind of stems from another really popular misconception, which is that the brain and the body don’t communicate that you have what happens in the brain and you have what happens in the body.

And you know, maybe they occasionally exchange a letter, but by and large they’re not talking. And what we now know is. That there is constant bidirectional communication between the brain and the body. And the best example may just be this gut brain axis. And we know that what happens in our GI tract, especially our microbiome, but also in our gut immune system, is able to influence what happens in the brain through a variety of different channels, the vagus nerve, the bloodstream.

And so we’ve kind of gotten [00:12:00] rid of, at least in the scientific world, this idea that the brain and the body. Exist in isolated chambers, but I think most people kind of fail to understand the gravity of that science because what it says is that your brain doesn’t exist away from your body. That your decisions that you make in terms of the food that you eat, in terms of even what you put on your skin, what you breathe, how they direct influence on your brain health.

And I mean, I can give so many examples of how this happens, but maybe the one people are most familiar with is hunger. So what is hunger? Hunger is a response to sure a low energy state, but it’s programmed by hormones that are produced, for example, in your stomach, one called ghrelin, that actually increases your level.

Of hunger. Another called leptin that’s produced in part in the gut, but also in your fat cells that helps you to feel full. It’s a satiety hormone. So what that means is signals from your gut, signals from your body, signals [00:13:00] from your fat cells are telling your brain how to behave and telling you how to change your decision making.

So if you follow this line of reasoning to its natural extension, what I’m saying here is even though we like to operate as though. We’re in control. We’re up here. We’re directing all of the things around us that our brains are responsive in real time to the things that we are consuming to our environment.

And this is one of the reasons why I would say that your best opportunity for making healthy decisions and having a healthy life is not to rely on willpower and forcing yourself to make healthier choices, but it is to program your brain to make it more likely that you make those healthy choices to make it easier.

This is kind of the whole idea of developing healthier habits. Your brain, as much as we see it, as part of us as our identity is constantly changing, and we have the opportunity to rewire our brains for health. Or let our brains be rewired by what happens [00:14:00] around us, which by and large, when you look at the consumed data points in the American world and largely around the world, what we’re consuming is programming our brains for disease and poor health.

So it is incredible opportunity for us to change the narrative and build brains that not only serve us today, but for decades to come.

Dr. Weitz: So how do we reprogram our brains that way? You’re talking about having a eating schedule, an exercise schedule, a sleep schedule. Is that what we’re talking about?

Dr. Perlmutter: Sure.

There are many things you can do, any person can do to help bring their brains back to a state of relative balance. I do think it’s important for everyone out there to know. That your brain changes every day, every moment across your lifespan. So it isn’t as though you’ve missed your opportunity If you’re 70 and saying, oh, I’m not thinking as clearly as I used to.

You always have the ability to direct your brain function for the better. And one quick point that I wanna make before we jump into some of the [00:15:00] tangibles here is that some recent research came out and it in essence showed that midlife so kind of. The middle period of our lives is a key window in terms of what directs our rate of brain aging.

There’s a publication called The Middle Aging Brain that came out in trends in neurosciences, and what they said is that between the age of 40 and 65, this is a key window that directs your future for brain health, and the key pathway seems to be the immune system. So let’s talk here specifically about what you can do to help program your brain’s immune system towards a better state, a state of relative balance towards a state that helps to hopefully prevent your risk of developing a host of brain related disorders, because as I’ve said, it isn’t just your risk for developing dementia that’s associated with a brain immune state activation.

It’s also very strongly a risk factor for depression, which is one of the reasons why I wrote a paper back in 2021 looking [00:16:00] at COVID and the pandemic and the correlations between infection with COVID, but also. People’s lifestyles as a function of lockdown. So this was kind of an interesting thing because back then, as of now, as now, there’s a lot of polarization around what happened, what went wrong, what should we or shouldn’t we have done?

And the point that I made was whether you’re worried about a virus or worried about the lockdown procedures, depression was rampant. And it’s because in part, we’re programming our brain’s immune system towards inflammation. So our goal here is to try to go against that chronic neuroinflammation brain inflammation in order to preserve brain function, enhanced brain function, and protect against what happens in the future.

What can we do about it? I would say. You want to be thinking about the ideas of what you’re consuming each day. So what we consume becomes our biology, and that’s across the entire spectrum. So for example, if you were to be [00:17:00] exposed to a bunch of radiation changes our biology, but more practically for most people, you want to think about what you’re breathing.

You want to think about what you’re eating, you want to think about what you’re putting on your skin. And if you cover those bases, you’re actually getting the majority of the major lifestyle variables. I’d say exercise and sleep slightly outside of that, but we can talk about that in a second. So when we think about the nutritional or yes, let’s start with nutritional.

When we think about the nutritional variables that are most associated with inflammation in the body and in the brain, what I would say is on the one hand, you have the things that you don’t want to consume because at high levels especially, they’re correlated with higher levels of inflammation.

There’s two major things that I would like to address there. One is the Western pattern diet, the standard American diet, the ultra process diet. We can talk all sorts of nuance around individual nutrients and keto and paleo, but the bottom line is if you consume ultra processed food, [00:18:00] most of the time you’re putting your brain and body at risk of chronic inflammation.

So what is an ultra processed food? There are different scales that you can use to determine whether it’s ultra process or not, but one really easy way to determine if it’s an ultra processed food is if you read the ingredient list on the back of a food, and there are things there that you don’t have in your kitchen that is most likely an ultra processed food.

Now, are all ultra processed foods equally concerning for brain health? No. There’s one in particular that I would say is at the top of the list that I would highly recommend most people. I would say everyone should dramatically cut back on or try to avoid completely. And that is an ultra processed food that has almost zero value in terms of what it provides for health.

And almost everything slated towards what it takes away from your health. And that is sugary beverages, sugar sweetened beverages. There is no nutritional value in these beverages, aside from the calories that come from the sugar. So if you were absolutely [00:19:00] starving or if you were incredibly dehydrated, sure.

But for most people, and most of the time, they’re getting absolutely no value from consuming sugary beverages. And sugary beverage consumption is correlated with worse brain health, higher risk for dementia, higher risk for depression. And why is this the case? Well, all that sugar appears to rev up the immune system and promote neuroinflammation.

So very briefly, ultra processed foods eat less of them, but specifically try to avoid the sugar sweetened beverages. And as long as we’re on the topic of beverages, I think it’s notable that. Large doses of alcohol seem to activate microglial cells, increase brain inflammation, so there’s still a lot of debate as to moderate, mild high levels of alcohol, but at high levels and specifically in alcoholism and other people who have had specific brain damage related to alcohol, one of the key mechanisms appears to be neuroinflammation.

So if you’re worried about brain inflammation, high levels of alcohol. [00:20:00] Not a good idea. So those are kind of from a nutritional perspective, the things that I would recommend against in order to decrease your exposure to neuroinflammation and all the things that come with it. On the flip side, if we’re talking about what to do more of, well the opposite of an ultra processed diet is a minimally processed diet.

It’s foods that humans have messed with the least. And what’s kind of nice about brain research is there’s conclusive data, at least as of now, 2025, that there is one diet that is kind of the best overall diet for most people to prevent brain issues and to in particular, help to slow brain aging by targeting these key pathways.

And that’s the Mediterranean pattern Diet. Many people have heard of it before. Different people have different ways of kind of describing the Mediterranean pattern diet, but the key to it is made up of a lot of minimally processed foods. You have fruits, you have vegetables, olive oil, nuts and seeds.

It tends to deprioritize red meat. [00:21:00] It tends to have you consume more fish Omega-3 rich foods. And in particular it is a diet rich in molecules called polyphenols, which are these plant-based nutrients that have been associated with better brain health. So a minimally processed Mediterranean pattern diet is the diet that is best studied to help slow rated brain aging, prevent dementia, and even to improve neurological function in the context of things like.

Depression and mental health issues. We can get into a lot of the specifics of it, but kind of the core constituents that I’ve been most involved in studying, again, polyphenols, Omega-3 fatty acids. These are nutrients, polyunsaturated fat, linked to better brain health, and then fiber, which is something that most people just are not consuming even half of what they need each day.

So I’ll pause there. That’s a lot specifically on the nutrients that can help to offset some aspects of the brain aging process. The good news to all of this is even though there’s no magic bullet, that every [00:22:00] day there’s a chance to do slightly better when it comes to the food that we’re eating.

Dr. Weitz: Right. And it turns out that the Mediterranean diet, even though it’s always a little bay, does it include dairy? Does it include bread? Does it include this? But we have a general sense of what it is. It’s also seems to be the most effective diet for reducing cardiovascular disease and most of the other chronic diseases.

So I think that all sort of goes hand in hand.

Dr. Perlmutter: Yeah, there, there’s no huge liability here. I mean, I think for certain people, you know, there’s a lot more to be said about maybe saturated fat intake and the forms of fat intake. But by and large, what’s great about the Mediterranean diet is that population-based analysis and even interventional data support, that it is a good diet for basically every condition.

So it is a general longevity promoting diet and it also happens to be good for brain health. So it’s nice that you don’t have to say, well, actually this diet is the worst diet for your heart, [00:23:00] but it’s really good for your brain. You don’t have to choose, in this case, which always makes it a little bit easier to be talking about,

Dr. Weitz: you think that somebody who’s starting to have the beginnings of symptoms of decreased brain health.

Should consider more of a ketogenic yeah. Focused diet where maybe they’re gonna be getting their energy more from fats and from carbohydrates.

Dr. Perlmutter: It’s, so there’s an interesting correlate here, which is this question of brain metabolic function and something called cerebral hypometabolism, which is a complicated way of saying as the brain gets older, it seems to have more trouble extracting glucose and using glucose this doesn’t mean there’s less glucose around.

It just seems like the brain metabolizes glucose worse. And this change in metabolism, which some people call type three diabetes is correlated with. Overall brain atrophy and risk for mild cognitive impairment and risk [00:24:00] for Alzheimer’s disease. So what you’re bringing up here is mechanistically. It seems that as we age, our brains become less able to use glucose as a fuel.

I should say this. Glucose is the brain’s primary fuel source. We mostly run on glucose. So this isn’t saying sugar is bad, we need the sugar to run on a brain. So that’s very different from saying added sugar is good, added sugar not good, but we do need to have stable levels of glucose. So a diet that is low in carbohydrate, or I should say just fasting not eating anything whatsoever.

Would increase levels of what are called ketone bodies. And what makes these ketone bodies interesting is that they actually are a more I shouldn’t say bioavailable, but the brain actually will use those in place of glucose. And so that’s interesting. It’s not just the brain, the heart, other tissues can use ketone bodies.

And so the hypothesis here is that if a brain has more trouble using glucose for a number of [00:25:00] reasons, you could bypass that fuel source and provide ketone bodies either through a diet that is very low in carbohydrate, or through fasting or through exogenous ketones. So you can now consume ketones in little, you know, shots or beverages.

What we know so far is that mechanistically, it should work. There have not been any large scale studies proving that a ketogenic diet is, powerful in terms of reversing aspects of Alzheimer’s disease or even significantly mitigating the cognitive issues. There’s some data for improvement in symptomatology, so kind of activities of daily living.

I’m optimistic that metabolic therapies will actually prove to be efficacious for Alzheimer’s disease, and I’m not in any way opposed to ketogenic diets for people who have metabolic dysfunction because not only may it be beneficial for the brain, but cutting back on carbs I think can actually be quite advantageous, specifically in reversing aspects of type two [00:26:00] diabetes.

And so there’s some really powerful data showing that you can reverse type two diabetes with a low carbohydrate diet. My concern around this would be if you are a person who is looking at decades of of age ahead of you, and you’re trying to do the best you can to protect yourself against Alzheimer’s and other brain related issues.

And you start a very restrictive diet like the ketogenic diet. Not only could it put your body under metabolic stress long term, and that’s some of the data that we’ve actually seen in fasting and other more restrictive diets, but you’re missing out often on things like fiber and polyphenols that have also been correlated with better brain function.

So I think I would be opposed to a wide scale recommendation that people should adopt a ketogenic diet for long periods of time for brain health, because I don’t think the data substantiates it. I would be in favor of trying a ketogenic diet. If a person has underlying metabolic dysfunction, which to be fair is about 90% of Americans, but in the context of doing it [00:27:00] alongside a practitioner where you’re actually monitoring and creating a plan for.

What is the sustainable version of this look like? Because I don’t think, just like I wouldn’t recommend long-term fasting for people, I don’t think it is reasonable to bypass the whole question of, is this sustainable when we make dietary recommendations? So I’m interested in the ketogenic diet. I’ve been following the literature.

There’s some preliminary data suggesting some potential value, but as of now, I think it’s still too early to make a broad recommendation specifically for brain health that a ketogenic diet outweighs something like a Mediterranean pattern diet.

Dr. Weitz: And when we talk about metabolic health for brain health, I recently read Chris Palmer’s book, brain Energy, and he talks about the importance of brain getting enough energy through the mitochondria.

And so therefore, what we’re using for energy, whether it be carbohydrates or fats or a combination thereof, is very important for overall brain health.

Dr. Perlmutter: That’s [00:28:00] right. I mean, the brain, two to three pounds uses up 20 to 30% of your glucose at rest uses up a ton of energy. And so if for example, you were to cut off blood supply to the brain and you didn’t have access to glucose and oxygen, you’d die within minutes.

Right? This is not kind of a a long-term process that the brain is able to work without energy. It has tons of mitochondria. You have thousands of mitochondria, potentially more per neuron. They’re clustered around areas that require lots of energy specifically to reset after depolarization. And what does seem to be pretty strong data is that as our systemic metabolism is compromised, and again, depending on the study you look at, it’s somewhere between 88 and 92% of Americans now with some aspect of metabolic or cardiometabolic dysfunction.

But as our body becomes resistant to insulin, as our blood sugar levels start to go up, as we start to develop dyslipidemia the other things that accompany metabolic syndrome. And a fat [00:29:00] that is more programmed towards inflammation. Our brains are not immune to this. And so while there may be a kind of a slight buffer in between developing systemic metabolic dysfunction and brain metabolic dysfunction, there’s no clear line to say, okay, your body’s metabolically unhealthy, and your brain is fine.

It doesn’t seem like that’s the case. So there’s a lot to be said for, you know, the pathways involved, what we can do around that. I do think you know, Dr. Palmer and others have really called excellent attention to the fact that your brain’s energy function is critical for. For general health, but also to mental health.

And I think that’s something we’re learning. I wouldn’t say the data is nearly as strong for metabolism and depression as it is for inflammation and depression, but we’re starting to get more and more of an understanding as to how these pathways interface. So certainly metabolic function, something we all need to pay attention to.

I just think as it stands right now, it’s a little bit more towards immune [00:30:00] activation for the mental health, cognitive health continuum and the metabolic health is a little bit more towards long-term cognition in terms of the risk profile.

Dr. Weitz: What are some of the other important dietary factors? You mentioned Omega-3 fats, which we get from eating fatty fish taking fish oil supplements, and potentially also some alpha linoleic acid that we can get from nuts and seeds.

Dr. Perlmutter: Yeah, so, so I think you know, at Big Bold Health we’re focused on three pillars of kind of nutrition. So one is the omega threes, as you’ve mentioned. Omega threes are interesting in that they’re highly kind of conserved and prioritized in our brains. So our brains are mostly fat by weight, but they’re also incredibly rich in one specific Omega-3 called DHA or docosahexaenoic acid.

And so we want to make sure our brains get enough of that to be able to maintain membrane fluidity, to be able to maintain general immune balance with more EPA or [00:31:00] cosent acid. So the or sorry, cagno acid. So the the basic idea here would be that we want to make sure that we’re prioritizing omega threes.

And by and large, most people don’t consume enough omega threes. I don’t think that’s highly debated. You can get it from diet, so it’d be great if you’re able to get access to, ah. Salmon seafood, eat that each day. The reality for most people is that’s not sustainable. So then you get to kind of supplementation.

I think many people are kind of fixated on this idea of getting two to three grams of EPA plus DHAA day. I’d say most of the quality recommendations from various groups would say closer to 500 milligrams is kind of the sweet spot for maintenance. Now, there are certain conditions, for example, depression where about two grams of, again, EPA predominantly, but also DHA seems to be most effective.

But most of us benefit from just shooting for that 500 milligrams a day. Again, D-H-A-E-P-A, there’s some data for [00:32:00] alpha-linolenic acid, as you said, a LA, this precursor to EPA and DHA. But what seems to be key to understand is that most people cannot convert the a LA to the EPA and subsequently the DHA at high enough levels to where they’re actually getting access to that.

If they’re only consuming plant-based sources. So if you’re a vegan, if you’re somebody who primarily eats plant-based food and you’re not consuming any seafood, I think you’re probably going to wanna look at supplementing with something like an algae-based Omega-3 supplement. Beyond the omegas. The real kind of concentration of my research with big, bold health has been on polyphenols.

And so polyphenols are a group of molecules, 8,000 plus molecules found in plants that have been historically thought about as kind of throwaway molecules, meaning they don’t do that much. We’re now understanding that they’re actually one of the key sets of nutrients that signal between the soil and the plant and the human meaning.

That polyphenols change the microbiome of [00:33:00] the soil, that plants actually send out polyphenols to attract various microbes. And they communicate in this way to promote a healthier plant that polyphenols then can translate those polyphenols to us when we consume them. And that when we eat polyphenols, they have names like quercetin and rootin, that these molecules can have effects on our microbiome, our immune system, and by extension may influence our brains.

Some of these may actually penetrate the blood brain barrier and influence brain immunity. And so we’ve been focused on polyphenols from a certain plant called Himalayan Tery buckwheat, which is an interesting plant because unlike most things that people tend to consume, it’s incredibly high in polyphenols.

And so, if you think about, you know what people typically eat in a grain-based form, wheat rice, these tend to be. Basically stripped of the hu, which is the most strong source of polyphenols. So they’re low in polyphenols. They basically convert to sugar quickly. They’re low in fiber. Buckwheat [00:34:00] has higher levels of polyphenols, but there’s a variant of buckwheat called tart buckwheat that is a little bit bitter.

And the reason for that is because it’s so concentrated in these polyphenols, in particular rootin. I think it is the single most concentrated form of rootin, of any plant that exists. And so we’ve been looking at this subset of polyphenols as to how it relates to immunity. And we studied this in a trial that we published last year in Frontiers and Nutrition, showing that the polyphenol compliment in this Himalayan artery, Bucky.

Significantly impact metabolic, immune and longevity related pathways, which from my understanding at least at this point, is pretty much the first study to ever look at tery, buckwheat and show that it can impact these immune and longevity pathways. So polyphenols, I think, really important to consider I for overall health, for longevity, and we’re starting to look at this more as it relates to brain function.

Other nutrients to consider here. I mean, there are many, so magnesium something that a substantial percentage [00:35:00] of Americans are really not consuming enough magnesium. There’s a debate over the right form of magnesium that has the most kind of brain availability. But the bottom line is you want to be getting several hundred grams or a hundred milligrams of magnesium each day to support good brain function.

And there is data showing that when people do not consume adequate magnesium, that their brain function declines. Similarly, there’s data now for creatine monohydrate, specifically at around the five to 10 gram a day range in terms of supporting overall brain health and promoting brain energy, which I think is super cool.

There’s data around vitamin B, there’s data around vitamin D, but I think the cornerstone to this is really diet. It’s not the supplementation. So trying to build a diet, again, the Mediterranean diet. Which is high in all these things, naturally is a great place to start. And I think that if you’re concerned about this, especially if you’re concerned about cognitive decline, you know that’s where a healthcare practitioner is really best situated to help you because it’s [00:36:00] not as helpful to just assume that you should take vitamin D.

Some people may have a very low vitamin D despite thinking that they’re high, and other people may not need supplementation. I will tell you from getting my own levels tested, I never know exactly what I’m gonna get back until I’ve seen those labs, and then you can change your levels of intake. Maybe you just need 5,000 IUs.

Maybe you need a whole lot more. Maybe you need a whole lot less, but you won’t know unless you actually test. So bottom line to this, lots of nutrients that influence the brain. I think Omegas, polyphenols, creatine, magnesium, those are some of the top ones on my list and things that I try to prioritize each day.

I think the creatine is one that you really can’t get enough from diet for most people because we’re talking about five to 10 grams magnesium. Some people get enough through diet Omegas, maybe some do, but probably not. And then polyphenols, you gotta be prioritizing a lot of plant-based foods, a lot of spices, a lot of herbs.

And if you’re not doing it through that mode, you may not be getting kind of the one to two grams of [00:37:00] polyphenols a day that are probably best situated to be supporting overall health.

Dr. Weitz: Yeah. Definitely inflammation is a big factor and omega threes help to reduce inflammation And I even like using the, the the resolve ins from fish oil to help reduce inflammation. When it comes to testing, I think that’s super important. There’s no way you know how much you need of various new. Nutrients unless you test. There’s so many different factors. You don’t really know what the content of food is.

You can look at a chart and see that eating a carrot has this much vitamin A, but each particular carrot has a huge variance. We have different receptors, we have different metabolisms, we have different abilities to absorb nutrients. So if you don’t test, you’re guessing. And so I think it’s super important that all of us get our important nutrients tested.

You mentioned vitamin D and Omega-3 [00:38:00] and magnesium, but I think if you can get all these nutrients tested and do that periodically, I think that’s the best, most scientific way to know you’re getting optimal levels. That’s what we need. We want to get optimal levels of all these nutrients and not just what’s considered the normal level.

Dr. Perlmutter: Yeah I totally agree with you and I think you know, I think sometimes people say, oh, I’m just going to tweak my diet a little bit and should be fine. And that’s the great thing about labs because unless you know, the lab company messes up, which does happen on occasion, you’re actually getting a good snapshot as to what is happening in your physiology.

And I think there’s a risk to over supplementing just as there’s a risk to not getting any additional nutrition if you need it. So I think that is a good call. I will just mention a couple of other nutrients. Choline lutein, xanthin. These are all nutrients that have been studied to potentially help with certain brain aging pathways, including inflammation.

And so, you know, these are things that you can take in supplement form. Egg yolks tend to be very rich in [00:39:00] them. Leafy greens. I feel like I’d be remiss if I didn’t mention it’s a great source of a lot of these nutrients that we’ve been talking about. Can

Dr. Weitz: we talk about choline for a second? Yeah, go for it.

So choline a, there’s a bit of controversy about it because for sure there’s tm, there’s a particular Yeah, exactly. TMAO. So we have this researcher from Cleveland Clinic, Stanley Hazen, who’s done some research showing that TMAO levels increase your risk of heart disease and consuming choline, a carnitine increases your risk of TMAO.

In fact, FISH is the greatest natural source of TMAO directly. And yet we know these foods like choline and fish are so beneficial for our overall health, for brain health, for cardiovascular health. So I have a tough time with that TMAO concept.

Dr. Perlmutter: It’s interesting, right? So the TMAO is one of the most consistent kind of data points that vegans or plant-based people will point to in terms of saying that, you know, eggs are [00:40:00] bad, seafood’s bad generally speaking based products are bad.

You know,

Dr. Weitz: unfortunately in this set of diet wars we have people lining up in different political parties and sometimes they’re looking for, you know, a weapon that they can use and there’s the TMAO weapon to show why the vegan diet’s best.

Dr. Perlmutter: Yeah. So, I’ll just say, and as somebody who, you know, doesn’t have a huge bone to pick in this, other than I think it’s really unhelpful when we keep going back and forth on what people should be eating.

So, TMAO has actually been linked to this is trim triethylamine an oxide, right? Trimethylamine an oxide, which is a metabolic byproduct of choline. So. Is linked to specifically cardiovascular disease specifically atherosclerosis and death from cardiovascular disease. So the idea then is if you eat a bunch of choline, you make a bunch of TMAO and therefore higher risk of cardiovascular [00:41:00] disease.

But then the question is that the actual pathway? Or is it measuring something else? And so my understanding of the data right now, and I’m sure that you’ll have guests on, or maybe you know this better than I do, is that there is no direct study showing that choline intake correlates with worse cardiovascular outcomes.

There’s this surrogate where there’s an assumption, which is because choline increases, TMAO and TMAO is linked to higher levels of cardiovascular disease. Therefore choline is bad. But in terms of what I can tell right now, there may be a confounder or another variable, but I’m not seeing the data showing that specifically.

Consumption of choline translates into worse cardiovascular disease. And you would think if that was the case too, just as you said then higher consumption of things that are rich in choline would correlate with higher levels of cardiovascular disease. But that’s not really what the research is telling us, so, right.

I think, yeah,

Dr. Weitz: I think that, I think the key factor is the microbiome. And I think that people who produce [00:42:00] TMAO, it’s not because they’re consuming choline, it’s because they have a a dysfunctional or less than optimal microbiome. And I think if they change their microbiome, they won’t have a problem with TM ao.

Dr. Perlmutter: Yeah, I think it’s certainly an interesting thing. I mean, there’s a lot of mechanisms at play to talk through, but we know choline is an essential nutrient for brain health. And so personally, I have not modified my diet based on the TMAO component in terms of decreasing choline intake.

And I think I would be super interested to keep following this research, but I think this may be a scenario where you know it’s part of the story but not the complete story. So. Right. A little tangent there on Colline, but certainly Interesting.

Dr. Weitz: Yeah. So polyphenols, these are part of the phytonutrients that we find in plant foods.

And we know the importance of all these different phytonutrients, including polyphenols. And the way we can get [00:43:00] ’em is by eating lots of colorful plants, fruits and vegetables and and then there specific seeds and grains like the Himalayan Tart buckwheat.

Dr. Perlmutter: Yeah, that’s right. So the richest source of polyphenols in the diet is going to be, I think, as lasso, right?

I think it’s cloves of all things, but it’s spices and herbs are gonna be the most concentrated source of polyphenols. But any minimally processed plant food is going to be a good source of polyphenols. The more food has been processed, typically the more the polyphenols are removed. So again, going back to the example I gave before, if you’re eating a bleach white flour, if you’re eating a bleach white piece of rice, that’s gonna be.

Probably much lower in polyphenols than eating a colorful piece of fruit. And what’s interesting about polyphenols is that they have this they can actually create some bitterness when you eat certain foods. That’s why coffee is bitter. It’s why dark chocolate is bitter. And so we can offset that by adding sugar, which is what most people do, or fat, [00:44:00] which is a popular thing.

So there’s a reason why the top form of chocolate is milk chocolate and why most people like a latte and don’t drink, you know, a black coffee first thing in the morning. And usually add sugar to both of those things as well. But the fundamental kind of idea behind this is that. When we consume bitter foods, we’re actually programming our immune system through these polyphenols.

So bitter isn’t bad. Bitter is actually a signal that we’re getting good levels of these nutrients. And so that’s what we found with tartar buckwheat compared to even conventional buckwheat, it is a little bit more bitter, and that’s because of the polyphenols, but what we’ve been doing is sprouting it.

And what’s interesting about the sprouting is that you actually produce a new molecule, a new polyphenol that helps to dampen down the bitterness. So it’s kind of a polyphenol metabolite that has an anti bittering effect. It’s homo aol of all names, right? It’s a kind of a random one, but this is a nutrient that helps to decrease bitterness to the point where companies will actually put this in their foods as a way of [00:45:00] offsetting bitterness.

And what happens with this tar bucket is when you sprout it, you produce an anti bittering agent, which is just a cool little bit of biology. As we’re looking at what poly what polyphenols do to our physiology, what is known is that polyphenols are actually a form of prebiotic. So they influence the microbiome, they change the makeup of the microbes in our gut.

Polyphenols also appear to influence the immune system, both indirectly, for example, by influencing the microbiome. And they seem to bind to immune cells and change their programming. And so, polyphenols are now thought to be kind of messengers that alter. Immuno metabolic pathways. And so this is just kind of taking this story and making it more and more complicated.

But metabolic health and immune health are not separate, right? So our immune cells are powered by metabolism, and our metabolism is influenced by our immune system. And so polyphenols act on both sides of that pathway. So polyphenols. Are thought to [00:46:00] be immuno metabolic agents that can actually change our risk for chronic diseases and impart influence brain health.

So it’s kind of just a really cool area of science because we’re taking this idea of food is medicine and we’re expanding it beyond just the idea of, oh, well, polyphenols are antioxidants. Antioxidants are good because oxidative stress is bad. And now transitioning to saying, actually no, polyphenols are changing the signals within our body, influencing our immune system, influencing our metabolism, and this may be one of the reasons why people who live in these blue zones that Dan Butner has described tend to live longer and healthier lives, is because they consume large quantities of these polyphenols that can help to program their immune system and their metabolic system, both of which are some of the biggest predictors of how long we live in the quality of our lives to a more balanced state.

So. Eating colorful fruits and vegetables, eating more spices and herbs isn’t just for the flavor, isn’t just for the look. It’s actually a wonderful [00:47:00] way to bring in more of these nutrients, which most people do not consume enough of, because most people eat mostly processed food. So what’s been taken out of those foods tends to be maybe as much of a risk from what we consume as the things that have been put into those ultra processed foods.

Dr. Weitz: It’s kind of interesting for a number of years, Dr. Bland was focused on another bitter of food hops and did a lot of research on with hops and developed a number of products from hops and it’s kind of interesting how he’s transitioned to Himalayan Tart Buckley. He,

Dr. Perlmutter: like, he likes bitter, but I think more importantly, he just, he likes the polyphenols, right?

Yeah. He’s kind of obsessed with how. Food is able to program our body, and our physiology and certain foods, and you brought it up, this great example, hops. So beer is bitter, but if you look at all of these different groups of foods that have somehow become popular, despite their bitterness, they tend to be accompanied by something else.

So in the case of coffee, it comes [00:48:00] with caffeine. In the case of bitter. For, or I should say hops that bitterness comes with alcohol. So people are, you know, they make these associations in their brains. What I will say is what’s interesting now we have these non-alcoholic beverages like hop water for example, or non-alcoholic beer that still gives you the bitterness without the alcohol, and they’re growing in popularity dramatically.

So. Oh, interesting. It makes me. It makes me think that maybe we are transitioning to where it doesn’t have to be accompanied by the, you know, potent brain, I should say neurotoxin, right? In the case of alcohol. Yeah. Or the added sugar that maybe we are able to just enjoy the the beverage without it having to be bad for us, which is exciting.

Dr. Weitz: Yeah. I love using herbal bitters. I use ’em with a lot of my patients to stimulate digestive enzymes and bile flow and hydrochloric acid. And I love taking some herbal bitters prior to eating to get those things going. So I think [00:49:00] more bitter foods are gonna be better for our health for sure.

Dr. Perlmutter: Bitter is better.

Just have to get over the hurdle. Bitter is better,

Dr. Weitz: you know,

Dr. Perlmutter: get over the hurdle and stop. Being only willing to eat the foods that people have processed to the point where they’re not really food anymore.

Dr. Weitz: And of course, exercise is super beneficial for brain health and brain energy and brain inflammation.

Dr. Perlmutter: Yeah, I mean, that’s an entirely separate, but I guess related topic I’ll just kind of do the main takeaways here, which are that there’s no single intervention that has been most more shown to improve brain function and even reverse aspects of cognitive decline than exercise. Kirk Erickson and others have kind of shown that the hippocampus grows in people when they do exercise regularly, which is a super cool thing to do because the hippocampus is the part of the brain that tends to shrink most along with aspects of the cortex and people with Alzheimer’s disease.

So exercise promotes [00:50:00] neuroplasticity, grows new neurons, exercise suppresses inflammation. It improves metabolic function. And these are things that most people already kind of know. So what I’ve been talking about more recently is that there’s cardiovascular exercise what we would typically think of as aerobic exercise, where we’re doing repeated motion.

So jogging is probably the best example. You know, brisk walk things where we’re just kind of doing these repeated motions that get our heart rate up but don’t completely exhaust us. And then there’s anaerobic exercises, so things that take away all of our oxygen. And that could be something like sprinting or high intensity interval training, but it could also include or does include resistance training, weight training.

What makes that super interesting to me? Is that we now understand that one of the key pathways by which exercise improves our brain health is the production of these molecules called mykines. Myokines are produced by our muscles. They actually can go to our brains and influence brain immune and metabolic pathways.

[00:51:00] And they have names like irisin and brain derive neurotrophic factor cathepsin b kind of esoteric names. But the key of it is to understand myokines molecules move that are moved to our brain through our muscles are activated by things that activate our muscles, the things that activate are skeletal muscles.

To the most significant extent are actually going to be weight training. So if you lift weight, if you do resistance training with your biggest muscle groups, which are found in your legs, you are going to have the biggest increase in some of these myokines that are linked to better brain function and potentially that can help to prevent or at least significantly mitigate risk for developing brain issues like dementia.

So all of this is to say, yes, exercise is essential, but don’t skip leg day at the gym. You’ve gotta do weight training, and you’ve gotta do leg exercises, and it doesn’t have to be giant weights on the squat rack or on the, you know, the [00:52:00] deadlifts. You can do body weight squats, you can do lunges, you can use bands.

The key though is to actually do resistance training with your muscles and in particular, your leg muscles, because those are going to produce the most of these positive signals, these myokines that may help to boost our brain function.

Dr. Weitz: Not to mention, no. Decrease your risk of falling. And they’ll increase not only muscle mass, but bone density.

So those are all important for longevity.

Dr. Perlmutter: Yeah, it’s, you know, it’s just like the Mediterranean diet. It’s not just going to benefit your brain, but it’s definitely going to benefit your brain along with other aspects of your health.

Dr. Weitz: That’s great. So, I guess, we can wrap this discussion. Any final thoughts you wanna leave us with and then tell us how we our listeners can learn more about you and the work you’re doing at Big Bold Health.

Sure.

Dr. Perlmutter: Yeah. Well, I mean, I’m hopeful that as people have listened or watched, that they’ve been able to pick up a couple of tools in terms of things that they may be able to do to help decrease their risk for developing [00:53:00] brain aging or at least slowing their rate. Of brain aging. One thing that we didn’t talk about, which I would be remiss if I didn’t bring up, is that what we inhale has a major role to play in our brain health.

And so I’ve been for the last couple of years educating on and writing about air quality as a risk factor for dementia. For depression. What we’re seeing in journals like Gemma and other top tier journals around the world is that air quality is a massive risk factor for brain health and unfortunately.

Even though in the United States overall air quality outdoors has gotten better in the last couple of decades, there are two things that have happened that can put our brain health at risk because of poor quality air. One is we’ve actually seen a relative plateau and a decrease in some places in air quality as a function of wildfires.

So that has been in spec specifically in the on the west coast of the United States. A big issue because we are being exposed to more and more days with very high levels of air pollution that are [00:54:00] linked to risk for dementia, depression, violent crime, metabolic dysfunction, cardiovascular disease, early death, all the things.

The other thing which we have much more agency over is what air pollution we bring into our homes. And so what I would say here is, this is probably the most important hidden risk factor for brain dysfunction, is what you are inhaling in your home. There’s lots I can say as to the specifics, but just recognize that if you’re creating smoke in your home, whether that’s, you know, because you’re a smoker or living with a smoker, that’s a pretty obvious one, but it’s a huge risk factor.

Or because you’re cooking things on the stove top and generating a lot of smoke, or because you’re burning candles or incense, all of these are massive risk factors for worse overall health, lung health, immune health, cardiovascular. But in my case, what I’m concerned about is. Brain health. And the other component of this is it’s not just the smoke, it is all of these chemicals that we introduce into our homes, perhaps unwittingly in terms of volatile organic [00:55:00] compounds.

So that could be air fresheners, that could be cleaning supplies that could even be cleaning out your vacuum cleaner or creating dust in your house because you’re sweeping. These are all sources of air pollution. Again, lots more to say on that. I actually started a company called Lichen Air, L-I-C-H-E-N.

A i r.com and you can learn about that on the blogs there. But the main thing to understand is to appreciate that what we inhale is a major risk factor for our brains. We won’t get into today, obviously what we put on our skin. Another big consideration, right? So our skin is a massive organ. It absorbs what we put on it.

It actually has a microbiome that we can throw off, but I think that’s probably sufficient in terms of some of the things that people can do. And then la that last piece, just to understand that if you are using incense scented candles in your home, I would say to be cautious about that because even though it’s associated with wellness, it’s having the exact opposite effect on your brain health.

Dr. Weitz: Are there any kind of candles that are safe, you think? [00:56:00]

Dr. Perlmutter: I think in order it’s scented candles are the worst paraffin, specifically soy candles, and then b wax unscented candles. So the reason for that is most candles are made out of petroleum derivatives, so that’s not ideal. Scented candles produce a bunch of volatile organic compounds that are poorly regulated and may actually introduce new molecules into your environment like formaldehyde, which you don’t want.

And beeswax tends to produce lower levels of all of those molecules, especially if it’s unscented. But the key thing to understand is if you are seeing smoke in your home, that is particulate matter and particulate matter exposure, there’s no, you know, good level, there’s no hormesis, there’s no benefit.

It’s basically a graded exposure risk. The more you inhale, the higher your risk of having health problems. Doesn’t mean, you know, you can’t light a candle, it doesn’t mean you can’t use some incense, but you also have to put that into the context of. If I’m not ventilating this room, if I’m not [00:57:00] doing this for a short amount of time you know, it’s like eating junk food.

It’s, maybe it’s enjoyable, but recognize, I think in this case it’s actually worse than junk food, but recognize that what you’re doing is actually not good for your health, as opposed to, I think, some common mythology, which is you burn some Palo Santo and you know, you do some smudging and you’re doing something good for yourself.

The exact opposite is true.

Dr. Weitz: Interesting. Even if you’re burning an herb or something like that.

Dr. Perlmutter: If there’s smoke, it’s bad for your brain.

Dr. Weitz: Okay. What about breathing in essential oils?

Dr. Perlmutter: Yeah, so there’s a bit more debate on essential oils. Certain essential oils have actually been associated with better brain function.

So lavender, for example, may be calming. Cedar oil, for example, may be able to activate the parasympathetic nervous system. The thing about essential oils is when you diffuse an essential oil, you’re actually aerosolizing a lot of molecules, volatile organic compounds. So not just the ones that you can smell, but a lot of additional [00:58:00] molecules that are found in the vehicle for that essential oil.

If any essential oil diffuser is going to decrease the air quality in your room pretty dramatically. Some of that is just the water vapor, but there’s actually this potential where if you’re using tap water, you could actually be introducing heavy metals into your local atmosphere. So the recommendation there would be if you’re going to use an essential oil diffuser to use filtered water, that can help in some ways and to buy essential oils from brands that you know are only using a pure essential oil.

I think that. Like most things in wellness, you know, there’s differing degrees of quality, but beyond just purchasing from a reputable source, Johns Hopkins recommends, and I would agree with this, using it locally as opposed to diffusing it. So if you want to have a little bit of essential oil, put it on your skin again a diluted version that’s very different from saying, I’m just gonna run this diffuser in this room for the next three hours and just completely saturate this environment with these molecules, [00:59:00] because it’s not just about what’s in the essential oil.

These molecules can react in the environment to create new molecules. Some of which we definitely don’t want to be inhaling. So I don’t want to burst everybody’s bubble when it comes to this. I think, you know, some essential oils seem like they’re fine, but I think localized use as opposed to just saying.

We’re gonna run this thing in the background for the next 10 hours. And one last thing I’ll say there is, but when

Dr. Weitz: you say localized use, you’re talking about putting little on your skin or

Dr. Perlmutter: skin. Okay. Getting a couple of spritzes, you know, in your bedroom as opposed to just running the diffuser.

Dr. Weitz: Okay.

Dr. Perlmutter: The other thing I’ll just say here real quick because it’s close to this, so air fresheners, which many people use them for the same reason as essential oil diffusers. I won’t name any brands, but the plugins, the Wix, we know those

Dr. Weitz: are really toxic for sure. Yeah.

Dr. Perlmutter: So don’t do those. I think that’s just, that would be my recommendation.

There’s no, oh, just a little bit. They’re not good. And to be honest, like I’m trying to build up [01:00:00] to have a protocol around you know, Uber drivers, taxi drivers, because you get into those cars and the little dangly tree, it’s the same thing. And so it’s. It’s challenging sometimes some of these things you can’t do anything about, you know, I understand that.

But if you are staying if you, it is in your home and you have the little plugin thing that’s pumping out this unregulated air pollution every five seconds, I would just toss it. And the same with the sprays. If you’re looking for a way to improve your air quality, if you simmer some spices on the stove top, I’d say that’s a much better option.

Dr. Weitz: What about some of the natural sprays you’ll see at you know, at the health food store? Yeah. Like vanilla spray, you know, that you spray in the air a little bit.

Dr. Perlmutter: Well, I guess I, I’ll be cautious here because I don’t know exactly the one you’re referring to.

Dr. Weitz: Okay.

Dr. Perlmutter: If it’s an air freshener, if it’s an air freshener, I would just say, generally speaking, I would’ve try to avoid it.

If it is a cleaning spray, that’s a slightly different [01:01:00] scenario. And I think one way to go there is the environmental working group. Just kind of look at their individual products and they can give you a sense as to their perceived risk with the product. But I’d say anything in the air fresheners aisle, I would just avoid.

Dr. Weitz: Great hints. I think some people are gonna be disappointed to hear that their favorite way to freshen up a room is not good anymore.

Dr. Perlmutter: You know, I’m not telling people what they have to do, but I will say there’s a lot of natural

Dr. Weitz: health people with with diffusers. Listen I

Dr. Perlmutter: totally get it right.

It’s, it feels like a nice thing. But, you know, drinking a sugary beverage also tastes like a nice thing. It just. I would just say in terms of prioritization here, an essential oil diffuser is much lower on my list of concerns than is incense. Than is, you know, anything that smokes. There’s good data showing that incense produces insanely high levels of pm 2.5.

[01:02:00] Actually, if you were to burn one gram of incense, it produces five times more air particulates than a cigarette would. So it’s not some sort of an esoteric thing. Incense is designed to smoke and so it is designed to produce air pollution in a really big way. Candles, you can mitigate a little bit, trim your wick, make sure that it’s not super high so you’re not getting the sputtering and producing a bunch of smoke and some candles can be nice.

I don’t think having a candle on occasion in the house is the issue, but go with an unscented candle. I think essential oils, you know, some pros and cons, there’s actually some literature showing that they can be beneficial. But you wind up in the same scenario, which is you gotta ask yourself, if you’re gonna be inhaling these molecules for the next four hours, how much do you trust the quality of this company, this multi-level marketing company that is really incentivized just to sell this product?

You know? So there, there are sometimes unpleasant questions to ask about the things that we use, but I think they’re necessary. [01:03:00]

Dr. Weitz: Right. Alright, great. Give up the diffuser if you so choose. Thank you Austin. So how can people find out more about you and what you’re up to? For sure.

Dr. Perlmutter: So my, best ways to get ahold of me would be My website is austin perter.com.

That’s where I have my brain health newsletter. It goes out to 170,000 people a week. For people who are interested to learn more about the Himalayan Tar Artery buckwheat research, big bold health.com, and then for people who want to, I guess learn more from me and the big bold Health team in any way, shape or form, you can find us on YouTube.

You can find us on social media. I’m on social media at Dr. Austin Protter. And Big, bold Health is there at Big Bold Health. And otherwise, I guess if you ever go to conferences, I’m at a lot of conferences speaking on these topics. So if you happen to listen to this podcast and you see me at a conference, let me know.

Dr. Weitz: Sounds good. Thanks, Austin.