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An Integrative Approach to Depression & Anxiety with Dr. Peter Bongiorno: Rational Wellness Podcast 328

Dr. Peter Bongiorno discusses An Integrative Approach to Depression and Anxiety at the Functional Medicine Discussion Group meeting on September 28, 2023 with moderator Dr. Weitz.  

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Podcast Highlights

9:27   The Neurotransmitter Theory of Depression and Anxiety.  This theory is that specific neurotransmitters are responsible for mood disorders. For example, this theory includes the idea that depression is caused by a deficiency of serotonin.  In 2008 the New England Journal of Medicine published a paper suggesting that maybe this whole serotonin theory wasn’t true, and a lot more people who took SSRIs actually didn’t have as positive effect. [Belmaker RH, Agam G. Major Depressive Disorder. N Engl J Med 2008; 358:55-68.]  Then Fournier in JAMA published a paper showing that SSRIs had no better effect than placebo for mild to moderate depression, though they are beneficial for severe depression. In 2020 a paper discussed that the evidence is that “The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations.” [Moncrieff, J., Cooper, R.E., Stockmann, T. et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry (2022).]  Some studies show that a medication, Stablon, which lowers serotonin, is equally effective as SSRI drugs that raise serotonin levels.  This is not to say that serotonin has no effect but only 27 to 35% of patients who take an antidepressant have a positive response.  Even if serotonin is a factor, there may be other factors that affect whether that antidepressant can be effective, such as do they have enough amino acids in their diet to make neurotransmitters?  It could also be because estrogen or other hormones are low or their adrenals or thyroid are off. Even if depression or anxiety are related to a neurotransmitter issue, we should be trying to figure out what caused this dysregulation of neurotransmitters.  Those reasons can include physiology, nutrients, hormones, inflammation, digestion, lack of sleep, not enough exercise, too much exercise, mitochondrial dysfunction, toxicity, mold.

16:02  SSRIs.  Drugs that potentially modulate serotonin and the other neurotransmitters, like the Selective Serotonin Reuptake Inhibitors (SSRI) even when they do work, tend to stop working after a period of time. And there are many problems with these drugs, including that they are very difficult to get off of these drugs when you want to stop taking them and they have significant side effects, including a significant increase in all-cause mortality.  Dr. John Neustadt spoke at the Connecticut Naturopathic Conference about how SSRIs increase the risk of osteoporosis by changing osteoblastic and osteoclastic activity.  Also when you place someone on these SSRI medications, it does change the function of the HPA axis and does change the ability and the balance of how the body regulates things like circadian rhythm, how it regulates the production of neurotransmitters, how it regulates the production of receptors.

20:32  Dietary Factors.  Two of the most important factors are the patient sleeping and pooping?  It is critical that the patient is having a good bowel movement daily.  We need to facilitate that whether it is adding fiber, water, magnesium, etc. If the patient has a lot of anxiety, that tends to put them into sympathetic mode, which shuts down the bowels. So we need to calm their anxiety, whether that is through supplements or acupuncture. Then the next step is to look at their diet and see what we can change to get them eating better.  The best diet is probably some version of the Mediterranean diet, which Professor Almudena Sanchez-Villegas showed in several papers how it improves the endothelial lining of the blood vessels and reduces inflammation and also that this diet both prevents and helps to treat anxiety and depression. [Sánchez-Villegas A, Henríquez P, Bes-Rastrollo M, Doreste J. Mediterranean diet and depression. Public Health Nutr. 2006 Dec;9(8A):1104-9.]  [Sánchez-Villegas A, Delgado-Rodríguez M, Alonso A, Schlatter J, Lahortiga F, Serra Majem L, Martínez-González MA. Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Arch Gen Psychiatry. 2009 Oct;66(10):1090-8.]  [Sánchez-Villegas, A., Martínez-González, M.A., Estruch, R. et al. Mediterranean dietary pattern and depression: the PREDIMED randomized trial. BMC Med 11, 208 (2013). https://doi.org/10.1186/1741-7015-11-208

23:35  Blood Sugar.  Blood sugar is especially important for anxiety.  Kids who have anxiety often have high blood insulin and low blood sugar from eating highly processed, high carbohydrate foods, which stresses out the primitive brain.  Dr. Bongiorno will sometimes see kids who are eating poorly and will have high insulin, low blood sugar, and low iron (ferritin) and that is a recipe for anxiety.  A patient like this may have multiple nutritional deficiencies.  Such patients often have trouble focusing, so they may get put on medications for focus and ADHD, which ramps up the dopamine and this makes the anxiety worse. We may now have a young girl who other than her poor diet is otherwise healthy and now she finds herself on medication for focus and several medications for anxiety and we still haven’t fixed the underlying issues yet.  This patient is likely not eating enough protein to give her brain enough of the amino acids and other nutrients needed to produce the serotonin that she is taking medication to try to increase, so this approach is likely to fail.  Or they may have poor digestion or low stomach acid or they may not be chewing their food well because they are anxious and in a rush, which means they are not breaking down their proteins.  Or their microbiome may be out of balance and this may affect neurotransmitter production and hormone production, etc. A good recommendation for such patients is to make sure to have a good breakfast in the morning when their digestion is its strongest.  While intermittent fasting can be beneficial for a number of reasons, for the patient who is anxious and undernourished and has low blood sugar, it may make more sense to have smaller, more frequent meals.  On the other hand, for a postmenopausal woman who is having trouble taking weight off, intermittent fasting and detoxification may be beneficial.

30:54  Coffee.  Coffee can be healthy and beneficial, especially for those with depression, and its a good way to get the bowels moving.  On the other hand, depending upon the person, it could increase anxiety.  It depends upon how well that person processes caffeine. It should be organic and we should avoid putting sugar and dairy in it.

32:58  Alcohol.  We used to think that a modest amount of alcohol was healthy, but now the studies seem to be showing that for cancer, no amount of alcohol is good.  It may have a slight benefit for heart health in raising HDL levels.  Alcohol has a relaxing effect, so that may have some benefit, esp. for anxiety.  Dr. Bongiorno told how his parents used to drink a Manhattan before dinner, which they placed gentian bitters in, which they would do while his mom was making dinner. The alcohol relaxed them and the bitters promoted the release of digestive enzymes, promotes better digestion.   

36:17  Sleep.  Sleep is crucial to good health and mood.  During sleep is when we detoxify our brains and where our mitochondria build back up.

38:19  Exercise.  Exercise is crucial for mental health and if you are feeling stressed and you don’t move your body, the stress hormones tend to affect your brain more.  When we are under stress, we are in a fight or flight mode and we need to move to equalize that stress, while we work on creating better balance in our nervous system.  Exercise helps us build better mitochondria, which we need for our nervous system to work really well.  In the short term, exercise increases gut permeability, but when we exercise regularly, we have less gut permeability and we have better digestion.  People who exercise regularly feel better and live longer.

47:04  Labs.  Dr. Bongiorno likes to run labs for mental health, whether the problem is anxiety, depression, schizophrenia, or bipolar disorder.  But first we should take a good history and make sure the basics are there, including sleep, exercise, eating green vegetables and consuming essential fats.  Then he will usually run the basics like a CBC, blood sugar, insulin, A1c, a full thyroid panel with antibodies, vitamin D and an iron panel, incl. ferritin for iron storage. And then looking at some of the vitamins, magnesium, zinc, zinc-to-copper ratio, B12.  Depending upon the patient, he will also run sex hormones and then look at adrenal cortisol testing, melatonin and glutathione levels, and mycotoxin testing can be helpful. Stool testing can also be beneficial to look at the microbiome.  He will try to work through Quest and LabCorp when possible for the basic lab work in order to have them covered by insurance and then he relies on specialty labs like the DUTCH panel, Genova for adrenal testing, Diagnostic Solutions for genetic profiles and stool testing, RealTime Labs and MyMycoLab for mycotoxin testing.

55:25  Nutritional Supplements. NAC has some impressive research findings for its benefits of depression, including severe depression and even as an acute intervention for patients who are suicidal. [Hans D, Rengel A, Hans J, Bassett D, Hood S. N-Acetylcysteine as a novel rapidly acting anti-suicidal agent: A pilot naturalistic study in the emergency setting. PLoS One. 2022 Jan 28;17(1):e0263149.] It’s beneficial for bipolar disorder and for trichotillomania or hair pulling, which can be part of an obsessive compulsive disorder. [Nery FG, Li W, DelBello MP, Welge JA. N-acetylcysteine as an adjunctive treatment for bipolar depression: A systematic review and meta-analysis of randomized controlled trials. Bipolar Disord. 2021 Nov;23(7):707-714.]  NAC is a precursor for glutathione and its a good mucolytic.  Some of the other most effective supplements supported by research for mood disorders are St. John’s wort, SAMe, curcumin, and Rhodiola.  St. John’s wort is supported by many studies and meta-analyses but some are concerned about the fact that it affects the metabolism of certain drugs, such as blood thinners like Plavix. [Canenguez Benitez JS, Hernandez TE, Sundararajan R, Sarwar S, Arriaga AJ, Khan AT, Matayoshi A, Quintanilla HA, Kochhar H, Alam M, Mago A, Hans A, Benitez GA. Advantages and Disadvantages of Using St. John’s Wort as a Treatment for Depression. Cureus. 2022 Sep 22;14(9):e29468.] Fish oil supports healthy cell membranes, which facilitates the flow of nutrients into cells and ability to remove toxins from the cells.  Dr. Bongiorno likes using the omega check to measure essential fatty acids is helpful.  Fish oil helps the anti-depressants to work better. S-adenosyl-L-methionine, can help the body move some of the cycles that help create better neurotransmitters, especially if people have poor methylation.  This is also needed to make CoQ10.  Methylated B vitamins can also be very helpful.  Rhodiola is a natural COMT inhibitor and it can work synergistically to keep neurotransmitters at a higher level.  Curcumin is also a natural anti-depressant as well as an anti-inflammatory.  Saffron has been shown to have benefits for libido for patients with libido problems when taking SSRI drugs.  Lithium orotate, aka nutritional lithium, is effective in helping to calm anxiousness and impulsivity. It helps to calm the amygdala. You can check on lithium levels with hair analysis to make sure you don’t end up having too high a level.  The dosage is usually between 5 and 20 mg.  It also works well combined with CBD.  [Hamstra SI, Roy BD, Tiidus P, MacNeil AJ, Klentrou P, MacPherson REK, Fajardo VA. Beyond its Psychiatric Use: The Benefits of Low-dose Lithium Supplementation. Curr Neuropharmacol. 2023;21(4):891-910.]  Specific amino acids can help to support the production of various neurotransmitters, including 5-HTP for serotonin, Mucuna and tyrosine for dopamine, GABA, etc.  Vitamins B6, Vitamin D, and zinc are important co-factors.  Dr. Bongiorno likes to use 5-HTP for daytime and tryptophan at night for sleep.                                        

 

 



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

Dr. 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. Dr. Weitz is also available for video or phone consultations.

 



 

Podcast Transcript

Dr. Weitz:                   Hey, this is Dr. 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.  Okay. Hello everybody. I’m Dr. Weitz, in case you don’t know. Thank you for joining our functional medicine discussion group meeting tonight with Dr. Peter Bongiorno on an integrative approach to depression and anxiety. I hope you’ll consider joining some of our other upcoming meetings. October 26th, we’ll be discussing integrative cardiology with Dr. Howard Elkin, and this will be our first in-person meetings since 2019. November 16th, we’re going to meet again. Topic is most likely going to be long COVID, though I still have to confirm it. December, we’re going to be off, and then January 25th, we’ll start off the year with Dr. Vojdani. I encourage you to participate in the discussion by typing your question into the chat box, and then I’ll either call on you or ask Dr. Bongiorno your question when it’s appropriate.  If you’re not aware, we have a closed Facebook page, the Functional Medicine Discussion Group of Santa Monica. This is for practitioners that you should join, so we can continue the conversation when this evening’s over. I’m recording the event and it’ll be included in my weekly Rational Wellness podcast.  The Rational Wellness Podcast is available on Apple Podcast, Spotify. There’s a video version on YouTube. If you don’t listen to it regularly, please check it out. If you do listen to it regularly, please give me a five star review on Apple or Spotify. And I’d like to thank our sponsor now, which is Integrative Therapeutics, and we have Steve Snyder on the line to tell us about a few Integrative Therapeutic products. Steve?


Steve Snyder:             If I can unmute. I always hate talking at these things because I know that everybody’s waiting for the speaker to talk and they’re way more interesting, but this one happens to be kind of right up our alley, and we have a few products that I just want to remind people about. The big one is Lavela, which is our lavender oral essential oil, essentially for anxiety. This is one of the products that we grow ourselves and market in Europe. So there’s about 25 clinical studies on it showing significant reduction in symptoms and similar efficacy to pharma products. It’s the real deal. Really the only side effect to it, and Dr. Bongiorno, you might be able to … people burp lavender. It’s not the worst thing in the world. It’s better than fish oil, but we also have a product called Neurologix that includes saffron, citicoline, and a unique spearmint extract that’s mostly for kind of a cognitive improvement, but it does also have a serious impact on mood, and we feel like those are sort of connected. And then… Yeah.

Dr. Weitz:                   Hey, Steve, can you just address the concern that some people have about using lavender? There’s this thought out there that’s going to decrease testosterone levels.

Steve Snyder:             So this is one of those urban legends that we can’t get to go away, and thanks for letting me throw this one out there, too. Sort of like black pepper and curcumin. The lavender issue is related sort of, if you do a little Google searching, it all comes back to one doctor who had one patient, it was a kid who used to bathe in lavender and he got gynecomastia. It went away when they stopped bathing him in lavender. But there’s really nothing to that other than that sort of snowballed into all of these references that basically go back to that same thing.  We have a warning on it to not use it in prepubescent men or males, but it’s literally one of our top five selling products, and we’ve never had any report of it. So if you know us, you know how conservative we are on labeling stuff. If there was any kind of worry about it, we would have it plastered all over the product and we don’t. And literally, this is one of the most heavily studied nutritional supplements out there. It’s over 20 studies now, so it’s not something we’re worried about. And if we’re not worried about it, I’m fairly certain you shouldn’t be worried about it. So does that help?

Dr. Weitz:                   Okay. Great. Yeah, thanks Steve.

Dr. Bongiorno:            And then the Theracurmin, the curcumin supplement, that’s a big one for mood and memory as well, all kinds of cognitive stuff. We actually have a new one that’s better than Theracurmin called Curalieve. There’s no clinical studies on anxiety and depression yet, but there’s a great one on memory and mood. And then Cortisol Manager, that’s everybody’s favorite for everything, so we always say that one. So I’ll throw some links into the chat and if anybody [practitioners] wants to know more about them or sample any of these, we can make that happen.

Dr. Weitz:                   That’s great. Thanks, Steve.

Steve Snyder:             Yeah.


Dr. Weitz:                   So, let me just quickly introduce the topic and then we’ll introduce our speaker and we’ll get started. So we’re going to talk about mood disorders. Depression is a mood disorder characterized by a persistent feeling of sadness and hopelessness and a loss of interest or pleasure in previously enjoyed activities. Gallup research found in 2023 that the percentage of US adults who report having been diagnosed with depression at some point in their lifetime has reached 29%, the all-time high and 10 points higher than in 2015. Anxiety is characterized by feelings of worry, nervousness, or fear that are strong enough to interfere with one’s daily activities.  In 2023, 28% of US adults reported symptoms of anxiety disorder in the past two weeks, though this was lower than the all time high in 2021.

                                   Dr. Peter Bongiorno is a naturopathic doctor and acupuncturist in New York City, and he also works with clients via phone and Skype. He’s written a number of books including Healing Depression, Holistic Solutions for Anxiety & Depression, which is an incredible book, and I’m reading it again for the third time. And there’s just so many great clinical pearls, especially for functional medicine practitioners.  And he also wrote How Come They’re Happy and I’m Not?, and Put Anxiety Behind You: The Complete Drug-Free Program. Both of these are for patients. His website is drpeterbongiorno.com. Peter, thank you so much for joining us.

Dr. Bongiorno:            Thank you, Dr. Ben. Thank you for that introduction, and thank you for bringing people together and spreading good energy. Really appreciate it.

Dr. Weitz:                   Absolutely. Yes, it’s my mission. So it sounds like anxiety levels were highest during COVID, which I guess is understandable, but it sounds like maybe depression has resulted from all this, and I wonder if this might even be a untalked about symptom of long COVID.

Dr. Bongiorno:            Yeah. Well, I mean, I think there are a lot of similar underlying factors that contribute to long COVID, and a lot of those factors and mechanisms also play a very strong role in depression as well. So it makes a lot of sense to me that we’re going to see this clinical and subclinical long COVID syndrome. And along with that, we’re going to see more depression, too.

Dr. Weitz:                   Right. So let’s start by talking about the neurotransmitter theory of depression and anxiety for those who aren’t … I’m sure we must all be familiar with it, but the concept is that somehow depression, for example, is caused by a deficiency of serotonin, and that specific neurotransmitters are responsible for these mood disorders, and that’s somehow we can modulate this by taking medications that increase serotonin or norepinephrine.  Where are we in terms of this theory?  Have we learned?  Is there more evidence for this concept, or is it even more in doubt?

Dr. Bongiorno:            Yeah.  Well, I mean, in the end, it really depends on the patient, right?  But if you look at the literature, the New England Journal of Medicine in the early aughts, I think it was maybe 2008 or nine had published a paper suggesting that maybe this whole serotonin theory wasn’t true, and a lot more people who took SSRIs actually didn’t have as positive effect.   And then a few years later, a fellow named Fournier in JAMA, right?

Dr. Weitz:                   Yeah.

Dr. Bongiorno:            The Journal of the American Medical Association, published a paper looking at all the studies that supposedly weren’t looked at. Some people felt they were hidden, and that’s why we didn’t see them. And when he looked at them all, what he noticed was that SSRIs really for mild to moderate depression, really didn’t have a better effect than using a placebo. In severe depression, there was a beneficial effect, but not in mild to moderate.  And then really about a year and a half ago, another paper came out of strongly suggesting that serotonin itself might not be as strong a player in depression as they thought originally. And it’s interesting because again, maybe about 10, 15 years ago, there are some studies on another medication called Stablon, which is the opposite of an SSRI.  It’s a serotonin…it actually helps keep less serotonin around.  And they found that about 30% of people did well with that drug, about the same amount that did well with the SSRIs.  And so, kind of people scratching their heads going, “Wait a second. One drug that does the exact opposite has as good effect as the drug that’s supposed to keep the serotonin around.”  And in my opinion, that’s not to say that serotonin has no effect.  What we need to understand is that neurotransmitters are real. If you think about disease, very typical metaphor, the disease is like an iceberg, right?  So neurotransmitters are the tip of that iceberg. So the question is, and there are maybe 27 to 35% of people when they take an antidepressant, they do feel better. And I believe that’s true. I’ve seen that clinically. So it’s not that no one does well with it, but it’s not, unfortunately, the high rates that originally that were being told to us. And the reason is is because there’s many, many other factors in depression besides serotonin, and maybe for 25, 30% of people, that is a major piece of it, but for many people it’s not. And then for the people that serotonin is a major factor then we have to ask, well, why is serotonin low that when we use the drug, it does work?

                                                And that could be so many other reasons. It could be not enough amino acids in their diet. It could be because estrogen is low or other hormones are low or adrenals are off, or thyroid. I mean, so there’s a whole lot of reasons. So that’s the question that we need to ask, not whether neurotransmitters themselves are the only reason. And that’s unfortunately where I think modern psychiatry has been for a long time. And when you think about psychiatry, I’ve worked with many psychiatrists over the years, and the ways explained to me was that before there were psychiatric meds, psychiatrists themselves weren’t looked at as, quote, “Real doctors,” because they didn’t have drugs. So they themselves felt like they weren’t real doctors because when somebody got sick, there wasn’t a drug to use. And then as the years went on, they developed all these different drugs. They accidentally, they were unearthed that they had some benefits. It was actually in the beginning, it was studying TB is actually how they started isoniazid. And they started figuring out this whole idea of mono means and the blocking of those. And anyway, that’s another story.

                                                But the point is then psychiatry started having drugs that they did notice having an effect, especially for patients who were originally put in sanitariums and locked away. And so, like the magic pill for so many other things, that seemed like the approach to take. And unfortunately, that’s still the approach that’s being taken. And we’re not getting to the point where we’re saying, “Okay, this human being has a lot of physiology going on.” And there’s a lot of different reasons in that physiology, nutrients, hormones, inflammation, digestion, lack of sleep, not enough exercise, too much exercise, mitochondrial dysfunction, toxicity, mold, all of these things that are going to play a role in why neurotransmitters change. So that’s what I’m hoping, as the years go on, that we’re going to start to understand is we have to really treat that whole person and all of those issues. And maybe it is a neurotransmitter issue, but we don’t want to just focus on trying to regulate a neurotransmitter. We want to figure out what the underlying cause of that dysregulation is if it is a neurotransmitter.

Dr. Weitz:                   Absolutely. And it also sounds like there’s a large number of neurotransmitters that have a number of different complex roles, and it sounds like it’s not as simple as just serotonin for depression and just another neurotransmitter to make you happy. There’s this complex symphony of various neurotransmitters that play various roles that we probably only scratching the surface on.  And then of course, we have the problems with these drugs, which are number one, that even when they do work after a while, they tend to stop working. They’re very difficult to get off of, and they have significant side effects, including a significant increase in all-cause mortality.

Dr. Bongiorno:            Yeah. I recently went to the Connecticut Naturopathic Conference and I gave a talk there, and one of my colleagues, Dr. John Neustad, he was speaking about SSRIs and the effect on osteoporosis, for example. And that was something that I’d heard a little bit about, but I didn’t know too much, and I didn’t realize how deeply those mechanisms lied and how they changed osteoclastic and osteoblastic formation.  And so, that was something kind of new for me in the world of SSRIs, which I always think about them even from a hypothermic pituitary adrenal access standpoint, how they really do change function. And I do find when patients are put on these medications, which sometimes in an urgent care situation where somebody might hurt themselves or somebody else, sometimes it can be lifesaving. So I’m not trying to say that they should never be used, but I think at this point, the prescriptions way outnumber the need for it by a factor of many.

                                    And unfortunately, when you place someone on these medications, it does change the function of the HPA axis and does change the ability and the balance of how the body regulates things like circadian rhythm, how it regulates the production of neurotransmitters, how it regulates the production of receptors. And especially in younger people, I see that sometimes can make it much harder to actually treat them because even if they feel better for a while with the medication, it still becomes more of a challenge to work on the underlying issues because now you have this HPA axis that’s now been manipulated and changed a bit, and that sometimes can make it a little more challenging to really treat the underlying causes.

Dr. Weitz:                   Interesting, interesting. So our challenge from a functional medicine approach is more difficult.

Dr. Bongiorno:            Yeah. And look, like I said, if you have somebody who can’t get out of bed, is thinking of hurting themselves-

Dr. Weitz:                   Absolutely.

Dr. Bongiorno:            .. when you want them to do all this nice testing and go to Whole Foods and buy some salmon, if anyone’s ever gone through it, you know. It’s nice to think about these things, but you feel awful and there’s nothing.  So sometimes medication can get you out of that place and bless it if it can, but it is a challenge once it’s there to figure out how to help the body rebalance. Not impossible, but it’s definitely, I think as functional medicine, naturopathic, holistic practitioners, and especially those of us who are working with the conventional psychiatry world, we have to create a process and maybe a flow that allows us to question like, “Okay, do we need this medication in the beginning? Is it safe to start with that one? Can we start by working on more of the basics? Does this person monitored properly and in a safe place? And are they a single mom who needs to take care of a child and isn’t taking care of this child?” We have to ask all these questions to find out whether, be a little more judicious when we start using medications and see if there’s an opportunity to not use it because I think that allows the functional medicine to work even better once we bring it in.

Dr. Weitz:                   Right. Especially as you’re describing in a case where somebody has mild to moderate depression-

Dr. Bongiorno:            Exactly.

Dr. Weitz:                   … they’re not suicidal, they’re not in a situation where they’re an air traffic controller or taking care of young kids that they might not otherwise be able to take care of. Certainly in those situations, whatever you can do, medication, anything else to get that person doing better is the most important thing.

Dr. Bongiorno:            Absolutely. Yep.

Dr. Weitz:                   So what are some of the most important dietary factors that play a role in triggering depression and anxiety? Is there a best diet? What sorts of things should we be thinking about?

Dr. Bongiorno:            Yeah. Well, when I think about working with someone who has any condition, but especially mental health, I think about two things. Are they sleeping and are they pooping? So as far as pooping, the first thing I think about is are the bowels moving enough? Because if the bowels aren’t moving preferably every day, it is hard to create balance with inflammation in the body, with toxicity, with hormones, with nutrition absorption. All of those things really rely on bowel movements and the bowels moving every day. So I find that that’s critical, and we need to do our best, whether it’s to add fiber, to add water. Sometimes when anxiety is so high, that can be a reason the bowels shut down because, of course, when you’re running from a bear, you’re not going to be sitting down to eat a meal. So the body, the perimeter brain naturally shuts the gut down.  So sometimes doing things more acutely to help lower anxiety can be useful, whether it’s through supplements or acupuncture, just to kind of calm things down a little bit to get the bowels moving. So getting the bowels moving is my first order of business. In a sense, I don’t even get as concerned with what a person’s eating unless I think it’s constipating them too, because we just want them moving. The body’s so resilient, and we all know this. We know people who can eat absolute junk and stay really healthy because the body just wants to be healthy. And sometimes with the right genetics, it could do it even with poor food, not that I’m recommending that.

                                                And then the next step would be sit down and say, “Okay, what are we eating here and what can we change for the better?” And I would say without knowing a person or knowing their sensitivities or their preferences, if I had to pick a diet, I’d probably start with some version of the Mediterranean diet. Sánchez and Villegas in Spain started studying the Mediterranean diet in the early aughts, probably about 2003 or four were the first papers that came out. And so many papers have come out since then. And they’ve really shown how the Mediterranean diet works on that endothelial lining of the blood vessels. And it really helps with inflammation. It really calms inflammatory markers, the benefits it has on anxiety and depression to both prevent and treat the condition.   When you really look at even studies on longevity and the blue zones, people are pretty much eating some geographical version of the Mediterranean diet. So that would be a place I would start in terms of foods.

Dr. Weitz:                   What are some of the other important dietary factors? Blood sugar we know is super important.

Dr. Bongiorno:            Yeah. So blood sugar is definitely, especially with anxiety, I find blood sugar regulation is a key. I was working with a young girl who came in 17 with her mom and very severe OCD and anxiety, and we talked a little bit and it was so clear that her blood sugar was so low. And then when I looked at her blood work, her blood sugar was around 62, her fasting blood sugar-

Dr. Weitz:                   Wow!

Dr. Bongiorno:            … which is pretty low, not the lowest I’ve seen, but pretty low for a fasting blood sugar. And because it wasn’t high, no doctors really talked about it that much. No one had mentioned it to her. No one looked at an A1c, but I bet you the A1c is probably around four, and no one really looked at insulin. And sometimes now in young people, you see these very high insulins because of all the highly processed carby foods we’re eating, it spikes all this insulin and then it drops their blood sugar. So you have kids who really don’t eat much nutritionally, and they’re still eating a lot of sugar. So you get this high insulin, low blood sugar, and if you want to get the primitive brain stressed out and create an anxiety response, just keep the blood sugar low.  And then in this particular case, one of the other things that I noticed was that the ferritin was very, very low. And I see this also because you get these young women who are menstruating typically earlier and earlier, they’re not really eating nutritional food, not getting iron in, blood sugar is low, iron is low, and that’s a recipe for anxiety. By the time they’re 17, 18, now they’re starting to get really anxious and they don’t know why.

Dr. Weitz:                   Yeah, this is somebody who’s undernourished and probably has a huge amount of nutritional deficiencies.

Dr. Bongiorno:            Yeah. And then because they feel that way, they’re not focusing well. And then guess what happens. They get put on medications for focus, ADHD medication.  What does that do? That ramps up the dopamine so they focus a little better, but now the anxiety’s getting worse, and now we’re in this cycle, and I tell you, and you see this pattern over and over, and I think to myself, “Gosh, we have to work on the underlying issues here. We can’t just keep this ongoing,” because now you have a young girl who’s otherwise healthy and is now being told you have anxiety and focus issues, and you have these diagnoses. Now they’re on a couple of medications for anxiety, and we haven’t fixed the underlying issues yet.

Dr. Weitz:                   Right. You were talking about the need for amino acids to be able to produce neurotransmitters. And of course, that could be one reason why some of these medications are not effective in some cases because you take a serotonin reuptake inhibitor, which is supposed to keep serotonin around longer in the brain, but if the body doesn’t have the right precursors, amino acids and other nutrients to make the serotonin in the first place-

Dr. Bongiorno:            Absolutely.

Dr. Weitz:                   … it’s doomed to fail.

Dr. Bongiorno:            Right, absolutely. So then the question is is the person not taking them in or are they taking them in and the digestive tract isn’t absorbing them? If stomach acid is very low, you’ll see people with SIBO, small intestinal bowel overgrowth, their stomach enzymes are very low, their hydrochloric acid is low. They’re not really breaking down their protein. They might not even be chewing their food very well because they eat in a rush and they’re so anxious. And so, how is a person supposed to get enough protein digested for a good amino acid intake to make these neurotransmitters?

Dr. Weitz:                   Absolutely. And they may have H. pylori infection, and that’s usually associated with lower hydrochloric acid secretion. So maybe you can talk about the microbiome and its importance for the health.

Dr. Bongiorno:            Yeah. And the microbiome, so that’s the other side of the gut. So we have the stomach acid being produced in the upper gut and then down in the lower gut, we have … all these bacterias that are so important, and the microbiome and the microbiota is just such a key to keep in balance, to help produce neurotransmitters in the brain, to help keep inflammation balanced, to help process hormones in the gut. The liver, yes, processes a lot of hormones, but a lot of hormones get processed and get absorbed through the gut, and the microbiome has a lot to do with that. Plus the microbiome, that good bacteria also creates a lot of short-chain fatty acids, which has also a very important role in helping keep the brain in balance, too.

Dr. Weitz:                   And of course, to make sure you get enough amino acids, you’ve got to make sure you’re eating good quality protein.

Dr. Bongiorno:            Yeah. So yeah, protein is a key. And I tell my patients, especially first thing in the morning when your digestion is its strongest, it’s a really good idea, have a good breakfast, have good protein. But so many patients who come in, their cortisol levels are so high in the morning and they feel so awful. And I’ve been through it myself during a very stressful time where my cortisol levels are very high and I didn’t want to eat in the morning either. So I know exactly what that feels like. So it kind of sets up the day where you’re not eating in the morning, that your blood sugar is going to bounce around all day because you didn’t get the foods you needed first thing in the morning.

Dr. Weitz:                   And now, of course, a lot of people who are trying to promote their health are doing intermittent fasting, and a lot of them are instituting that by skipping breakfast.

Dr. Bongiorno:            Yeah. And for some people, it’s fine. If their blood sugar’s balanced and they’re getting their macronutrients in and their digestion’s good, then that could work for them because it does make sense. You give your liver a little bit of a break and it can clean out and do a little more in terms of detoxification. But for people who have that kind of blood sugar imbalance and their sugar gets really low, I do tell them the opposite. Usually using that example of the 17 year old with that OCD and anxiety, she probably needs less detoxification. She just needs more nourishment.  So for her, small frequent meals are better, but maybe for someone, let’s say a perimenopausal woman in her forties, maybe for her a little more intermittent fasting and detoxification would be good for her liver, might help balance her hormones. So there’s almost nothing that’s really good and bad anymore. It’s like, well, what’s going to be appropriate for an individual patient that’s going to really work for them? And that’s really the key.

Dr. Weitz:                   Personalized care, which is one of the keys to functional medicine. Yeah.

Dr. Bongiorno:            Absolutely. So yes, intermittent fasting could be very, very beneficial. It just depends who we’re using it for.

Dr. Weitz:                   Is coffee good or bad for mood disorders?

Dr. Bongiorno:            Yeah, so coffee could be pretty good. No, again, it depends on the person. So I always think about … My father’s going to be 90 and my mom’s going to be 86, right? They’re immigrants from Sicily. And my father can have four espressos and he’ll go right to bed and no problem. I don’t think he’s had a day of sleep problems in his life. My mother can drink decaf and be awake for two days. It depends on you. Some people, their liver, and now we know there’s certain genetic polymorphisms that will make us more or less able to process caffeine in a proper way through phase I of liver detoxification. And so, coffee has definitely been shown to be helpful in terms of cardiovascular health, in terms of liver health, it certainly gets the bowels moving in a natural non-addictive kind of way.  So I ask my patients, as long as the bowel movements aren’t too loose, as long as they don’t have a lot of anxiety or sleeping problems, then I think coffee’s good. I always make sure my coffee is organic because there are a lot of pesticides in coffee. And I do drink it black to make sure there’s no sugar, there’s no dairy in it. And so, for me, I feel like it’s healthy.

Dr. Weitz:                   Do you do the low mold coffee as well?

Dr. Bongiorno:            I haven’t gotten there yet. No.

Dr. Weitz:                   Me neither.

Dr. Bongiorno:            But look, it makes sense to me and especially for people who are sensitive, that might be a good idea. Look, I have patients, that’s something maybe in the beginning I might’ve said, “Oh, what’s the use of that?” But now I think about, I have patients who are celiac, if they use a shampoo that has gluten, their antibodies go up and I’ve seen it. So some people are that sensitive and they need that level of care, so yeah. So it might be a good idea for some people who are really mold sensitive.

Dr. Weitz:                   Right. What about alcohol?

Dr. Bongiorno:            Alcohol? Well, look, again, if you look at the literature, the studies keep bouncing up and down about how beneficial. We used to think that generally a little bit was fine and beneficial, and now it seems like it’s landing in such a way that for cancer, any amount of alcohol is not good, that any amount, depending on the person can help promote cancer. And that for heart disease, there doesn’t seem to be much benefit, but there might be a small benefit because alcohol is one of the few things that raises HDL levels.  So that’s my understanding right now. I also understand that alcohol has a relaxing effect for people, and I think that might have some benefit.

                                    Again, I’ll bring up my parents. I grew up, my parents always had a little bit of Manhattan before dinner, not enough to get drunk or even buzzed, but just a little bit. And when I think about that, I think now my father would come home from work. He worked hard all day. He was a bricklayer. My mom would be making dinner and you’d smell the food in the air. They would make the Manhattan with a little bit of bitters in it. They had the gentian bitters, they sip their Manhattan, they talk a little bit. They listened to some music. Then we sat down and we ate. Nobody does that anymore. So think about the role the alcohol played, it relaxed them. They got the bitters, the digestive juices were flowing. They smelled the food that they were cooking. That promotes good digestion. Those are just all things we’re not doing anymore.  So whether the alcohol is tremendously healthy for them, I’m not sure. But the overall ritual and effect I think was. And that’s what I think is missing in our lives today. We’re all so busy. We’re not sitting down having a little aperitif, cooking our food, smelling our food, our digestions getting ready, what do we do? We order food. We’re eating in the car. It’s a quick meal. “We got to go. Who’s got to go to practice?” And so, I think there’s a lot to be learned from the way we used to live.

Dr. Weitz:                   Absolutely. And herbal bitters is a great way to stimulate digestion.

Dr. Bongiorno:            Absolutely. So good to the liver.

Dr. Weitz:                   Stimulates pancreatic enzymes, stimulates hydrochloric acids, stimulates bile production.

Dr. Bongiorno:            Yeah. And the other thing it does is it helps promote our interest in non-sweet foods.

Dr. Weitz:                   Ah! Interesting.

Dr. Bongiorno:            We’re so used to sweet, sweet sweets, and a lot of us now don’t like bitter food because we’re so used to sweet because the primitive brain wants sugar because sugar, you pack fat and you make it through the winter. So if you have a winter where there isn’t enough food in a primitive world, you’re the one who’s going to live. So we’re so programmed for sugar, but the truth is the bitters are just so, like you’re saying, it has so many beneficial effects on our digestive system. And the more people can eat those bitters, the more they’re going to be inclined to eat more bitters and eat less sweet.

Dr. Weitz:                   How important is sleep and circadian rhythm?

Dr. Bongiorno:            Yeah. So sleep is basically the first chapter of all the books I write. Like I said, if we’re not sleeping and we’re not pooping, it’s hard to fix anything else. So no matter what any patient comes in with, it’s really important. I ask them about sleep and how they’re pooping. And if they’re not sleeping, then we want to work on that because sleep is where we detoxify. It’s where our mitochondria breakdown and build back up and build better mitochondria. It’s where our lymph system cleans out. It’s where our gut lining fixes itself. It’s where the liver fixes itself. It’s where the kidneys do most of their work because when we power down for the night, our body says, “Okay, now we can use our energy to do things we need to do for maintenance.” For years, nobody really understood why we slept, but now we know. We have all this great information and research teaching us why we need to sleep.

Dr. Weitz:                   Do you get into analyzing sleep? Do you have your patients use a Oura Ring or some other device to look at quality of sleep and REM and deep sleep and et cetera?

Dr. Bongiorno:            I do sometimes. Usually a good patient intake will tell me what’s going. I mean, a patient knows if they’re sleeping or not. A great question is when you wake up in the morning, do you feel rested? So oftentimes they know if they’re not sleeping. But yeah, I do think it helps and I find patients do like to see the data to see what their REM and non-REM sleep is, and if they’re getting into deep sleep long enough. So I do think it’s helpful. And I do find those things for the most part correlate with what we’re hearing clinically. I can’t say from my perspective it’s changed too much what we do, but I think it’s valuable. And I think if it helps a patient motivate to make the changes we need to make, then I’m all for it. Yeah.

Dr. Weitz:                   What about the role of exercise in helping them manage mood disorders?

Dr. Bongiorno:            Yeah. So exercise is definitely a key. If we’re not moving our body … One time somebody asked me the question, I had to think about it, “If you could only do one thing, exercise or eat well, which would it be?” And I had to think about that. And when I thought about it, I don’t even remember what I said as the answer, but when I thought about it over a couple of days, and I thought to myself, “Well, if I ate well and just sat in bed all day, I would die,” right?

Dr. Weitz:                   Right.

Dr. Bongiorno:            But if I ate crappy and moved my body, I think I had a chance. So now I’m starting to think, “Okay, well maybe exercise is more important.” I mean, neither is more important. We need both of them, obviously. But exercise, the point is that exercise is crucial and it’s absolutely important for mental health. There’s no question about it. When you get stressed out, you want to run. It’s fight or flight. You want to run, you need to move your body.   So when we have all these stress hormones and we’re not moving our body, what happens is these stress hormones affect our brain. And our brain starts to look around and our brain doesn’t realize that there isn’t a bear coming at us. Our brain just knows that there’s stress hormones up and that there’s something wrong. So if you have an average person who’s just going to work and doing the normal things of a day, but those stress hormones are high, now the brain is going to start conjuring things. And that’s where anxiety comes from and obsessive thoughts and impulsive and all these things come from because there’s something not right. The level of stress hormones in our body does not make sense with what our brain is seeing on the outside.

                                                And so, exercise is a brilliant way to try to equalize that while we’re working on the underlying reasons we are that stressed out. Exercise helps us build better mitochondria, which we need for our nervous system to work really well. Exercise. It’s interesting, there’s studies that show how exercise in the short term actually creates more gut permeability. While you’re exercising, there’s a little inflammation and you get this transient permeability. But people who exercise regularly, what’s been shown is they actually have less gut permeability because now the body reacts by healing it and creating a better gut. And we actually have better digestion as a result and less leaky gut.

                                                So many good reasons to exercise. There’s a study out of the University of Copenhagen that came out of a few years ago and showed that people who exercised moderately by running or some kind of cardio work, the men live 6.2 years longer. The women 5.6, something like that, years longer. I mean, if there was a drug that somebody could sell to you and say, “Hey, you spend $2 a day on this drug, you’ll live six years longer, no side effects, and you’ll feel better, wouldn’t you take it?

Dr. Weitz:                   Absolutely.

Dr. Bongiorno:            I would take it. I would take it. I would buy it.

Dr. Weitz:                   The longevity benefits of exercise are just so many, it’s incredible.

Dr. Bongiorno:            Unbelievable.

Dr. Weitz:                   Maintain bone density, as you mentioned before, maintaining your muscle mass, your balance, because as you get older, that’s crucial for longevity.

Dr. Bongiorno:            Yeah, it’s amazing. And you know what’s amazing to me too is that I never heard of that study in the media. No one ever mentioned it. I never saw it on the news. Five to six years live longer. Why wouldn’t somebody want to talk about that?

Dr. Weitz:                   Well, because there’s no pharmaceutical company that patented exercise and hired a PR firm to get the word out about it.

Dr. Bongiorno:            Yeah, it’s just not right. I don’t know what else to say about that.

Dr. Weitz:                   No, I know. It’s incredible.

Dr. Bongiorno:            It’s why we have a job, right? I mean, in a way, that’s it.

Dr. Weitz:                   Yeah. No, absolutely. It’s good they did the study though, because not enough research is being done on nutrition and exercise and these natural things because it’s not easy to make a lot of money out of it. And that’s who’s paying for most of the research.

Dr. Bongiorno:            Right. And a lot of the studies we see on natural medicines come from other countries because there are other governments who at least see some value in it, and the money’s put in. And if you notice, very few actually come from the United States because it’s just not a priority.

Dr. Weitz:                   No, I know. It’s amazing. I interviewed Dr. Terry Wahls, and you probably know about her.

Dr. Bongiorno:            Yeah, of course.

Dr. Weitz:                   Her story’s incredible reversing MS, and almost all the money coming for her research studies is coming from private donors.

Dr. Bongiorno:            Right, exactly. Yeah. People who care and are interested in making a difference. Yeah.

Dr. Weitz:                   Because the NIH is just not really funding a lot of that type of research on using diet and exercise and natural methods for combating chronic degenerative diseases.

Dr. Bongiorno:            Right. That’s right. Yeah.

Dr. Weitz:                   So what about in today’s world with electronics and social media? Is that something you address with patients with mood disorders?

Dr. Bongiorno:            Yeah, absolutely. Especially patients with focus issues and attention issues, and especially younger people. I mean, these bright screens, and, I mean, look at what I’m doing right now. It’s 10:18 in New York, and I’m staring at a bright blue light screen. I mean, yeah. We’re laughing, but that’s the truth, right?

Dr. Weitz:                   Yeah. No, absolutely.

Dr. Bongiorno:            Right now my melatonin wants to come up, but it can’t because I’m doing [inaudible 00:44:28]. And yeah. And that’s an issue. Plus a lot of screens there’s a lot of fast moving things. When you take kids out into nature, nature’s very slow. It doesn’t move the way a video game moves. And so, they start to get anxious about it because they’re waiting for the next dopamine hit because that’s really what it is. It’s getting addicted to dopamine and producing dopamine quickly, and it feels really good. And then when it goes away, things don’t seem as fun. Things seem bored, and then you kind of looking around for the next dopamine hit, and that’s the problem. And some kids are more susceptible than others. There are some kids, there’s interesting studies during the pandemic that showed how kids, because they had to isolate and be home, that that isolation and having to do things virtually really affected young women very heavily. And they tended to get more depressed and a lot more anxious.

                                                They found for young boys, too much was no good as well, but they found that some was actually more helpful and that some of the gaming and stuff actually kind of kept them up enough where otherwise they wouldn’t have been. So every kid is different, and certainly gender can affect it as well, but there’s no question that we’re all doing too much screen time and that’s not great for our brain.

Dr. Weitz:                   And you mentioned going out in the forest. Forest bathing is a wonderful therapy.

Dr. Bongiorno:            Yeah. Yeah, I talk about that in my books, too. It’s called shinrin-yoku, right?

Dr. Weitz:                   Yep.

Dr. Bongiorno:            And that the forest itself, the trees actually emit something called phytoncides, and that we breathe them in, it gets into our bloodstream, and it affects our nervous system in a very healthy way. It’s very calming. Inflammatory markers go down. Yeah. I mean, we’re made to be in nature.  I remember when I was in naturopathic school, one of the advice, Dr. Mitchell, one of the founders of Bastyr University, used to tell us, he used to say, “I want you to go outside and just find your favorite tree and sit and look at it, talk to it, listen to it, get to know it.” And it’s really powerful. If you’ve never tried it, sit with a tree and just talk to it a little bit and listen to what it has to say. It’s pretty interesting.

Dr. Weitz:                   Cool. So let’s go into lab testing. Tell us about what kinds of labs you like to run with your patients with mood disorders?

Dr. Bongiorno:            Yeah. So I’m a big fan of running labs. I think there’s so many, for mental health, like we were talking about earlier, there’s so many factors involved in why someone’s mood might not be right, whether it’s anxiety, depression, schizophrenia, bipolar disorder. There’s so many possibilities. And so, we want to run some labs to figure out what we need to work on. So there’s some basics that I like to run with everybody, like a CBC, blood sugar, insulin, A1c, a full thyroid panel with antibodies, vitamin D and iron panels, critical and ferritin for iron storage. And then looking at some of the vitamins, magnesium, zinc, zinc-to-copper ratio, B12. Sometimes you can’t run everything on everybody because it’s just too many vials. But what you can do is get a really good history and then start to narrow down.

                                                And then usually depending on the patient, I’ll run hormonal tests. I’ll run tests to look at cortisol and adrenal function, take a look at melatonin levels, glutathione levels, mycotoxin testing could be very important as well. And then looking at stool testing in some patients, too. Looking at the microbiome a little further. Sometimes if I hear some basics are very off, again, we were talking about that 17-year-old girl with anxiety and OCD, if there’s some basics that just aren’t there, then sometimes I won’t run a lot of testing because we know we need to get those basics in. Maybe a person needs to get to bed earlier, they need to start moving their body, they need to eat green vegetables, make sure they’re getting essential fats in their body. So if there are a lot of basics not there, then sometimes it’s not worth running a lot of tests because we know we have to get these in, and then if they’re not better, then we could also run additional testing, too. So everybody’s different.

Dr. Weitz:                   What are some of the favorite lab testing companies you like to use? Do you send patients to Labcorp and Quest, or do you use-

Dr. Bongiorno:            Yeah, I mean, I use, if we can work through their insurance and Labcorp and Quest usually that gets the job done for a lot of the basic blood work. There are a couple of specialty labs I tend to rely on. I do the Dutch panel, which is very good, but Genova also has some very good adrenal testing, too.  I love Diagnostic Solutions Laboratory.  I think they do a good job, especially with the genetics and using the Opus23-powered genetic profiles.  So that’s very helpful, too.  The GI-MAP testing is excellent.  RealTime Labs has their mycotoxin testing. Dr. Campbell has their mycotoxin. I think they all have benefits as well. So, yeah. So there’s a number of different good ones out there. Those are probably the ones I tend to use and rely on the most.

Dr. Weitz:                   For nutrients, are you running serum levels?  Are you doing some of the specialty micronutrient testing?

Dr. Bongiorno:            Yeah, I don’t do too much of those. Not that I don’t believe in them, but just that there’s already so many tests. And usually with a blood panel, it’s almost like you can’t run them all. But I get an idea from the ones we do run, and then we just make sure we cover them all with our intake. And as long as I think somebody’s absorbing, then we’ll do, but I could see some benefits of running specialty labs as well.

Dr. Weitz:                   Give us some insights on some of those labs that are helpful in how you approach patients.

Dr. Bongiorno:            Yeah. So you have somebody who can come in who could be very fatigued, and there are people who have very high cortisol, and that could fatigue them because when cortisol’s very high, it bathes the brain. And especially if DHEA is low, then you’ll see a brain that people feel really tired and almost like this kind of floaty effect at the same time. And then you have other people that are tired and their adrenals are just flat. They’re not making any cortisol, and they can have very similar clinical presentation. So running a test that looks at adrenal function, looks at cortisol could be very, very helpful because it can differentiate between those two things.

Dr. Weitz:                   That’s really interesting because we typically think of cortisol being high as the person has trouble sleeping and they’re overstimulated rather than showing fatigue.

Dr. Bongiorno:            Yeah. And I would say the majority of the time that’s true, but not all the time. So that’s why the tests are so nice. And then, yeah, for nighttime, when people aren’t sleeping, it is nice to see, is cortisol super high at night and is that the problem? Or is cortisol really normal, but they’re not making enough melatonin, or maybe they’re making enough melatonin and their cortisol is normal and it’s completely something else. So that helps differentiate. And what I’ve noticed is it kind of gets me there a little faster to help create a treatment plan that’s effective. So that’s why I like using tests like that because it can help to differentiate

Dr. Weitz:                   And hormones. Do you sometimes recommend hormones when their hormones are low?

Dr. Bongiorno:            Yeah, absolutely. I mean, hormones from pregnenolone, which helps make both cortisol and progesterone through one pathway and DHEA and testosterone, and then into estrogen in another pathway, all of those different steroidal compounds will affect the brain and the receptors that the brain makes for neurotransmitters and the metabolism of the neurotransmitters themselves. So for example, if a woman or a man has low estrogen, that’s going to affect their production of serotonin and affect the ability of the serotonin receptors to be produced, too. So yeah, we’d want to look at that.

                                                Testosterone, of course, is very important as well. In fact, I wanted to talk to Steve about that. Steve, there’s one test. We were talking about lavender and testosterone. They did this test on animals. I’ll have to pull it up, but I remembered while you were talking that they looked at, I think it was rats who were given formaldehyde poisoning to affect their liver and their testes, and they found that these rats that were treated with the formaldehyde, testosterone levels went down. But when they were given lavender, it actually protected the testicles and they didn’t see the decreases in testosterone so I thought that was kind of interesting.

Dr. Weitz:                   Really, really interesting. Yeah.

Dr. Bongiorno:            Something to think about.

Dr. Weitz:                   So you mentioned men with low estrogen that they can have trouble making serotonin. How do you address that?

Dr. Bongiorno:            Yeah, so men have have actually more estrogen in their brain than women does. So estrogen’s important, and that’s why the panels look at estrogen in men. We don’t see progesterone in those panels. We use the estrogen.

Dr. Weitz:                   So what do you do with men with low estrogen?

Dr. Bongiorno:            Well, so the next thing you want to check is are they making testosterone because testosterone gets made into estrogen. So sometimes if that’s low or really flagging, then that could be a reason. And then you want to look down the line. Are they making DHEA? Are they making pregnenolone? Are they making cholesterol? Cholesterol’s the first one that everything else is made from.

Dr. Weitz:                   Or are they taking heavy statins and trying to get their cholesterol as low as possible.

Dr. Bongiorno:            Exactly. Right. That could be an issue. It could be an issue that they don’t have enough fat tissue, that maybe they need … It’s not common, but sometimes that happens, too. So we see that as well.

Dr. Weitz:                   So you’re saying your body fat is too low?

Dr. Bongiorno:            Possibly. Yeah, possibly. So not common, but it’s possible. So then-

Dr. Weitz:                   Right. So then-

Dr. Bongiorno:            I’m sorry. Go ahead.

Dr. Weitz:                   No, I was going to say let’s go into supplements that are beneficial for depression and anxiety. And I wanted to maybe start with NAC. I was going through some of the literature, and there’s amazing research on NAC. There’s studies showing it can be used as an acute intervention for patients who are suicidal. It can be effective for severe depression, not just mild or moderate.

Dr. Bongiorno:            Yeah. Also for bipolar, there’s strong research for bipolar, for trichotillomania, which is hair pulling, which is basically an obsessive kind of [inaudible 00:56:09]-

Dr. Weitz:                   What was that term?

Dr. Bongiorno:            Trichotillomania.

Dr. Weitz:                   Great word.

Dr. Bongiorno:            Yeah, that’s the word of the day, trichotillomania. And so yeah, no, NAC, N-acetyl cysteine, it’s a precursor for glutathione, basically. And in its own right, it’s a very good mucolytic. So the perfect patient is someone who has some mood issues and are all stuffed up all the time. So maybe we get them off of dairy, do some nasal rinses, and take some NAC for all of that, and it could be very helpful. Yeah, I love N-acetyl cysteine, and unfortunately, it’s something that’s been threatened on and off for the past couple of years to be taken off the shelves.

Dr. Weitz:                   Right. Yes. Yeah. Apparently what happened is that it was originally studied as a drug.

Dr. Bongiorno:            Mm-hmm. That’s right.

Dr. Weitz:                   So there was some thought that the FDA might ban it because of that, and so Amazon stopped selling it, but it’s still being made and it’s still being sold.

Dr. Bongiorno:            Yeah. Interestingly, Amazon doesn’t also sell CBD, right?

Dr. Weitz:                   Oh, really?

Dr. Bongiorno:            You can’t even get CBD on Amazon. And I noticed also Fullscript doesn’t sell, Amazon doesn’t sell CBD as well.

Dr. Weitz:                   Really?

Dr. Bongiorno:            Yeah, yeah. Try to get it on those. You’re not going to find it.

Dr. Weitz:                   Oh, interesting.

Dr. Bongiorno:            Yeah. So, there’s still some-

Dr. Weitz:                   [inaudible 00:57:40].

Dr. Bongiorno:            Yeah. Well, it seems like there’s still-

Dr. Weitz:                   Is it the marijuana thing, you mean?

Dr. Bongiorno:            Yeah, I think there’s still some residual regulatory issues about that. I know of cases where PayPal, when people have stores, practitioners have stores, PayPal will shut it down if they’re selling CBD. So there’s still a lot of things like that going on.

Dr. Weitz:                   Oh, wow.

Dr. Bongiorno:            Yeah. We’re not there yet. But that’s an interesting thing too, because we see all this legalization of marijuana, which I’m not necessarily against, but I think the powers that be should have really taken a look at the literature and shown that people who take marijuana every day, especially young people before the age of 25, 26, when the nervous system and the brain is fully formed, it really does affect in a negative way things like the HPA axis. And I do wish, even though I think marijuana clearly has medicinal use along with CBD, I think it should have been regulated to be legal after that age, because I’m very worried about people. I have a daughter who’s 15. In a couple years, she’s going to go to college, and most likely the college she goes to, marijuana is going to be legal for her age. And I really am very concerned about kids and young people using marijuana every day.  And the problem is now marijuana is not the marijuana from the ’60s. It wasn’t like, oh, indica or sativa and sativa’s a little bit stronger. Now. It’s this very, very high THC content, low CBD content. So now we’re getting something that we’re seeing, I’m seeing it now in my practice, a lot more cannabis overuse syndrome, because people are smoking what they think is reasonable amounts, and now they’re getting addicted to it, and now they’re starting to get these syndromes, these cyclic vomiting issues, these digestive. So this is something that’s coming, and it’s going to be a big concern, too. So something that I think has a lot of benefit can also be an issue.

Dr. Weitz:                   Interesting. So what is some of the other most impactful supplements for mood disorders?

Dr. Bongiorno:            Oh, yeah. Sorry. I got sidetracked.

Dr. Weitz:                   That’s okay.

Dr. Bongiorno:            So if you look at the literature and you say, “Okay, just from meta-analysis,” for example, probably the top ones are St. John’s wort, SAMe, curcumin, and I would say Rhodiola, St. John’s wort, Hypericum, is probably the most studied herb of all time. There are meta-analysis of meta-analysis now on St. John’s wort, meaning that meta-analysis is a study of studies. Now, there’s studies of the studies of studies, and so thousands and thousands and thousands of people, and what’s been shown is that St. John’s wort clearly for mild to moderate depression works just as well as SSRIs with less side effects. So we want to be careful with St. John’s wort because if people are on a number of drugs, it can affect the activity of those drugs through the liver. It affects the cytochrome system. So you always have to be a little more careful with St. John’s wort than maybe a few other things because of that processing issue.

                                                But there’s studies that also show, for example, if people are taking Plavix, which is a drug for blood clouding to help protect the cardiovascular system, what they’ve shown is that when people take Plavix and can’t take more because of side effects, and they take some St. John’s wort, they can actually get the effect they need from the Plavix without having to increase the drug. So as much as we’re worried about negative interactions, we need to study more of these positive interactions because now we know there’s benefit there.

Dr. Weitz:                   Exactly. So I’m assuming it’s inhibiting part of the cytochrome P450 liver detox.

Dr. Bongiorno:            Exactly. Yep, exactly. And sometimes we can use that to our advantage.

Dr. Weitz:                   Absolutely.

Dr. Bongiorno:            As long as we know the medications patients are taking, how the drugs work, how the cytochrome system works, then we can make actually good decisions and use them together.

Dr. Weitz:                   Right. You can use grapefruit juice also as a way to modulate.

Dr. Bongiorno:            Exactly. Very strong. Yep.

Dr. Weitz:                   Yeah. Fish oil.

Dr. Bongiorno:            Fish oil, yeah. I mean, absolute favorite. No question about it. Studies keep coming out about fish oil. Fish oil just supports healthy cell membranes, and when you have a healthy cell membrane, you’re going to be able to get nutrients in a cell, you’re going to be able to get toxins out of a cell. You’re going to get tempered, balanced immune reactions because a cell membrane breaks when immune reactions need to happen. And that keeps it a much more tempered immune system.  Probably about a year and a half or two. Yeah, it’s probably two Augusts ago, so over two years ago now. There’s a study that came out in, I forget which journal, I apologize. One of the psychiatry journals showing how in patients who are treatment resistant to antidepressants, when they take fish oil, then the antidepressants work better. Which also made me wonder, did they need the antidepressant or did they were really just low in fish oil?  Actually, one of the tests I probably started using more and more in the past couple of years is an omega check, a fish oil, basically looking at essential fatty acids in the bloodstream. And that’s very helpful to see.

Dr. Weitz:                   Yeah. So what were those herbs you mentioned besides St. John’s wort that you said? [inaudible 01:03:37].

Dr. Bongiorno:            Oh, yeah. So the other ones I think are pretty clear from a meta-analysis standpoint, showing benefits at least as equal as the medications. And I want to qualify that because I said earlier that medications for depression work maybe 25 to 35% of the time for depression. So I’m not even suggesting that the supplements work better. They work probably around the same. So it still tells us we have a lot of other work to do. But I would say, someone with mild to moderate depression who isn’t at risk of hurting themselves or someone else, why would we start with a medication with more side effects? Why not start with something more natural to the body that can work just as well with less side effects?

Dr. Weitz:                   So yes, SAMe, which is S-adenosyl-L-methionine, can help the body move some of the cycles that help create better neurotransmitters, especially if people have poor methylation. Sometimes we’ll see people with things like high homocysteine and they have MTHFR polymorphism and we know maybe if we support the methylation with things like SAMe, you need methylation even to make CoQ10. It’s hard to make proper amounts of CoQ10 without that. So that’s a very good choice for some patients.

Dr. Weitz:                   And then of course, methylated B vitamins to go along with that.

Dr. Bongiorno:            Yeah. And in the right patients, methylated B vitamins can be very helpful, too, to help move those as well and lower the homocysteine. And then I mentioned Rhodiola. Rhodiola has a rich history starting in Russia when it was first studied, and that definitely is something that can be very, very helpful. It’s considered a natural COMT inhibitor. COMT is one of the genes that’s important for how we break down neurotransmitters. So sometimes people who are very depressed, you can use Rhodiola as a way to help keep neurotransmitters at a higher level. So it’s very supportive that way.  And then curcumin. There’s forms of curcumin that have been studied that have very good antidepressant quality and that makes sense because it’s a very potent anti-inflammatory. But there’s a fellow named Aggarwal who’s done a lot of studies on curcumin and he shows that there’s so many more mechanisms than just the pure anti-inflammatory effect that creates some of the benefits.

Dr. Weitz:                   Yeah, curcumin’s an amazing herb. I’ve seen some of the anti-cancer effects and one doctor showed a chart that showed just affecting 20-

Dr. Bongiorno:            Yeah, exactly.

Dr. Weitz:                   … different pathways that all potentially could decrease your risk for cancer growth.

Dr. Bongiorno:            Yeah, absolutely. Yeah, it might’ve been that same fellow. I don’t know because I know he’s someone who’s studied at a high level and it’s just amazing. And I remember him saying in this conference, it was a number of years ago, he said, “There’s no drug that did this, and if there was a drug, it would be an absolute blockbuster cancer drug.”

Dr. Weitz:                   Right.

Dr. Bongiorno:            So I remember those words.

Dr. Weitz:                   Yeah. What about saffron? Steve mentioned saffron. That seems to be a newer herb that seems to have some benefits.

Dr. Bongiorno:            Mm-hmm. Yeah, it’s interesting. A number of years ago I did some formulations for Douglas Labs and the formula I created was actually the first formula for mood to have saffron in it. So it’s something I’ve been interested in for many years. I first caught wind of it when I was looking for something to help patients who had libido issues with SSRI drugs, and, albeit small, there are studies in men and women that show benefits for libido when they’re taking SSRIs. So sometimes I have a patient either can’t get off a medication or really don’t want to, but they want help with libido and there’s some research there. I mean, of course we want to work on all the other underlying factors that contributed to libido, but when you see that clear SSRI-induced change in libido, that’s a reasonable choice to try.

Dr. Weitz:                   Right. Lithium, I know you wrote a paper about lithium.

Dr. Bongiorno:            Yeah, so lithium orotate also known as nutritional lithium, so not lithium carbamate the drug. Is it just very small amounts, milligrams, usually between five and 20 milligrams is helpful. I use it to help people with typically anxiousness, impulsivity, even in children, a milligram, two milligrams up to five can be helpful, too. And it’s known as a way to just help calm the amygdala, help calm that fear center of the brain, help it work better. You can check it with hair analyses and see if levels are low or just start on low levels. I personally have never seen it affect kidney function or thyroid function the way the drug does. I think it’s still a good idea to check those before and during just to make sure. But I’ve been using it for years and I haven’t seen any issues like that, thank goodness.

                                                In fact, I was on a group today, I was teaching nurse practitioners and functional psychiatrists, and one of the fellows, I think it was a psychiatrist, had told me that he saw somebody go up to 30 milligrams and do quite well with it with no issues as well. So I hadn’t actually used it at that high. Usually I don’t go past 20, but he said 30 milligrams wasn’t a problem, at least in the one patient he saw. So yeah, definitely very, very helpful. I actually like combining it with CBD. I find they work really nicely together. So supporting the endocannabinoid system, calming the amygdala seems very helpful.

Dr. Weitz:                   And then there’s specific amino acids and other nutrients to help support the various neurotransmitters. So we have 5-HTP, we have Mucuna for L-dopa, we have GABA. What about some of those supplements?

Dr. Bongiorno:            Yeah, I mean, if you hear that when patients tell you that, “Oh, I took a drug, it raises dopamine like Wellbutrin,” for example, which is very good at raising things like dopamine, then yeah, then it makes sense. Well, why not support the dopamine pathways more naturally if we can? And Mucuna, which is a natural amount of low levels of L-dopa can be useful along with some tyrosine, which helps support the pathway to make dopamine. Of course, we always want the co-factors in there. We want vitamin B6, vitamin D levels, zinc levels appropriate as well, because those are going to be really important for the body’s ability to use those materials to make the eventual neurotransmitters, too.

                                                But yeah, those are great, 5-HTP to support serotonin. Sometimes I use tryptophan, sometimes I’ll use 5-HTP. I find tryptophan helps people stay asleep better at night, so sometimes I’ll use tryptophan at night, but 5-HTP during the day. I know some practitioners from a theoretical standpoint feel that if there’s a lot of inflammation and they’re going through that quinolinic acid pathway, then maybe 5-HTP is a better choice. I find this really interesting, even though theoretically and it makes sense. I’ve seen in practice that hasn’t necessarily affected it, so I just try to use what’s best and what I think is working for a patient.

Dr. Weitz:                   Interesting. Which company do you get the tryptophan from?

Dr. Bongiorno:            I’ve been using tryptophan from Douglas Labs typically. Yeah. They have a little bit of B6 in there, so it’s nice if a patient isn’t taking B6 or doesn’t have enough level, then that’s helpful.

Dr. Weitz:                   Okay, good. Yeah. I think most of the functional medicine supplement, professional supplement companies are carrying 5-HTP, but not so much tryptophan.

Dr. Bongiorno:            Right? Yeah. I know tryptophan’s a little bit old, but I don’t know. They took=

Dr. Weitz:                   Well, you took it off the market.

Dr. Bongiorno:            I’m a little bit old. Well, that was a mistake. That was purely because the company had introduced the bacteria there. In fact, it was interesting. When I did research when I was in my twenties, right out of college at the National Institutes of Health was, it was like this sort of predoctoral fellowship, and there was a doc in one of the labs I worked in. Her name was Esther Sternberg, and she was actually one of the people who testified because she was a well-known tryptophan researcher. So they brought her in to talk about tryptophan. And so, she was one of the people that helped them understand that tryptophan itself doesn’t cause eosinophilia-myalgia syndrome, this EMS, which about 30 or 40 people unfortunately die from. But it was actually just the bacteria that was introduced by the company who I guess shouldn’t have been making that they didn’t know exactly what they were doing.

Dr. Weitz:                   Right. Okay.

Dr. Bongiorno:            Yeah. Very unfortunate.

Dr. Weitz:                   Excellent. Any final thoughts you want to leave us with?

Dr. Bongiorno:            No. Well, what I would say is if you’re listening out there and you have mood issues, and I know what they feel like because I’ve had some myself and I’ve been through a little bit, unfortunately, too. When you’re going through it, it just feels like nothing can help you. It almost feels like this monster from the outside who just comes and goes as he or she pleases and doesn’t let you live the life you want to live. It’s always worth looking for a practitioner who will sit and listen to you and help look at these underlying issues. And I can tell you that there are things that can be done and it’s always worth searching for them. And of course, if for at any time you feel like you want to hurt yourself or something, please call a loved one. There’s wonderful hotlines, people who really want to listen and who care and who are there to help.

Dr. Weitz:                   Anybody on the call right now who wants to ask Peter a question, you feel free to unmute yourself or type it into the chat box. Okay. And then how can folks who listen to this get ahold of you?

Dr. Bongiorno:            Oh, yeah. Thank you. So yeah, so my website is drpeterbongiorno.com. That’s D-R-P-E-T-E-R-B-O-N-G-I-O-R-N-O dot com. It’s a very long name, drpeterbongiorno.com. Yeah, so feel free to. All my contact information is there.

Dr. Weitz:                   Excellent. Thank you so much.

Dr. Bongiorno:            Oh, thank you. And thank you for all the work you do and just having me on. And it’s really an honor and I appreciate everything you’re doing, all the good information you’re putting out there.

Dr. Weitz:                   Thank you, thank you.

Dr. Bongiorno:            Thank you, Dr. Ben.

 


 

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 certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. That way, more people will discover the Rational Wellness Podcast. And I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective.  So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

 

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The Benefits of Polysaccharides with Dr. John Lewis: Rational Wellness Podcast 327

Dr. John Lewis discusses The Benefits of Polysaccharides 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

13:26  Polysaccharides.  Polysaccharides are complex sugars and some of them have unique health promoting properties, including those that come from aloe vera and from rice bran.  Aloe vera is 99% water, so you have to extract the polysaccharides out of the aloe vera plant and this acetylated polymannose has amazing properties.

20:25  Polymannose.  Dr. Lewis met Dr. Reg McDaniel who had been working on the aloe plant since the 1980s at the Texas A & M vet school, who is still doing research at 87 years of age.  Dr. McDaniel shared studies that these aloe derived polysaccharides were anti-inflammatory, antioxidant, antiproliferative, and have wound healing benefits.  He found that in addition to the wound healing and stem cell production boosting function of aloe vera, this polymannose is a key sugar when the endoplasmic reticulum and the Golgi of the cell are communicating with each other and making other bioactive compounds that you need.  This polymannose is similar to d-mannose, which is often recommended as part of a protocol along with L-carnitine and CoQ10 for supporting the heart muscle in patients with congestive heart failure, though Dr. Lewis’s research was more focused on brain health.

25:51  Aloe polymannose multinutrient complex.  In their study on the polysaccharides for Alzheimer’s patients, Dr. Lewis and colleagues used an aloe polymannose multinutrient complex, including aloe polymannose, rice bran, larch tree, cysteine, lecithin, tart cherry, inositol hexaphosphate, yam, flax seed, citric acid, and glucosamine.  They gave the patients this nutritional supplement four times per day in a powdered form that put into a liquid to drink. For the Alzheimer’s study, they took patients with moderate to severe disease, which means the sickest of the sick and this group is the hardest to see improvements with.  The neuropsychological testing showed a significant improvement at nine and twelve months.

35:06  Alzheimer’s study lab results. The lab results showed statistically significant reductions in VEGF and TNF alpha.  There was an improvement in CD4 to CD8 ratio, which obviously is very important for all of us.  They also showed an improvement of just under 300% in CD14 cells, which is a marker of adult stem cells.  And the average age of these patients were 79.9 years of age.  They theorized that these adult stem cells migrated to the brain and created new neurons, new synapses, and repaired damage to neurons.  Also BDNF levels went up by 11%, though this was not considered to be statistically significant.  They did not ask these Alzheimer’s patients to change their diet or to exercise or do anything else to improve their lifestyles.  We can only imagine how much more benefit might have been derived if this nutritional intervention were used as part of a Functional Medicine approach that also put them on a healthy diet and had them perform vigorous exercise and do brain stimulating exercises as well, such as the approach used by Dr. Dale Bredesen. [The Effect of an Aloe Polymannose Multinutrient Complex on Cognitive and Immune Functioning in Alzheimer’s Disease.]

44:45  MS study. These patients with relapsing remitting MS were placed on a similar aloe polymannose multinutrient complex four times per day for 12 months.  The FAMS (Functional Assessment for MS) questionaire was used for functional assessment and results showed very significant improvements in every scale.  MS patients frequently get infections and these patients who took the nutritional intervention had much fewer infections.  Serum biomarkers, quality of life, symptom severity, and functioning also improved. [The Effect of a Polysaccharide-Based Multinutrient Dietary Supplementation Regimen on Infections and Immune Functioning in Multiple Sclerosis]  and  [The Effect of Broad-Spectrum Dietary Supplementation on Quality of Life, Symptom Severity, and Functioning in Multiple Sclerosis]                            



Dr. John Lewis is the founder and President of Dr. Lewis Nutrition and the website is DrLewisNutrition.com. Dr. Lewis was a professor of Psychiatry and Behavioral Sciences at the University of Miami School of Medicine and he was the principal investigator of over 30 different studies in his research career.  Much of his research has focused on the effects of nutrition, dietary supplementation, exercise, and medical devices on various aspects of human health and disease.  One study that he was involved with that we will discuss is The Effect of an Aloe Polymannose Multinutrient Complex on Cognitive and Immune Functioning in Alzheimer’s Disease.

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. Dr. Weitz is also available for video or phone consultations.

 



 

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. Our topic for today is the benefits of polysaccharides with Dr. John Lewis. We have discussed many topics in nutrition, especially as related to brain health. And typically, part of the discussion is usually about reducing carbohydrate intake to improve insulin resistance, getting the brain to work off of ketones, et cetera. We’ve recently had discussions with Dr. Dale Bredesen, Dr. Heather Sandison, and Dr. Kabran Chapek, all of whom advocated for some version of a low-carb or ketogenic diet for most patients with cognitive challenges like Alzheimer’s disease or after concussions. Now we have Dr. Lewis to advocate for polysaccharides or carbohydrates for brain health, the lowly carbohydrate, the much maligned carbohydrate in the world of nutrition.

                                Dr. John Lewis is the Founder and President of Dr. Lewis Nutrition. He was a professor of psychiatry and behavioral sciences at the University of Miami School of Medicine. He was a principal investigator of over 30 different studies in his research career. Much of his research has focused on the effects of nutrition, dietary supplementation, exercise, and medical devices on various aspects of human health and disease. One study that he was involved with that we will look at is the effect of an aloe polymannose multi nutrient complex on cognitive and immune functioning in Alzheimer’s disease. Dr. Lewis, thanks for joining us.

Dr. Lewis:            Thank you for having me. It’s a pleasure to be here, and I’m happy to follow such distinguished guests that you recently had.

Dr. Weitz:            So how did you become interested in health, nutrition, and dietary nutritional supplementation?

Dr. Lewis:            Well, like a lot of people, I think I was lucky. I started out at a very early age, my grandfather pitching baseball to me out in the backyard and getting me on a track of playing sports most of my youth. And then after high school, getting into drug-free competitive bodybuilding. It was kind of just a natural progression for me, continuing to be active, obviously in a much different fashion as opposed to playing team sports. But then, at that point, I kind of got, I would say, very interested in how nutrition, exercise, stress, how all of that affects the body, affects everything from our individual cells all the way up to who we are as a human. And so I sort of went from there. It’s been a long evolution, a long progression, but excuse me, in my twenties, I shifted out of more of an interest in performance and sports, there’s nothing wrong with that, of course, but into more of a health orientation.

                                And I felt like for people who are gifted with the opportunity to play competitive sports at a very high level, obviously that’s a very, very tiny percentage of our population, but everyone’s affected by health regardless if you have any sports acumen. So I thought it was much more important to go down that road in my professional career of looking at, as you said, the way nutrition, supplements, different types of exercise, affect health and really many different parameters around health as opposed to performance. I mean, I still lift every day. I’m still very active in my own personal exercise routine, obviously, I’d be a hypocrite if I was not. But as far as all of my interests go, I’m going to continue the rest of my life looking for ways really mostly through nutrition and supplementation to help people be healthy, because I feel like, I don’t know about your opinion, but I believe as far as the science goes, nutrition is up here. To me, it’s the absolute number one behavior. Exercise is a pretty far number two below it, and then obviously everything else sort of falls into place.

                                To me, nutrition encompasses so many different things just simply because every time we put something into our mouths, we’re giving coded information to ourselves, guided by our genes, to either express or suppress or do things genetically. But all those other downstream effects of metabolism, there’s nothing else that you, well, other than of course, drugs and smoking. I mean, those are different topics, but nutrition, everything we put in our mouth, what we eat and drink, just gives our… It really is true. You are what you eat. And so all that is very important to me in terms of what I’ll do the rest of my life continuing to look for answers for health.

Dr. Weitz:            I’m on the same page with you. Nutrition is information, learned that from Jeffrey Bland 30 years ago, and I think that’s a big basis of functional medicine, which is a big part of my practice. So what led you to, by the way, I also was a competitive bodybuilder back in the eighties, and so we have a similar start, except I didn’t go into academics, I went into becoming a chiropractor. What led you to a research career in academics?

Dr. Lewis:            Well, that’s an interesting part of my life as well. I got into undergrad and I’m trying to, like many people in college and university, you’re trying to figure out what you want to do with your life. And I just sort of fell into it actually. I decided once I really, as I mentioned previously, got into this idea of getting really focused and really understanding why the body works, as you know as a former competitive bodybuilder as well, it’s so important to be very dialed-in and very specific in what you do, because otherwise you really are going to struggle with achieving anything if you’re not very focused on your effort and making the best use of your time. And so as I continued wanting to develop really my knowledge, which actually there are obviously many aspects of that too. I learned a lot of things just in my own discovery through reading the literature.  But I just, as I continued going from my undergrad to my master’s degree to my PhD, it seemed like I enjoyed the academic lifestyle at that point in my life. And I felt like conducting research was something very valuable. I guess I was a bit naive at that point in terms of all the funding and how you have to be such a dog-eat-dog kind of personality to really bring in funding to be able to do your research. And then, oh, by the way, here, a guy like me, as you mentioned, I’ve had this long career at the University of Miami, which is a very conventional pharma-focused institution. So here a guy like me, a physiologist, doing nutrition and supplementation and exercise research in a very, very conventional environment where the majority, not the majority, almost everyone is doing, if you’re not doing pharmacology or genetics or some combination, you’re pretty much a black sheep.  And so I was very much a black sheep most of my academic career, and ultimately that was a big reason that I actually left academics. Don’t get me wrong, I’m not bitter because I did end up making what I feel like are for some very important and cool discoveries. But I just, to answer your question, I really enjoyed the academic lifestyle at that point in my life, but eventually I got to a point where I was so burned out on spending so much of my time trying to raise money and trying to break into this clique, if you will, in NIH and other large foundations where they really only want to fund, again, drug research or genetics research. Nutrition, they may talk a good game publicly, but they’re not interested in nutrition. They don’t view it as a way of making money eventually.

Dr. Weitz:            Exactly. This is unfortunately one of the issues I talk about quite a bit is that while the capitalist free market economic system is a great system for spurring innovation and creativity and has led to a great economy, I don’t think it’s a great way to run the healthcare system. And most of the money and research is coming from drug companies. I talked to Dr. Terry Wahls. I mean, she has the most incredible story, is helping thousands of people to turn around this horrible condition, MS, and her data’s incredible, and all her research is being funded by private, wealthy donors who she happens to know because there just isn’t a lot of money around. As you said, the NIH, most of the people on the NIH, have worked or have closely worked with big pharma and big pharma controls all the money. So if there’s not a lot of money to be made, unfortunately the research is not going to get done, which is too bad.

Dr. Lewis:            That’s right. And just to extend that point, so I left academics full-time about six years ago, and I still have a voluntary appointment. But when we published, which I’m maybe jumping ahead a little bit, but the results of the Alzheimer’s study that for me was so profound and still is so profound in terms of my own career. We published the first article from that study in 2013, and I was so excited at that point. I really had a high, what we had shown, and we’ll talk about that hopefully in a minute.

Dr. Weitz:            Yeah, you would’ve thought that the people from NIH would’ve been begging to give you more money.

Dr. Lewis:            Exactly. I tried twice with NIH, twice with the Alzheimer’s Association, to get funding to extend our work. I got crickets in response, nothing.

Dr. Weitz:            But they’re spending tens of billions of dollars researching these drugs that have had zero benefit for patients with Alzheimer’s. And they’ve been approving a series of these drugs recently. And the only benefit is to slow down the worsening of the disease. None of them make any of the patients better.

Dr. Lewis:            I know. It is so sad. And I guess that’s where my naivety or my gullibility of how academic research works pretty much came to a conclusion at that point. When I know for a fact, I mean, I’ve had friends who worked for NIH, I’ve had friends who’ve spent a lot of time sitting on review committees, and they all have told me that the typical NIH mentality is, they don’t want to fund something that they think will not work. So in other words, when they get reviewed, when these reviewing people, when these board members get reviewed, their boss wants to be able to say, “Well, yeah, so-and-so funded all this research that showed this many benefits to society or health or whatever.” And so they have this bias where if you submit an application that if they ultimately decide, well, there’s no snowballs chance in hell of this thing working, we’re not giving this guy any money.

                                Well, in my case, we were submitting a proposal with data, like we actually said, “Hey, look at what we’ve done. We have already demonstrated some success here. Give us more money to help us extend this line of research.” And for 10 years, that has not happened, which is like a hole in my heart. I mean, thankfully for Dr. Wahls, she’s had people supporting her work in MS. Well, that was the same in our case. The only reason we even ran this Alzheimer’s study was due to the generosity of a family who had lost four of their family members to Alzheimer’s, and they gave us money to run a study. So you’re absolutely right. I mean, if you don’t have some network of really wealthy people that have more money than common sense, then if you’re trying to do something in our world in nutrition, I don’t know where it comes from.  So my goal, part of my business goal as an entrepreneur, is to make my company successful enough where I’m going to fund my own research eventually. I’m not begging people. You know what? I’m over the begging game. I begged the government, I’ve begged foundations, I’ve begged people. I’m done with all that. I’m just going to make enough money in my own business that I’m going to fund the research myself.

Dr. Weitz:            Well, the problem is you’re trying to promote health and our so-called healthcare system is only designed to treat disease. There’s no promotion of health at all.

Dr. Lewis:            Zero. It’s not a healthcare system.

Dr. Weitz:            It’s not. It’s a sick care system.

Dr. Lewis:            That’s right. It’s a travesty.

Dr. Weitz:            Let’s get into the topic at hand. What are polysaccharides and why should we be excited about them? Aren’t carbohydrates bad?

Dr. Lewis:            I love it. I love that question. For me, it’s just such a neat little thing to do when I talk about sugar. So yes, to your point, I mean-

Dr. Weitz:            Well, why don’t you start by defining what is a polysaccharide.

Dr. Lewis:            Exactly. So it’s a complex sugar. I can imagine some of the other folks you’ve had before that talk about keto and this and that. I mean, it is fine. I’m not here to be an enemy to people like that or to try to be some maelstrom type person. But these polysaccharides are so unique in their function and they’ve been shown, just time and time again, not just through the work in our lab, but people all around the world that these complex sugars. And if I said, “Well, sugar is good for you.” Again, most of your listeners will probably laugh me off the screen here, but a sugar is not a sugar. And so for me, when you say the word sugar, you have to be very careful because you’re using a very generic term that if you’re talking about high fructose corn syrup, well sure, that’s not good for you, don’t eat it. Look on your label, and if anything says high fructose corn syrup on it, put it back on the shelf, don’t buy it.

                                But these complex sugars, and again, a sugar is not a sugar. It depends on the molecules, it depends on the chain in the molecules, and it also depends on the source. It’s not just a matter of whether something is a mono or a di or a polysaccharide. It also, in my view of the world, it depends on the source of these things. So what we’ve shown in our work now, going back close to 20 years, is that these two particular polysaccharides that we’ve focused on a lot come from aloe vera and rice bran. Well, obviously humans have been using aloe vera since recorded history. I mean, that’s pretty much a no-brainer, but unfortunately, most people think of aloe vera as something for a topical purpose, which is fine. If you have a sunburn or a cut or a wound or something, I don’t knock you for putting a little aloe vera gel on there, that’s fine. But an aloe vera gel is 99% water, and so to get the polysaccharide out of that gel to have a very therapeutic benefit is going to be unlikely.

                                You really need it in a concentrated form where all that water has been taken away and the polysaccharides have been extracted out of there. So mannose, acetylated polymannose, aloe polysaccharide, there are a lot of synonyms for the same thing. But basically this particular polysaccharide coming to us from the aloe vera plant is just so dynamic and so amazing. And then the rice bran, not the same, but similar to, the same story. Obviously, humans have been eating rice since recorded history, but unfortunately, most of the world prefers to eat white rice. Well, when the rice is milled from when it comes from the field into the processing center, when the kernel is stripped off, which is mostly the bran, and the bran is actually packaged up and fed to animals, the animals are actually getting the best part of the rice. If you’re only eating white rice, you’re eating just basically simple carbohydrate, and you’re not getting all the dynamic polysaccharides that are contained in that rice bran.

                                So the interesting thing for me, when I think about this whole keto, even the carnivore craze that seems to be growing, which I completely don’t understand, that’s another topic, but you don’t have to be like, we’re talking just a couple of grams of carbohydrate per day. To me, that’s what’s interesting about people typically talking about carb, carb, carb and carb, carb is bad, but we’re only talking about, from our research, and again, people in other labs around the world, you only need a couple of grams at the most of these polysaccharides per day. I mean, really, is somebody going to be offended by taking 500 milligrams, a gram, a couple of grams of these polysaccharides per day when you’re so focused on protein and fat? I mean, to me, that just doesn’t… You know what I’m saying? That’s irrelevant.   When somebody’s eating 500, 600, even a thousand grams of carbohydrates per day of mostly processed garbage, sure you’ve got a big problem. But if you’re going to talk about being keto or carnivore or whatever, and then adding a couple of grams per day of these polysaccharides into your diet, and you have a problem with that, I’m sorry, you’re lost. You are totally missing out on some incredible benefits from these polysaccharides.

Dr. Weitz:            You might be better for marketing purposes describing it as a phytonutrient.

Dr. Lewis:            Sure, absolutely. But you know what? I had a lady call me up the other day ripping my butt over the fact that I had flaxseed in our formula, and she’s telling me about all the problem with phytoestrogens and this and that. I had to endure this lady because I’m subject to being left some horrible review on Google or something. This lady’s completely talking out of her butt. She didn’t have any idea what she’s talking about making all these wild accusations about, she’s going to call the FDA and tell the FDA that anything that’s got flaxseed in it should have a label warning that says, “Oh, it contains phytoestrogens.” I’m like, “Lady, you don’t even know what you’re talking about. Lignins are some of the most anticarcinogenic phytonutrients known to humanity, and you’re telling me that a few hundred milligrams of flaxseed in my formula is a health problem. Are you nuts?”

Dr. Weitz:            Yeah. You just have to ignore that.

Dr. Lewis:            Are you nuts?

Dr. Weitz:            There’s a lot of opinion. When you talk about rice bran, it’s interesting. I’ve had Dr. Barrie Tan on talking about tocotrienols, and I know rice bran is one of the sources for tocotrienols.

Dr. Lewis:            Yes. Well, again, rice bran, I mean, I think, again, in my view of the world, I’m going to put rice bran, if I have to make a hierarchy, I’m going to put the aloe polysaccharide at number one. I’m going to put the rice bran polysaccharide at number two. But I mean, there have been thousands of different amino acids, fatty acids, in addition to the polysaccharides, vitamins, minerals, elements, co-factors, metabolites, all found within rice bran. I mean, what a dynamic food source this is. And so anybody that says, “Oh-“

Dr. Weitz:            Of course, a source of fiber as well.

Dr. Lewis:            Fiber as well, exactly. So anybody that says, “Oh, I can’t, can’t have a little bit of rice bran in my diet, I’m too strict.” Well, okay, fine, but you’re losing out on some amazing nutritional benefit to your cells.

Dr. Weitz:            Tell us about how the aloe polysaccharide, how does it have these health benefits, and about the studies you’ve done?

Dr. Lewis:            Well, again, we ran these trials. Actually, we also ran a trial in MS as well, in addition to the Alzheimer’s study. But I was very fortunate to meet a couple of people back nearly 20 years ago. One gentleman, Dr. Reg McDaniel, who had been working on the aloe polysaccharide for, gosh, he started back in the eighties, and this man is still going to his office every day, 87 years old, still fighting the good fight. I mean, what a warrior for health Dr. McDaniel is. I don’t know about you, but in school, I thought maybe, if I recollect, it’s very many years ago that I was in school, but I may have had a half a lecture in biochemistry at one point about polysaccharides or saccharides in general. And all I knew about them at that point was that they were an energy source.

                                I didn’t really know much about anything else related to their function. But when I met Dr. McDaniel, and he started sharing with me all of the work that he and his colleagues had done, primarily at Texas A&M at the vet school, it was just an amazing enlightening experience. And just, as you do, once you go down a path and you start building your knowledge base and you discover all these different things that these polysaccharides can do, and again, mostly focused on aloe vera at that time. But to answer your question, what’s ultimately been shown, and I’ll talk a little bit about our findings as well, but before even running our study, if you just look into the literature, go to PubMed and type in acemannan, mannose, acetylated polysaccharides, you’ll find many studies that have shown that it’s anti-inflammatory, it’s anti-oxidative, it’s antiproliferative, of course, all the wound healing benefits.

                                In fact, I think FDA actually has some sort of, I don’t know, I’m not too familiar with the FDA world in terms of approvals, but FDA has granted some sort of a wound healing benefit to aloe vera that people can use, I guess, for labeling and claims purposes. But in addition to that, boosting stem cell production, there are just lots of different mechanistic functions that this polymannose has. And so what has been shown by other people around the world, again, not in our lab, but just in general, people looking into the glycomics field, is that this particular mannose, this one key sugar that comes from aloe vera is needed when the endoplasmic reticulum and the Golgi are communicating with each other, and they’re making other bioactive compounds that you need so many molecules of mannose in that process.

                                So obviously oxygen is our number one nutrient. And then beyond that, we have vitamins and minerals, amino acids, fatty acids, but mannose is very important in that chain where, again, when you’re talking about that activity in the organelles and all that coded information, again, going back to what Dr. Bland said, all that coded information from mannose, from these polysaccharides, is actually way, way more than what you get from amino acids, fatty acids, even vitamins and minerals. So it’s so much coded information in there, in that mannose, to be able to then guide the cells to do their job. And so whether it’s again, creating another bioactive compound, phosphorylating, glycosylating, communicating with another cell, I mean on and on and on, that mannose is so crucial to that.

                                And so what we’ve showed really in our research kind of at a helicopter view level is that, I like to use the analogy of an old car. If your car has water in the gas tank, you get the gas cleaned up, you get the water removed, and you start giving it high test gasoline, your car may function better, it may start driving like it’s a newer car again. Same thing with our cells. It’s really true. Again, we are what we eat. And so these polysaccharides, it’s just like pouring gasoline on the fire. Once you give the cells the proper nutrients, the raw materials that they need to function properly, they will do that. And so it’s basically going back to a very key component of the bioengineering of life.

Dr. Weitz:            So I’m familiar with the use of d-mannose as part of a protocol for supporting the mitochondria in the heart along with l-carnitine and CoQ10, is this polymannose similar to d-mannose?

Dr. Lewis:            Absolutely. It’s the same chemical structure.

Dr. Weitz:            Oh, okay. Exactly. So there’s a ton of data showing the benefits of that for patients with congestive heart failure. So potentially your product could have benefits there as well.

Dr. Lewis:            That’s right. Well, and again, our only limitation in terms of answering research questions is just simply money. I mean, if we had an unlimited source of funds, we’d be running other clinical trials. It’s just we’ve been very focused on the brain due to this family’s generosity and wanting us to stick with Alzheimer’s. We did run a sister study in MS as well, but if you want me to, I’m happy to share with you the results of our clinical trials in both of those studies.

Dr. Weitz:            Sure. But by the way, I was looking at the paper, it looks like it’s a combination of products. It looks like a combination of different nutrients in that product that you use, correct?

Dr. Lewis:            That is correct. So we were not interested in trying to create or fall under the pharmacological model of one synthetic or one chemical for one mechanism of action for one disease or symptom of disease. We really, due to the severity, and I don’t know if you’ve had any family members with Alzheimer’s, I personally have not, but just due to the severity of the disease, the lack of anything from a conventional treatment perspective to even help people, and just really the desperation, the sheer desperation. I mean, when I got into running the study and hearing from these caregivers that are just the most desperate people on the planet to find something, we believed that just looking at say, aloe by itself, while it could have been very effective, was probably a limited view and not really a nutritional view.  So as you well know, nutrition is more like a shotgun where you’re providing hundreds if not thousands of things all at once to the cells compared to the pharmacological paradigm where again, it’s just one chemical or one synthetic compound for one mechanism of action. So we were trying to help people the best we could, and combining with some of these other things like the rice bran, the flaxseed, the tart cherry, the sunflower lecithin, the [inaudible 00:27:30], the citric acid. Again, we were trying to really give these folks something to help them. 

Dr. Weitz:            I’m kind of interested in all these compounds. Maybe just real briefly, you could give us a thought as to why you included some of these other compounds. I see, besides the polymannose from the aloe and the rice bran, there’s large tree fiber, large tree soluble extract, cystine, soy lecithin, ultra terra calcium, aluminosilicate, tart cherry, inositol, yam powder, omega-3, citric acid, and glucosamine.

Dr. Lewis:            Yeah, and actually we had a change in the formulation midway through the study. We actually had to swap out some of the larch due to supply concerns that we increased the amount of aloe in that second iteration of the formulation. But to answer your question, so for example, the flaxseed, obviously being a very rich source of omega-3 and lignins, and fiber as you mentioned. I mean, that was-

Dr. Weitz:            So the flaxseed, is that the omega-3?

Dr. Lewis:            Yes, exactly that, yes. And then we actually switched from soy lecithin to sunflower lecithin. Again, because some people are very touchy about soy. So we decided to switch to sunflower, which obviously is a good source of choline. So choline has been shown in many different studies to be very beneficial for the brain.

Dr. Weitz:            Precursor for acetylcholine.

Dr. Lewis:            Yes, exactly. The IP-6, that’s a very interesting compound that actually also comes from rice bran and much more so than say for brain health effects, but it’s actually been shown to be very anticarcinogenic. So we felt like anything like that that could help to lower inflammation. And obviously, the people that we ran in these clinical trials, they didn’t just have Alzheimer’s or MS. I mean, they had other comorbid conditions as well.  The tart cherry is very interesting. I mean, it’s just got a plethora of different nutrients in it. It’s actually a good source of melatonin as well.  So we felt like for overall, again, this strategy of giving an overall compliment to different metabolic pathways, it was a good selection.  The diaspora, the wild yam, is a very nice endocrine modulator.  It’s got these saponins in it that are not completely understood why they affect or modulate the endocrine system, but they’re very beneficial from that.  What else am I missing?   The ultra terra clay has some very interesting properties. It comes from a very deep water lake in the state of Mississippi, and it has very potent chelating properties to it. So one of the nice things that this formula does is, while it’s giving you all these different nutrients, we’ve got the clay in there to help strip out different things that build up over time, whether it’s heavy metals, arsenic, PCBs, PFAs, all these different things. So it’s got a very nice detoxifying effect as well. So while you’re feeding the body on the one hand, you’re also helping to clean it up on the other with the clay. So we love that particular ingredient in the formula. Of course, citric acid, it’s obviously a very well-known antioxidant part of the Krebs cycle, being very important to help produce all the different cellular metabolism. Oh, I’m forgetting NAC, n-acetylcysteine, obviously is a precursor to glutathione.    So prior to some of these more recent technologies using liposomes or micelle or other nanotechnology, obviously there’s been a big problem for many years of trying to deliver glutathione orally. So if you can put in NAC where it’s obviously the precursor to glutathione, now you’re helping to boost the body’s own production of glutathione. So again, we were looking at multiple metabolic or mechanistic components to this formula in terms of lowering inflammation, lowering oxidation, boosting overall immune function. And then we ultimately, to our surprise, to our pleasure, or to our excitement actually, we showed an increase in adult stem cell production. So all these things ended up happening in our Alzheimer’s study on the one hand.

Dr. Weitz:            So you gave this nutritional product once a day, twice a day?

Dr. Lewis:            Four times per day.

Dr. Weitz:            Four times per day, okay.

Dr. Lewis:            Yes. About two and a half grams per serving.

Dr. Weitz:            So is that like a scoop or something that they put in liquid?

Dr. Lewis:            Yes.

Dr. Weitz:            Okay. And they took this for a year?

Dr. Lewis:            Yes. So for the Alzheimer’s study and the MS studies, actually, they were both one-year interventions. For the Alzheimer’s folks, as I mentioned, we did a powder that, we felt like for a lot of people with dementia or Alzheimer’s, they have issues with swallowing. So a powder would be preferable, and it turned out to be true as opposed to taking a capsule or a tablet. So that was a good choice for that study. For the MS study, it didn’t matter quite as much. They didn’t really report having swallowing difficulties per se. But for the Alzheimer’s study, we chose people with moderate to severe disease. We felt like we wanted to choose the sickest group of people. And as I’m sure you know, those folks are not typically ever selected for studies with big pharma. Big pharma looks at those folks as lost causes basically.

Dr. Weitz:            Just so we have a context, what would be the range of MoCA scores?

Dr. Lewis:            Oh, gosh. On the MoCA, we didn’t use the MoCA. We used the ADAS-Cog. So the ADAS-Cog is really the gold standard for assessing cognition in dementia studies. The ADAS-Cog goes from a 70 where you’re basically like a piece of furniture, you have zero cognitive ability all the way to a zero, which is basically perfect cognition.

Dr. Weitz:            Oh, the opposite of some of the other tests.

Dr. Lewis:            Yeah, exactly. So it goes down. Going down means a good thing. And for the ADAS-Cog, I believe I don’t have the data in front of me. I think at baseline, it started out in the forties and it got down to, well, it was a four point change, which according to what the ADAS-cog people say, anything four or greater is clinically significant. And we were just beyond four points at both nine and 12 months. So we did the neuropsych testing at baseline 3, 6, 9, and 12 months, and then we drew blood at baseline and at 12 months. Unfortunately, our budget was limited. We didn’t have enough money to draw blood at three, six, and nine, but the neuropsych testing was done every quarter. And again, we got clinically and statistically significant improvements in cognitive function at nine and 12 months. So at that point, I mean, we were just beyond thrilled, and that’s where I was still in sort of my naive thinking that NIH or Alzheimer’s Association or somebody was going to jump on this and help us out, which never happened.

Dr. Weitz:            What were some of the results of the labs?

Dr. Lewis:            So the most exciting things in terms of the labs were we showed statistically significant reductions in VEGF and TNF alpha. So those were probably, I think, probably the first time that had ever been shown in people with Alzheimer’s. I don’t think anybody else had shown that, at least not with moderate to severe. And of course, those two markers typically have mostly been looked at in either cancer or heart disease. So again, I think we were the first group to actually publish that in Alzheimer’s. So that was really interesting.

                                The second interesting finding was the improvement in CD4 to CD8 ratio, which obviously is very important for all of us. It’s not just for people with dementia or even people with HIV, for example, but for all of us. As we age, we want our helper cells to be as high as possible in relation to our cytotoxic cells. So that was a really nice finding. And then third, we showed an improvement of just under 300% in CD14 cells, which is a marker of adult stem cells. We couldn’t believe how much those dramatically improved. And oh, by the way, I didn’t mention that the average age of our subjects was 79.9 years of age. So we’re talking a relatively old group of people that not only had this tragic Alzheimer’s disease, but also had other comorbid issues as well. So we were just blown away with those findings.

Dr. Weitz:            What about adult stem cells correlated with Alzheimer’s? I’m not really aware of how that’s directly correlated.

Dr. Lewis:            One of the things that we theorized in the discussion section of that first paper is that when you look at the triumvirate here of results that we have, so on the clinical side, we have this improvement in cognition, which again just blew us away. We were so happy with that result, but also lowering inflammation and improving this adult stem cell production process. The only thing that made sense to us, mechanistically speaking, is that the stem cells migrated to the brain and either created new neurons, created new synapses, repaired damage, all the above. I mean, obviously it’s speculative and it’s theoretical. We can’t prove that per se. We didn’t have money, and I don’t even know back almost 15 years ago if the imaging at that time was even not that good.  But today, if we had a new study to be able to actually do images of the brain, PET, CT, whatever, SPECT, whatever technology, that we could actually show changes morphologically in the brain. But again, we’re speculating that because we had such a dramatic increase in adult stem cell production, the only thing that made sense to us is why these people were coming back from the ether is that their brains were getting repaired. I mean, to us, that was the only thing that made sense to us.

Dr. Weitz:            Sure. And then in terms of the MS study, what did you find?

Dr. Lewis:            Well let me, if I may, just share one other little quick thing.

Dr. Weitz:            Yeah, go ahead.

Dr. Lewis:            On the Alzheimer’s study. So we did two other papers, not as exciting to me, but to your point, of still trying to figure out, okay, well what really happened here, mechanistically? We did a secondary analysis. We looked at brain derived neurotropic factors. So from the point of publishing the first article in 13 to then publishing these two subsequent articles, we looked at BDNF because there had been other articles coming out showing BDNF’S, link to hippocampal function, memories, all sorts of neuroplasticity, all sorts of different things that we thought might help to explain it. Unfortunately, we didn’t show a statistically significant improvement in BDNF, it only went up by about 11%. But it was linked to different cognitive improvements and different changes on the immune system as well. We actually had done another study with HIV positive people many years before that where we discovered that if you had a BDNF level of 5,000 units or higher, you actually had worse, I’m sorry, you had better cognitive function than people that had less than 5,000 units. I can’t really tell you why that’s true. It’s just one of those artifacts of nature, basically.

                                But we decided to split our group of people with Alzheimer’s at that 5,000 point level as well. And it turned out to show basically the same thing, that if you had a BDNF level higher than 5,000, you had better cognitive function and you also had better immune function. So that seemed to be interesting to us. And we got two more papers out of that. And then we actually have a fourth paper that’s currently under review for another thing. I don’t know if I should really talk about it too much. I usually don’t typically talk about articles that haven’t been published yet. But briefly, what I’ll tell you is, we are looking at some, again, very unique, and I think for the first time published data in people with Alzheimer’s where we looked at the Th1 to Th2 components of the immune system, which had never been characterized.

                                I spent hours looking in PubMed. One of our other co-authors looked at it as well. We couldn’t find anything else that had ever been published before in people with Alzheimer’s looking at the balance between the Th1 and Th2 components in the immune system. And so we’re going to characterize that for the first time. We’re going to show that our formula actually helps to balance it. We’ve also compared the folks with Alzheimer’s to people with normal or healthy levels. And the differences are just so wildly different that you’ll say, “Well, no wonder these folks are so sick.” And then sort of the cherry on top of the cake is that the rebalancing of the Th1 and Th2 levels is correlated with an improvement in cognitive function. So it’s a really exciting new paper that hopefully will be published in the very near future.

Dr. Weitz:            Now, these patients in your study, were they also put on a healthy diet or told to exercise?

Dr. Lewis:            Oh, I’m glad you asked me that. Thank you for asking me that. I totally forgot to mention, that’s the beauty of our study. We didn’t change anything else. We didn’t change their diet, exercise, socialization, medication, nothing. They stayed completely static in terms of their daily routine, their medication regimen. Of course, in the event of an emergency, they had to be intervened, but everything else was static. So that-

Dr. Weitz:            So imagine if this supplement was used in the context of a functional medicine approach that would’ve put them on a healthy diet, had them doing vigorous exercise, had them doing brain stimulation, controlling for other factors, taking a functional medicine approach like Dr. Bredesen does with his Alzheimer’s patients.

Dr. Lewis:            That’s exactly right. And that’s what Dr. McDaniel and I have been saying for years. Gosh, if we just had the money to run subsequent studies, and to your point of making it a more holistic functional medicine approach, my goodness, what could we show demonstrating that adding this supplement into all these other things can be so potent and really benefiting people because ultimately that is what this is all about. And before I talk about the MS study, I just want to make a point real quick to your listeners that it’s wonderful to do science, especially when you’re doing science like I did for most of my career where I wasn’t beholden to a drug company or something like that where I felt like, oh my gosh, what am I doing here? But to be able to actually run good science is wonderful, but when you can actually run good science and then show that you can help people on top of it, man, to me, that’s like the pinnacle of science.  With all due respect to my basic science colleagues who run experiments on cells or tissues or animals. A rat never was late for a study, or a mouse never didn’t just show up and not call you and left you hanging there wondering when you were going to do your assessment. So for basic scientists who do all these very controlled experiments and show interesting things, a lot of times unfortunately for them, their discoveries never end up translating to how it helps people. They may be interesting discoveries scientifically, but do they actually ever end up helping people? No. But in our case, the stuff that we were running with nutrition, we knew immediately, yes, this stuff can help people. And so I had caregivers, I didn’t even mention. I had caregivers calling me in the middle of the study and tears of joy telling me that their loved one was talking about things or doing things that he or she in some cases hadn’t done in years.

                                We even had a very skeptical staff. The center where we ran the study, the psychiatrist especially, he was very skeptical. He said, “Well, we don’t really do nutrition here. We do pharmacology. You guys have some money, we’ve got plenty of patients, we’ll help you. But we don’t really think this is going to do anything.” I mean, that was the kind of response that we had going into the study. So I just love to point out that we actually did stuff that made a difference in people’s lives. And to me, that’s beyond just being a good scientist that’s actually doing things to help people.

Dr. Weitz:            Yeah, that’s great. So go ahead and give us a little information about your MS study.

Dr. Lewis:            So with the MS study, it was a very similar design in terms of a 12-month intervention. It was the same assessment schedule, obviously different assessments for people with MS, but these were people with relapse remitting MS. People that had been, I think the average time of diagnosis was like 15 years. So again, these were people that were very sick, had been sick for a long time, and were looking for alternatives to try to improve their lives. So we put them on a very similar, basically the same formula. Again, we tweaked it a little bit over the years, but we looked at pretty much the same group of biomarkers in terms of the blood work at baseline and 12 months. The clinical assessments were obviously much different again with people, as you know, people with MS don’t typically have the same level of cognitive impairment as folks with dementia, but we were really much more focused on functionality and quality of life.

                                So the FAMS, much like the ADAS-Cog is considered the gold standard for dementia, our cognition assessment and dementia. The FAMS is considered the gold standard for functional assessment for people with MS. And we had just wildly significant improvements in almost every scale. I think one scale was not significant, even though it was borderline close, but every other scale was statistically significant. And so that was very impressive. We had the BD&I, the Beck’s Depression Inventory. Obviously, mood is a very big issue for people with MS. That’s statistically significantly improved. We looked at three different quality of life measures. They all statistically significantly improved. We had a homemade, I say homemade, it’s an assessment the clinic uses, a homemade assessment of symptoms. That thing wildly, statistically, significantly improved.

                                We had just all sorts of really nice anecdotal responses from the subjects as they’re talking about their improvements and how they can function every day, how they can move, how they can get around, how they’re better able to take care of themselves, not being reliant on a caregiver or having other people to help them. So all that clinical stuff, just again, wildly, significantly improved. And then on the biomarker side, one thing that I had no clue about when I got into running these two trials was that the leading killer of people with MS is actually infections. I had no idea. And so we went from having, I think at the baseline, these folks had eight infections at baseline, typically eight different types of infections. At 12 months, they were down to two and a half. So that was just-

Dr. Weitz:            I wonder if those infections are because they’re taking immune suppressing drugs as part of their treatment.

Dr. Lewis:            Exactly. I’m sure it is. That’s at least part of that process. But to get that many infections under control where again, these poor people are just dealing with all sorts of infections. I mean, that was a huge discovery. I don’t think anything else has remotely come close to that. And that goes back to one of the things that I mentioned about the aloe polysaccharides is initially we were talking, their potency against pathogens is just remarkable. Whether it’s virus or bacteria or fungi or whatever it is, not fungi, protozoans, their ability to counteract these infections is just really, really remarkable. But so we had that really nice discovery in infections.

                                And then also in a different way, it is kind of a mouthful to go into in terms of explaining all the different effects, looking at the cytokines and growth factors, and then of course the overall immune function as well. But essentially what happened was very similar, or very parallel to the Alzheimer’s study, in the sense of lowering inflammation and then improving overall immune function. So again, it is a very nice story when you look at the clinical improvements combined with lowering infections, combined with changing the immune function and lowering inflammation at the same time. So I think both of those studies really just were kind of beyond anything that we expected. Certainly we were optimistic and we were hopeful, but to be able to make such discoveries and again, be able to help people at the same time, we just were so pleased with our work.

                                We’re going to actually look at the same, this Th1, Th2 phenomenon in the MS dataset as well. As soon as we get this Alzheimer’s paper published, hopefully in the next couple of months, I’m going to move on to doing that MS analysis as well. So we currently have three papers we published from the Alzheimer’s study, two from the MS study, and then hopefully if things go well, we’ll have two more totals. We’ve got a really nice base of knowledge and information from running these two clinical trials. Again, it’s only due to the lack of funding. People ask me all the time, “Well, what are you going to do next?” I’m like, “Well, write me a check.” If I had an unlimited amount of money, if I had more money than common sense, I’d already be running more clinical trials. It’s just, clinical trials are very expensive to run, and I haven’t been able to do that. But that is definitely a goal of mine for the rest of my life, as I mentioned, to continue the research, obviously running it, of course, we will have a relationship with someone else to actually run it.

                                I feel like spending 20 years in the trenches was enough of my life, but if I have the money to be able to pay another group or even a contract research organization, I really don’t care who ultimately runs the studies. As long as they do a good job and they do it the way that they’re supposed to, then again, that’s my goal, to continue running these trials and answering these questions about why these polysaccharides are so beneficial and kind of taking it, one more thing that I’d like to point out about these polysaccharides is, again, the body, it’s intelligent enough to recreate or recomposition simpler sugars into mannose or galactose or xylose. Some of these very unique polysaccharides, the body is smart enough to be able to do that. When you just feed it junk, it can still do that. But there’s something very special about these polysaccharides that again, come from aloe vera and rice bran.  I think it may be something beyond biochemistry. I think there may be actually something on the physics level at play here. And so to me, that’s something that I want to spend, again, when I have the funding to do it, to answer the question of what it is-

Dr. Weitz:            What would that mean, something on the physics level?

Dr. Lewis:            Well, so what I’m saying is we think of biochemistry or nutrition as being biochemical. Everything about nutrition is on the biochemical level, but to me, there’s something about, we are frequency beings, right?

Dr. Weitz:            Right.

Dr. Lewis:            We resonate at a frequency. All of our cells resonated a frequency, and so there’s got to be something special or dynamic about the resonant frequency of these particular polysaccharides compared to others. Because to me, I’m just continuing to ask myself, why is it that these things are so damn special? What is it that gives them this quality to heal us? I don’t know. My theory could be completely proven wrong ultimately, but I think there’s something beyond biochemistry that has an explanation here.

Dr. Weitz:            I wonder if it could have anything to do with possibly deuterium levels. You familiar with that concept?

Dr. Lewis:            A little bit. I’m not too knowledgeable about it, but that’s-

Dr. Weitz:            So having lower levels of deuterium, meaning for every million water molecules, you’ll have, I think the average is, in seawater, 150 molecules of deuterium. So it’s basically heavy hydrogen, hydrogen with two neutrons instead of one neutron. And so if your polymannose product had lower deuterium levels, there’s a bunch of sort of interesting, not super fleshed out, but research showing that lower levels of deuterium have all these health benefits.

Dr. Lewis:            Interesting.

Dr. Weitz:            So it might be something to look into. Have you tried to reach out to Terry Wahls or talk to her at all?

Dr. Lewis:            I have not.

Dr. Weitz:            Yeah.

Dr. Lewis:            I saw her on an IFM lecture one time, but other than just hearing her lecture, I haven’t tried to contact her.

Dr. Weitz:            Yeah, she’s got a bunch of ongoing research and she’s very big into using a wide range of different plants and phytonutrients as part of her program. She doesn’t follow a vegan program, but she’s very big on having a huge number of different phytonutrients as part of her program. She was in a tilt-up wheelchair, not able to walk or anything, and she’s totally reversed it and walks and teaches and rides a bike. It’s incredible.

Dr. Lewis:            That’s awesome. Well, I have a customer, client who also had MS or has had MS for I think 35, 36 years. She heard me lecture last year. She started using our formula. She had been in a wheelchair, I think she said for the previous two, three years prior to that, was just getting really progressively weak. Got on our formula, and within less than 60 days she was walking again.

Dr. Weitz:            Wow, that’s a great story. In fact, probably a good story to end on.

Dr. Lewis:            Right.

Dr. Weitz:            I think we’re hitting the top of the hour. So tell our listeners and viewers how they can find out about your product.

Dr. Lewis:            Well, I’d be happy if anyone goes to drlewisnutrition.com to read more information about all the work that we’ve done describing the formulation, product reviews, testimonial videos, that would be the best source of information about all of our work. Of course, I don’t publish the full articles of our studies there. I don’t want to violate any copyright, but anybody could go to PubMed and search my name and you’ll pull up all of those articles as well. But I have, again, very good summaries of all the research. So just go to drlewisnutrition.com is the best source of information. That’s D-R with no period, L-E-W-I-S nutrition.com.

Dr. Weitz:            That’s great. Any other final thoughts you want to leave us with?

Dr. Lewis:            Well, again, I’d just like to say that for those of you who think sugars are bad, just don’t throw out the baby with the bath water. We’re talking about, if you can add a couple of grams per day of these polysaccharides to your life, man, you’re going to make a huge difference for yourself. And so just don’t prescribe to this notion that a sugar is a sugar because they’re not, they’re very different. And these sugars are very beneficial for us. And I’ve really kind of become a specialist in this. Of course, I still, general nutrition, supplementation of other things, obviously is important, daily activity. I mean, I’m about all that stuff and that’s what I do every day. But you can only, I don’t know about you, and I don’t pretend to know everything there is to know about nutrition. I think anybody who does comes across as a fraud because to me, the field is so massive, there’s just no possible way.

                                I don’t care if you’re the smartest person on the planet, you can’t possibly know everything there is to know about nutrition. So I try to stay in my lane of polysaccharides and maybe a couple of other things here and there. But really I think for me, just again, opening, if you’re so opposed to carbohydrate, just read our research and do your own research of other people around the world looking at these two particular polysaccharides about how much benefit they provide and how much of a loss it would be to you, your family, your friends, whoever, to not be open-minded to say, “Hey, maybe these things could help me too.”

Dr. Weitz:            We’ll just talk about polysaccharides. Don’t mention that they’re sugars.

Dr. Lewis:            Yes, exactly. Just polysaccharides, forget that sugar word.

Dr. Weitz:            Exactly. Thank you, Dr. Lewis.

 


 

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 certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. That way more people will discover the Rational Wellness Podcast.  And I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica, Weitz Sports Chiropractic and Nutrition office at 310 395 3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

 

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The Science and Energetics of Water with Michael Hobson & Karen Weitz: Rational Wellness Podcast 326

Michael Hobson and Karen Weitz discusses The Science and Energetics of Water 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

6:16  Primary water.  This Aquene Springs water is a primary water.  It does not come from rain that forms underground aquifers and accumulates in lakes and rivers. Oxygen is actually the most common element in the earth’s crust, followed by silica as the second most prevalent element.  Oxygen combines with hydrogen to form water and they form steam because of the heat in the earth’s crust and it comes to the surface and roars out of the ground at 140 degrees Fahrenheit. So that’s an example of primary water that is made in the Earth’s crust on a continuous and ongoing basis.

12:14  Silica.  The Aquene Springs water is high in silica dioxide, which is a silicon atom with two oxygens, which is the most common form of silicon found in nature.  And silica, which is a trace mineral, has lots of benefits for our health.  Silica is the basis for bones, hair, teeth, skin, it helps with blood flow, is beneficial for cardiac health, and is also helpful for gut issues.  It also binds with aluminum, a heavy metal, and pulls this out of the body.  As we age we tend to lose water and aging is a process of dehydration and losing silica also contributes to a loss of health.  Michael also recommends a plant based diet partially because this will also result in getting more silica in your diet.   

20:05  Hydration.  There are a few ways to improve out hydration. One is to drink water. Another is to eat foods that contain water, like fruits and vegetables. Taking a shower or a bath also helps to hydrate you, since we absorb water through your skin. An additional way that we get hydrated is through the electron transport chain.

 

Michael:               Well, there’s that. Okay, I’m with you on that. Chlorine’s, not necessarily a good thing for our bodies, for skin, but there’s a third way that Ben, I think will appeal to you from the scientific standpoint. And that is the well-known process of the electron transfer chain, which was discovered by Albert St. Georgi, won Nobel Prize in 1937 as a result of some of this work.  So it turns out that particularly at night, but even during the day in the human body, we take carbohydrates or fats, which store what? Hydrogen. But hydrogen in a very interesting form, not in H2 like it is when it’s bound to oxygen for water, it’s atonic hydrogen, it’s H. If you look at those molecules, it’s H bound up with other molecules. So hydrogen bonds to those in a way that when this electron transfer process happens, hydrogen atoms are released, they find each other, and when hydrogen atoms combine , two Hs find each other and form H2, they release energy in the form of heat. And at the same time they bind to oxygen because what do we have in our body? We have oxygen, which is a crucial element. So what I’m saying to you is that the output of the electron transfer mechanism is heat, to warm our bodies to keep them stable at 98.6 degrees and water. So we actually make primary water in our bodies.



Michael Hobson is the founder of Aquene Springs, which is a source of pristine primary water that comes out of the ground at 80 gallons/minute and it is a silica-rich, deuterium depleted water with a low surface tension.  Michael is a mathematician, an econometrics professor and a corporate business consultant.  He had several businesses in the music industry and his interest in frequencies eventually brought him to water.  His website is AqueneSprings.com and using the discount code Rational10 will get you 10% off an order of this special water.

Karen Weitz is a Reiki energy master, Akashic Reader, Reiki Master, and Sound Alchemist.  Her website is AllInDevineTime.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. Dr. Weitz is also available for video or phone consultations.

 



 

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, DrWeitzs.com. Thanks for joining me, and let’s jump into the podcast. Hello, Rational Wellness Podcasters.

                                Our topic for today is the Science and Energetics of Water with Michael Hobson. When I was considering having Michael on the podcast, I read about what he’s about and I read where he talks about the energetics of water. And I talked to my wife, Karen, and I said, I’m not sure if this topic really resonates with me because I’m really more focused on the science. And so Karen said, “That’s totally my topic because I’m totally into the energetics.” So this is the first time I’m having my wife, Karen Weitz join us on the Rational Wellness Podcast. And Karen is a Reiki energy master and she’s also a Sound Bowl healer, and you can find her at her website at allindivinetime.com. And she also posts a lot to Instagram under her name at @KarenWeitz.

                                So Michael Hobson is the founder of Aquene Springs, which is a source of pristine primary water that comes out of the ground at 80 gallons per minute. It’s a silica rich, deuterium depleted, low surface tension water. Michael is a mathematician, an econometrics professor, and a corporate business consultant. He had several businesses in the music industry and his interest in frequencies eventually led him to water. Michael, thank you so much for joining us.

Michael:               It is such a pleasure to be on this podcast with you and honored that it’s the first podcast that you’ve had that includes your wife.

Karen:                  How fun is this?

Michael:               I’m thrilled.

Dr. Weitz:            That’s great. So Michael, how did you get involved with water and did any of your prior business experiences help lay the groundwork or the groundwater?

Michael:               Such a great question, Ben. I thank you for the introduction. I won’t spend a lot of time talking about my past. It turns out that all the things that you mentioned are things that led me to where I’m at right now. So my training actually is as a mathematical economist and econometrician, but that’s another lifetime that I was in academia, and then I spent some time in corporate life. And then in the last 33 years, I’ve started 11 businesses, Aquene Springs. That’s how it’s spelled… it’s pronounced, I should say. Sorry about that.

Karen:                   No, no worries.

Michael:               Yeah, and just gives me the opportunity to say that that’s a native word that means peace, tranquility, and clarity. So that’s why we chose it, because the place where it comes from is very special, and I’ll talk a little bit more about that. So anyway, the answer to your question is that along the way, it’s interesting. At any given point in time, if somebody had stopped me and said, guess what, you’re going to be involved in water at 10, 15, 20, 30 years from now, I would’ve said, you got to be crazy. In fact, I admit sheepishly that probably up until about 10 or 12 years ago, I wouldn’t call myself a big water drinker or consumer.

                                So I can’t look back and say, oh yeah, I’ve always cared about water. I’ve always been passionate about it and so forth. It’s only when it came up as part of what my path was, what I’m here for, that I got involved in water. And it started, and I’ll just give you a short little story. It started when someone… I was involved in a business that I started called Classic Records and Reissue vinyl company of all things that I started in the mid-90s, and somebody about somewhere in the early 2000s was interviewing me and they said, oh yeah, Hobson, you’re a serial entrepreneur, blah, blah, blah, what are you going to do next?

                                And I hadn’t really thought about it because I was being interviewed about this current business and without hesitation, and it’s a true story, I said, I don’t know, but it has something to do with water. So that was the first time I knew where I was going. I didn’t know why I was going there or where I was going. And then as time went on, you could say that there was this series of fortuitous or coincidental occurrences. But of course when you look back, you say, well, that’s part of the path. And so everything that I’ve done as I look back, all makes sense now based on where I’m at. Okay, so that’s a long answer to your short question. But yes, the trajectory was there and it really does have to do with what Nikola Tesla said. “If you want to understand the universe, think in terms of energy, frequency and vibration.”

Dr. Weitz:            So this water is a primary water, what is that and why does that matter?

Michael:               Well, okay, so most people understand that the bulk of the water that is consumed worldwide is part of what’s involved in the hydrologic cycle, right? So it’s evaporative in nature, be it from lakes and rivers and streams or the ocean, which form clouds and then clouds under circumstances that are still mysterious, let that water fall back to earth and it replenishes, and we draw it out of mainly aquifers, lakes and streams and so forth. And for municipal purposes, we put that in pipes and that’s what we consume. And then there’s the whole other bottled water industry that comes from aquifers of some description or another.

Dr. Weitz:            Or somebody’s tap.

Michael:               Well, yeah, that’s part of the municipal supply. And here in California, we know that in Southern California, we get most of our water from Northern California as a result of that nice Mulholland ditch some people call it, that brings water down from Northern California, and then we process it. And that’s what most people drink. So little known but true is that there’s another source of water. And I’m going to tell you there’s an anecdote here. I know people are aware of the as above, so below comment, and I’ll explain in a minute how actually what happens in the earth happens in our bodies as well. So the above and below is appropriate. So in the Earth’s crust, the number one element, and this is true, you can look it up, is oxygen. So the Earth’s crust contains primarily oxygen followed by silica in terms of the second most prevalent element, actually silicon. But there’s a technical thing-

Dr. Weitz:            I would’ve thought it would’ve been carbon.

Michael:               Nope, not. Again, all verifiable third, and this is one that I didn’t know and I was a little surprised. The third is aluminum. And we can talk a little bit about silicon and aluminum.

Dr. Weitz:            Once again, I would’ve thought steel would’ve been much higher. Iron would’ve been much higher than aluminum.

Michael:               I know but again, all verifiable scientifically, have a look. If you were a geologist, you would know this. And I’m not either. So anyway, so in the earth’s crust, you have oxygen also, we have hydrocarbons, right? Back to your point, and most often hydrogen’s bound up with carbon because hydrogen doesn’t like to be on its own, right? It’s one of those elements that is an unhappy bachelor, I like to say.  And so when you have a circumstance where hydrocarbons are in the presence of heat, geothermal areas, what happens is when you apply heat to a molecule, in this case a hydrocarbon, the heat breaks the bond, and hydrogen is freed up as well as carbon. But hydrogen’s freed up. Well, remember, it doesn’t like to be on its own. So it’s looking around for a partner. And guess what it finds? Oxygen, and when those two combine in that circumstance, they form steam because there’s heat around. And that steam in this case and in other cases, makes its way through the Earth’s crust, picking up trace minerals. In our case, we think the most important of which is silica. And then it comes to the surface and roars out of the ground at 140 degrees Fahrenheit. So that’s an example of primary water that is made in the Earth’s crust on a continuous and ongoing basis.

Karen:                   So I was listening to someone talk about where we have a water shortage, that there’s no water shortage of primary water. Can you speak to that?

Michael:               Well, I would say that that’s true, that it’s really about finding those sources. And there are actually sources of primary water in California, and I just don’t think that there’s enough attention paid to that because people aren’t really aware. But I think geologists do know about it, but it’s not very common. And so maybe there’s a future where we can tap into the primary water that Mother Earth makes. And one of the great things about primary water is that when you think on this level of purity, it really doesn’t get any pure than that because of course, the water that’s part of the hydrologic cycle is subject to all of the stuff that we already know about, the pollutants in the atmosphere. It’s also subject to all the runoff and pollutants that are in the ground and that make their way into groundwater and aquifers and so forth increasingly. So, yeah, in terms of purity, it’s about as good as it gets.

Dr. Weitz:            Now, when people hear about silica, that’s essentially silicon, right?

Michael:               Yeah, so it turns out silicon, if you look in the periodic table is the element. But again, you’ve got another one of those elements that does not like to be on its own. So the common form of silicon is bound with oxygen, and so it’s referred to as silica dioxide, which is a silicon atom with two oxygens, silicon dioxide. And that’s the most common form in nature.

Dr. Weitz:            And so one of the benefits of this water is that it’s very high in silica. Can you talk more about why silica is good? And then some people are afraid of silicon because they heard about silicon breast implants and silicon getting in the body, right?

Michael:               Yeah, a very different thing than silicon implants and so forth. Silica is what we call referred to as a trace mineral. In fact, it’s widely regarded in the scientific community as one of the very most important trace minerals. So what happens is that it is the basis for bones, hair, teeth, skin, it helps with blood flow. It embeds into the capillaries and arteries and veins in our body to help with blood flow. It’s known to be beneficial for cardiac health. It also binds to aluminum. And so-

Dr. Weitz:            How does it help with cardiac health?

Michael:               Again, with the binding to the walls inside of the heart and so forth to allow the blood to flow more readily.

Dr. Weitz:            So is it keeping the arteries more flexible?

Michael:               That’s one of its purposes. Yes, exactly.

Dr. Weitz:            Interesting.

Michael:               Now, interesting sidebar is that… And there’s two comments here, one about water specifically, and that is that when we’re born, we’re about 85% water by volume, and by the time we reach the elderly state, or let’s say close to death, we’re about 70 or 65% water. So you could say, and I think rightfully so, that the process, the aging process is a process of dehydration. Now, I’m not saying that dehydration causes the aging process, but they are hand in hand. And so the argument for staying hydrated, not just during your life, but as you reach the elder years is important. And again, well-known that that’s the case. What’s not well-known but is also true is that over that same course that I just described, that period, we lose silica. So is it any surprise that elderly people have issues with their skin, teeth, hair bones, gut health, silica is good for gut health as well, have gut issues, blood flow,

Dr. Weitz:            Really, do you have any idea how silica can help with gut issues? Is there a mechanism that you know of?

Michael:               I don’t know specifically about what the thought is, but there are studies that suggest that silica is important for the digestive process. But with blood flow is something that the elderly suffer and struggle with. And then there’s the issue of silica binding to aluminum. So what I was going to say a little earlier is, and again, there are books written one by a guy called Steven Exley I believe, The Aluminum Age, that talk about silicas role in detoxifying the body of aluminum and aluminum’s everywhere.  It’s in the air, it’s in food stuff, it’s in things that we drink. We live in the aluminum age, and it’s the third most prevalent element in the Earth’s crust, but it’s highly toxic to plants, animals, and human beings. In the case of animals and human beings, silica binds to the aluminum in our bodies, and we excrete it by sweating or urination. Plants actually, because they absorb aluminum from the soil, the silica that they also uptake encases the aluminum and renders it unable to inflame the plant. And that’s what happens effectively with aluminum is it causes inflammation. In the case of Alzheimer’s and some of the chronic inflammatory diseases that a lot of the elderly suffer from, it’s an inflammatory situation, at least in part the result of aluminum toxicity. So-

Dr. Weitz:            I think that silica is a bit of a natural binder.

Michael:               It is and sadly we lose it over time. And so if there’s a message here for me to share with people, it’s that certainly as we age, we should be doing things that, or eating things or supplementing silica intake.

Dr. Weitz:            Either eat some sand or drink some high silica water.

Michael:               Well, so I’m going to say I don’t endorse people eating sand. I know that might it’s-

Dr. Weitz:            It’s not particularly good for the teeth.

Michael:               Well, it might drive a few mothers crazy because they’re worried about their kids playing in the sand and so forth, which is a whole nother subject I won’t get into. But yeah, so it turns out silica, even though it is the basis for sand is digestible in this particular case and the case of plants and vegetables and fruits, which is the main way that you get silica in your diet, another good reason to have a healthy plant-based diet. I’m not suggesting people become vegetarians or vegans, but it is good from a silica standpoint. It turns out that the best way to get silica into your system is through water. It’s the most bioavailable method of doing that.

Karen:                  I think it’s interesting that you said that we are 75% water because the earth is also 75% water.

Michael:               Shocking, isn’t it?

Karen:                  Yeah, isn’t that amazing?

Michael:               Shocking, isn’t it? Another thing I wanted to share that I mentioned before, the as above, so below, so it turns out that when people think about hydration and they want to have their body fully hydrated, there’s a couple of ways to do that, right? A few ways to do that. One is to drink water. You could drink other fluids as well that contain water or eating, obviously a lot of food stuff, fruits and vegetables particularly have a high water content. So those are different ways, but interestingly, people don’t realize that taking a shower or a bath or swimming is also a way to hydrate yourself because it turns out that our pores are a two-way street. So we can actually absorb water as a result of that.

Karen:                  The filter, the water that we shower in.

Michael:               Well, there’s that. Okay, I’m with you on that. Chlorine’s, not necessarily a good thing for our bodies, for skin, but there’s a third way that Ben, I think will appeal to you from the scientific standpoint. And that is the well-known process of the electron transfer chain, which was discovered by Albert St. Georgi, won Nobel Prize in 1937 as a result of some of this work.  So it turns out that particularly at night, but even during the day in the human body, we take carbohydrates or fats, which store what? Hydrogen. But hydrogen in a very interesting form, not in H2 like it is when it’s bound to oxygen for water, it’s atonic hydrogen, it’s H. If you look at those molecules, it’s H bound up with other molecules. So hydrogen bonds to those in a way that when this electron transfer process happens, hydrogen atoms are released, they find each other, and when hydrogen atoms combine , two Hs find each other and form H2, they release energy in the form of heat. And at the same time they bind to oxygen because what do we have in our body? We have oxygen, which is a crucial element. So what I’m saying to you is that the output of the electron transfer mechanism is heat, to warm our bodies to keep them stable at 98.6 degrees and water. So we actually make primary water in our bodies.

Dr. Weitz:            Interesting.

Michael:               Yeah.

Karen:                  I have a question. I go to Mount Shasta a lot and we drink well water in the hedge waters, silica in the hedge waters, or is that different water than-

Michael:               Well, that’s a great question. I can’t speak intelligently to that. I don’t know if they report whether it’s silica rich or not, or what the silica content… If you check out most waters, the silica content is either non-existent or it’s actually very low. So there are supplements, right? There are supplements that you can buy, silica dioxide, and you can make a cocktail, which I think it’s pretty expensive to do, but that’s another way to do it.

Dr. Weitz:            I want to say horsetail, I think is a-

Michael:               Good source of silica.

Dr. Weitz:            Yeah, you’ve seen that as part of a supplement.

Michael:               Yes, yes. I would agree wholeheartedly. So that at least is a dive into primary water from the standpoint of purity. And an interesting sidebar about us actually making water inside of our bodies.

Dr. Weitz:            So what is structured water?

Michael:               So there’s a lot of controversy around this concept of structured water, and this idea is from most scientists, even some people involved in water, the idea is that water molecules form in clusters, but then soon, very quickly break up. And so the argument is by most physicists and chemists, and even biologists quite frankly, is that there is no basis to structured water, that it’s really not possible. There is a subset of people that are working in biochemistry and some physicists as well, and some medical doctors that understand this concept of what are called coherent domains. And that’s a situation where water molecules as a result of some type of stimulus, some type of energy input, be it from the cosmos, which we’re being bathed with, maybe even from cell towers that we use, we’re caught up in that as well. And maybe even the wiring in our walls, the 60 hertz in our walls, all of that affects us and it affects water and so forth. So what I’m really saying is some type of electromagnetic or vibratory input causes the water to form into different shapes that can contain patterns and-

Dr. Weitz:            So my understanding of structured water, and Correct me if I’m wrong, is that we normally think of water as having one of three states. It’s either liquid, it’s frozen, and it’s solid, or it’s evaporating. And this is sort of a fourth state, like a gel-like state. Is that correct?

Michael:               That is correct. In fact, a dear friend of mine is a professor at the University of Washington, an esteemed professor called Gerald, and he’s written a book that you may have heard about called the Fourth Phase of Water. And it’s becoming more and more widely accepted. It has been pretty controversial, but I think it’s quite frankly, irrefutable. And I think there’s a lot of application of that activity in our bodies and in particular, think about this, right? This is what we call bulk water, this is some of the spring water, but it’s just liquid water. And we drink that, and of course we sweat some of it out and we urinate and so on. But the water that we uptake into our cells and tissues and so forth is not in that state. It’s actually in a very structured crystalline state. So it turns out that the water around different organelles inside of our bodies and inside of our cells is actually in a crystal in state, and that is well known.

                                So it’s not bulk water. And by the way, it is becoming more and more well understood. I’ve got a book here that I think people should take a look at. It’s called We Are Electric by an English Woman, Sally Ade, and it talks about the electrical nature of our bodies and how the cells communicate with each other, tissues, how there’s communication between the brain, the heart, different tissues. And all of these systems are communicating, using light, using photons, and using electromagnetic impulses.

                                And it turns out that the water in our bodies with the minerals, and that’s one of the reasons why the minerals are critical, is conductive. And so we need enough water, it needs to have the right minerals in it, in order for those neurons and those conductive pathways to be able to communicate effectively. Again, back to the elderly. What happens there? They’re dehydrated and as a result, unable to communicate in a way that keeps them in a state of health.

Dr. Weitz:            Now, I can’t recall the name, but I did interview this doctor who talked about the fact that in order to get this structured water, it was better to get your water from eating fruits and vegetables than from drinking water because by doing that, you’re getting this structured water in this water in this crystalline state.

Michael:               Absolutely, in fact, I would not necessarily agree that that’s the only way to do it. But from the standpoint of consuming food, absolutely. Yet another argument for consuming fruits and vegetables, because it turns out that the water that is there is in a structured state. And so I believe that that is an accurate statement. However, from the standpoint of drinking water that’s structured, it turns out that most spring waters across Europe, across the United States and so forth are naturally structured, right? That they have some structure to them. And I’ll zero in on this in a minute. I really haven’t answered your question about what-

Dr. Weitz:            It’s hard for me to understand that because what’s in my head is if this is a crystalline state and now you’re drinking a liquid, how does that square?

Michael:               Well, think about how water is uptaken into our tissues through the blood. So that’s one way that it gets into our… So if you have water that has structure to it, then it can make it into the blood. It also is absorbed into tissues through the gut, through those little cilia that absorb nutrients, that also absorbs water. That’s how water gets into tissues as well. So that would be a way to… And I think that’s one of the reasons why we know instinctively, without even being told that spring water’s kind of better for us than municipal water. I like to say that municipal water will keep you alive, but spring water will help you thrive, right?

Karen:                  I do a couple of things to my spring water. I think it’s structuring it, so I’m not sure, but water needs to be moving. So I’ve worked-

Michael:               Absolutely.

Karen:                  And then I also have a tensor ring. Are you familiar? That [inaudible 00:31:56] tensor ring over the spout and that’s supposed to structure it?

Michael:               Yeah, and now we’re back to the question you asked me. I’m sorry. I kind of went off out into the hinterlands there about structured water and about how important it’s for our body. But I think that’s some background. So if you ask the question, what is structured water? At least one of the definitions of structured water is it’s a water that when you pass light through it at different frequencies that it absorbs in a specific range, okay? Because remember water, when you shine light through it can just pass a fair amount of that light through.

                                But there is some part of the spectrum that is absorbed. And if you look at some of the work that Gerald and those folks have done looking at a characterization of structured water, it’s water that absorbs in the 240 to 280 nanometer range, okay? So turns out interesting fun fact that DNA and many of the organelles inside of our cells absorb light in the 240 to 280 nanometer range. So again, the argument is, and this is true, that around DNA inside of our cells and so forth is this crystalline structured water which aids in the communication of all of the bodily functions. We are electric after all. So anyway, if you wanted to take some water and have it tested through spectroscopy, and again, a lot of spring waters absorb in this range, and that’s an indication that there is some structuring going on. I want to speak to Robin’s point… Sorry, let me just finish this. I want to speak to Robin’s point about there are a lot of devices in the market, some of which involve electromagnetic treatments, some involve magnets.

                                Often they involve turning the water. And I think to Robin’s point, that the water that we drink should have been active on some level, and that’s another indication of spring water because what happens with spring water, it’s been turned and so forth in the streams before it’s collected and so forth. And so yeah, there are different devices that I do think structure water, do they structure it in a way that’s beneficial for us? I can’t speak to that, but water is this wonderful molecule that is really the source of life.

Dr. Weitz:            Cool, so you also say that your water is deterrent depleted or low deterrent, and I’m sure that’s a concept that a lot of people are not necessarily familiar with, though we have had several discussions on the podcast about the issue about deuterium and why it’s beneficial to have low deuterium water and even how to structure your diet so you get a lower amount of deuterium as being beneficial for health.

Michael:               Yeah, yeah. I want to speak to that, but it just occurred to me that I misspoke and called your wife by a different name, Karen, is what I meant to say. I get caught up and so forth. And I think I was so surprised that she’s part of the podcast that I’m still getting used to her wonderful presence here. So about deuterium. So deuterium for me, it’s as controversial as structuring of water. And what I mean by controversial is that there are a good number of people that are suggesting that water that is deuterium depleted however it is naturally, which in the case of Aquene springs water, it just comes out that way. It’s naturally that way. There are methods to produce deuterium depleted water. You could think of deuterium depleted water as light water as opposed to its counterpart, which is heavy water, which is used in hydrogen bombs.

                                So the process actually of making deuterium depleted water, not in the earth, but in real life, and with some of these companies that are offering deuterium depleted water is one of separating… It’s a byproduct, let’s call it, of the making of heavy water for different industrial processes. So let’s just take a step back for those people that don’t know what deuterium is. Deuterium, it’s a molecule that is closely related to hydrogen instead of hydrogen has, according to the physicists, an electron that circles a proton. It’s the most simple of the elements. Deuterium has an extra neutron, so there’s a neutron and a proton at the nucleus, and there’s still one electron. So the significance of that is that it’s heavy, it’s heavier than a hydrogen molecule. And it turns out-

Dr. Weitz:            Let me just butt in really quick. It’s interesting, there’s actually an element that has three neutrons, and that’s called tritium. That’s actually the basis for the hydrogen bomb.

Michael:               Well, and by the way, it’s something that as a result of those explosions, has shown itself in small quantities, but measurable quantities in the atmosphere and in almost all water sources that are part of the hydrologic cycle. So for example, Aquenes springs water when tested does not have any tritium. It’s never been to the surface before. Now, I’m not going to suggest that drinking tritium depleted water is going to make you live longer, but that’s just an interesting, fun fact.

                                So anyway, so deuterium occurs naturally in water, and in fact, in saltwater in the oceans, there’s 155 parts per million of deuterium in the water, and that’s the standard right? So if you say, what is deuterium depleted? It’s anything below that. And there are some people that say, well, if it’s really deuterium depleted, it’s got to be 125 parts per million. But the truth of the matter is that anything below that 155 parts per million is considered to be deuterium depleted. Now, why is that important? That’s where I think the controversy comes in, because there’s a scientific theory or model of the way the cell makes energy or the way that it operates.

                                And I know you’ve been involved in this or you probably know about this, Ben, it involves a shaft and a rotor and a shaft. And these rotors and shaft turn around with little hydrogen molecules that get freed up from the structured water in the cell and they pass through the rotor, and that’s what causes them to turn. Well, the deuterium molecule is a little fatter. It’s a little heavier. And so it kind of gums up that process according to the theory. And so the idea would be then that if you drank deuterium depleted water, that you’d have more energy, there’d be less deuterium to gum up the energy production inside the cells.

Dr. Weitz:            Yeah, I mean, higher levels of deuterium according to that line of thinking and research is related to higher levels of cancer and heart disease and mortality. And so if it’s really true, it’s really a big deal.

Michael:               Agreed, and the only reason I describe it accurately that way, but the reason I say it’s controversial is to be honest, I’ve never been down into the cell and seen those rotors and the shafts and so forth. So I can’t speak intelligently about whether that’s actually on or not.

Dr. Weitz:            Now interestingly, the folks who promote, I’m trying to have a low deuterium level. Number one, they do sell a low deuterium water, but it is unbelievably expensive. We’re talking about, I don’t know, somewhere’s on order of $20 for a quarter or something and-

Michael:               It’s actually much more than that.

Dr. Weitz:            Much more than that, okay. It’s really expensive, right?

Michael:               Yeah, it makes our water, which is a premium water, seem really quite inexpensive.

Dr. Weitz:            Okay, and then number two,

Michael:               You’re talking about between a $102 quite often for a bottle of this water.

Dr. Weitz:            Oh, really? Okay, I knew it was really expensive.

Michael:               It’s really expensive.

Dr. Weitz:            Number two, their conclusion is in order to get less deuterium, because water generally contains a certain amount of deuterium, you want to follow a ketogenic low carb diet because carbohydrates have more water, and if you get more water through your food, you’re going to have more deuterium.

Michael:               I think that that’s a logical set of conclusions and steps if one as the old saying, goes into the weeds with this stuff. And I want to shift things a little bit because I think this will play very much to Karen’s expertise in this area, particularly when if she treats people. And so-

Dr. Weitz:            Yeah, lead me down in the weeds where I like to be.

Michael:               The modality. Well, there’s some weeds here too, my friend.

Dr. Weitz:            No, I like to be buried in the research and deeped in the bowels of PubMed.

Michael:               Which is somebody has to do that, and I can’t think of anybody better for the job. I’m going to go on record as saying something that some people find controversial, and that is that because we are almost all water, in fact, by the way, molecularly, if you count the molecules in our body, and this is indisputable 99.999% water. And again, we talked about it being into this crystalline state, and we know about how important it is.  Fritz Pop knew how important it was, another Nobel Prize winner in terms of cellular communications and so forth, both from an electromagnetic, a photonic, and from a vibratory standpoint. And what I’m going to suggest is that our thoughts get expressed in our body vibratory, and that’s what happens to a lot of the cells and tissues in our body, is that by virtue of whether we have thoughts that are life enhancing or life detrimental, and I think people can pretty much easily understand what those are, that that changes the structure of the cells in our body, the size and shape of them, and that impacts their function, right?

Karen:                   Yeah, I always say to Ben, because he does functional medicine and he gets to the root cause, and I always say I get to the root cause of the root cause through thoughts, and I can say the words you speak is the house you live in.

Michael:               Absolutely, absolutely. And so I personally have come to understand, and I won’t go into details about that, probably not the right space for that, but that our voice is the vibratory equivalent of our thoughts. And we’re given this voice for a number of reasons, by the creator or nature or whatever, or evolution. And one of those is to change ourselves and to affect others. When you go to a music event, when you go watch a movie where people are speaking or you’re at a concert or you see someone of great stature speaking and you’re affected by that, that doesn’t just come I think from the intellectualization of what they’ve said, it comes from an impact on your body.

Karen:                   Sure, when I do sound healing, I just had a client whose whole body vibrates from the sound and the water starts activating, moving in their body, and sometimes they get uncomfortable, their arms get heavy, their hands curl up so much activity from the vibration of the sound against the water in their body.

Michael:               Absolutely, and so I think if we look forward, I think more and more we’re going to understand that there is two ways to approach the human body. One is from below, which I would say is the biochemical approach, which is what we eat, what we drink, the supplements we take, and so forth. And by the way, let’s not forget something, that every single one of our senses is vibratory in nature,

                                Every single one of them, okay? So our sense is the way we experience the world is vibratory in nature. And let us also not forget that we’re on a planet that’s spinning at a thousand miles an hour at the equator. Everything is constantly moving. Everything that we put into our body is moving, and everything has a pattern to it as we sense it. When you look at a painting that affects you by virtue of the vibratory pattern that your eyes see, and that affects your body, and sometimes it repulses people and sometimes it makes them feel wonderful. So I think what I’m trying to say is that what I call the top down approach, which I’m not suggesting is the only or the best approach, just another way to think of it is from the vibratory standpoint. And those two kind of meet in the middle, if you will.

                                And I’ll suggest this, although it might make some of the MDs and the pharmacists out there crazy, but I think all the compounds that are in drugs have exactly that effect. I think that’s the mechanism, this lock and key mechanism, I don’t see it, but there’s a lot of people that are bought into that and they can’t see it another way. But the truth of the matter is all compounds vibrate. So you put a compound into your body and it has a vibratory impact and it has an outcome in effect, and sometimes it has some side effects, right? It’s the same exact situation with homeopathy, right?

Karen:                   Yeah, well, they say the medicine of the future is frequency.

Michael:               It is. I think it is but again, I want to marry these two and suggest that it is about frequency and vibration in terms of everything we consume, everything around us, everything we consume with our senses, everything that processed through our bodies, and it’s all passed around in the context of water.

Karen:                   Yes, water has memory, the memory of water.

Michael:               So sorry, Ben, I probably overwhelmed you there.

Dr. Weitz:            No, that’s good.

Michael:               Sorry my friend.

Karen:                   Well, he had me on. He knew that it had to go in that direction.

Dr. Weitz:            Absolutely, so I want to cover just one more topic. And then I think that our listeners can get the water at some sort of discount, but I can’t remember what the code is.

Michael:               We set up a special code for your consumers and it’s rational 10. Okay, so rational 10 and that’s a coupon code that if they go to our website, which is www.aquenesprings.com-

Dr. Weitz:            Can you spell that?

Michael:               Yeah, that’s A-Q-E-N-E springs.com. At checkout, you can put that code in. It’ll get you a 10% discount, so yeah. You want people to try it, I think once you try it… Now I have a question for you, and that is, I think we sent you out some water to try. What did you think? Put you on the spot.

Karen:                   I should speak to that because-

Michael:               Please, thank you, thanks Karen.

Karen:                   Because I can taste every water, and he used to think I spent a lot on water and that it was all the same once upon a time. And I had him put 10 different waters out and I could tell you what each one was, and then he understood that I really have that ability to taste. So when I tasted your water, the first thing I noticed was the softness to the texture of the water. So that kind of surprised me in a good way. The taste is so clean, so easy, it feels very healing. But I just was surprised by the softness and the texture, so.

Michael:               Yeah, you are a great candidate for becoming a water sommelier.

Michael:               I know you’re actually water sommeliers, believe it or not,

Karen:                  There’s such a thing. I would be right.

Michael:               There really is and there’s a training that one can take and golden tongues and so forth.

Dr. Weitz:            For those who don’t know, a sommelier typically is an expert at wine, right?

Michael:               Exactly, there are water som… And in fact, believe it or not, there are restaurants that have a water menu now.

Dr. Weitz:            Really?

Michael:               Yes, really. I was at a fine tasting, it’s called Fine Waters Event that was held in Athens, Greece a couple of months ago.

Karen:                  Gosh, I would’ve loved that.

Michael:               I’ll tell you honestly, I really learned something. We went to a local restaurant that was a very well-regarded restaurant, and we had, I think six or seven courses. And with each course, the water sommeliers who were there at the event and who were also judges, because this was a worldwide competition of specialty waters, high-end waters. But they paired the waters with the different dishes and it’s unbelievable.

Karen:                  Oh my God, I-

Michael:               Really is unbelievable. So yeah, there is a lot to be said. I think one of the things we talk about is the mouthfeel. So there’s a kind of softness of velvety, and then there’s what we call the leaf, which people talk about in wine tasting as well. But there’s a slightly sweetness, and we don’t put anything in the water, so it just is naturally that way such that almost it becomes addictive in a kind of a way. Once you have it, you sort of go, geez, tap water just isn’t quite the same after that.

Dr. Weitz:            Okay, so the final topic is… I just wanted to ask about, your website states that the water has low surface tension. What is this and why is this beneficial?

Michael:               So surface tension is a characteristic of fluids. So it applies to everything. There’s a surface tension to oil, there’s a surface tension to water. And so it has to do with the interface. And what I mean by interface is the interfacing waters’ case with the air or with other molecules, let’s call it, right? So for example, if you said, I have a high surface tension water, which by the way, a lot of municipal waters are high surface tension, I’ll just throw that out there as a fun fact, then the water is able to support things more readily.  So you could float a penny or a pen or something more easily in a high surface tension water. And by the way, I think surface tension is a characteristic that also floats boats, right? It’s part of that interface base with the water that makes things float. So by comparison, low surface tension is something that is less structured, if you will, in the tension state at the interface. The implication of which is that high surface tension water doesn’t combine well with other things. It likes to be on its own. Low surface tension water on the other hand, is more readily combined or absorbed in this case by the tissues and cells. So low surface tension water in general would be something that would be typically more hydrating and allowing more of the uptake of the water into the body. Municipal water, a lot of it just passes through.

Dr. Weitz:            Awesome.

Karen:                   When people say drink eight glasses of water or gallons or however many, would you say you don’t need as much water drinking your water?

Michael:               I would say just in general that people don’t need… That was an old rule of thumb, either eight glasses a day, there’s another rule of thumb that was half your body weight and ounces, which for some people can be at least three liters, sometimes close to a gallon. Again, it sort of depends. If you’re drinking tap water and a lot of it’s just passing through, you probably do need to drink a little bit more. If you’re taking a long leisurely bath every day, you probably don’t need quite as much, right? If you’re living in a climate where it’s a little cooler and maybe humid, then you don’t need as much. In Southern California, in desert areas, I think you need more in those cases. So it’s really hard to sort of pin it down.

Dr. Weitz:            Depends how much activity you do in your day, how much exercise, how much you’re sweating.

Michael:               I mean, if you’re on a century ride on a bicycle, you better be taking a bunch of fluids or you’re going to be in trouble. So it’s a difficult thing to say, but also keep in mind we make water in our body as well. So it’s trying to keep things in balance, and it’s a little tricky. I read somewhere recently where this woman was dehydrated as a result of being in the weather or in inclement conditions, and she drank a gallon of water and died as a result of drinking too much water. You can actually drink too much water. And then there’s another thing I think, Karen, you’re probably aware of as well. Some people have this idea that drinking distilled water that’s devoid of any other minerals is a good thing to do, and some people do that to detox, and I think under the right supervision, maybe that’s a good idea. But in general, we do need minerals in our body for reasons that I already mentioned. And so I would never advocate that people exclusively or on a long-term basis, drink nothing but distilled water.

Karen:                   Yeah, well, your water is very easy to drink so I’m Grateful for that.

Michael:               Thank you.

Dr. Weitz:            Okay, great. So thank you, Michael. Thank you, Karen. I guess one more time, tell us your website again so we can find out more information.

Michael:               Yeah, thank you. It’s a Aquene Springs, and that’s www.aquenesprings.com. and again, the promotional discount code is rational and the number 10 at checkout, and that’ll get you a 10% discount. And we just really want people who care about health for longevity to give this water a try and if it works for you, great.

Dr. Weitz:            Excellent.

Michael:               Okay.

Dr. Weitz:            Thank you.

Michael:               Thank you.

Karen:                  Thank you.


Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. That way more people will discover the Rational Wellness Podcast, and I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardio-metabolic conditions, or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way.  That usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

 

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Improving Fertility with Dr. Jane Levesque: Rational Wellness Podcast 325

Dr. Jane Levesque discusses How to Improve Fertility 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

0:55  One of the biggest obstacles for couples trying to conceive is that there is so much information that it is difficult to know what is true and what’s not and where you are in your journey.  Some couples wonder if the conventional route, whether it’s IVF, IUI, or medications like letrozole or Clomid to stimulate ovulation is the only option.

3:00  When Dr. Levesque sees a new client for the first time, she spends a lot of time going through their history and then she starts by looking at their previous labs, which often their doctors have not looked at very closely.  Often their doctors may have told them that their labs are normal because they are busy and skim through them and they also are only looking at the reds and have no sense of what optimal ranges are.  For example, when it comes to vitamin D and the normal range is 30 to 100, but if you are at 30 is that good?  No, that’s low and vitamin D is important for hormone production, to make our neurotransmitters, and for our immune system function. There’s actual vitamin D receptors on both the egg and the sperm.  Dr. Levesque likes to see vitamin D levels in the 60 to 80 ng/mL range. 

6:35  For women it is important to figure out if they are ovulating and if the quality of their eggs is good.  If the woman is not healthy, then her eggs will likely not be healthy.  If they are struggling with fatigue, digestive disorders, anxiety, or skin issues, then they are not going to have healthy eggs either.  We need to look at the FSH to LH ratio and estrogen and testosterone on day three and at progesterone on day 21 or 22, if they have a 28 day cycle.  We also want to look at electrolytes, at a liver panel, a kidney panel, and then it is helpful to get a Gut Zoomer stool test.  Dr. Levesque has seen a number of women in their 20s with an FSH well above 10, which is a strong indication that they are no longer ovulating and this may indicate premature ovarian failure.  When testing on day three, we want a FSH/LH ratio to be close to 1:1.  If LH is really high, this is a sign of Polycystic Ovarian Syndrome.

10:04  Hormone testing.  Dr. Levesque likes to test estrogen on day three of the cycle but she also likes to look at the DUTCH (dried urine) hormone panel to look at the metabolites to see you well you are breaking down your hormones.  A lot of symptoms, such as painful periods, heavy periods, fibroids, and even endometriosis are related to the bad estrogen, Estrone, due to endocrine disrupting substances.  There are three main forms of estrogen: 1. Estradiol E1, 2. Estrone, E2, and 3. Estriol, E3.  Estradiol is the good estrogen, Estrone is the bad estrogen and the one most associated with breast cancer, and Estriol that is in the middle. Estriol is high during pregnancy, but also high in fibroids and endometriosis.

14:09  Birth control.  Many women have been taking birth control for years and sometimes for decades and this can make it difficult to become pregnant. Birth control is synthetic hormones and your body has to process it and this takes a lot of nutrients, including N-acetylcysteine and CoQ10, zinc, and selenium. There’s also a connection with the gut microbiome.  Imbalanced hormones affect the microbiome balance, which makes it harder for the body to produce neurotransmitters like dopamine and serotonin. 

16:01  The microbiome and hormone connection.  There’s a connection between the microbiome and our hormones.  If you have imbalanced hormones you likely have microbiome issues.  We think that our gut is separate from our reproductive system but your uterine lining is only separated from your GI tract by a tiny, little membrane.  If you have a bunch of pathogenic bacteria surrounding your reproductive organs, this can make a successful pregnancy more difficult.

 

 



Dr. Jane Levesque is a Naturopathic Doctor, who specializes in fertility. Her mission is to help high-achieving couples get pregnant naturally, have complication free pregnancies and give birth to healthy babies.  Her website is DrJaneLevesque.com.  You can also contact her through her Instagram account @drjanelevesque.

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. Dr. Weitz is also available for video or phone consultations.

 



 

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.

                                           Our topic for today is infertility with Dr. Jane Levesque. Dr. Jane Levesque is a naturopathic doctor who specializes in fertility. Her mission is to help high-achieving couples get pregnant naturally, have complication-free pregnancies, and give birth to healthy babies. Thank you so much for joining us, Dr. Levesque.

Dr. Levesque:                    Thanks so much, Ben, for having me. I’m really excited to chat with you today.

Dr. Weitz:                          Excellent. So, what are some of the biggest obstacles that couples have when trying to conceive, especially today in 2023?

Dr. Levesque:                    I think in 2023 the biggest obstacle is that there’s so much information and it’s really hard to decipher what’s true and what’s not. I have a lot of patients coming to me basically just, “I’ve already tried this. I’m taking a handful of supplements. I have no idea what to do, what’s working, what’s not working.” And feeling like the conventional route, whether it’s IVF, IUI, even medications, letrozole, Clomid, to stimulate ovulation is the only option.  And so, it’s being able to have a filter on the information and also understanding where you are in your journey that makes it difficult for couples. Because if you’re just starting out your journey and you have no idea what it’s going to be like, your biggest obstacle that I see for couples is that you’re just overwhelmed and you’re fearful of the future and sometimes unnecessarily so, and sometimes there is, of course, a reason to that fear or anxiety. And couples who have been struggling for a long time, it’s like, “I have no idea what to do. I have no idea what’s working. I don’t have any answers, and I’m tired of throwing things at the wall and hoping something that’s going to stick.”

Dr. Weitz:                          Not to mention that fear, stress and anxiety is a major obstacle to getting pregnant.

Dr. Levesque:                    Absolutely. Absolutely. Yeah. And it’s this vicious cycle where I follow a lot of people in the infertility community where it’s, “Stop telling me to relax.” Or, “Going on a vacation doesn’t help.” And I know what they’re saying because obviously if you have endometriosis or PCOS or fibroids or other conditions, going on a vacation isn’t going to fix that.

Dr. Weitz:                          Right.

Dr. Levesque:                    But relaxation and having a calm and soothed nervous system is absolutely part of being able to conceive.

Dr. Weitz:                          So, when you’re seeing a new client for the first time and going through their history, what are some of the things that come up most commonly?

Dr. Levesque:                    Yeah. A lot of the times actually as a general thing is people have no idea what’s going on even though they’ve had all the testing done. So, one of the things that I’ve been really telling my couples and on my channels is, make sure you have copies of your lab tests and your practitioner should be going through them with you. What we’re seeing now is you’re getting this, “Labs look normal, nothing that we know of.” And then you’re left feeling, you’re in this space like, “Okay, well, I guess I still have my painful periods. I can’t get pregnant. I’m still tired. I still have brain fog, but my labs look normal.”   Where in reality they’ve never actually even looked at their labs and they haven’t seen if there’s any L’s or any H’s or any just abnormals, reds, because the doctor is just skimming through and a lot of the times they’ll miss information. And so, I have patients who had no idea that they had adhesions on an ultrasound or even little fibroids that were present. They had no idea that their estrogen was out of range for the mark that they were in. And so there’s, of course, the normal range and the optimal range, and that’s the initial consultation when I first see people, it’s like people just have no idea.

Dr. Weitz:                          Maybe you should explain the difference between the normal range and the optimal range.

Dr. Levesque:                    Yeah, for sure. So, let’s take vitamin D. Everyone talks about vitamin D now. It depends if you’re in the US or Canada, but the range can be anywhere between 25 to 100 or 120.

Dr. Weitz:                          Right.

Dr. Levesque:                    If you’re at 25, are you really at an optimal range? It’s like to me that’s a low … Especially if you’re trying to conceive, because now vitamin D is important for hormone production, it’s important for mood, our neurotransmitters, our immune system. There’s actual receptors on both the egg and the sperm, vitamin D receptors. So, if both male and female are going to be low on that, that reaction isn’t going to be as strong for fertilization.  So, if you’re telling me that, “Okay, I’m in the range.” But you see that you’re on the bottom half of the range or on the top half of the range, it’s likely that you’re probably low or there is and imbalance, right? Because everything in the body is about balance. Even too much of a good thing is, it’s too much and obviously not enough isn’t as well.

Dr. Weitz:                          Yeah, I think in the US the average doctor will say, and I think most of the labs say, “Over 30 is normal, anything more than that is a bad idea.” And yet, I feel for a couple trying to get pregnant that they should get their vitamin D level at least up to 50.

Dr. Levesque:                    Yeah. And I say 60 to 80 is a good range. I have a couple patients in California, so it’s, if you have access to the sun, you need to be going out to the sun. I live in Calgary, Alberta where we don’t get a lot of sun for a lot of time of the year. So, when we can get access to it, go for it. But when you can’t, that means you need to supplement. And the best way to know how much you need to supplement is just by doing some testing.

Dr. Weitz:                          Besides low vitamin D and fear and stress, what other sorts of things do you see come up in history?

Dr. Levesque:                    For sure. So, for females, it’s figuring out if they’re ovulating and if that ovulation is good and the quality of the egg is good. Now, there’s no tests that show quality of the egg, but the way that I look at it is your eggs are your cells. If your cells are healthy, then chances are your eggs are also going to be healthy. Because women who struggle with low quality eggs are also women who are struggling with fatigue, with digestion, anxiety, skin issues, you name it, weight, all that jazz.  So, for women, I’m always looking at the FSH/LH ratio, estrogen and testosterone on day three from hormonal perspective. And then day 21, day 22, 7 days post-ovulation ideally you’re looking at progesterone and that’s going to give us a really good idea if number one, you are ovulating and number two, how strong that ovulation is. And then we want to look at your electrolytes, your liver panel, your kidney panel, and then I’ll go deeper into Gut Zoomer and all that. Usually people don’t have that when they come to me. They have just the basic information. And I’ve had women who had their FSH well above 10 in their 20s, which is a strong indication that that woman is no longer ovulating and it’s whether it’s premature ovarian failure-

Dr. Weitz:                          Maybe you can explain about LH and exactly what that indicates at what range.

Dr. Levesque:                    Yeah, for sure. So, the LH strips is something that women use to help them detect that ovulation halfway through the cycle, which again is something that I don’t want to say I advise against, but it’s not a super reliable way to tell if you’re ovulating or not, because LH is a pulsatile hormone. So, sometimes it comes before ovulation, sometimes it comes after. And so, it can confuse women.  Where when we’re testing it through blood on day three, we’re looking for a FSH and LH ratio to be close one to one. So, if that LH is really high, usually it’s a sign of polycystic ovarian syndrome. Now, that’s not the only thing, but you need to look at that ratio. The FSH, the follicle stimulating hormone, if it’s above 10, let’s say between day three and five, it’s typically a sign that the body is not ovulating or that ovulation is really sluggish.

                                                And the way that I like to describe the relationship between the FSH, if you will, is FSH is a brain hormone and the brain is where ovulation starts. The brain is the one that has to tell the ovaries to start growing the follicle, getting it ready to produce. If FSH is nice and low, it’s like the brain has to just whisper to the ovary, to say, “Hey, it’s time to ovulate.” Versus if that FSH is really high, that means now the brain is screaming. It’s like a parent-child relationship, whether you tell your kid really quietly to put on their shoes and they do it, or you have to yell at them several times and they still don’t do it, then that’s the relationship there. So, when that FSH is high, it’s a sign that the brain and the ovaries are not communicating. And so, we want to address that because obviously if you’re not ovulating, it’s going to be very hard for you to get pregnant.

Dr. Weitz:                          What are some of the other things you’ll see on a hormone panel besides FSH and LH?

Dr. Levesque:                    Yeah. So, estrogen, if you test it on day three, for the most part, I find women are in range. So, this is testing it through blood. Now you can test estrogen through blood, through saliva or through urine, and blood is going to be your gold standard diagnostic. Will show you exactly what’s happening in the body this moment in time. Whereas I do a lot of urine analysis, I’ll use the DUTCH hormone panel by Precision Analytical, where we’re looking at the metabolites, so how are you breaking down your hormones?  And that breakdown then shows us what’s happening with your progesterone, what’s happening with your estrogen, what’s happening DHEA, testosterone.  And so, I like to compare the two because we want to see what’s happening in the body right now versus how is your body breaking it down?  And it gives us an idea of some genetics.  It also gives us an idea of how your liver is working.  So, I’ll typically see really high estrogens or you’re favoring a bad estrogen versus a good estrogen.  And a lot of symptoms come with the quote, unquote, “bad estrogen.  Whether it’s painful periods, heavy periods, fibroids, and even endometriosis.  All those conditions are driven by an endocrine disrupting process.  It’s a hormonal imbalance, right? For [inaudible 00:11:29].

Dr. Weitz:                          Right. Explain what you mean by a bad estrogen.

Dr. Levesque:                    Yeah. So, there’s three different metabolites, E1, E2 and E3, and so there’s some that are more harmful and some that are better. Right? So, E1 is the good one, if you will, and then there’s E2 that’s more of the bad estrogen. And then E3 is kind of this in the middle where we see it in conditions where there’s a lot of replication, if you will. So, we’ll see that a lot in fibroids. We’ll see it really high in pregnancy because there’s a lot of growth that’s happening during pregnancy. And then you’ll see it in fibroids, endometriosis, and in pregnancy. And then E2, usually we see it in relation to cancers, whether it’s breast cancer, whether it’s cervical cancer.

Dr. Weitz:                          You’re referring to estrone as the bad one, estradiol as the good one, and estriol as-

Dr. Levesque:                    This middle where sometimes it’s okay to have it, but other times … It’s more about the ratios than it is anything else.

Dr. Weitz:                          Right. Some doctors consider estriol a weaker estrogen and estrone a stronger estrogen.

Dr. Levesque:                    Yeah, for sure. And like I said, in the body, it’s all about balance. Right? So, if I look at, they give you the gauges, and if you’re seeing someone really push towards one side, then you’re asking … Because some of it, it’s like I said, you’re going to see a little bit of genetics too. Right? We have certain enzymes that are upregulated, and so they’re going to push certain pathways, and so you might need to eat more cruciferous vegetables just because that’s what your system needs in order to function at its best. And this is where we can get into more customization and personalization as opposed to this generic advice of, “Yeah, absolutely everybody should be eating vegetables and having good quality protein and clean water and all that jazz.”

                                                But when that’s not enough or when you’re not getting results from that, it doesn’t mean that, “Oh, okay, I guess this isn’t for me.” It’s more like, “Well, what else is missing? And let’s dig deeper and maybe we need a little bit more of something and maybe now we need to tweak your supplement routine and take a look at your environment a little bit deeper.” Because we know those are the basics. We can’t get away from that in terms of as a human, everybody needs to move their body. We can’t not move our body and say that we’re healthy. That’s the same kind of what I see with some of the basics of the protein and eating enough protein, eating enough veggies, water, all that jazz.

Dr. Weitz:                          Now, when it comes to hormones, one factor that I know is very common is quite a number of women who’ve been taking birth control and often taking birth control for years and years.

Dr. Levesque:                    Yep.

Dr. Weitz:                          How do you deal with that?

Dr. Levesque:                    It’s a huge problem. Yeah, it’s a huge problem. I mean, one of my patients right now, she just conceived, she’s at 10 weeks. She was on birth control for 20 years. Since basically 12 years old, was put on birth control, whether it was PCOS or something, and then just one of those never got off it. Didn’t know enough about it. And so, it took us almost a year to regulate her cycle to a point where instead of it being every 60 days and then 55 days and 42, and it was a lot of work.  So, birth control, that relationship that I talked about, the brain and the ovaries, it just shuts down that communication altogether. So, now the brain and the ovaries are not talking. And if they’re not talking for a year, okay, the brain can restore that relationship, and maybe it’s even five years, it’s okay, it might take some time. But if it’s been a decade, if it’s been 15 years, it’s going to be harder and harder for those pathways to come back and to come back in a good strong way, if you will.

                                                Then the next component with birth control is, I mean, it’s a synthetic hormone, so your body has to process it, and it takes a lot of nutrients, so it depletes a bunch of nutrients from your system. And of course, like I said, it’s a synthetic hormone, so it’s strong. Your system has to work through that. And so, we see deficiencies in B vitamins, in a lot of antioxidants that are really important for fertility, like an N-acetylcysteine and CoQ10, zinc, selenium. Things that are of course also important for the thyroid.

                                                And then there’s a connection between the microbiome as well of the gut. We talk about hormones a lot, but it’s like you can’t balance hormones without gut function. If you have poor hormone function, guaranteed you’ll have something in the gut even if you quote, unquote, “Go to the bathroom, have a bowel movement once a day, twice a day, and you don’t have any issues. I have mild bloating.” I find a lot of us are disconnected and have no idea what a good bowel movement actually looks like and feels like. And so, if you have imbalanced hormones, you probably have microbiome issues as well. But the connection there, Ben, is that it’s a huge impact on … It wipes out a lot of the good bacteria, and so then, hey, that’s going to make it really hard for the body to produce neurotransmitters like dopamine and serotonin. And so then there’s anxiety and depression that’s associated with that. So, it can just spiral downwards.

Dr. Weitz:                          Yeah. Shame on them. They should have the Bristol stool chart on their wall.

Dr. Levesque:                    That’s it. Exactly. Exactly. But in all honesty, we’re not really taught and I’ll have a lot of women who have shame around even talking about bowel movements because it’s like it’s a private thing, you shouldn’t talk about it. And we’re holding this all the time, and so our pelvic floor is really tight. And we’ll look at the stool analysis and it’s like there’s an insane amount of overgrowth and there’s so many pathogenic bacteria there.  And we think that our gut is so separate from our reproductive system, but if you look at the abdominal cavity, it’s like it’s all crammed in there. Your uterine lining in your uterus is separated from your GI tract by a tiny little membrane, and all of that stuff travels back and forth. And so, you might not have a bunch of yeast infections or UTIs or whatever, urinary tract infections, to have pathogenic bacteria that’s all surrounding your reproductive organs, which becomes really vital for a successful pregnancy.

Dr. Weitz:                          So, how do you like to analyze the stool? What’s your favorite stool test you like to run?

Dr. Levesque:                    I’ve used the Diagnostic Solutions before and over the last couple of years I’ve switched to Vibrant America and I love it. It’s probably the most comprehensive. The Gut Zoomer is the most comprehensive one I’ve seen to-date. They test up to eight inflammatory markers, and they do all the immune system and the microbiome and the pathogens. Detecting your pancreatic elastase, so how well you’re absorbing, digesting food. Short chain fatty acids.  So, I’ve really learned to love the test and I find it gives me so much information to just really look at the gut in depth, so we can start attacking and addressing some of the things that are going to come up. Because there’s no such thing as a normal stool analysis. There’s a little bit of fear, I think, from people like, “Well, I don’t want to invest into lab testing because everything is always normal.” And it’s just like, yeah, it’s not possible.

Dr. Weitz:                          Well, the other thing is patients, they don’t understand the levels and depths of lab tests that are available.

Dr. Levesque:                    Exactly.

Dr. Weitz:                          And they go to their doctor, they get a CBC and a chem screen and maybe a basic lipid profile if they’re lucky, a couple of hormone tests. And each test is put on a separate sheet of paper, so it looks like they had every test that you could possibly get. And actually-

Dr. Levesque:                    Is that why they do that?

Dr. Weitz:                          … on the scale of lab tests, they had this much done.

Dr. Levesque:                    Totally. Yeah. No, I agree. And that’s the point that I made before, it’s like, you want to understand what really got tested. I just took on a couple a month ago and they were like, “Yeah, sperm analysis is fine.” And I put out this freebie to be like, “Hey, if you’re not getting pregnant, make sure you check your partner’s sperm analysis, and these are the parameters.” Turns out he didn’t even have enough volume to run the test. And so they read it as, “Oh, it’s normal, don’t worry about it.” Versus he had to go back in and do it. And so, it’s like there was this six months period that they had no idea that something was wrong, where in reality there was a lot of things wrong.  So, infertility and fertility in general, once, especially we as women decide we want to have children, that time is on. You just feel like every month the clock is ticking. And so, from the perspective of not feeling like you’re wasting time, you want to understand what’s going on, both of you because it takes two. And so hopefully whoever is listening is like, “Hey, collect your labs and take a look at them yourself.” And if you have no idea what you’re looking at, your doctor should be showing you that. That’s what a good doctor does is, hey, doctor is teacher, right? “I’m going to show you that these are the things that are wrong. This is how you’re going to fix it.” Instead of waiting for the big red diagnosis, you can do something about things … We all have something to improve on, right? Always.

Dr. Weitz:                          And I think the health of the man gets overlooked quite a bit. And that’s at least 40%, right, of the potential issue?

Dr. Levesque:                    Huge. Oh yeah, for sure.

Dr. Weitz:                          It’s easy for a guy to say, “Well, I’m fine. It’s not my problem.”

Dr. Levesque:                    Yep. Totally. And the saying that I like to say is, men don’t go to the doctor, they go to the emergency room. All my men who come on, they’re like, “Everything’s fine. Everything’s fine.” And then I look at even half the stuff and we test and I’m like, “Oh my God, how are you not…” Because there isn’t that report card that you get every month. Males in general are not … You don’t have this cyclical, where we as women, if something is wrong, we will know it in the second half of the cycle. Men’s cycle is daily, right? That testosterone, it’s up and down and then peters and then up again and down. And so, it takes a lot for a male to be very aware and in tune to say, “Hey, something is off.”

Dr. Weitz:                          And men tend to ignore their health.

Dr. Levesque:                    Yes.

Dr. Weitz:                          They fill out those health questionnaires that we have everybody fill out, and the guys will have one or two and you start asking them and they go, “Yeah, actually I do have constipation and bloating, but it’s fine.” So, they put zero down. And, “Yeah, I do have fatigue, but I put nothing down because it’s okay.” And once you start going into their history, there’s a million things going on. They just don’t-

Dr. Levesque:                    For sure. And some of that I think is training, right? I’m not sure what you experience in your practice, but societal that, “Hey, I have to be the strong tough guy and I can’t show weakness.” That we really need to start breaking that barrier because I know for me, it was a big, with my husband when we first met, it’s like I’m a naturopath, he was into fitness, but it’s like there’s a big discrepancy in terms of what you do when you’re working out in a gym versus a naturopath. And I was very straightforward of, “This is really important to me. I want to grow with someone who is also going to want to be healthy and grow a healthy family together.” And this was before we got married, because it’s like, “Hey, if we’re not on the same page now, it’s going to be very hard to be on the same page down the road.”

Dr. Weitz:                          Your husband’s into fitness?

Dr. Levesque:                    Yeah. We owned a CrossFit gym four or five years and we have been in the fitness industry. I was a personal trainer for a while, and then looked into nutrition and just deeper layers of like, I had IBS and weight loss resistance after you gained the freshman 15. For me, it was more like freshman 25. And it’s like, hey, I’m exercising, I’m eating well and my weight is not coming off, so something else is going on here.  And as a trainer, I used to see women and men who would work so hard and they would eat so well and nothing would happen. And it was just like, okay, there’s more to it than just nutrition and exercise. I think it’s an important piece, but I call my approach the pizza approach, where nutrition and exercise is important, but now you have to look at detoxing. You have to look at environmental toxins. You have to look at labs. You have to look at supplements. You have to look at mental and emotional health. You have to look at community and who’s supporting you, and stress.  So, when you look at just exercise and nutrition, now you’re like, oh, that’s just two pieces of the pie. So, if you’re doing that and you’re not seeing results, just know that it’s not that you don’t need to do those pieces. You absolutely still do, but there’s at least six other pieces that are missing.

Dr. Weitz:                          Yeah. My path to functional medicine and health and chiropractic came initially via fitness, and I did the whole bodybuilding thing back in the ’80s.

Dr. Levesque:                    For sure. Yeah.

Dr. Weitz:                          And learned how to manipulate body fat and everything else.

Dr. Levesque:                    Yep. Yeah, it’s funny, we’ve come full circle. I started in the bodybuilding and then we got into CrossFit, and then we went back a little bit into bodybuilding. Now we’re getting into running. And it’s just exploring different ways of moving your body and what your body’s capable of. But the theme doesn’t change. It’s what I was saying in the beginning, it’s like you have to move your body. That’s not an option, not to.

Dr. Weitz:                          Right.

Dr. Levesque:                    That’s just the machinery and how it works and what it needs. So, how can you make it fun for yourself?

Dr. Weitz:                          Yeah. So, you mentioned nutrient levels and looking for micronutrient deficiencies. What tests do you like to run? My guess is you like the Vibrant micronutrient test.

Dr. Levesque:                    Yeah. Yeah, I do. I like to run the same lab if I can, because for the most part, it makes it easier for myself, but obviously for my patients as well, because they’re getting one package versus 17 different ones.

Dr. Weitz:                            Right.

Dr. Levesque:                    And they run the red blood cell and the white blood cells. So, the red blood cells show us what’s happening now versus the white blood cells shows us what deficiency has been around for longer, so usually minimum three months, but sometimes we can see that six to nine month mark if it’s been truly deficient for a long time.   So, I like that test. And it gives, of course, lots of different antioxidants and vitamins and minerals and amino acids and fatty acids. And fatty acids are really important, like the omega-3, omega-6 ratios, because there’s a lot of different diets out there now. And so, people have thrown themselves into different diets, whether it’s keto or metabolic diet or you name it. There’s just so many different stuff that people are trying. Where I like to see, hey, how’s the body doing? And then we feed it what it needs, because if your diet is missing something and you need to supplement, like we all need to supplement now, but you know what I mean? It’s like if it’s really deficient because you’re not getting in your diet, then it’s probably not a good diet for you.

Dr. Weitz:                          Right. Better to test, don’t guess, rather than just pick a diet based on philosophy.

Dr. Levesque:                    For sure. Yeah. Yeah. And with that advice, I say it depends on where you are. If you’re just starting out, you can probably get away with just some general advice of, “I need to drink more water. I need to start moving my body.” But if you’ve been at this for a while and you feel like the amount of effort you’re putting into your health doesn’t match the output, meaning, I’m putting in all this effort and my cycles are still irregular and I still can’t lose weight, then there’s a missing piece. And so those general approaches are not going to work for you anymore because you’ve already done that.  And so, that’s kind of, if I can bridge the gap for some people to say, “Oh, and I’m ready for the deeper level.” Versus just generalities of eat better, exercise, sleep more, all that jazz that we all need to do anyways.

Dr. Weitz:                            What are some of the most common micronutrient deficiencies you’ll see, let’s start with women who are having issues with fertility?

Dr. Levesque:                    For sure. So ,I mean, vitamin D is pretty up there. Selenium usually. Selenium and zinc. So, thyroid. Sometimes I see things like the vitamin A and vitamin E, so those really strong antioxidants. Surprisingly enough, I don’t see a lot of CoQ10 because so many women will supplement with CoQ10 because they’ve seen the research and the studies. And so, one of the things I always say is, “You might need CoQ10, but you might not.” And so, if your CoQ10 levels are good, but you’re taking it, that’s the whole, “Well, I tried this and it didn’t work.”  So, a lot of the thyroid nutrients, like I said, the selenium, zinc, vitamin A, vitamin E, even sometimes vitamin C. And that usually depends on what’s going on with the immune system. Vitamin K, if there’s a lot of digestive stuff, K1 and K2, because we produce a lot of that in the gut. So, I’ll see that deficiency. So, usually I never just run one test, right? Not one test is going to give us all the information. So, it’s being able to connect those dots.  And then the omega-3 and omega-6, the omega-6s are usually high and the omega-3s are low, so it makes that ratio way off. And so you’re more inflamed, and that comes out in different ways for women, whether it’s painful periods, whether it’s heavy period, maybe it’s skin issues. It’s inflammation, so it shows up in different ways for people.

Dr. Weitz:                            So, let’s talk about fish oil or omega supplementation. For a woman who tests is low, what would be a typical recommendation, let’s say for 100-and, I don’t know, 30 pound woman?

Dr. Levesque:                    Yeah. So, I actually first look at the diet because sometimes it’s not so much that the omega-3s are really low, it’s that the omega-6s are really high and that ratio is thrown off. And so, omega-6s are going to come from seed oils. Right? And it’s not that we don’t need omega-6s, it’s just that we can’t have too much, and there’s even omega-6s in eggs. Right? So, it’s not that, “Oh my God, I need to stop eating eggs.” It’s understanding the ratio and how much balance.

Dr. Weitz:                            Yeah, there’s omega-6s in nuts and seeds.

Dr. Levesque:                    Exactly. And so, it’s not that we don’t need it, it’s that where’s it coming from? And so, the big popular trends of the oat milk and the almond milk, if you look at the ingredients, and I like guilty, jumped on the train was like, “Oh my God, amazing. Another milk alternative.” But if you look at oat milk, it’s seed oils and it’s really high in sugar because it’s oats, oats are sweet. And so it’s probably one of the worst combinations that we can throw into our system with this really high bad fat, high seed oil and high sugar.

                                                And then you look at conventionally grown meat, and even chicken, chicken breast has probably the lowest nutrition profile. So, all my fitness geeks out there who love chicken because it has the best macronutrients on there, it’s so high protein, no fat, no carbs. It has the worst nutritional profile, and it depends on what those chickens were eating. So, if they’re eating a lot of seeds, and the same with beef, it’s like why grass fed? Well, grass fed beef becomes high in omega-3s, but conventionally grown corn and grain fed beef is now high in omega-6s.

                                                So, it’s switching the type of food that you eat will actually make this big difference because now let’s talk about fish. We have to look at, it’s really hard right now to source high quality fish without any contaminants of heavy metals, plastics, BPAs and phthalates and all this stuff that literally the fish is absorbing, and that includes getting really high quality fish oil. So, I would make sure that that company is reputable and they do the testing. And you probably are still getting some exposure, but it’s very minimal and the pros are going to outweigh the cons.

                                                So, I go through the food first to make sure that, hey, what’s happening with our diet? Because again it’s, “Oh, I’ve been eating chicken breasts exclusively for however long. I don’t eat red meat because I thought…” Whether it’s a macronutrient thing or, “I can’t digest it because I don’t have enough…” Or whether it’s, “I decided to be a vegetarian or a vegan.” And then, “Oh, I’m having all these milk alternatives that turns out have really high seed oils.” Or even crackers and popcorn, things that are healthy, there’s still a lot of seed oils in there.

                                                And so, it’s everything in moderation, but it turns out you’re not having it in moderation. It turns out it’s the majority of your diet. And then we look into high quality supplementation, and I’ll do anywhere three grams to six grams of total omegas. The EPAs we’re looking at probably a gram a day is what I’d like to get in. So, you have to read your labels, because like a high potency one it’s usually one teaspoon twice a day versus if you’re just getting something on the shelf, it’s like you’ll need to take 12 caps to get that.

Dr. Weitz:                          Yeah. Especially if you’re using a … What’s that one source of omega-3s from the little fish? What’s it called? I drew a blank. Anyway.

Dr. Levesque:                    I know, I was like aqua-something, but I’m not sure if that’s the same one that I’m thinking about.

Dr. Weitz:                          Anyway.

Dr. Levesque:                    NutraSea.

Dr. Weitz:                          What about adding additional DHA, since DHA is so important for the nervous system, brain development?

Dr. Levesque:                    Usually, I do both.

Dr. Weitz:                          You do both?

Dr. Levesque:                    Yeah. Usually it’s a combination. Yeah.

Dr. Weitz:                          So, you do a typical EPA, DHA and then add additional DHA? Yep.

Dr. Levesque:                    Yeah. The-

Dr. Weitz:                          Yeah, oh krill oil, I was talking about. Most krill oil capsules have maybe 100 milligrams of EPA and DHA.

Dr. Levesque:                    Yeah, that’s right. So, I mean, it’s really understanding because the micronutrient testing again will show you the EPA and DHEA. And once my patients are pregnant, especially in that second trimester, I’ll put them on a much higher dose of DHEA. But usually the fish oils, they’re not just one omega, they have the ratio, and so it’s just playing around with the ratio. So, instead of it being two-to-one of EPA to DHEA, that ratio is flipped.  And so, it really will depend on your needs and where you are in the process. Like I said, in pregnancy, I’ll hype that up even more. And with supplements, when you’re just exploring it yourself and doing it yourself, you’re going to stick on the lower side of the recommendation or whatever the recommendation is. But it’s like half the times that’s maybe a quarter or maybe half the dose of what you need. So you’re like, “Oh, I didn’t notice the effect.” It’s like, well, yeah, what if you got prescribed a medication and you only took half the dose? Unlikely you would feel that same effect. Right? So, it’s the same with supplements.

Dr. Weitz:                          Yeah. In terms of not getting enough EPA and DHA, the same thing goes for some of these prenatals.

Dr. Levesque:                    Yes.

Dr. Weitz:                          Sometimes they’re prescribed and they contain fish oil in it, and patients feel like, “Well, this has everything I need.” But if you’re taking one tablet or capsule, the amount of EPA and DHA you can get in there is minuscule.

Dr. Levesque:                    Well, in sticking fish oil with everything else, the way that fish oil is stored should be different than the rest of your vitamins.

Dr. Weitz:                            Right. For sure.

Dr. Levesque:                    And so to me, that’s a red sign. If anyone who’s watching this was like, “Don’t want to do that.” Because number one, I know you’re going to get a low dose. Number two, it’s unlikely that you’re keeping your prenatal in the fridge. And then you can’t extract where that fish oil is coming from. So yeah, there’s certain things that we just need to keep separate. And that, I would say, is one of them.

Dr. Weitz:                            Yeah. What are some of the other nutrients that women particularly tend to need more of during trying to get pregnant and important for raising a healthy baby?

Dr. Levesque:                    Yeah, I think protein is really under … If I go back to the micronutrient analysis, if I test the amino acids, you can see different types of amino acids that are missing for women. So, if you have a lot of digestive issues, L-glutamine is going to be way off. Usually if you’re seeing a lot of stress, serine is going to be off, and that heightens that anxiety and inability to sleep and just feeling like things are not right, if you will.  So, women need that 30 to 40 grams of protein per meal. And ideally, it depends on if you’re exercising or not and what your goals are, but you should be hitting that minimum 100 grams a day. And I think you would be-

Dr. Weitz:                          Yeah, I would say most women are not getting that or even close to that.

Dr. Levesque:                    Yes. No. Yeah, if you actually track your food, use MyFitnessPal and write in what you’re eating. I have a lot of people, even my marketing manager was like, “I’m eating so well.” And blah. And I’m like, “Show me your breakfast.” And as soon as she shows me her breakfast, it’s like, that’s seven grams of protein. You have one egg, you have a bagel, and you have some whatever fruit on there. And it’s just like that’s considered a healthy … And then it’s like punch that in and understand that you need to make that 30 grams. And she’s like, “Oh, so even two eggs is not enough?” Yeah, even two eggs at breakfast is not enough.  And so that if you think that you have enough protein and you think you’ve tried everything, just go ahead and punch your food in for three days and you’re going to learn so much about what’s happening in your system. Because I can tell by just the way that the body looks as I’m sure you can, how the person is feeding themselves, how they’re taking care of themselves, what they’re taking, what they’re doing. And so, it’s like if you’re not getting enough protein, you need that for literally everything in the system.

                                                But your hormones, we talked about FSH and LH, they’re amino acid hormones. We have fat-based hormones, so those are all steroid hormones. Vitamin D is needed for that. Omega-3s are needed for that. Then we have the amino acid hormones, they’re peptide chains, that’s your FSH and your LH. So, your system literally cannot function without protein. And then talking about building a new human, guess what it’s build out of? The things that you eat and your tissue. And so, if you’re tired and exhausted and your nutrients are depleted, the body has nothing to draw from, and so it just can’t do it.  I say that we as women create from a place of abundance and vitality. It’s like that energy needs to be overflowing like it has nowhere else to go but to make a baby. It’s like, how many women listening to this right now feel like that? 1%, 2%?

Dr. Weitz:                            A nutrient that’s come up on the radar screen for me and I’ve seen it on some of the micronutrient tests with women trying to get pregnant or even who are pregnant, being low, and at least one company has started adding 500 milligrams to their prenatal is L-carnitine. There’s actually quite a bit of interesting research on its importance for fertility.

Dr. Levesque:                    Yep. Yes. Yeah, I don’t see it a lot low on my stuff, but I do know about it. Of course, it’s the same as CoQ10, I think it just depends on who comes through your … But L-carnitine is huge. I see it a lot in weight, of course weight loss, but L-carnitine is important for mitochondria. Right?

Dr. Weitz:                          Yeah.

Dr. Levesque:                    And so, mitochondria is the essence of our fertility. Everyone is doing research on it in terms of aging, anti-aging. If you have good functioning mitochondria, you’re basically, you’re set because the mitochondria does so many things for us, but it’s a very important nutrient. I would agree with that.

Dr. Weitz:                          What are some of the micronutrient deficiencies that tend to come up among men?

Dr. Levesque:                    Yeah. So, for men, again, it’s going to depend on what’s their picture, but for fertility sake, if you will, so stress is a big one. And then stress impacts testosterone levels. And so, then you’re looking at is it digestion that’s preventing you from absorbing all those nutrients? Do you have pathogens that’s taking that up?  So, in males we’ll see actually very similarly, selenium, zinc, vitamin A, vitamin D, vitamin K, if their digestion is off. But now it’s playing a different role for them, meaning that it’s not so much the thyroid, but production of usually you need all those nutrients for production of good, strong sperm. And then with the immune system connection, if there’s a lot of environmental toxins or even pathogens like gut pathogens, then if all those nutrients are going towards dealing with that instead of making good sperm.

                                                I’ll see amino acid deficiencies as well. And cysteine is a big one. So, N-acetylcysteine, that’s a really important antioxidant, really important for fertility as well. And so it’s funny, right? The nutrients that we as females need are very similar to the nutrients that the males need as well. They just play different roles within the body.

                                                And then L-glutamine if there is a lot of digestive. And I’ll see glutathione low, and glutathione is a really strong antioxidant. And I find typically that’s because males are not as … Even when couples say, “Oh, we basically eat the same thing.” But the female just adds a little extra micronutrient, microgreens on her salad, or she throws a little extra hemp seed or some other antioxidant powder into her smoothie that the male just doesn’t tend to do unless the female is making it for him. But those little things add up.

                                                Like the females will get the salads at the restaurant where the males are more likely to go … Right? And I know that I’m making some general statements here because obviously, it’s not true for everyone. But what I see is that glutathione will be on the low sign because males are more likely to drink a little bit more, they’re more likely to maybe stay up a little bit later. Not make those little choices of … And I speak from my experience, my husband is not the one who’s like, “I should sprinkle some microgreens on this.” I’m like, “Put this on there.”

Dr. Weitz:                            So you mentioned toxins, and we’ve heard a lot about estrogenic substances in the environment that are common in BPA and phthalates and pesticides, et cetera. What type of toxin testing do you like to do? And then, what are some of the typical detox strategies you like to incorporate?

Dr. Levesque:                    Yeah. This is a big topic, and honestly that is the 99% of my practice is getting people cleaned, cleaning out their environment and helping them clean out their system so their body can work the way that it’s designed. I use CellCore products. I don’t know if you’ve heard of CellCore, but they’re really big in the detox space and have made some groundbreaking products that have been very defining for my practice and my patients and myself.

                                                But I use the Vibrant America total toxin burden test because I get the heavy metals, I get all the environmental toxins, so the plastics, the phthalates, the parabens, the volatile organic compounds. They actually just released a test where you can test the PFAS, so the forever chemicals as well, to see how much your system is excreting. And I’ll look at organic acids, which is just how your cells are metabolizing things, right? Nutrients, fatty acids, carbohydrates, and then bacteria, yeast, that fungus, we can see that.

                                                Because the belief here is that the toxicity is actually the thing that’s causing the nutrient deficiency. I’ve come from a place where I’ve supplemented a lot and nothing shifted. And so, the idea that if you have to throw a bunch of supplements at your body just to barely function, doesn’t add up. So, I use the bathtub analogy a lot like with a shower head, and then you’re the goldfish swimming in that bathtub. The water coming in, the cleanliness of that water is going to be really important. So, that’s you figuring out what’s in your environment that needs to be tidied up. Is it the lotions and the potions that you’re putting on your face? Is it the quality of the water that you’re drinking? Do you have a good reverse osmosis or distilled water or are you still drinking BRITA and bottled water?

                                                What is the quality of the food that you’re eating? How much of it is organic or locally grown or you grew yourself versus processed versus conventionally grown and heavily sprayed with pesticides? Because we can look at all those things and we can test all those things. And then of course, any past exposures, like I have patients who grew up with parents who smoked in the house. And unfortunately some of those heavy metals like cadmium and mercury, they’re still very much present and persistent in the system because it takes a long time for the body, the body tries to protect you, and so it stores it in the fat. And so, those are the same women who have a hard time losing weight, they have painful periods, they have endometriosis, adenomyosis, because they’ve had this really heavy toxic load and the body has just not been able to process it.

                                                So yeah, we’re going to clean up the environment, that’s the shower head, but now let’s look at the drain and then let’s look at the sewer. Because if you put clean water in, that’s fantastic, but what about all the grime that’s still left on the sides? What about the murky water? You need to open up that drainage. So, you need to make sure that that liver is working, that gut is working well, right? You’re sweating on a regular basis.

                                                And then once that drainage and the sewer is working well, then we’re going to get in there and we’re going to scrub and we’re going to scrub the sides. And so, you’re not going to start with a heavy metal detox. You just need to open up that drainage first and make sure the body has enough energy to even detox. And then once you’re having two or three bowel movements a day and they’re really full and you’re eating enough veggies and you’re sleeping well … And for some people that takes months, for some people it takes years. So, I always say, “I don’t care if you’re a slow cooker or a microwave, you want to move in the right direction. It doesn’t matter the speed, but move in the right direction, but don’t start scrubbing before you do the other things because it’s wasted effort. Right? We don’t want a wasted effort. Let’s be strategic because we all have limited amount of time. That’s our most precious resource.”  So yes, clean up the environment, open up that drainage, make sure that sewer is not clogged and nothing is coming back up. And then we scrub so that water is clean and that fish can be happy.

Dr. Weitz:                            Cool. Let’s hit one more topic. Let’s hit thyroid and then we’ll wrap and you can give us your contact info.

Dr. Levesque:                    Yeah.

Dr. Weitz:                            So, thyroid is super important for fertility, for being able to get pregnant. There’s been a lot of focus on it.

Dr. Levesque:                    Getting pregnant.

Dr. Weitz:                            So, give us your take on thyroid. What tests you like to run, what interventions do you recommend?

Dr. Levesque:                    So, I’ll say that thyroid is never the only thing. I find it’s rarely the culprit. I find that it is impacted, but it’s not the root cause. And so, it works in conjunction with stress with the adrenals and the ovaries. It’s a whole hormone picture. But most people, first of all, do not get the proper thyroid panel. So, you test your TSH and you’re told that it’s fine. Your TSH just tells us how well the brain is communicating to the thyroid, doesn’t actually tell us how much thyroid hormone your body has. And so, that’s not a complete test. So, you need to have a TSH, but you also should do free T3 and free T4. And then you should probably run some antibodies to see if there is an autoimmune condition that’s present within the thyroid, because autoimmune conditions are going to put you at a much higher risk for miscarriages, and they go unnoticed, undiagnosed all the time.

                                                And then even things like reverse T3, I don’t want to say that necessary, but it’s good to look at it. Right? I’ll run all that stuff. A lot of docs will just run the free T3 and free T4 and the TSH, and it won’t look at the antibodies. But thyroid, it’s your metabolism hormone. It turns everything on. It’s so important for being able to conceive, but also to be able to maintain the pregnancy, and that’s something that should be checked. Again, I have so many patients who have to fight to get these tests, which is insane to me that, hey, your TSH is high, you’re pregnant. You should be like, “We need to address this right away.” As opposed to, “Oh, it’s okay, it doesn’t matter.”

                                                So, I find that a lot of people will focus on thyroid if they have weight issues especially, because everyone’s educated themselves, “If I have poor thyroid function, I’m going to struggle to lose weight.” But in reality, usually there’s a bigger component. Usually the liver is involved. Usually there’s some sort of inflammation. For some people, the immune system is going to be involved. And so you want to look at the gut, thyroid, the stress, the inflammation, and look at it as a whole picture instead of just these single … When I see the thyroid is off, I just know that something is off, but we don’t understand why. So, let’s dig deeper.

Dr. Weitz:                            So, let’s say you get a patient, and I am not sure what figure you like to see as far as TSH, if it’s 1.5 or 2 or 2.5.

Dr. Levesque:                    1 to 2. 1 to 2 is where I’d like to see, yeah.

Dr. Weitz:                            1 to 2. Okay. So, let’s say you get a patient who has slightly elevated TSH, like 2.5, 3, and then their free T3 and their free T4 are in the low end of normal, maybe there’s no antibodies. What would you do? Would you send them back to their primary care doctor to get Synthroid or what would you do?

Dr. Levesque:                    Yeah. That’s a great question. So no, usually when it’s just you’re starting to see it low, this is where natural medicine really, this is our jam. Right? We just start to see that the thyroid is sluggish. The next thing I’m going to look at is, well, why is that low? So, if both free T3 and free T4 are low, it’s likely that you don’t have enough nutrients to make those hormones. And whether it’s amino acids, whether it’s that vitamin C, selenium, zinc, vitamin A we talked about, or iodine, or then the communication between the brain and the thyroid, because everything is a negative feedback loop.

                                                So, you’re just going to look at, okay, if both of them are low versus we make mostly T4 and then it’s converted into T3 in the liver. If you’re making lots of T4, but that T3 is really low, chances are that liver is sluggish and so that conversion isn’t happening. And so, you can start to get an idea of what’s going on, but this is worth some more testing. If I look at micronutrients and all your thyroid hormones are low, hey, guess what? You probably just don’t have enough of the actual nutrients. So yeah, we want to boost that.

                                                But then the next question is, well, why are those things low? “Oh, let’s look at the gut. Okay, you’re not absorbing. You have these pathogens. Okay, so let’s fix the gut.” And then, “Why do we have all these pathogens and why is the liver overburdened? Let’s look at the environmental toxins.” So, I say there’s the test that shows what’s happening and tests that shows why it’s happening. We want to know the what because it helps us get quick wins. I want you to feel better now so you can keep going, but if we don’t address the why, you’re going to be stuck in the what all the time, right? You’re going to be now dependent on those supplements. So, that’s my approach is that, okay, this is good. We want to keep an eye on this, but let’s go deeper. Let’s go a little bit deeper.

Dr. Weitz:                          And that, of course, is the true magic of the functional medicine approach and what really looking at root causes is.

Dr. Levesque:                    100%. Yeah. And I have a lot of people come to me who’ve come to practitioners said, “Well, they never looked at this.” And so if there’s practitioners listening to this, I encourage you to dive deeper. I know that some of your patients don’t want to do it. I have a ton of patients who I don’t accept because they don’t want to do it. They’re just like, “Oh, I want help, but not really.” So, it’s okay. What I hope is recognized for those patients that know that you don’t really want the help, and that’s okay if you’re okay with that, but if you want the help, this is the work and there’s people who want to do the work.  And I think it’s our job as practitioners to really show people that this is what’s possible and here’s some general advice that’s really great, but if you want to take it to that next level and actually heal your endometriosis or your PCOS instead of just manage it, then it’s not going to be just take CoQ10 and inositol and whatever and hope that it works. It’s going to be doing some much deeper work, the scrubbing, getting the gloves out, and doing the scrubbing.

Dr. Weitz:                          That’s great. Good. So, how can people get a hold of you? What’s the best contact information?

Dr. Levesque:                    Sure. Honestly, the best place to contact me is going to be through my Instagram. I’m on there, really active. I go on stories, I share lots of valuable content. I have my own podcast as well, Modern Health with Dr. Jane. But @drjanelevesque and lots of resources. On the Instagram you can send me a DM and say hello, and then I have the resources for the website.

Dr. Weitz:                          Can you spell your name for the listeners?

Dr. Levesque:                    Yeah. So, Dr. D-R J-A-N-E and then L-E-V-E-S-Q-U-E.

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

Dr. Levesque:                    Thanks so much for having me, Ben. It was a pleasure.

 


 

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 certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. That way more people will discover the Rational Wellness Podcast.   And I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective.   So, if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

 

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Mast Cell Activation, Dysbiosis, and IBS with Dr. Tom Fabian: Rational Wellness Podcast 324

Dr. Tom Fabian discusses Mast Cell Activation, Dysbiosis, and IBS at the Functional Medicine Discussion Group meeting on August 24, 2023 with moderator 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

6:18  IBS is a condition that is diagnosed mainly by symptoms and these are part of the Rome IV Criteria.  [These are found at TheRomeFoundation.org]  There are four recognized subtypes of IBS: IBS-C (constipation), IBS-D (diarrhea), IBS-M (mixed), and IBS-U (undefined).  Bloating and distension are common symptoms associated with IBS, but they are not officially included in the Rome IV criteria.  There is no currently accepted test for the diagnosis of IBS.  This is a good review article on what we currently know about IBS: Camilleri M, Boeckxstaens G.  Irritable bowel syndrome: treatment based on pathophysiology and biomarkers.  Gut. 2023 Mar;72(3):590-599.   

11:38  There are a number of conditions that result in similar symptoms to IBS, including Bile-acid malabsorption, exocrine pancreatic insufficiency, carbohydrate intolerance, SIBO, SIFO, Dyssynergic defecation, Ehlers-Danlos syndrome, mast cell activation syndrome, eosinophilic gastroenteritis, intra-abdominal adhesions, celiac disease, and giardiasis. Dr. Fabian noted that we are learning that a significant number of patients with IBS symptoms, esp. on the diarrhea side, have a sucrase-isomaltase deficiency, which is one of the brush border enzymes in the small intestine.  This leads to a malabsorption of sucrose and certain starches.

16:15  IBS Mechanisms.  Diet is an important factor since 85% of IBS patients report their symptoms are triggered by eating, often 60 min or so after eating.  Leaky gut is a factor in most GI conditions. We see immunoactivation/inflammation, though a more subtle form of inflammation than what we see with inflammatory bowel disease like Crohn’s disease. This is where mast cells come into play. There is also the gut-brain axis.

18:12  Disorders of Gut-Brain Interaction.  The new name for functional GI disorders being adopted in research is Disorders of Gut-Brain Interaction.  This is a good review article on this:  Vanuytsel TBercik PBoeckxstaens G.  Understanding neuroimmune interactions in disorders of gut–brain interaction: from functional to immune-mediated disorders     We see as part of the pathophysiology in IBS a subtle mucosal infiltration of immune cells, especially mast cells and eosinophils, along with the increased release of  nociceptive mediators, which lead to visceral hypersensitivity, which plays a role in abdominal pain.

22:20  The pathogenesis of IBS is explained well in the following article: Carco C, Young W, Gearry RB, Talley NJ, McNabb WC, Roy NC. Increasing Evidence That Irritable Bowel Syndrome and Functional Gastrointestinal Disorders Have a Microbial Pathogenesis. Front Cell Infect Microbiol. 2020 Sep 9;10:468.  Dysfunctional microbiota leads to increased intestinal permeability that leads to immune activation that results in mast cell activation and visceral hypersensitivity that leads to abdominal pain, bloating, and altered motility. 

       

              



Dr. Tom Fabian is a leading expert on the role of the microbiome in health, immune function, chronic disease and aging. He received his PhD in molecular biology from the University of Colorado Boulder, and he’s worked as a biomedical researcher in the biotechnology industry and more recently as a consultant in the microbiome testing field.  Currently, Dr. Fabian serves as a consultant and science advisor with Diagnostic Solutions Lab. Tom’s website is Microbiome Mastery.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. Dr. Weitz is also available for video or phone consultations.

 



 

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.

                                                All right. Hello, everybody. I’m Dr. Ben Weitz, and welcome to the Functional Medicine Discussion Group meeting tonight with Dr. Tom Fabian on the connection between diet, gut dysbiosis and mast cell activation in IBS, quite a title. I want this meeting to be interactive, so please participate by typing your questions into the chat box and then I’ll either call on you, or ask Dr. Fabian your question when it’s appropriate. Thank you for joining our monthly meeting and I hope you consider attending some of our future events.            September 28th, we have an integrative approach to depression and anxiety with Dr. Peter Bongiorno. October 26th, we are going to go back to our in-person meetings at the Santa Monica Library, and that will be an integrative approach to cardiology with Dr. Howard Elkin. I don’t know if I’ll be able to make it available remotely live, but I’ll certainly record it. I’ve got to figure out how to possibly do that. November, I’m not sure what the date is, but we’ll probably do it on the third Thursday instead of the fourth Thursday since third Thursday is Thanksgiving. December, we won’t have a meeting, and then we’ll start up again in January.   If you’re not aware, we have a closed Facebook page for practitioners only, the Functional Medicine Discussion Group of Santa Monica, that you should consider joining so that we can continue this conversation when this evening is over. I’m recording this event. It’ll be included in my weekly Rational Wellness Podcast which you can subscribe to on Apple Podcasts, Spotify, or YouTube. If you enjoy listening to the Rational Wellness Podcast, please go to Apple Podcasts or Spotify and give me a five-star ratings and review.

 


 

Our sponsor for this evening is Integrative Therapeutics and Steve Snyder is here with us this evening. And so Steve, why don’t you tell us about a couple of the integrative products?

Steve Snyder:              Well, hi, Ben. Thank you. The conversation earlier about the gluten, we learned this kind of the hard way. There is actually a lower limit of gluten you can have in products, which you can call them gluten-free even though they’re not gluten-free. You were talking about where are people getting exposed to gluten when they’re really sensitive, all over the place. We had a product called AllQlear that had a vanilla flavor in it. It had a little bit of gluten in it. It was below that lower limit, but we kind of pride ourselves on truth and labeling, so we said, “This product contains gluten,” and everybody freaked out and wouldn’t use it. It turns out it had less gluten than half the things in Whole Foods Market that say gluten-free, so that’s just a little nugget there.

                                                I know that we’re going to talk about SIBO again, and you guys have heard this all before. But we have reformulated the Elemental Diet, it’s quite a bit less sweet, quite a bit fewer calories from carbohydrates, so it’s much better tolerated. It’s a super powerful treatment option for SIBO. We do really great with it. Something around the neighborhood of 85% at three weeks have a negative breath test. So we have lots of support materials for it, lots of suggested protocols. We have samples. So if anybody’s interested in at least learning about it, you can reach out to me. We have several other products that go with that that we can talk about as well, some good prokinetic formulas, things like that. Yeah, we can talk about it any time you want. That’s it for today.

Dr. Weitz:                            Yeah, I use the Motility Activator, and that’s my favorite go-to natural prokinetic.

Steve Snyder:                      And we appreciate that.

 


 

Dr. Weitz:                            Okay. So thank you, Steve. Our speaker for this evening is Dr. Tom Fabian, who’s a leading expert on the role of the microbiome in health, immune function, chronic disease and aging. He received his PhD in molecular biology from the University of Colorado Boulder, and he’s worked as a biomedical researcher in the biotechnology industry and more recently as a consultant in the microbiome testing field. Currently, Dr. Fabian serves as a consultant and science advisor with Diagnostic Solutions Lab.  Tom, you have the floor.

Dr. Fabian:                          All right. Well, thanks so much, Dr. Ben, for inviting me here. And it’s great to be here this evening. Good to see everyone. I know it’s probably a little late in the day. I know it is here. I’m in Denver, Colorado and it’s not too far away from my usual bedtime. So bear with me, because my brain is slightly slower in the evening. So you can see here the title again is really all about the connection that we’re learning from just kind of an inundation of research the last few years on the links between diet, the microbiome, and particularly mast cell activation, IBS.

Dr. Fabian:                          So I’m going to go ahead and start here. I do have a fair amount of content to cover, but again, feel free to interrupt whenever you have any questions or anything you want me to clarify. I’ll be happy to stop and just answer any questions or discuss any of these topics. So just kind of a quick refresher here. I think everybody knows most of this stuff already. But in terms of diagnosis, we know IBS currently is still based primarily on symptoms and especially the Rome IV criteria.   So, of course, that really includes just a couple of things, altered bowel habits that are a main part of the differentiation between the subtypes, IBS-C, IBS-D, et cetera. And also abdominal pain. That really cuts across all types of IBS, so that’s a common feature. We’re going to talk about some of this pathophysiology research that’s coming out, and that really relates to both of these mechanisms and especially to abdominal pain, and that’s really where the mast cells come into play.

                                                We all know that bloating and distension are also common in this condition, but actually not officially included in the Rome IV criteria. The stats are a little bit different between IBS-C and IBS-D, so there’s tends to be a higher rate of bloating in constipation dominant IBS. There’s currently no widely accepted tests for diagnosis of IBS, although there’s lots of activity in this space, some tests that are available out there that I think over time some of these as they gain traction will become widely accepted. But currently there isn’t a given test that’s widely accepted across the [inaudible 00:07:58].

Dr. Weitz:                            By the way, Tom?

Dr. Fabian:                          Yes.

Dr. Weitz:                            IBS, you have IBS-C and D, which are constipation and diarrhea, IBS-M is mixed, and then IBS… What is IBS-U?

Dr. Fabian:                          So that’s a definition that I see sometimes and it, excuse me, refers to the mixed version. I mean, I’m sorry, the undefined version. So I guess that’s kind of a catchall for suspected IBS based on symptoms that doesn’t fulfill the other criteria.

Dr. Weitz:                            So that person doesn’t know if they’re coming or going?

Dr. Fabian:                          Exactly. Yeah, I’m really not that familiar with that definition other than it’s kind of the catchall bin for patients that don’t fit the other categories. So this is a really great recent review article, kind of on this trend now that we have so much research into these underlying possible connections with what’s going on in IBS that we’re possibly able to just start down this path of looking at what are some of these mechanisms, what sorts of tests can reflect these mechanisms, and some of these that are probably going to end up being emerging biomarkers. So this is, again, great review article by two of the leading experts in the field. That’s Dr. Camilleri, who’s been around for a long time. He is a big name in the IBS field. And also Dr. Boeckxstaens, who’s done some really great research recently on some of the aspects of this mast cell connection.  So they cover some of this in this review article. But I just want to cut to their summary here, where they sort of talk about this trend that we’re moving towards as we have more availability of these non-invasive clinical tests that can appraise the symptoms responsible for symptom generation that provides the opportunity to advance the practice from just treatment based on symptoms to individualization of treatment that’s guided by this pathophysiology, then, of course, based on the identified micro biomarkers as well. So I think this is a very exciting area of research. That’s definitely why… my motivation behind presenting this information, because there’s just so much of this research out there, thousands and thousands of papers, and I think it’s hard to keep up on all this information. So I think this is really especially useful for those of you who do a lot of gut microbiome stool testing, because some of what’s coming out really pertains to markers on these tests including GI-MAP.

                                                In terms of IBS pathophysiology and symptoms, when we’re looking at these underlying factors, obviously they have to account for these main symptoms. They have to help explain the altered bowel habits, particularly abdominal pain since that cuts across all types of IBS. But also the related symptoms, particularly bloating, distension and even the comorbidities. We know that stress, mood disorders, anxiety, depression are much more common in patients with these types of conditions like IBS. Even allergies are noted to be more common in patients with IBS. And then also clarify the relationship with these related conditions, we’ll see a list in a moment, that feature similar symptoms. And in many cases, the symptoms are almost identical so it’s hard to differentiate between IBS and some of these other conditions without specific testing, and sometimes unfortunately invasive testing.

                                                So, this is an example of one of those lists. This is by no means exhaustive, but these are some of the common conditions. You can see the title of this table here from a recent review article that references at the bottom. So they’re basically looking at all these different conditions that have symptoms similar in this case to inflammatory bowel disease, which certainly, especially in terms of IBS-D, diarrhea dominant IBS, tends to overlap with IBD. But just to give you a sense here, here’s IBS, and of course these are the common symptoms. If you look through that symptom column, you can see that there’s quite a few things there that have virtually identical or at least overlapping symptoms.  So, at the top we can see… Actually, let me go back to that. You can see bile acid malabsorption, pancreatic insufficiency, carbohydrate intolerance. So those are related to different aspects of digestion absorption. We certainly see evidence of that with our experience with GI-MAP. And there’s a fair amount of research, especially on bile acid malabsorption pertaining to IBS-D. It’s thought that 25, 30% of IBS-D patients actually have bile acid malabsorption. Pancreatic insufficiency is fairly common as well, not necessarily the full outright pancreatic insufficiency.  We also see patients with decreased pancreatic function based on the elastase marker. That doesn’t necessarily constitute full-blown insufficiency and yet we still see patients frequently will have bloating and IBS-like symptoms without sufficient pancreatic enzymes. [inaudible 00:13:23]-

Dr. Weitz:                            And Tom, the bile acid malabsorption, is that seen with the fat in the stool?

Dr. Fabian:                          So sometimes yes. You can imagine if basically foods are moving through too fast, there’s not sufficient time to absorb the fats, that can be part of the picture. We do see that sometimes. We don’t actually see high steatocrit all that often though. It’s usually in pretty extreme cases, and a lot of that actually has to do with a pancreatic insufficiency. So patients have really a poor pancreatic function, then they’re much more likely to have steatorrhea, i.e., fat in the stool.   The carbohydrate intolerance aspect is important. Of course we’re all familiar with FODMAPs and that FODMAPs can cause symptoms in IBS patients. But there’s greater recognition now that other types of carbohydrates… depending on the details for the patient. So there’s growing recognition, for example, of this sucrase-isomaltase deficiency, so that’s one of the brush border enzymes in the small intestine. Patients may be actually having IBS symptoms, especially on the diarrhea side, due to a malabsorption of sucrose and also certain starches. It’s thought that if a low FODMAP diet isn’t really helping patients and they seem to still have some sort of carbohydrate tolerance, it may be the starches and sucrose.  And again, some studies suggest that that may be as high as one third of IBS-D patients may have this sucrase-isomaltase type deficiency. So a lot of active research there. We’re going to to go into a little bit of the connection there between that and the microbiome, especially Klebsiella, small intestinal bacterial overgrowth, I know your audience was very familiar with that as well through Dr. Pimentel’s work, small intestinal fungal overgrowth. And then there’s of course a number of other things here. Mast cell activation syndrome itself has overlapping symptoms, and of course now we think that mast cell activation, not necessarily the MCAS syndrome, the classic syndrome, but a form of mast cell activation seems to be part of the picture in IBS, at least a subset of IBS patients.  Then there are a few other things here. You can see celiac disease near the bottom, even giardia infection can mimic IBS symptoms. So important to kind of consider this whole picture, and not necessarily just to any one particular conclusion off the bat. You do want to consider what else may be going on for patients.

                                            All right, so quickly, this emerging paradigm, I’m just going to summarize it here and then show a fair amount of the supporting evidence that we can talk about as time permits. But certainly, again, there’s this focus on switch from the assessment, diagnosis and treatment going towards the evidence-based pathophysiological mechanisms. And these leading mechanisms mostly currently implicate diet. So there’s a major role for diet. About 85% of IBS patients report that their symptoms seem to be diet triggered. And some of these studies that look at the occurrence of symptoms and the timing of symptoms, symptoms tend to occur in most patients, the majority of patients, within about an hour after eating, and then it sort of trails off after that.  So it is going to be variable, but the data does show that that’s pretty common for symptoms to be pretty soon within that 60 minute or so after eating.  First microbiome, we’re going to talk a lot about that today. Intestinal barrier dysfunction is well noted, not just in IBS but a long list of conditions. Immunoactivation, it’s not the type of inflammation we see in IBD, inflammatory bowel disease, it’s a more subtle type of inflammation. It’s more akin to a allergic type inflammation. So that’s really where mast cells come into play, because they do play a known role in allergies. And actually now it’s thought that dissimilar mechanism may be at play in IBS patients.  Then, of course, there’s the enteric nervous system, and then the connections with the gut-brain axis. All of these areas are actively being researched. And again, it is challenging to stay up to speed on all of this. But that’s where these review articles, I think, can be very helpful.

                                               This is another great review article that just came out earlier this year, Understanding Neuro-immune Interactions. And so this refers to the new name that’s being adopted in research for functional GI disorders. The primary ones are IBS and functional dyspepsia. And again, that new name is disorders of gut-brain interaction, to recognize this connection on the nervous system component.  So again, this article includes a couple of the researchers whose research we’re going to be talking about today, who’ve done a lot of work in this mast cell connection to IBS. Actually, I probably am going to go through most of this abstract just because I think it’s such a nice summary of the current state of research in this area of IBS. So at the top, they just sort of refer to that these functional GI disorders are now renamed into disorders of gut-brain interaction. Then they go on to say in the middle highlighted area, “Our understanding of the pathophysiology has evolved significantly over the last two decades, especially the last few years. Initial observations of subtle mucosal infiltration with immune cells, especially mast cells and eosinophils, those two are often related, are since recently being backed up by mechanistic evidence demonstrating increased release of what’s called nociceptive mediators,” those are pain mediators, “by immune cells in the intestinal epithelium. These mediators activate sensitized neurons leading to visceral hypersensitivity,” which is what they think primarily leads to abdominal pain.   So IBS patients tend to be more sensitive to even normal stimuli, such as even… Well, we think of gas production as being part of IBS. Studies indicate that IBS patients don’t necessarily always have more gas production, but they’re more sensitive to that based on this hypersensitivity. And then the last part they say, “This interaction between immune activation and impaired barrier function of the gut is most likely bidirectional with alterations in the microbiome, stress and food components as upstream players.” So that tells us a lot about how we can potentially intervene in terms of diet, modifying the microbiome, and of course, behavioral approaches as well.  This is from that same article, just kind of represented visually. So you can see here there’s the brain part of the gut-brain connection. Stress is a major factor. Stress certainly is known to activate mast cells. I will look at one of those example studies in a little bit. Food composition has a big effect on IBS. We know that that can be partly through altering the microbiota and its metabolites that it produces. The list of metabolites now that are implicated in IBS just keeps growing. There’s a lot of different vernaculars that they can produce.  And then we have those effects then of these different components on the intestinal barrier immune activation, and that can lead to neuronal hyperexcitability, which then leads to this… Just let me go back here. … disturbed gut-brain interaction and then the visceral hypersensitivity and motility. So we talked about the pathophysiology has to explain those two features of IBS, abdominal pain and motility differences. So this is representation at a high level of all these factors that we currently know can come into play. Is there any questions on anything so far, before we can dive into some of the details here?

                                                All right, so this is a… We’re not going to zoom in or look at this figure here. I’m going to zoom in on it just a bit. But another great review article. It goes through the evidence currently on the role of the microbiome and linking all the dots here. So this is a really busy figure, but I just want to break it down here real quick. We have the dysfunctional microbiome, also increased intestinal permeability, so things like LPS, some of these other factors they can produce histamine, et cetera, can get through and then affect the immune system and that can activate the immune system. That can then lead to this hypersensitivity that then explains these phenomena in IBS.  I just note off to the side here, they depicted mast cell activation degranulation that then can have an effect on the sensory nerves in the gut. And that’s thought to be one of the main ways in which mast cells can cause abdominal pain and also may have effects on motility as well. So it’s kind of a nice visual summary, once you break it down, on some of these key mechanisms. So a little bit of history on mast cells. It’s kind of a long history. It goes back as far as the late ’90s. This is an article from 2007 where they already were aware of some of these mast cell numbers increasing in IBS patients, mast cells being more active in IBS patients. So they knew some of these details as much as 15, 20 years ago. You can see there it’s 2007.

                                                Now, this is from a review in 2016, in terms of what they knew at that point. And this is kind of a nice summary of the different mediators that are released by mast cells. I’m just going to touch on some of the top ones here. Again, this is from a few years ago. Histamine is probably the best known. That’s thought to be involved based on various animal studies and a few human studies in IBS-C and IBS-D. Tryptase is what’s called a protease enzyme. Proteases are also implicated in IBS. You can see here both types, IBS-C, IBS-D. Serotonin actually is another one released by mast cells. We certainly know that has major effects in the nervous system, also thought to be involved in IBS-C and D. So this is kind of a summary of what’s been known.

                                                And this is, I think, overall just kind of a nice summary visual. You can see the reference at the bottom for all these different ways in which mast cell activation is thought to play a role in the different aspects of IBS. At the top here are different things that can actually activate mast cells. This highlights stress, food and bacterial products. We’re going to talk about some of those here. And then that can cause mast cells to be activated, then it releases these mediators that we just talked about like serotonin, histamine and proteases. Then that can lead to further immune system activation, possibly chronic inflammation. It can also lead to altered permeability, i.e., leaky gut, smooth muscle cell effects that can change motility. And then again, affects on the enteric nerves that may increase visceral hypersensitivity.

                                                So essentially, even though mast cells are not necessarily thought to be the only mechanism of course, they certainly seem to play a significant role in all of the major aspects of IBS. This is a quick just example here that we know that stress… This is a study from a few years ago. You can just tell from the title, Psychological Stress. And then corticotropin releasing hormone, that’s one of the sort of high level hormones in the brain that’s released as part of that HPA axis stress response, that basically stress causes that to be released. And then that can affect an increase intestinal permeability in the gut through a mast cell dependent mechanism. So that’s been established for quite a while. We know that that’s one of the ways in which stress can affect the gut and leaky gut.

                                                All right, we’ve talked about the various connections here where stress, again, can disturb the gut-brain axis, impair the barrier, cause immune activation, neuronal hyperexcitability, et cetera. But now I want to talk about the microbiome a bit more and some of the metabolites. So the connection between the microbiome and mast cells seems to be through many different ways. But we know some of these microbes that are associated with mast cell activation, and in some cases we know the mechanisms for how they can activate mast cells in the gut. So this is a review article that summarizes some of what’s known about these various microbes. So in terms of the ones that are mentioned in this article, the key ones would be Staph aureus. That’s probably one of the key microbes overall, especially in studies on allergies, that are known to activate mast cells. Streptococcus species, Pseudomonas aeruginosa, Enterococcus faecalis, Candida, H. Pylori, and then these LPS-producing microbes like Klebsiella, E. coli, and others that also can produce histamine in many cases.

                                                So a lot of different types of opportunists. We have all of these on GI-MAP so they can be assessed in terms of whether they’re elevated compared to normal. But again, there’s links to activating mast cells in the gut from these various microbes. A number of them have also been implicated directly in IBS. We’re just going to focus on a few examples here. But just on a side note, at some point a little bit later when we have more of the Q&A, I do have a link that I could provide to this reference here if you’d like to have access to some of the list of functional groups that we have on GI-MAP, such as these mast cell activating microbes.

                                                So this is an example of recent study where they did this high-tech multiomics approach, looking at the microbiome, looking at their metabolites and other measures. But basically one of their observations summarized here… And you can see off the right here, whenever there’s a article that’s available that’s open access, that you can just go and download and read the whole article, I’ve noted that. So this is definitely one that doesn’t have a paywall, you can actually access it for free. So they say, “When using average data, but not the single time point data,” so this is basically looking at patients longitudinally, “we found a significantly higher abundance of multiple Strep both in IBS-C and IBS-D as well as in the composite IBS group compared to healthy controls.”

                                                There’s also an older study here also linking Streptococcus to IBS through an immune activation mechanism by promoting this inflammatory cytokine, IL-6. This is just an example of a study from about 10, 12 years ago linking Staph aureus also to IBS. So here they noted that about 17% of their population tested positive for Staph aureus versus none of the healthy controls. So again, another research association there. But this is thought to be one of the ways in which Staph… Again, this is probably one of the best linked to mast cells. But you can see here that it releases a number of these toxins that can induce allergic skin reactions in this case. But those have also been noted to be released in other areas where Staph can overgrow, such as the gut. So they noted this one is a potent inducer of mast cell degranulation.

                                                One more study here on Staph and Strep. Yet another pretty sophisticated study where they’re looking at gene interactions in a variety of different common GI conditions. So they specifically looked at colorectal cancer, IDB and IBS and looked at what are these interactions with various microbes, particularly with a genetic component of susceptibility. And you can see here on the left, they basically found that there were three microbes that were common to all three conditions, and that includes, and they show those on the other side here, Staph and Strep. So we see these commonly elevated on GI-MAP. Probably among all the opportunists, these are the most commonly elevated. It may be that they’re linked to so many different conditions. We also know that upstream, poor digestion also has been shown to increase their levels, especially low stomach acid. And we all know, I think, that issues with digestion tend to be pretty common as well, whether it’s low stomach acid, pancreatic function, et cetera. So not too much of a surprise there.

                                                There’s just this growing amount of evidence that these two certainly are associated with IBS and likely play a role partly through mast cell activation. This is just one of those examples of a meta-analysis where they looked at 19 eligible… So these are high quality studies looking at the effects of PPIs on the microbiome and they found consistently across these studies that PPIs, they inhibit stomach acid, lead to increased Strep and Enterococcus, Staph and Bacillus among others. So certainly that’s one of the common things we do see clinically as well.

                                                Just a couple more notes on some of these other microbes that are associated. Definitely some studies linking Pseudomonas to IBS going back about 12 years or so, and several other studies since then have also found the same association. Pseudomonas’s interesting, it’s a little bit different from some of the other LPS producers like E. coli and Klebsiella that can be in the small intestine and large intestine. This one is primarily in the small intestine. It’s not thought to be active in the large intestine. A little bit about Candida and fungal dysbiosis, that’s also been associated with IBS type symptoms and also specifically visceral hypersensitivity. So, of course, I’m not going to go through all these, but this is just showing you that there’s a fair amount of research linking Candida also with mast cell activation through specific mechanisms. So we know Candida is another one of these microbes that can activate mast cells.

 


 

 

Dr. Weitz:                            So we’re having a great meeting, but I’d like to pause for a second to thank our other sponsor for this evening, which is Diagnostics Solutions Lab. Diagnostics Solutions Lab offers the GI-MAP stool test, which is the stool test that we use most frequently in our office, and I rely on it very heavily because the results are very helpful and very accurate. It’s been just a godsend for our functional medicine practice. So the GI-MAP from Diagnostic Solutions Lab is a comprehensive gastrointestinal assessment that uses quantitative PCR technology to detect parasites, bacteria, fungi and viruses. Results from the GI-MAP help reveal the root cause of diagnostic complaints, immune dysfunction, skin conditions, and more. For unparalleled results that optimize patient outcomes, leading practitioners rely on GI-MAPs, so go to Diagnostic Solutions, get an account and start utilizing the GI-MAP stool test. I think for sure you’re going to find it very comprehensive, very accurate, very helpful and the technical support is also great. So now, let’s get back to our discussion.

 


 

Dr. Weitz:                          Hey, Tom, with respect to Candida being picked up on a stool test like GI-MAP, it doesn’t seem to come up that often. There’s a thought in the functional medicine world, and I’m not sure about the research on it, that stool testing is not that sensitive to Candida. A number of practitioners will use organic acids testing because they see that as a more sensitive way to pick up Candida. What do you think about that?

Dr. Fabian:                          Yeah, I mean I think we do know that PCR is pretty sensitive, so if it’s there in appreciable numbers, we will pick it up. Candida actually is a little bit more challenging from the standpoint that when you kind of do that whole processing of the stool sample, basically you’re having to open the cells to release the DNA so that you can purify the DNA and then run the PCR. Candida cells are harder to break down. Our lab does use the methodology that’s recommended for Candida to break those down, so they’re pretty confident that if it’s there we are likely to see it. But there’s always the chance, because it is harder to break those cells down, that we may be not seeing as much as what’s actually there. I think our overall [inaudible 00:36:52] is… Sorry.

Dr. Weitz:                            I’m sorry, go ahead.

Dr. Fabian:                          [inaudible 00:36:56]

Dr. Weitz:                            I was going to say another issue might be that Candida could be found in other parts of the GI tract besides the colon.

Dr. Fabian:                          Yeah, yeah. I mean we can detect organisms coming from higher up. I mean H. pylori is kind of the case in point, coming from the stomach but it is easily picked up in stool. And we even know from lots of studies that oral microbes, depending on the microbe, can be detected in stool. So it is going to depend on the microbes. Some survive the transit, they’re more hardy. Some don’t really survive the transit, so it’s a little spotty. If you want to know the composition of the oral microbiome, you have to do a saliva sample, for example. But we can pick up some of these. So long story short is it’s certainly possible that the higher up you go in the GI tract, the less likely we are to detect low level Candida. But if it’s a high level, we’re highly likely to detect it. So it’s hard to say because there haven’t really been studies comparing those two tests with a gold standard. That would really be what’s needed is looking at organic acids versus stool PCR versus some other ways to confirm the actual presence of Candida.

Dr. Weitz:                            Okay, thanks.

Dr. Fabian:                          But I see them as kind of a little bit at both ends of the spectrum because it does seem to be commonly assumed that organic acid testing may pick it up more frequently and we don’t have, again, any studies we can point to saying that that’s not the case.  

                                                All right. I’m just coming back to this list here of these organisms that are known to stimulate mast cells. We talked about Staph, Strep, Pseudomonas, Candida. Now I want to focus on these histamine and LPS-producing microbes a bit. And then once we get done with that, I’m going to go into a quick case example, unless there’s any questions before we dive into that. So this is a major study that just came out last year in one of the top journals, Science Translational Medicine. It’s kind of after all these years of research into the mast cell connection with IBS and knowing that there’s probably some general association with microbes in mast cells, this one really, I think, drove that point home in demonstrating in many different ways.  This is a very involved study. They looked at microbes in human, some of the products they produce and also looked at animal models to look at specific mechanisms. So it’s a very thorough study. But they were able to show… Actually, I’ll bring it up here in the next thing here that, “We observe that the fecal microbiota from patients with IBS with high, but not low, urinary histamine produced large amounts of histamine in vitro. We identified Klebsiella aerogenes carrying a histidine decarboxylase gene,” that’s the gene that converts histidine to histamine, “as a major producer of this histamine. Also, this bacterial strain was highly abundant in the fecal microbiota of three independent cohorts of patients with IBS compared to healthy individuals.”  They kind of went on to show that this histamine actually not only activate mast cells, but acted as essentially a chemokine, which is an immune molecule which attracts immune cells. So they found that histamine increased the number of mast cells in the gut, and then also activated the mast cells. This was thought to be produced in this case primarily by this Klebsiella species. From previous research, we know that there are other organisms, also that we have on GI-MAP, that are known to produce potentially high amounts of histamine. Morganella and Klebsiella pneumoniae are two additional ones. We often see these elevated in patients with IBS type symptoms as well.

                                                We do have these listed on our resource sheet in the histamine producing section. Now I’m going to just talk a little bit more about some of these patterns and additional microbes that are often seen in IBS. This is a review of what was known at the time a couple of years ago, 2019. And they’re summarizing the major findings visually here. So you can see, in general, this is particularly true in IBS-D, that there’s often a decrease in Bifidobacterium, and Faecalibacterium prausnitzii, that’s one of the major butyrate producers. We do see that frequently decreased in patients with different diarrhea conditions, whether it’s IBS-D, inflammatory bowel disease and infections sometimes also, where patients have diarrhea.

                                                And then there’s often an increase in other groups. But the ones that we see most commonly… We don’t see the Lactobacillus one as often, but we do see high Bacteroidetes. And then I don’t know if many of you are familiar with this term Enterobacteriaceae, but it’s commonly used in research to refer to these LPS producers. So organisms like Klebsiella, E. coli, Proteus tend to be in that Enterobacteriaceae group. That’s the inflammatory LPS group, they tend to be elevated. We see that a lot, especially E. coli. That’s a pretty significant signature for IBS-D.

                                                Interestingly, this other study noted that especially E. coli, was found in biofilms that are prevalent in IBS, and also to some extent in ulcer colitis. That’s shown here. For the top… mostly in health individuals that lack biofilm. And they found that the biofilm was mostly in the ileum and the first part of the colon. So that’s where the biofilm was mostly concentrated in IBS patients. For ulcerative colitis, it tended to be more in the colon, especially the distal colon. But you can see for the healthy individuals, they generally had good levels of Faecalibacterium prausnitzii. But in the ones with biofilm, that was about 60% of IBS patients, more likely to be the IBS-D patients, again, Faecalibacterium was low. E. coli was one of the organisms that was increased and found in the biofilm. So we do see these patterns quite a bit on GI-MAP. These LPS producers are also noted in this review resource article. 

                                                Interestingly, a few years ago, they had already noted that patients with IBS-D had increased serum levels of lipopolysaccharide. So it’s likely that this increase in LPS producers is part of that picture. And this is where the diet component starts to come into play. So, of course, it’s always been thought that FODMAPs likely cause symptoms through fermentation and gas production, which certainly is part of the picture. But these FODMAPs actually can feed the LPS producers, and we’re going to see some of that evidence with Klebsiella. But they say here, I’ll just cut to the part that’s underlined, “That our findings indicate that a high FODMAP diet causes mast cell activation by promoting LPS, which in turn leads to colonic barrier loss, meaning leaky gut. And then a low FODMAP diet reverses these changes.” So this is thought to be a major mechanism now for how FODMAPs actually when they’re high can cause symptoms, and how the low FODMAP diet may be beneficial by reducing this LPS.

                                                So to summarized so far, these are some of the key microbes that have been implicated in IBS pathophysiology. Klebsiella, Staph, E. coli, Pseudomonas, et cetera. And then of course there’s products that they produced, and there’s more and more… This is just kind of a short list. These are some of the ones that are better studied, but probably the one at the top that has the best evidence is histamine. Lots and lots of research now is showing that excess histamine seems to play a role, at least in a subset of IBS patients. But there are others like serotonin, lipopolysaccharide. Obviously it would take a lot longer to cover all these different metabolites in the evidence behind them. But just be aware that there are quite a few. All right, so any questions on any… We covered quite a bit here. Any questions before we dive into a case example?

Dr. Weitz:                            In terms of mast cell activation, where do we think it most likely fits in? Is it resulting from dysbiosis, bacterial overgrowth? Is it occurring at the same time? Is it leading to dysbiosis?

Dr. Fabian:                          That’s a great question. So it’s thought that for many patients it is dysbiosis. So Klebsiella is, again, one of the best studied ones in terms of that link. But then there are these others like Staph and E. coli. When you go through all the upstream triggers of IBS, so we know that there’s postinfectious IBS, so we know gastroenteritis can cause that, there’s lots of evidence that all kinds of infections, bacterial, viral, parasitic infections. Once they’re gone in a subset of patients, those patients have persistent dysbiosis and persistent either outright inflammation, which could actually lead to things like inflammatory bowel disease, or more subtle inflammation.  So that probably depends on the patient’s genetics and other variables, but there’s often a trigger. So antibiotics are thought to be a key trigger. Lots of research now shows that antibiotics can lead to a bloom of these LPS producers and then they can potentially shift the balance long-term. Diet, lots of studies show that high-sugar diets promote these LPS producers. So it’s probably a combination of things. I’m sure diet is a major component, but maybe not sufficient all by itself. There has to be usually some sort of initial trigger or even just a genetic susceptibility.

                                            Are there any questions in chat that we want to take now?

Dr. Weitz:                            Yeah, I don’t know. Some of these questions have to do with treatment like use of diamine oxidase for treating mast cells, probiotics possibly making things worse or better. Berberine, does that affect a microbiome? Do you want to address those later?

Dr. Fabian:                          Actually, yeah, if we go through the case example, I do have a section on some of the treatments, and I know Berberine was actually in one of those resources. So short answer is yes, there’s actually… In terms of the approaches, certainly we know that there are diet triggers, FODMAPs being one of the best known, but there are others. I mentioned the sucrose and also the starches, so the whole carbohydrate intolerance piece is part of that. And then there’s some other things as well, but there are also things that can address the dysbiosis. There’s also treatments for mast cells and histamine, so there’s potentially different ways to approach it depending on-

Dr. Weitz:                            And do you have a sense of… Do you recommend doing multiple things at the same time? So if you’re going to try to use diet for SIBO, you’re talking about the low FODMAP diet, but then if you’re trying to address histamine, there’s a low histamine diet. Do you layer that on top? Do you treat the dysbiosis first and then if you still have a problem, then look at the histamine? In terms of the treatment protocol, where do you think you put the focus on the histamine?

Dr. Fabian:                          That’s a great question. So certainly depends on where that histamine is coming from, so if we do see histamine producing type microbes, and especially if symptoms are consistent with that. I don’t work directly with patients, but I work on these free consults that DSL offers for practitioners. So I review a lot of cases, and it’s pretty common for us to see pretty significant dysbiosis, like Klebsiella overgrowth, Morganella, in patients where they’re described as having histamine type symptoms or mast cell activation type symptoms.

                                                So definitely if it’s suspected based on symptoms and we see those organisms, then those would be likely a key target for practitioners for using antimicrobial herbs. But you have to look at the big picture. So a lot of practitioners kind of go top down. If they see something happening upstream, like H. pylori, or something that’s more small intestine like Candida overgrowth or evidence of poor digestion… So there’s lots of evidence now that poor digestion is a major cause of dysbiosis. If digestion is not optimal, certainly that needs to be addressed. And that could be one of the reasons why antimicrobials alone either don’t work sometimes, or they work temporarily and then patients relapse, which is pretty common. And that’s likely because some of these other upstream root causes are not being addressed, with digestion being one, certainly diet.   It’s really going to depend… My experience in working with so many practitioners is it’s going to depend a lot of the patient and the details of their assessment, and also what the test results show. They rarely just treat the test results by themselves. They’re certainly taking that into account with everything else that they know about.

Dr. Weitz:                            Yeah. You’ve mentioned H. pylori a couple of times. That seems to be a more and more controversial finding on a stool test. I recently did a podcast with Dr. Steven Sandberg-Lewis, and he’s a big believer that you should, in most cases, not treat H. pylori, even if you find it. In fact, he says don’t test for it, and he feels that it’s typically a commensal and helps protect against reflux.

Dr. Fabian:                          That’s a good question. So certainly if you look at the research, that is recognized that it’s not necessarily automatically pathogenic or that it always needs to be eliminated. But even in research and medical circles, there is disagreement over just how pathogenic it is, how aggressive the treatment should be. Overall though, just from reviewing all these studies, I would conclude that at low levels, likely it does not need to be treated. So on GI-MAP, we have about probably 80% of patients that have that E2 level that’s not flagged as high. Most of those patients don’t seem to have significant symptoms that could be attributed to H. pylori, so it doesn’t appear that it’s something that would need to be treated. The higher the level is-

Dr. Weitz:                            What you’re saying is if we see H. pylori, it’s above detectable levels, right? Because theoretically, all these potentially pathogenic or pathogenic bacteria should be below detectable levels. So it’s above detectable levels, but it’s not flagged as high.

Dr. Fabian:                          Correct. Yeah.

Dr. Weitz:                            Okay.

Dr. Fabian:                          Yeah. So E2 range generally is considered pretty low, detected but usually not an issue. Some patients do seem to have issues though, and that’s mostly based on practitioner feedback that they decided they wanted to treat because it made sense in the context of patient’s symptoms, and then they report that the patient improved after treatment. So that would be evidence suggesting that in some cases, based on your assessment, that you may still want to consider treating. But I think there’s two categories of treatment. There’s the classic view of H. pylori as being very inflammatory, causing ulcers, increasing risk for stomach cancer, et cetera, causing severe gastritis. Certainly in those cases, obviously would have to be aggressively treated, or patients that are high risk for stomach cancer and other conditions.

                                                But in patients that don’t necessarily have a high risk or any severe symptoms, we do know H. pylori, from a functional standpoint, can suppress stomach acid. So it is often one of the contributors to hypochlorhydria. So I think that’s where practitioners in the functional medicine space may be more likely to treat at levels that are maybe lower than what would be treated in conventional medicine.

Dr. Weitz:                            And what part does the… GI-MAP, for those who don’t know, also listed virulence factors for H. pylori. To what extent the appearance or non-appearance of those virulence factors, how does that change whether or not we should consider treating H. pylori?

Dr. Fabian:                          That’s a good question. So as always, it’s in the context of the patient, your assessment of the patient, their symptoms, but in general, they’re considered risk factors. So it’s a bit of a numbers game. The more virulence factors that are detected, the more likely the strain or strains that are present are more aggressive, more potentially pathogenic. And even there’s some differentiate among the virulence factors, with CagA and VacA being kind of the most widely recognized, more inflammatory type of virulence factors. So it does add some weight to treatment, but again, by itself it may not be sufficient unless the patient is obviously really symptomatic or high risk. But it’s really up to practitioner judgment as to… We try to educate them on these various considerations, but it’s every practitioner’s decision on whether they feel it should be treated or not.

Dr. Weitz:                            Okay. Great. Thanks, Tom.

Dr. Fabian:                          You’re welcome. So I’m just going to cover this quickly here. It is 8:30, at least my time, so we’re at the hour mark. Not your time. What time would you like me to completely wrap up by?

Dr. Weitz:                            I mean, we sometimes go till another 30 minutes, but it’s up to you.

Dr. Fabian:                          Okay. I do have the time to go through the… I do have another 30 minutes.

Dr. Weitz:                            Okay.

Dr. Fabian:                          So for those who want to stay, I’m happy to continue going through-

Dr. Weitz:                            Okay, great.

Dr. Fabian:                          So as far as this case example, it’s a pretty interesting one because it pertains to one of these sort of differential diagnoses and where there might even be an overlap. And kind of a side note is there’s a relatively new video I just saw. I’m not sure if anyone in this group is familiar with Dr. Lin Chang. She’s at UCLA, she’s one of the leading IBS researchers globally. At the DDW conference this past May, she gave a keynote lecture on the connection between stress and IBS. But she had kind of a short video with one of the other leading IBS researchers on this sort of differential diagnosis and overlap of IBS, especially IBS-D and inflammatory bowel disease. And that’s actually what this case here is about.

                                                So if you look that up. I think it was on… I’ll have to put that in the chat as well if I can find that link. But I think it was on something like Medical Xpress or one of those websites. But I’m sure if you google her… And then the other researcher is Magnus Simren, S-I-M-R-E-N. And they had a helpful video on this overlap scenario. The patient here, as you can see, is female, 74 years old, diagnosed with Crohn’s disease decades ago. The practitioners that we consult with don’t always have the full information, but they mentioned that part of the intestine was removed. They did not have the details of how much, which was certainly a key piece of information that does help with interpretation. But we certainly know that part of the intestine was removed.

                                                This patient always has some degree of diarrhea, depends a lot on Immodium. But recently, kind of inexplicably, their diarrhea worsened. So this patient has really been adamant about avoiding the standard medical approaches. For a while had been on steroids, for example, but eventually went off them with the help of a functional practitioner. You can see her had been taking a Chinese herbal colitis formula, also supplementary short-chain fatty acids, particularly butyrate and the typical probiotics, some polyphenols, definitely increasing the berry intake, more vegetables. And unfortunately multiple three-month rounds of antimicrobial herbs, and then three months on an elemental diet, basically none of these ultimately helped, and this patient’s diarrhea is still not so good.

                                                So the patient’s very discouraged because the natural approaches weren’t working and they really don’t want to have to go back on steroids. This patient, I think, from what I understand, hadn’t had a recent colonoscopy. Of course, that was discussed as well as to… Depending on how recent that was, that’s something that probably would need to be repeated. So this is their GI-MAP, no current pathogens detected. H. pylori was negative. Now, we’re looking at two time points here, so that’s why this looks a little bit different. They had done these about three months apart, with some of these antimicrobial herbal protocols in between. But again, really no significant improvement in symptoms.

                                                So this is the normal commensal section. You can see there’s a little bit of a shift here overall. Generally though not much… kind of some slight improvements, like you’ll see the Akkermansia was not detected, now it’s detected. So there were some minor improvements, but also some things that worsened. One thing I want to point out here, and I’m actually going to… I think this is highlighted. Yeah. So that classic signature of IBS, diarrhea dominant, is very similar to inflammatory bowel disease. Both of those conditions feature typically increased Escherichia, that’s E. coli. We did see that. It was high certainly on the second test. Faecalibacterium prausnitzii is typically seen as low or not detected with patients with inflammatory bowel disease and also diarrhea dominant IBS.

                                                So that signature was present. That’s a common signature. It’s known in literature, and we see this a lot in patients with diarrhea. Same with the high Bacteroidetes. We don’t always see the high… Or actually, no, this is low Formicidaes, but we do see a high Bacteroidetes. That’s thought to maybe play a role in this bile acid diarrhea scenario, which I won’t get into the details there, but there seems to be a link where Bacteroidetes may worsen the symptoms or contribute to bile acid diarrhea. So this is a classic signature. We definitely saw this for this patient. We do know that she was already diagnosed with inflammatory bowel disease, so not a surprise.

                                                And again, this is just reiterating that this is a common signature, well known in research for inflammatory bowel disease, and it over laps with IBS-D. So that’s, again, high Bacteroidetes, these Enterobacteriaceae, LPS producers tend to be high, Faecalibacterium tends to be low. You also note Roseburia, which we do have on GI-MAP, is also something that tends to be low in IBD. So this is their overgrowth opportunistic microbe section. Still looks pretty bad both times, despite all these treatments. You can see Bacillus was high, and Terracoccus, Morganella, that’s one of the key histamine and LPS producers. That was super high.

Dr. Weitz:                            Hey, Tom, in terms of Bacillus being high, Bacillus is a bacteria that’s included in spore-based… All spore-based probiotics, I think, are Bacillus based.

Dr. Fabian:                          Right.

Dr. Weitz:                            So should we think of Bacillus as potentially bad in some situations?

Dr. Fabian:                          It’s listed in this. You can see the title here, not the main title, but the subtitle is Dysbiotic and Overgrowth. So it’s really just an overgrowth bacteria. It tends to be elevated, especially in patients that are not digesting very well. Whether or not it actually contributes to symptoms is unknown, but not likely. Numerically, it’s not that prominent in the gut. And we get asked that question a bit, if it’s high, is it something where we would not recommend taking these spore-based probiotics? I don’t think it would be contraindicated. And there are plenty of practitioners that still supplement because they suspect SIBO or other conditions where these are commonly used and patients tend to improve. Part of that could be-

Dr. Weitz:                            If a patient were taking a spore-based probiotic, would we expect a Bacillus potentially to be high?

Dr. Fabian:                          It can, yeah. And that may be one of the reasons why we didn’t… In the early years of GI-MAP, we didn’t seem to see the Bacillus as high as often. And then these spore-based probiotics came out, became very popular, then we started seeing higher levels. We have no way of knowing whether that’s due to the probiotic, but it doesn’t seem to be a negative to supplement even though these numbers are high. And that could be because the specific species and strains in the probiotics are not the same as the ones that are in the patient’s microbiome, so they may still be getting the benefit of those probiotic strains.

Dr. Weitz:                            Are the Desulfovibrio and Methanobrevibacter broken out because those are often known to be associated with SIBO?

Dr. Fabian:                          No, they’re broken up because… So the commensal term just means that they’re present, they’re normal residents of the gut. They’re present in virtually everyone. And they’re thought to be beneficial at normal levels. And then they’re thought to be an issue when they’re overgrown. So again, that’s why they’re in this overgrowth section, because-

Dr. Weitz:                            I thought all the dysbiotic bacteria were potentially present in normal levels.

Dr. Fabian:                          It’s kind of a fine point of distinction, but it has to do with overall prevalence. So that’s frequency in the population. So these commensals are highly prevalent, so most people have them, whereas most of these dysbiotic microbes, with a few exceptions… So streptococcus arguably could be under the commensal, because it is a commensal in the mouth all the way through the small intestine.

Dr. Weitz:                            Okay.

Dr. Fabian:                          So it’s a little bit of a mixed picture, and there’s just kind of these nuances with the microbiome. But Desulfovibrio and Methanobacteriaceae, the methanogens, are present in virtually everyone, and usually not an issue unless they’re overgrown.

                                                So we definitely see an overgrowth pattern here. One of the most common contributors to this type of pattern, both from research and what we see clinically, is poor digestion. So it certainly doesn’t prove that patients have low stomach acid or pancreatic dysfunction. Luckily we do have a pancreatic marker on our test, so that can be checked, but it’s certainly something to suspect when you see these elevated. And many of these are more predominant in the small intestine. So that’s true in particular for Pseudomonas, which wasn’t initially in this case. Especially true for Staph and Strep. Those are much more common and much more abundant in the small intestine. In fact, Streptococcus is usually the number one most abundant species in the mouth, all the way down through the small intestine.

                                                So, again, Morganella tends to be one of these that is commonly associated with inflammatory bowel disease, and it does produce high amounts of histamine, so it may also be a contributor to IBS type symptoms. In this next section or two, we have the inflammatory microbes, particularly Klebsiella in this case. Now note that Klebsiella is not officially high. But there’s some nuances with these organisms and we do tend to see that patients often have symptoms when Klebsiella pneumoniae is present. And it’s thought that actually Klebsiella is a lot like Strep in its location. It’s actually thought to be a resident in the oral cavity and the respiratory tract. You can kind of guess by the name that it’s found in the lungs, Klebsiella pneumoniae. But they’re generally found pretty commonly a higher up and tend to populate the lower gut after there’s disruptions.

                                                It’s been linked to low stomach acid. Antibiotics can predispose to its colonization of the lower gut, et cetera, and it’s likely coming from higher up. And studies actually show that, that once you detect it in stool, that means it’s definitely colonized and likely overgrown higher up. In the commensal inflammatory section, this patient also had, at least on the second test, high Escherichia, that’s E. coli, high Fusobacterium, which has also been linked to inflammatory bowel disease. Several different studies out of different labs have linked Fusobacterium to some cases of IBS-D as well. And also Prevotella, which can be an inflammatory microbe in some cases. No fungi yeast, no viruses, no parasites at all. So those look good. And then we get to this last section, the intestinal health markers. So digestion actually looks like it’s, from the steatocrit standpoint, improved with the treatments. So a little bit of fat malabsorption before, now it’s fine. Pancreatic function looks to be pretty good. But look for that to be around 500 and above. It’s pretty close, not too bad.

                                                Again, we might suspect low stomach acid based on the overgrowth patten, but there’s no way to test for that directly with stool testing. GI markers, the first one looks good, Beta-Glucuronidase. Of course the occult blood, which is a common feature of IBS-D, this patient did have… I’m sorry, I should say inflammatory bowel disease, not IBS-D, especially ulcerative colitis. So this patient still had detectable occult blood. It was a little bit better. Secretory IgA went down, so that’s an improvement. Anti-gliadin actually went up. So this patient may have had some gluten exposure, which may have been related to some of these other patterns that worsened over the second time.

                                                This eosinophil activation protein, so that’s… I want to take a minute there just to talk a bit about that connection with mast cells. So mast cells and eosinophils tend to work together. They tend to activate one another. We don’t have a direct marker for mast cells, but eosinophil activation protein can be taken as a potential indirect marker. We also know from studies that this protein is linked to, and just general eosinophil activation is linked, most commonly to food sensitivities, but also to inflammatory bowel disease as well. So it’s again, another type of inflammatory cell. It’s telling us that there is an issue there as well.

                                                But calprotectin, which is a classic marker that we look at for especially inflammatory bowel disease, wasn’t too bad before. It was kind of in that yellow range, only 69. I didn’t include the cutoffs here, but it’s at 173, so it’s pretty far below 173. But the second time around with this patient not improving and some of the inflammatory microbes getting worse, calprotectin looks great. Right? So this patient’s been very concerned about having to go back on steroids. But so far, based on the calprotectin, that would suggest that this IBD scenario, that the patient may still be in remission. Only a colonoscopy would be able to confirm that. But this is suggestive then that this patient’s current symptoms may not actually be due to an IBD flare and it may be related to this IBS and IBD overlap. So this is one of the markers that is often used to differentiate between IBS and IBD. And again, at this point it appears like this patient may have actually IBS, diarrhea dominant.

Dr. Weitz:                            Would they still be having blood in their stool if they were not having an IBD flare?

Dr. Fabian:                          That’s a good question. Yeah. I mean that’s why likely this patient, if they haven’t had a colonoscopy recently, their gastroenterologist likely would want to, of course, revisit that, because occult blood is potentially concerning. But that would not be a common finding in IBS-D. So again, this speaks to this overlap where it’s kind of an in-between scenario, not fully consistent with IBD, but suggests possible overlap with IBS.

                                                And we’ve just talked about those markers, so I’m not going to focus on that. But that kind of takes me to… So that’s basically the patient scenario. I’d love to chat about… if you have questions about any of the potential ways to address those imbalances. But just a couple of things I want to talk about before we do. So we didn’t really talk about this food component here. I just want to touch on that a little bit, especially with regard to Klebsiella. So we tend to think of Klebsiella as a bad guy. It’s linked to all these different conditions. It’s also linked to a variety of autoimmune conditions, rheumatoid arthritis, ankylosing spondylitis, et cetera. So it’s found in a lot of different conditions, not just IBS-D. And I think we’ve known for a long time, especially those who are maybe more familiar with the ankylosing spondylitis scenario and the connection between Klebsiella and starches, this reinforces that. It’s just a brand new study. And also extends that observation that basically a full range of simple carbohydrates promotes Klebsiella growth. And that includes sugars, starches and even FODMAPs.

                                                That’s from various studies as well, not just from this study here. But they say, “We identify simple carbs as critical to the colonization of Klebsiella.” So that’s something to assess, of course, with patients’ diets, especially if the antimicrobial isn’t working so well. And they also find the opposite, that dietary fiber is necessary for colonization resistance against Klebsiella. So that gets in the conversation of if you’re eliminating FODMAPs then how do patients still get adequate fiber?

                                                Just another kind of interesting insight here. So they found that lactulose can be utilized as the sole carbon source, this is of course done in culture, minimal media for the tested strains of Klebsiella pneumoniae. “We confirmed that the addition of lactulose to cecum extract, so basically colon contents, increased the the growth of Klebsiella pneumoniae measured by optimal density, et cetera. Mice were provided lactulose in drinking water after colonization of Klebsiella. Compared to the water control, lactulose increase Klebsiella pneumoniae by tenfold.”

                                                So technically lactulose is considered a FODMAP, even though it’s not a natural compound. But interestingly, it kind of makes you think about the breath test prep and the breath test itself, because patients are recommended to avoid fiber, at least for a short period, maybe longer for constipation, and then they’re given a large dose of lactulose. So if they happen to have Klebsiella, technically this may actually make their Klebsiella worse. So I’m not sure how that might affect the breath test though.

                                                A couple of other things, so in terms of the fiber, we know that fiber definitely inhibits a range of these LPS producers, inflammatory microbes. And that’s likely through this mechanism, at least in part, that basically fiber leads to short-chain fatty acids, and then that can help to help to acidify the local environment. That’s just noted here. They say, “Here we demonstrate that an antibiotic, naive microbiota, suppresses growth…” So that’s basically commensals, “… suppresses growth of antibiotic resistant Klebsiella, E. coli and Proteus by acidifying the proximal colon and triggering short-chain fatty acid mediating intracellular acidification of those bacteria.” So that’s thought to be one of the key ways for how fiber helps to protect against these bad guys. So pretty essential in considering dietary approaches to keep these microbes from overgrowing.

                                                So I just want to mention real briefly some of the articles that point to some of these factors that may help with mast cells. There’s a lot of research on this. Certainly you know about certain things like quercetin that can inhibit mast cell activation. This figure shows a few others like lipoic acid, N-acetylcysteine or taurine, even biotin. So there’s growing research now that lack of biotin promotes these inflammatory microbes. And making sure there’s adequate biotin in the diet can suppress the inflammatory microbes.

                                                And that’s where berberine… I know we talked about that earlier, but berberine comes into play. Interestingly, this is a conversation for another day, but hydrogen sulfide I think these days has kind of a bad wrap over concerns about hydrogen sulfide SIBO and things like that. But normal physiological levels of hydrogen sulfide are thought to actually promote health in the gut. There’s a fair amount of research showing that normal production of hydrogen sulfide… Even certain beneficial bacteria can produce hydrogen sulfide and sulfur related compounds. So it’s thought that one of the ways in which berberine might be helpful, and/or hydrogen sulfide related compounds, is through these same mechanisms that can help to reduce mast cell activation. And I actually looked into that a bit, so that was an interesting connection. But hydrogen sulfide actually, there’s a lot of research now showing it can inhibit mast cell activation.

Dr. Weitz:                            Interesting. Hey, Tom, in terms of antimicrobials like berberine, have you seen, from looking at all these stool tests and talking to clinicians, et cetera, that the use of antimicrobials like berberine… do you see that they tend to damage the microbiome?

Dr. Fabian:                          That’s a good question. So it depends on, of course, the dosing and how long. So generally, no. A typical course of antimicrobials, afterwards the microbiome usually looks noticeably better. Frequently your key targets, which are those opportunists on page three, tend to be much improved in most cases. And that’s a major deal, because you need to get those opportunists down to help the good guys to recover. So for the most part, no, we don’t see that. But I have had a few unusual cases, for example, where for example a child, an autistic child, had been on Biocidin for a year or more and was really deficient. And for whatever reason, I don’t know why, but the clinician recommended that they just keep taking Biocidin indefinitely. So that’s an anecdote. We don’t have statistics, of course, to show for sure what’s happening. But from a clinical anecdote standpoint long-term… And it’s surprising how many clinicians will have patients on these antimicrobials for months and months or longer. So I’m not sure exactly why that’s the case. But I past a certain point, I would assume that if it’s not working, that suggests a different approach is needed.

Dr. Weitz:                            On the opposite end, in terms of probiotics improving the microbiome, we know that probiotics typically don’t become permanent residents. But now we’re starting to get a new breed of probiotics, in other words, Akkermansia is now available, and I think that Faecalibacterium prausnitzii may also be available. And there’s some speculation that those probiotics may actually colonize the gut. Have you seen anything in terms of that?

Dr. Fabian:                          Not so much yet in terms of published data. So probably the closest would be FMT, which is of course less defined than a probiotic. But FMT if fecal microbiota transplant, some of the microbes it depends on the individual, but often a large proportion of them seem to colonize. But some don’t, not sure why. And then some of these more defined commensal probiotics, I don’t think we have enough data on them yet to know for sure, but so far preliminary data suggests that probably they do colonize to some extent, certainly more than the typical probiotics.

Dr. Weitz:                            Okay.

Dr. Fabian:                          I think we’re just about at the end here. I think I had a couple more. One was about resveratrol, several studies showing that that also could inhibit mast cells, and probably many other polyphenols. Probably won’t get into this since we’re just at the end. I want to make sure we have some questions. But this is just getting into the idea that it’s not just FODMAPs and carbohydrates, that also some patients with IBS may have a food-allergy-like scenario where their mast cell activation and their IBS symptoms are due to a specific immune reaction that’s similar to a food allergy, but they have IBS symptoms instead of food allergy symptoms. So that would suggest some patients may have to get pretty specific about what foods that they’re avoiding because it may be very specific foods and antigens in those foods that are triggering symptoms. And that’s basically what this is speaking to, a major study from a couple of years ago. So I think I’m going to end here. Yeah, that was my last slide.

Dr. Weitz:                            Okay. So anybody who hasn’t been able to ask a question, do you have any questions you want to ask Tom about the microbiome or mast cell activation or IBS?

Dr. Fabian:                          I see Steve has his hand up.

Steve:                                   Right. Thank you, Ben. Thank you, Doctor. Quick thing I wrote in there, do you see any cross reactivity that people have had long-term Strep infections, especially some of our younger children now, and taking a probiotic that has Strep in that, do we see any cross reaction?

Dr. Fabian:                          I wish I had a good answer for you, but I’m not aware of any research on that and I haven’t come across that specific scenario clinically either. So theoretically, certainly I think that that could happen, but I don’t have any specifics that I can point to.

Steve:                                   Okay, thank you. Also, with the carnivore diet, do you see any pathologies in these patients that have gone carnivore?

Dr. Fabian:                          So that’s a really interesting topic and we don’t have enough samples, or at least I haven’t come across enough samples to say conclusively. I would say in total I’ve come across only a handful, maybe 10, over the last couple of years or so. And in most cases, but not all, and some cases there was a before and after, the microbiome often looks very dysbiotic. Whether that’s a long-term problem or not, we don’t really know. But from a standard assessment of the dysbiosis, we would say the dysbiosis tends to be pretty bad on the carnivore diet. That may be due to the fact that we know that amino acids, when there’s an excess that gets into the colon… So if you eat too much protein and you’re not digesting it optimally, and some of it gets into the colon, that can stimulate dysbiosis and protein fermentation. So I think a lot of it has to do with digestion as well.  If you digest protein really well, you may be doing much better on a carnivore diet than someone who does not digest well. But I do wonder about how these microbes with all these beneficial products fare without a good source of fiber because that’s really what they thrive on.

Dr. Weitz:                            Steve had also written a question about is there anything on the GI-MAP that has any relationship with polyps? And I would ask, and is there anything on the GI-MAP that might tell us anything about the potential risk of colon cancer?

Dr. Fabian:                          That’s a great question. So probably the number one marker that would at least raise suspicion of something off would be the occult blood. Fortunately, that’s pretty rare that a patient who hasn’t, for example, had a colonoscopy in a while but turns up with high occult blood. Usually it’s something temporary or it turns out to be something like an inflammatory bowel disease. But in rare cases, I’ve heard of a couple examples, where the patient went on to have a colonoscopy and they did find colon cancer. So the fecal occult test is one of the tests that can. It’s not exclusive to colon cancer, that’s the issue. So there is no marker that says, “Yes, of course.” We don’t have anything on the test that would be diagnostic for colon cancer. We have a few markers that would raise suspicion. A Fusobacterium would be another one. There’s definitely links between increased Fusobacterium in general and a higher risk for both IBD and colon cancer.

Dr. Weitz:                            Oh, interesting. I think Fusobacterium is one of the bacteria associated with hydrogen sulfite SIBO.

Dr. Fabian:                          Yeah, it is a significant hydrogen sulfide producer and it’s thought to mostly be present in the oral cavity. It’s known to produce a lot of hydrogen sulfide there. But when it gets down into the colon, it’s thought to stimulate inflammation in the colon. Not necessarily in everyone, but it’s something that can happen more frequently. It is an LPS producer, so that may be one of the ways in which it actually contributes to inflammation as well.

Dr. Weitz:                            Awesome. Thank you so much, Tom.

 


 

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 certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review, that way more people will discover the Rational Wellness Podcast. And I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way.  That usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

 

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Preventing Osteoporosis with Dr. John Neustadt: Rational Wellness Podcast 323

Dr. John Neustadt discusses How to Prevent and Reverse Osteoporosis 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

3:08  Epidemic of osteoporosis.  Today we have an epidemic of bone loss termed osteopenia and osteoporosis in the US and one reason is because our society is getting older.  In fact around the globe, there are now more people over age 65 than younger than five.  About 80% of osteoporosis cases are women and the fastest rate of bone loss is as women go through menopause and the ten years after menopause.

4:03  Women more at risk.  The main reason why women are more at risk for osteoporosis has to do with their loss of estrogen as they get older.  Another risk factor for women is the use of antidepressant medications that artificially raise serotonin levels and there are serotonin receptors in the bones that stimulate increased osteoclastic activity, leading to more bone breakdown.  As people get older they also tend to have more inflammation such as autoimmune diseases and they tend to have more insomnia, etc., which are both associated with poor bone health. The average American woman also only gets about 800 mg of calcium per day from their diet, which is below the recommendation. They are also not getting enough of the micronutrients found in fruits and vegetables, which puts them not only at increased risk of osteoporosis but also for cardiovascular disease, dementia, etc.  Have less muscle mass also puts post-menopausal women at risk as well and partially due to not getting enough protein in their diet and also due to not doing enough exercise, esp. resistance exercise. Osteoporosis is a chronic disease, so it doesn’t just have one cause.

7:54  Medications.  There are a number of other common medications that result in a loss of bone mass.  Proton pump inhibitors, acid blocking medication often prescribed for reflux and other gastrointestinal complaints, such as Prilosec, damage bone and increase fracture risk.  PPIs block calcium, magnesium, and other minerals from being digested and absorbed from our food.  Taking a PPI for four years results in a 60% increased risk of a hip fracture. As mentioned, SSRIs, antidepressants, increased bone loss and for every 19 people taking an SSRI, we would expect one to break a bone.  There is also a long list of other medications that increase bone loss, including anticonvulsants like Phenytoin, prednisolone and other glucocorticoids, and aromatase inhibitors.

12:28  Detecting and assessing bone health.  The standard of care is a bone density test through a type of x-ray called dual x-ray absorptiometry test, a DEXA test, and that detects the quantity of bone and that’s used to diagnose bone.  A T-score of -2.5 or lower is diagnostic of osteoporosis.  While bone density is an important marker to look at, the most important factor is fracture risk, which depends upon a number of factors, only one of which is bone density.  Bone density only predicts 44% of women who will break a bone and only 21% of men. There are various factors that can affect the accuracy of the bone density test, including which mean is used, how they are positioned including that the hips are internally rotated 15 degrees or if they are very thin or obese or have arterial calcifications or bad arthritis in their spine of if they are taking strontium. 

17:10   Bone Turnover tests.  There are tests that measure whether you are losing or gaining bone, including the C-Telopeptide test, which is a breakdown product of collagen in bone.  If CTX is high it means you’re breaking down collagen and that has been associated with an increase in fracture risk.  The most consistent predictor of fractures in gait or mobility.  Can you get up from a seated position on a chair or the floor to standing?  What is your balance like?  Can you stand on one leg for 30 seconds? 

20:45  Medications for improving bone strength.  The bisphosphonates like Fosamax, Boniva, and Actonel are the most commonly prescribed drugs for osteoporosis.  If you have post-menopausal osteoporosis but you haven’t broken a bone since you’ve had the diagnosis, none of the oral bisphosphonates are effective at reducing both vertebral and hip fracture risks.  The only bisphosphonate that has been shown to be effective for primary prevention of fracture is intravenous Zometa.  To get benefits from any of these medications you have to take it 70-80% of the time for years to reverse bone loss.  Dr. Neustadt prefers Prolia, which also reduces osteoclast activity but which works by a different mechanism than the bisphosphonates and which is better at reducing fractures in secondary prevention of fractures and Forteo, which stimulates the osteoblasts and is also better at reducing fractures.  Both these drugs must be injected.

26:12  Exercise for Bone.  Dr. Neustadt says that we do not have enough good studies looking at fracture risk for which form of exercise is best for bones.  He is not convinced that we need to do heavy weight training or that you need to go to a gym but he feels that it is important that whatever exercise you do be done safely and certain types of movements, such as too much flexion type exercises might be dangerous and cause injury.  There are a number of studies that show increased bone density but few that show fracture risk.  Dr. Neustadt also recommends the stork exercise, where you stand on one foot while brushing your teeth.  You stand on one leg while brushing your bottom teeth and then switch feet and brush your top teeth.  He likes the vibration plates. He does not feel that Osteostrong has enough research to support it, though theoretically it makes sense.

34:20  Diet for Bone Health.  Dr. Neustadt does not feel that consuming milk and dairy are necessary to having healthy bones.  A lot of people have immune reactions to dairy and they can become phlegmy and congested.  A lot of people have a difficult time digesting dairy and they could be lactose intolerant.  Yes, consuming calcium in the diet is important, but milk is not necessary. Sardines are one of the best sources of calcium and almonds and swiss chard are good non-dairy sources of calcium.  It’s the overall dietary eating pattern that is the most important factor and not just one food that is eaten.  The Mediterranean-style of diet is best and has been studied for over 70 years and shows a 20% reduction in hip fracture, the most dangerous type of fracture.  While eating a more plant forward diet is healthy, eating an alkaline forming diet will not make much difference because this concept that eating an acidic diet will pull calcium from the bones has been pretty much debunked as a valid concept. 

              



Dr. John Neustadt is a Naturopathic doctor and he has published over 100 research review articles and four books, the most recent of which is Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis in 2022. He is also the founder and President of Nutritional Biochemistry Inc. (NBI) and NBI Pharmaceuticals. The website is NBIHealth.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. Dr. Weitz is also available for video or phone consultations.

 



 

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 listeners. Our topic for today is osteoporosis and what we can do to prevent and reverse it, with Dr. John Neustadt.  Osteoporosis literally means porous bones, and it refers to a condition in which the bones become fragile and the risk of fracture is increased.  In fact, according to the National Osteoporosis Foundation, 1 out of 2 women and 1 out of 4 men over the age of 50 will break a bone due to osteoporosis. And that’s actually, I think an older statistic, so it’s probably worse now.  The most common sites of fracture are at the hip, the spine, and the wrist. If you have osteoporosis and you break your hip, there is up to a 40% chance that you’ll actually die within the next year.  When you look at a bone density scan, if there is a T-score of -2.5 or worse, this is generally defined as osteoporosis and a T-score of -1 to -2.5 is termed osteopenia, which is a loss of bone though not as severe as osteoporosis.  As I understand it, the way we should understand osteoporosis is that throughout our lives we have a balance of both cells that build new bone, osteoblasts, and cells that clear out old junky bone, osteoclasts.  When we’re younger, there’s a tendency for the osteoblast to dominate over the osteoclast, and when we get older, there’s a tendency for the osteoclast to dominate over the osteoblast.

                                                Dr. John Neustadt is a naturopathic doctor, researcher and frequent speaker. He’s published over 100 research review articles and four books, the most recent of which is Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis, and he just published this last year. He’s also the founder and president of Nutritional Biochemistry Inc., and NBI Pharmaceuticals.  Dr. Neustadt, thank you so much for joining us.

Dr. Neustadt:                     Thank you for inviting me to share what I’ve learned with your audience. This is a topic that is near and dear to my heart that I’m very passionate about.

Dr. Weitz:                            Good, and near to your bones too. Why do you think we have such an epidemic of osteoporosis and osteopenia in the US?

Dr. Neustadt:                     Well, part of it is simply because we’re getting older. The average age in the United States is getting older, and in fact there are more people over the age of 65 now globally than there are younger than five. The baby boom generation is aging out, and this is a disease that commonly affects people as they get older.  About 80% of osteoporosis cases are in women and about 20% in men, and it’s through menopause and the 10 years after menopause when women have the fastest rate of bone loss. And so not surprisingly, as they get older, as we all get older, we’re at increased risk for osteoporosis.

Dr. Weitz:                            What do you think is the main reason why women are so much more at risk? Is it mainly because of the hormones or does it have to do with less muscle mass or?

Dr. Neustadt:                     So the current thinking is that it has to do directly with estrogen, and even maintaining bone health in men is due to the conversion of testosterone to estrogen. Men do have some estrogen, and we don’t get the declines in testosterone in men or the declines in estrogen in men that we see in women.  In estrogen is what’s called anabolic, it helps build bone but it’s more than that. As we get older, we’re all at higher risk for chronic diseases. One of the common causes of osteoporosis now in women is antidepressant medications. So the selective serotonin reuptake inhibitors like Prozac, SSRIs or SNRIs, anything that artificially increases serotonin. People probably know serotonin as the happy hormone and it helps elevate our mood.  But there are serotonin receptors in the cells in bones, and when we artificially raise that serotonin and increase it, what happens is it creates an imbalance, as you put it very well, where you get higher osteoclast activity, that is the bone breakdown is happening faster than we can build up new bone, and that’s because we’re artificially increasing the amount of serotonin in the bone.

                                                So there are secondary causes beyond just estrogen that are more common in people as they get older. Medications is one of them. Comorbidities, meaning other diseases, as we get older, people are more likely to have other diagnoses. Diseases that create chronic inflammation cause osteoporosis like autoimmune diseases or inflammatory bowel disease.  People, as we get older, are less likely to get a full night’s sleep, so have problems with insomnia, and that’s also been associated with poor bone health and poor outcomes in osteoporosis.  Chronic poor diet, 80% of women only get about… Or I should say the average American woman only gets about 800 milligrams of calcium per day from their diet, which is below the recommendation. And then all the other micronutrients found in fruits and vegetables, most people are not getting enough of that, not only just to maintain bone health over time, but also it puts people at risk for cardiovascular disease, dementia, and the list goes on and on.

                                                Muscle mass is an issue, not getting enough protein despite how popular the high-protein diets are. The US recommended amount of protein that the government thinks we should get as we get older is not adequate for maintaining muscle and bone.  In fact, research has shown if you’re just getting the amount of protein recommended by the government, you’re going to be losing muscle mass and losing about two to 4% of bone.   So it’s important that people have that foundation of diet. People have a sedentary lifestyle, they’re not exercising a lot. This is a chronic disease, it’s a chronic condition. So very rarely, like all chronic conditions, does it just boil down to one variable or one thing. There are risk factors for that, and it’s important to understand what those are and control what we can control to improve and grow stronger bones and reduce our fracture risk.

Dr. Weitz:                           What are some of the other common medications that also negatively affect bone?

Dr. Neustadt:                     One of the more popular ones are the acid-blocking medications. So proton pump inhibitors or PPIs, half of those in the US are prescribed for only one condition, which is reflux, acid reflux.  First of all, the FDA, all the way back in 2010, put out a warning that the PPI category of acid-blocking medications, the proton pump inhibitors like Prilosec, they damage bone and increase fracture risk. So we’ve known this for a long time. Subsequently, research has come out-

Dr. Weitz:                           And is that mainly because they block the absorption of calcium?

Dr. Neustadt:                     So it’s multifactorial. There are different issues. The mechanism of action, when you look at it, it is blocking calcium but it’s other minerals as well. People who are stopping their production of acid also then put themselves at risk for other deficiencies of other minerals like iron and magnesium and difficulty digesting and absorbing nutrients from their food, and put themselves at risk for dysbiosis and intestinal infections.  And so there are multiple ways that this can affect bone, and we do now know that there is a very strong gut-bone connection. The health of the intestine and chronic inflammation and gut dysbiosis, directly and indirectly affect bone. So if that’s not balanced, if that’s not healthy because you’re stopping the digestive process right where it begins in the stomach, then you’re stopping the acid from helping to sterilize the food, you’re stopping the acid from activating your natural digestive enzymes, then you’re creating a whole cascade of potential problems down the road, and osteoporosis is one of them.  We know now after four years of continually taking PPIs, there’s about a 60% increased risk in hip fracture. And with the SSRIs, the antidepressants, just briefly, we now know there’ve been multiple studies that have come out and looked at this, that it’s estimated now that for every 19 people taking an SSRI, we would expect one of them to break a bone.  And that’s just two of a very long list of medications. Anticonvulsant medication like Phenytoin, anti-inflammatories like glucocorticoids, prednisone, [inaudible].

Dr. Weitz:                            What about Neurontin? That’s an anticonvulsant medication that now is being used more and more commonly for pain, because doctors are trying to avoid using opioids.

Dr. Neustadt:                     Great question. I don’t know of any relationship of Neurontin and fractures, which is great to understand that it’s not all medications have been associated with bone damage and fractures. If you need to take a medication, even in the same class of medications, there often can be a safer one.   So for example, if you have to take an acid-blocking medication, it appears that the histamine-2 receptor antagonist or what’s called H2RA are safer than the PPIs. So it’s just a matter of education. There’s a whole chapter in my book called Medication Induced Osteoporosis looking at that topic, where people should take a look in your medicine cabinet because again, that could be one thing that you may… in your doctor, it’s often a blind spot. Conventionally doctors don’t know which medications they’re prescribing are actually damaging bone and increasing fractures.

Dr. Weitz:                            And if you listen to the podcast I just recently did with Dr. Steven Sandberg-Lewis on reflux, only about 20% of patients who have reflux actually have hyperchlorhydria.

Dr. Neustadt:                     I believe it, yeah. In fact, the problem might be people aren’t producing enough stomach acid. You may have talked about that. They may have hypochlorhydria and in fact, simple dietary changes may be effective. There are about five common foods that commonly cause acid reflux in people, citrus and raw onion and raw garlic, chocolate, coffee. And so just making some simple dietary changes, working with an integratively-minded or a nutritionally-minded doctor, like yourself or others, can actually go a long ways to helping people get off those medications.

Dr. Weitz:                           So how do we best detect and assess bone health?

Dr. Neustadt:                     That’s a great question. So the standard of care is doing a bone density test through a type of x-ray called a dual x-ray absorptiometry test, a DEXA test, and that detects the quantity of bone and that’s used to diagnose bone. You mentioned a T-score of -2.5 or lower being diagnostic of osteoporosis, that value is derived from that x-ray test, that DEXA test.  Now with any test, it’s only as helpful as it can predict fractures. And similar with any recommendation somebody’s going to give you, the question, the most important question… I go through in my book over and over like, here’s the questions to ask your doctor, these are the most important questions. When it comes to osteoporosis, the most important question is, okay, you’re recommending I do a test? Well, has it been validated? How well will it actually predict my fractures?

                                                Okay, now you’re recommending an intervention. You’re recommending I do something, whether it’s a medication or diet or extradite. How well has that been shown? Has it been shown even to reduce fractures, not just change a number on a test?  So that T-score, it’s a number on a test. It’s what we call a surrogate marker. Clinically, the most dangerous thing about osteoporosis is breaking a bone, as you put so well at the beginning of this podcast. And so a T-score, a bone density test, only predicts 44% of women who will break a bone and only 21% of men.  National associations that have looked at the body of the research at osteoporosis and fractures have correctly concluded that fracture risk depends on factors largely other than bone density. And people get so scared because too often they go to their doctor, they get their test result, and the only thing the doctor focuses on is that number on the test.

                                                And it is a scary diagnosis. And what I counsel people is take a breath, let’s put the test in its proper context. Fracture risk is largely dependent on things other than the bone density. It’s only one piece of the puzzle and only one small piece of the puzzle. Most of the things that you can do to reduce your fracture risk actually have nothing to do with a test.  And I know people love tests, they want to see the number spit out, they want the quantitative evaluation but that’s just not how fracture risk works. It’s largely due to other things. Now, bone density test is important because it’s one piece of the puzzle, but it should not be overemphasized.

Dr. Weitz:                            And as I understand it, there’s some issues with the testing that if the test is done properly, and my understanding is a lot of labs don’t necessarily put the patients in the exact same position. The hips need to be slightly rotated in 15 degrees. The knees are supposed to be bent, it’s supposed to flatten the spine. If all those things are not done properly, then you could get a different result.  If patient has scoliosis and they have a curvature, you’re not necessarily going to see the proper density of the spine. If they go to a different lab that uses a GE machine versus some other machine, you can get different results as well. Isn’t that right?

Dr. Neustadt:                     That’s all true. If they’re too thin or if they have arterial calcifications or if they’re obese, all of that. If they have bad arthritis in their spine, all of that can change results. If they’re taking strontium as a dietary supplement, that will create false bone density test results. And that is all true.  And so it’s important to go to the same testing center and ask for the same machine and getting that done repeatedly at the same place can be helpful for mitigating any of that variation that may occur.   And I think it goes back to the point I was mentioning earlier that it is a test, it’s a surrogate marker. I do believe people should get tested. That’s one piece of the puzzle. But exactly what you’re saying, there can be errors on the test. It shouldn’t be over relied upon. It’s just one piece of the puzzle.

Dr. Weitz:                           When we get to the part of the discussion where we talk about supplements, I’m going to challenge you a little bit about the strontium thing.

Dr. Neustadt:                     Sure, I love it.

Dr. Weitz:                           So are there any other tests that you feel are important for assessing bone health? Blood tests? Any other tests?

Dr. Neustadt:                     So there are. There are some tests that can be helpful for giving a general idea. You can get what’s called a CTX test. It’s a C-telopeptide test. It’s a breakdown product of collagen in bone. So bone is not just its minerals. A bone density test only measures the mineral component of bone. And so when you look at the tissue, bone is a tissue, it’s a complex mixture of different things. It’s not just the minerals. Minerals give the quantity to bone, but it’s the collagen or the proteins that give bone its quality in its ultimate strength.  So when CTX is high, it means you’re breaking down collagen and that’s been associated with increase in fracture risk and it is a marker that’s recommended for compliance with treatment to be tested for by the… The National Osteoporosis Foundation actually rebranded last year, it’s now the Bone Health and Osteoporosis Foundation. I’m on their corporate advisory round table and also the International Federation for Laboratory and Clinical Chemistry. So that’s one of the bone turnover markers.  But the challenge with the bone turnover markers is similar to the challenge… and I think even worse when it comes to what you mentioned with the bone density test. There is a lack of understanding among clinicians about when to test, how to test… The CTX and other bone turnover markers are very sensitive to changes.   If someone were to eat a few hours before, so they need to be done fasting. If they exercise within the 24 hours, if a woman is still getting her period, depending on the phase within her cycle, that can change the bone turnover markers. If you did break a bone, bone turnover markers can be elevated for up to year afterwards. There’s seasonal variation, summer versus winter.

                                                Again, there’s just limited utility to testing those. The biggest predictor, the most consistent predictor of fractures is gait or mobility. So how well does somebody walk? It’s called about a six-second walking test. Can they walk unaided? How fast can they walk for six meters?   Can you get up from a standing position from a chair without using your arms? Can you get up from the floor unassisted? What is your balance like? Can you stand on one leg for 20 seconds or 30 seconds?   Things like that are going to be more helpful in determining fracture risk because 95% of fractures occur because somebody falls. In terms of looking at bone quality, making sure that you’re taking things out of your life that are damaging bone. And feeding bone and giving bone as much of a leg up, so to speak, as much nutrients and lifestyle and the environment to flourish and to do its job, then you definitely can grow stronger bones. You can increase bone density, you can improve bone strength and quality.

Dr. Weitz:                            In terms of the medications that are available, the bisphosphonates are among the most popular but there’s some real issues with those. What’s your take on the current bone medications and are there any of them that you would prefer over others?

Dr. Neustadt:                     So the bottom line and the most important question, I alluded to previously, is have they been shown to reduce fractures? So there’s a chapter in my book on osteoporosis medications and questions for people to take to their doctors. So has a medication that’s being recommended been shown to reduce fractures in someone with my diagnosis and my medical history? So those are two important questions.  So when it comes to post-menopausal osteoporosis, which is the most common cause of osteoporosis, the question is have you broken a bone before with osteoporosis or have you not? And that’s important because not all medications are equally effective in both situations.  So what we know is that if you have not broken a bone before with osteoporosis, you have post-menopausal osteoporosis, you haven’t broken a bone since you’ve had the diagnosis, or around the time you got the diagnosis, none of the oral bisphosphonates are effective at reducing both vertebral and hip fracture risks.  They can be effective at reducing vertebral fracture risk, but that’s not the most dangerous type of fracture. It’s hip fractures which are the most dangerous.  So I’m not sure why any doctor would only want to reduce the risk of fracture in one area of the body and not the most dangerous types of fractures, not both areas.  The only bisphosphonate medication that’s been shown to do both for what’s called the primary fracture prevention, that is you haven’t had a fracture before, is intravenous Zometa. So that’s both hip fracture and vertebral fracture prevention. It is effective. None of the other medications are.  If you have already had an osteoporosis fracture, then the other medications are more effective. I’m not so thrilled with all of them as a category of medications though. I think that if you do want to take a medication, if there is a strong argument to take a medication, there are better medications.

                                                I mean, first of all, in order to get the benefits of a medication, you have to take it 70 to 80% of the time. For the oral bisphosphonates and any of the medications, you have to be taking it consistently for years. Up to 50 to 70% of people stop taking their osteoporosis medications within a year of being prescribed because of side effects, because of compliance issues.  And so it is a big commitment that people need to educate themselves about and say, okay, if I’m going to do this, I’m committing to it. And of course if there are side effects and there can be quite uncomfortable side effects with some of the medications, some people are going to want to discontinue them.  But in terms of fracture risk, there are more effective medications than the bisphosphonates. Prolia is better at reducing fractures in secondary osteoporosis for secondary fracture prevention for both the hip and the spine. Forteo also better at reducing fractures. The challenge is those are both by injection.

Dr. Weitz:                            And those are both drugs, my understanding is, that stimulate the osteoblasts versus suppressing the osteoclast as the bisphosphonates do.

Dr. Neustadt:                     Correct, correct. And so part of the challenge becomes, and some of the side effects with the bisphosphonates in terms of they can actually create… in a minority of patients, but it’s statistically significant, it does happen… They can actually create new bone that’s weaker, that increases somebody’s fracture risk because it’s… You’re correct… poisoning the osteoclast. And so the osteoclast isn’t breaking down old bone, which we need it to do.  There’s a phenomenon bone called bone remodeling, where you’ve got osteoclast breaking down old bone that’s been used up and osteoblasts that are building and creating new bone, and it’s that healthy balance that creates strong healthy bone. And so when you’re not getting the old worn out bone removed and you just get new bone put on there, it can actually create areas of the bone that are weaker.  And in fact, in a dynamic system, a living system, which is our bones, about every 10 years with the healthy bone remodeling, your bones are all brand new again. There’s bone turnover constantly happening.

Dr. Weitz:                            So that’s why we see some fractures of the femur and certain other fractures associated with some of these bisphosphonates.

Dr. Neustadt:                     Correct. And when it does happen, it actually is more difficult for the fracture to heal unfortunately. And that’s also why you end up seeing osteonecrosis of the jaw, which there is a risk also with Prolia of osteonecrosis the jaw as well. It’s a very small risk, but it is there. All the drugs have some risk.  So it’s a matter of educating ourselves about the potential risks and the potential benefits, and making the best decision possible. And that comes down to making sure you’re asking the right questions so you can get the right information in the full picture, so you can make an informed choice.

Dr. Weitz:                            Now when it comes to exercise, what do you recommend for preventing and reversing osteoporosis? And there’s an argument that’s been made that we really need some sort of high-impact exercise to really load the bone sufficiently to create improvements in bone strength.

Dr. Neustadt:                     So the challenge is that it would take about 7,000 patients to do a controlled clinical trial on exercise with the fracture risk as the outcome, and that just hasn’t been done.  So when you’re looking at loading the bone and DEXA scans and all of that, there are studies that have been showing that doing resistance training can improve bone density, but they haven’t looked at fracture risk as an outcome.  There was one study many years ago that looked at some exercises as an outcome. It was a small study and it gave four different exercises to women. One was doing some sit-ups, one was doing kind of superman move where they’re on their back and stretched out. The other was a combination. Two were sitting in chairs, two were lying down. The bottom line was the flexion exercises where they were doing sit-ups and putting that pressure on the front of their spine, they were at an increased risk for fractures.  So when it comes to fractures and osteoporosis, to me, it’s not just a question of should we do weightbearing exercise? Should we not do weight-bearing exercise? Weight-bearing exercise is important, but we can just use our body weight.  But it’s also a matter of doing it safely because even with weightbearing exercise, even with your own body weight, if you have osteoporosis, you can actually be increasing your risk for fractures.  And so there are different types of exercises that can be done safely and there are ways to move to improve balance and improve strength to reduce fractures by reducing your risk of falling. But you don’t have to necessarily go to a gym. Yoga is great, but if you’ve got osteoporosis and you do certain moves in yoga, it can put a lot of pressure on your pelvis and potentially increase your risk for fractures down there. So it’s not a one-size-fits-all type of answer.

Dr. Weitz:                            Yeah, there was a study… I forgot the name of it, I was trying to come up with it. I think it was an Australian study that showed an improvement in bone density and one of the exercises, I think it involved maybe deadlifts and a couple of exercises like that and it involved them jumping up and onto a pull-up bar and then dropping down. So it added what might be seen as maybe a safer way of having some ballistic impact.  

Dr. Neustadt:                     That’s fascinating and I love that. I’d love to see that study. So this is where my mind goes when I hear that. So I would say, I would ask the questions, well, who is included in that study? Did they have osteoporosis already? Did they have a history of a fracture? It depends on their fracture risk if that could be safe for them or not.  The other thing I would say is, that’s great if it’s safe to do for somebody and somebody’s interested in doing it. What I’ve learned is that if it doesn’t interest people, these are like taking the medications to get the benefits from exercise, it’s something that needs to be part of somebody’s life. It’s longterm, it’s not a one-and-done kind of thing.  So I like to meet people where they’re at and say, look, you don’t have to go into a gym. It’s okay if you don’t like that. There’s tons of other things that you can do. Just going for a walk, walking 7,000 to 7,500 steps a day. Multiple studies have shown that’s been associated with the reduction in all-cause mortality of 50 to 70%, which is amazing. That includes death from all causes, including osteoporosis.

                                                I also love teaching the stork exercise, which is, you stand on one foot while you brush your bottom teeth for about a minute. If you need to steady yourself by holding the sink with one hand you can, and then when you switch to the top teeth, you switch legs and you do that twice a day. And even that will start working a little bit of your core, a little bit of your legs, your balance muscles, help improve your balance.  Park further away from the entrance to the store, take the stairs instead of the escalator or elevator. It’s all cumulative. Gardening can be phenomenal. So if you love going to the gym, I’m all for it. I just think it’s really important if you have osteoporosis or you want to do Pilates or you want to do yoga, whatever it is, that you make sure that you’re working with somebody who understands how to do it safely with somebody who has osteoporosis.

Dr. Weitz:                            What do you think about OsteoStrong?

Dr. Neustadt:                     I get that question a lot, it’s become very popular. So I met with one of the franchise owners a while ago and I asked for the studies and I looked at it.

Dr. Weitz:                           Is it John Jaquish?

Dr. Neustadt:                     I don’t remember. It was just a local, one of the local ones here that was [inaudible]-

Dr. Weitz:                           Oh, okay.

Dr. Neustadt:                     … I can’t remember his name. And what I learned at the time, so similar to many studies out there, there’s no fracture outcome data. So there are some studies showing improvement in bone density. But I do believe that the vibrational plate… And again, anything that can improve balance and working on a vibrational plate and they’ve got exercises where you’re strengthening muscles, I’ve got to believe it’s helpful, it’s good for you. So I don’t have a problem with it.

Dr. Weitz:                           Yeah, OsteoStrong is based on this concept that supposedly they can load your bones to something like 200 times your body weight or something.

Dr. Neustadt:                     And theoretically it sounds amazing. I think the concept is sound and it makes sense. Again, I ask the question, has it been shown in studies to reduce fractures. Now if there’s a lack of data… There’s a saying that a lack of evidence does not mean that that is evidence that it’s ineffective. It just means maybe it hasn’t been studied. It’s very expensive to do a study with fractures as an outcome. It’s much easier to do a study and less expensive where you’re just looking at a test result from a bone density test or a blood test. It’s cheaper and faster to do.  But that said, then I look at, we want to ask the question, well, does it actually make sense? So yes, if you’re reducing somebody’s risk of falling, you’re reducing their risk of fractures. And if you’re loading the bone and you’re improving bone density, that all sounds like great stuff.

Dr. Weitz:                            Yeah, from my perspective, I think it’s important that the exercise must A, load the bones in some significant manner. So there’s got to be some weight involved and it can’t be super light. B, there’s got to be some balance training involved, and you’ve got to make sure you’re strengthening the legs, which is what helps right you and reduces your risk of falling.

Dr. Neustadt:                     So I am in love with a new exercise that my wife Romy actually discovered, and she said I got to come with her to do these classes. It’s called Pvolve, and it started in LA. Kind of up in your neck of the woods, so I don’t know if you’ve heard of it. It’s a studio-based class, I do have some online classes, but the studio, I get a better workout. It’s amazing.  It’s functional training, and it’s working the muscles in your hips and your legs, your internal rotators and external rotators. And it’s resistance and it is flexibility and it’s strength and it is one of the best workouts that I’ve ever gotten in a class. And it can be done in a way that’s safe for, I believe almost anyone. Phenomenal.

Dr. Weitz:                           So what’s the most effective type of diet for improving bone density? Should we be consuming milk or dairy?

Dr. Neustadt:                     So milk and dairy are not necessary. So it’s really about-

Dr. Weitz:                           Are they bad, are they good, are they neutral? What’s the story on milk?

Dr. Neustadt:                     So I have a blog about dairy and milk and I think it’s called What’s in your Milk, or It’s Time to Ditch Dairy. I’m not a fan, I avoid it, I rarely eat it. Yes, I’ll have a little cheese now and then, every once in a while I’ll have a little ice cream, but you don’t have to consume dairy in order to have strong bones.  And it comes down to what I mentioned before, it’s the overall pattern. Just saying, okay, eat this one food and you’re going to have strong bones, that’s not reality. That’s not how the body works, it’s somebody’s overall dietary pattern.  I’m not a fan of dairy because a lot of people have immune reactions to dairy. They can become phlegmy and congested. Some people have a hard time digesting dairy, they could be lactose intolerant. But also in dairy, it’s a cocktail of hormones that’s from pregnant cows, and you’re putting those hormones in your body.  And research has shown there are a lot of other contaminants also that could be in dairy, including viruses and including other chemicals that accumulate in the dairy. And from a nutritional standpoint, it’s just not necessary.

                                                Yes, consuming calcium and having calcium as part of your diet is fantastic, but there are other amazing ways to get it that also give you other healthy nutrients. Sardines is one of the best ways to get it.  In fact, there’s a blog I have which are the top 10 non-dairy sources of calcium. Almonds and Swiss chard, there are lots of non-dairy sources of calcium, but it’s the overall dietary pattern that is most important.  And the research is clear that it’s the Mediterranean-style diet. It’s been studied for over 70 years. I’ve never seen any negative studies on it. It’s been shown to reduce the risk for osteoporosis, cancer, death from cancer, all-cause mortality, diabetes, obesity, dementia. I mean, the list just goes on and on and on.  And that’s primarily a plant-forward diet. In my chapter on diet, I walk people through how to transition into eating this way, making sure they’re getting enough plants and making sure they’re getting enough protein, which I mentioned before, how important protein is.  But that way of eating, that pattern of eating, has been associated with about a 20% reduction in hip fracture, the most dangerous type of fracture and better bone density. So that is the diet that has been shown to be the dietary pattern most effective. And it’s not a diet like, oh, I’m going on this fad weight-loss diet. This is really understanding and learning how you can eat to promote your health for the rest of your life.

Dr. Weitz:                            What about the concept of an alkaline-forming diet or acidic diet, does that make much difference? It’s a common thought out there that if you have a diet that’s more acidic, then the body’s going to pull calcium from the bones to alkalinize the system.

Dr. Neustadt:                     Nope. I mean, again, it’s the overall dietary pattern. If all you’re eating is… acid foods tend to be more animal proteins. And so if you’re eating just primarily an animal-type diet, you’re not getting the other nutrients required to feed your bones, you’re setting yourself for a problem. But is it because of the acid? There’s lots of studies that have been done, and it’s been debunked.  Now where it’s important to understand is if you’re eating a more alkaline diet or more balanced diet, you’re eating a more plant-forward diet, you’ll be eating more of that Mediterranean-style diet.  But again, it’s a complex condition and it’s a complex issue… It’s a chronic issue. So boiling it down to just one element of the diet, say, oh, it’s the pH of the diet, that’s the golden nugget of information that we all have to focus on. That’s just not how the body works, nor is it what’s supported by the research. It’s the overall dietary pattern.

Dr. Weitz:                            So let’s get into nutritional supplements for bone health, and I guess maybe we should start with vitamin D.

Dr. Neustadt:                     Okay, you got a specific question or do you want me to just go for it?

Dr. Weitz:                            We know vitamin D is super important, vitamin D is responsible for taking the calcium and bringing it to the bones. There’s some question as to what’s the ideal level of vitamin D we want in the body? What are your thoughts about this?   There’s the normal level which is over 30. There’s the moderate optimal range, 50 to 70. Some doctors like pushing it higher than that. What do you think is optimal for patients who want to have the best bone health?

Dr. Neustadt:                     Love it. Great setup. So first of all, I want to frame it with the most fundamental question when it comes to bone health and osteoporosis. Has vitamin D been shown to reduce fractures? If it hasn’t, that’ll change how I want to discuss it.  And the answer is yes. Calcium and vitamin D have been shown to reduce fractures. Now you asked the perfect question, what’s the optimal level of vitamin D for fracture reduction? What the researchers show is a vitamin D level between 30 and 44 nanograms per milliliter… That’s the units that are used in the United States. Canada and Europe, it’s different units… but 30 to 44 nanograms per milliliter is associated with the biggest reduction in hip fracture risk and the biggest reduction in fall risk, about 20% reduction in hip fracture risk.

                                                Now interestingly, back to that bone density study or bone density story, when you get to a level of vitamin D from nine to 30, nine to just below 30, right around that range, you see improvements in bone density, but they don’t find the reduction in fractures until you get higher than that. That 30 or 33 to 40 nanograms per milliliter range, that’s for bones.  You mentioned a higher level, 50 to 70. Now we’re getting more into immune system health and what the research shows is healthy for immune system. Vitamin D activates over 200 genes in the body. It has an incredible amount of activities in the body, beyond just helping with bone health or regulating calcium absorption.    And so for immune system function, the research does support at 50 or higher in terms of a blood level. I do recommend people get their vitamin D tested and track it that way.

                                                So vitamin D with calcium is the combination shown to work. Calcium by itself has not been. And when you look at the combination of calcium and vitamin D together, it’s associated and in clinical trials been shown to reduce fractures by about 18 to 23%. That’s supplemental calcium, supplementing. The US RDA for calcium is 1,200 to 1,500 milligrams per day.  And when people look at the recommendation from the government, the recommended daily allowance, that’s from all sorts of diet and dietary supplement. The average American woman consumes about 800 milligrams of calcium in her diet. So maybe supplementing if you need it with 400 milligrams, maybe a little bit more of calcium is appropriate to get you in that range.

Dr. Weitz:                            Some patients are afraid to take calcium, or a few studies that showed that calcium would increase heart disease. Some patients go to the doctor and he measures the serum calcium level and he says, “Well, you don’t need more calcium.”  What form of calcium do you recommend? Does it matter? Should it be calcium citrate, hydroxyapatite, carbonate? What form of calcium is best? Is calcium safe? Does it increase the risk of heart disease?

Dr. Neustadt:                     Great question. So the majority of the studies have done use calcium carbonate, which is a very poorly absorbed form of calcium, and you actually need stomach acid to break that apart.  So a mineral when you take it as a supplement, is not just a mineral, it’s connected to a carrier molecule carbonate in this instant, or citrate or malate. I believe you mentioned both of those as well. Those are the different forms that calcium can come in in supplements.  And what happens is as people get older, they’re at greater risk for having low stomach acid. And then if there are autoimmune conditions or if they’re taking acid-blocking medications, their stomach acid is going to be lower as well, they’re not going to be producing enough.  So your ability to actually digest and absorb the calcium from calcium carbonate is compromised. There is no indication that one form of calcium is better than another when it comes to reducing fractures. Zero. Zero evidence that one form is better than another.  I personally prefer the calcium citrate form because you don’t need stomach acid to be present in order to break that apart and absorb it. You actually absorb it in the small intestines and it disassociates. When there’s less stomach acid present, you can still absorb it. So that’s why I prefer calcium citrate. It also is relatively inexpensive to buy on the market and as a commodity in dietary supplements. And the reality is hydroxyapatite, coral calcium, whatever it is, there is zero indication that one is better than the other for reducing fractures.

Dr. Weitz:                            So how many times a day? With meals? At night? How do you like patients to supplement their calcium?

Dr. Neustadt:                     So the research points to the ability to absorb about 500 milligrams of calcium per serving at a time. So I personally, if you’re just taking calcium and vitamin D and all you need is 200 milligrams or 400 milligrams, you could take it once a day. You can spread it out twice a day. I think it’s personal preference.   This kind of segues into a conversation about the safety, is one way of taking it safer than the other? There’s no indication of that. Currently, the Bone Health and Osteoporosis Foundation and the American College for Preventative Cardiology have the position statement, having looked at all the research, that as long as somebody is not getting more than the safe upper limit of calcium as set by the National Academies of Medicine from all sources, diet and dietary supplements… And that amount is 2,000 to 2,500 milligrams per day of calcium.

                                                As long as people aren’t getting more than that, that it is considered safe from a cardiovascular standpoint. And there are studies, cohort studies and clinical trials, that have shown taking up to 1,000 milligrams per day has no effect on cardiovascular disease outcomes, and that means heart attacks.  So I think that the current state of knowledge right now is taking up to 1,000 milligrams is safe, but the reality is most people don’t need that amount. Most people only need maybe 400 milligrams of calcium.

Dr. Weitz:                            How do you decide how much calcium someone should take?

Dr. Neustadt:                     I look at their diet. In my book in the section on calcium or in my book, the chapter on diet, it talks about calcium, and then there’s in the appendix, a list of calcium-containing foods in helping people transition into eating this healthy way, this Mediterranean style. This osteoporosis-type diet that I teach and have walked thousands and thousands of patients through transitioning into.  I ask people don’t make any changes for a couple of days because first of all, you don’t want to make any huge changes overnight because those tend not to be sustainable, and just write down what you’re eating for a couple of days. People tend to eat the same foods day in and day out.  So just make a list without making any changes and then try an estimate. It doesn’t have to be perfect. It’s not an exact science. How many milligrams of calcium are you’re getting? How many grams of total fiber, how many grams of protein? And that’ll give you kind of a general idea. It’s not an exact science. People don’t have to be super particular about it. Get a general idea.

Dr. Weitz:                           With meals? In between meals? At night? Is there a best time to take your calcium?

Dr. Neustadt:                     I want to step back for a second because it’s really a question for me of what else is there in the formula? So if there’s vitamin D in the formula, then you want to be taking it with food because vitamin D is fat-soluble. So the fat-soluble vitamins like vitamin E, vitamin A, vitamin D, vitamin K, those are fat-soluble and those are absorbed better when there’s some fat there. And so you want to take that with meals because they’re probably going to be some fat with your meal. Plus it’s a good way to remember, it’s like I’m sitting down to my meal, create a habit around taking your supplements. It’ll just be easier to remember that way.

Dr. Weitz:                           Okay, let’s get into vitamin K.

Dr. Neustadt:                     Okay. I’ve loved the research on it.

Dr. Weitz:                           We’ve learned in recent years the importance of vitamin K, because vitamin K seems to reduce the potential for arterial calcification. It’s one criticism of some of the studies that seem to show that calcium might be a problem in terms of increasing heart disease risks that they didn’t include vitamin K.

Dr. Neustadt:                     So vitamin K is a phenomenal topic. So let me just start a little bit of the big picture because when people talk about vitamin K, they tend to think of it as just one thing, and that’s not the case. Vitamin K is a category, so there’s different-

Dr. Weitz:                           Right. So there’s K1, K2, MK4, MK7… I did a whole podcast on vitamin K actually.

Dr. Neustadt:                     Oh, phenomenal. It’s going to be fun talking to you about this then because you’re obviously up on the research. So the vitamin K1 and vitamin K2 are the two sort of big categories. Vitamin K1 is in plants, green leafy vegetables, and there is an association with a diet of eating more green leafy vegetables and a reduction in osteoporosis and fracture risk.  And then with vitamin K2, there are subtypes of vitamin K2. The most popular ones that you see in dietary supplements are MK7 and MK4. They’re designated by those numbers, but they are different molecules, they have different names, they have different chemical structures. They have similar effects in the body, it’s been shown, but they also have different effects in the body.  And when you look at outcomes trials, when you look at fractures, the only form of vitamin K2… the MK4, MK7… that’s ever been shown in any clinical trials to maintain or improve bone density, but most important, maintain strong bones as indicated by fewer fractures in clinical trials. The only form of vitamin K2 shown to do that is MK4, 45 milligrams a day.

                                                In fact, if you do a search for MK7 on the National Library of Medicine database and you look for MK7 and osteoporosis, MK7 and fractures, and you look at all the clinical trials… there were only a few… there are no outcome study of MK7 fractures showing that it reduces fractures.

                                                But even when it comes to bone density, the research shows those clinical trials in the National Library of Medicine database show that it only slows how fast somebody loses bone. It hasn’t been shown to actually increase bone density, but most importantly, it’s never been shown to reduce fractures. Only MK4, only in the amount of 45 milligrams per day.

                                                And it’s been so well studied that since 1995, it’s been approved by the Ministry of Health in Japan for bone health. And as a full disclosure, that’s why, because of that research and the decades of clinical trials, over 7,000 volunteers in clinical trials lasting for years, that I created my products. I needed it for my patients. Osteo-K and Osteo-K minis that have the clinical dose of MK4 in it, shown then to promote healthy bone density and maintain strong bones with calcium and vitamin D in those products.  So I don’t use the MK7 because it hasn’t been shown to work for the most important thing that we want to try and help when it comes to bone, which is maintaining strong bones.

Dr. Weitz:                            I think one of the issues with vitamin MK7 is it’s 100 times more expensive, and there’s more marketing behind it, and it seems to stick around in the bloodstream longer. It has a longer half-life. So they market it as being more effective because it lasts longer in the bloodstream, but the mere fact that it lasts longer in the bloodstream doesn’t necessarily mean that it’s being absorbed into the tissues. In fact, it may mean that it’s not getting absorbed into the tissues and it’s still sticking around in the bloodstream.

Dr. Neustadt:                     You’re exactly right. I mean, looking at just because it’s in the bloodstream, again, that’s not clinically the most important thing. That’s another surrogate marker. It’s just a number on a test. And our body has the machinery to actually create MK4 in small amounts. So MK7 is not produced produced by humans, it’s produced by bacteria, and when it’s absorbed in the body, the physiologically active form that accumulates in tissues around the body, the brain, the testes, the pancreas, the intestines, the breast, throughout the body, the form of vitamin K that accumulates is MK, which also points-

Dr. Weitz:                           The one exception is the liver. Apparently the liver stores vitamin K as MK7.

Dr. Neustadt:                     I’m not familiar with that. I will have to take a look at that, that’s not my understanding.

Dr. Weitz:                           But I think all the other tissues store the vitamin K, and if you consume K1 from green leafy vegetables, it ends up getting converted and stored in most of the tissues as MK4.

Dr. Neustadt:                     Well, and the reality also is, okay, what about clinical trials? That’s great, and that can give you some clues about where is it helpful. When you’re talking about liver health, there are no outcome trials with MK7 in liver health. There are outcome studies with MK4 in liver health.  There’s a published clinical trial, I believe it was published in the Journal of American Medical Association, looking at people who had hepatitis C. Hepatitis C increases somebody’s risk for liver cancer. When they took the MK4, 45 milligrams per day in this clinical trial, it significantly reduced the risk that it would go on and progress to liver cancer. And so we have outcomes data for liver health.  Look, it’s a dietary supplement. So I need to say that it’s not approved by the FDA, it’s not a drug. It’s not approved to diagnose, treat, cure, or prevent any disease.

                                                I’m talking about the research on this nutrient. It’s been shown to powerfully promote health in different areas of the body. Similarly, when it comes to bone health, bone is more than just minerals and collagen. Our bone also produces platelets for healthy blood clotting, our red blood cells and our white blood cells.  MK4 has been used in up to phase II clinical trials in people with acute myeloid leukemia and myelodysplastic syndrome and shown to promote healthy platelet production, kill blast cells… Those are the cancerous or pre-cancerous cells in blood… without harming healthy cells and improve red blood cells, numbers on tests.  So those are up to phase II clinical trials. Again, it’s not a drug. It’s not approved to treat any of those things, but MK7 has not been shown to have any of those health benefits either.

Dr. Weitz:                            Now, most experts on osteoporosis recommend consuming magnesium along with the calcium, is often recommended that you take them in a 2:1 ratio, but I understand from talking to you previously that you don’t feel that there’s enough data to justify magnesium.

Dr. Neustadt:                     So I keep asking, I’ve been asking… I’ve been doing this for nearly 20 years now… please send me studies that I can review that shows why this is actually important, not just a theoretical consideration.  Now, I love magnesium, don’t get me wrong. Magnesium is important. It has many different activities in the body, it’s a phenomenal nutrient. Magnesium has never been shown to reduce fractures.  And in the clinical trials using MK4, 45 milligrams per day for bone health, the only other nutrients that were given were calcium and vitamin D to get that over 70% reduction in fractures in those volunteers, they didn’t use magnesium.  Now, don’t get me wrong, I love magnesium and some people should probably supplement it, but there are no clinical data. There are no outcomes studies showing that it’s actually required when it comes to this goal of maintaining strong bones. To take it required, I’m talking about taking it as a dietary supplement, nor is there any indication that it has to be taken in a specific ratio.

Dr. Weitz:                            Okay. Strontium. So I know you’re not a believer of strontium and-

Dr. Neustadt:                      No, I am a believer in strontium. No, no, no. I am a believer in it. There is research on it. I just don’t recommend it for different reasons. When I say I’m a believer in it, what’s the most important question? The question is, has strontium been shown to reduce fractures? The answer is yes, I believe in that. That is good research, but that’s on strontium ranelate.  Strontium ranelate is a medication that was approved in Europe for osteoporosis. It’s not available in the US. It was actually taken off the market in Europe because of risks and health concerns. In the US is strontium citrate. There are no clinical trials on strontium citrate, either outcome studies or safety studies. And so I just want to be honest about what the research shows.

                                            Strontium citrate may be helpful. It may reduce fractures the same as strontium ranelate. We just don’t have the data supporting it, the data doesn’t exist. Now, that’s just an honest assessment of the research. With strontium citrate… Or if you looked at the research on strontium ranelate, there are six large clinical trials on strontium ranelate in Europe. Five of the six studies showed that it only reduced vertebral fractures. It didn’t reduce hip fractures. Only one study showed hip fracture reduction and the studies that showed vertebral fracture reduction, it was about 45%. So similar to Fosamax.  And so it gives false bone density test results. It competes with calcium for absorption, so you can’t take it at the same time. There’s some safety concerns potentially around strontium that it may increase the risk for blood clots that can cause heart attacks and strokes. And for those reasons, that’s why I don’t typically recommend it.

Dr. Weitz:                           Another nutrient that you don’t recommend is boron?

Dr. Neustadt:                     Correct.

Dr. Weitz:                           So boron has been shown to prevent bone loss. It’s been shown to slow down the activation of the enzyme that breaks down estrogen and testosterone. Boron seems to have a lot of benefits. It’s even been shown to be beneficial for osteoarthritis. It seems to make sense to add boron to the mix for osteoporosis prevention or reversal.

Dr. Neustadt:                     So here’s my philosophy on which I base formulate. Has it been shown… I’m going to sound like a broken record. Has it been shown to reduce fractures? No, it hasn’t. Does it mean it’s unimportant? No, it has important physiological functions. But when somebody comes to me and says, “Doc, I have a diagnosis of osteoporosis,” or, “I have this, what can I do nutritionally to help?” Hopefully people aren’t just taking one dietary supplement. This is a holistic approach with diet and exercise.  So I’m looking at what are the clinical trials shown to promote bone density, but more importantly than that, reduce fractures. Now, most people also are likely going to be looking at a multivitamin and mineral formula. Well, a good formula is going to have some boron in it. It’s just a trace mineral, you don’t need a lot. Right?   But even when we’re talking about whether you should take it or shouldn’t take it, the study showing more than 70% reduction in fractures with the MK4, didn’t use boron. It wasn’t there, it’s not necessary.  If we get a little boron, can we get that up to 75 or 80%? I don’t know. It’s theoretical, but you’re going to be getting boron trace. If you’re eating a plant-forward diet, that’s where it’s found. You’re going to be getting those trace minerals. You’re going to be getting enough vitamin C. You’re going to be getting enough boron and then supplement with a good multivitamin mineral formula if you want a little bit of an insurance policy. But when it comes to bone health, I’m very focused on what can we do to reduce people’s risks of breaking a bone, and based on clinical trials.

Dr. Weitz:                           And since bone is built on a matrix of collagen, does it make sense to add collagen to the supplements?

Dr. Neustadt:                     It’s not my first line. There are no outcome studies looking at collagen and fractures. There’s one study looking at collagen and CTX where somebody took supplemental collagen or volunteers did, and their CTX… that’s that laboratory marker I talked about earlier… did significantly decrease. And maybe there’s also rationale for taking melatonin. There was a study in osteopenia that looked at melatonin, a dose-response study where one or three milligrams and taking three milligrams of melatonin also improved bone density if somebody’s having a difficult time sleeping.  But those are not my first line. I think, yes, if you want to be more aggressive, collagen may be good to take. But also, I think more importantly than that is getting the nutrients from food, eating enough protein, making sure you’re getting an adequate amount of dietary protein, to me, is more important than taking the supplement.

Dr. Weitz:                           Okay. Have you looked into any of the peptides?

Dr. Neustadt:                     I have not.

Dr. Weitz:                           Okay. All right. I think those are the questions. Any final thoughts you want to leave our listeners and viewers about bone health, osteoporosis?

Dr. Neustadt:                     Yeah. The first thing is it’s a scary diagnosis for sure, and it is a serious situation. But when somebody gets the diagnosis of osteoporosis, just to take a deep breath and realize this isn’t an emergency, that I have time to educate myself so I can make the best decisions for me. I have time to put together a holistic plan for myself, which is what my book Fracture-Proof Your Bones does. It walks people through how to create a holistic plan for themselves.   And so that’s the take-home message, that it’s not just about a number on a test, it’s what can you do to reduce your risk for fractures? What can you do to actually maintain strong bones and improve your bone strength?          And take a deep breath. There’s time to educate yourself, get the resources together so you feel comfortable that you’re not being pressured into making a decision to taking a drug, or doing something that you’re not really sure that you want to be doing.

Dr. Weitz:                           How can listeners find out about your products?

Dr. Neustadt:                     They can find everything on the website, NBIHealth.com… NBIHealth.com. There are links also to all the research studies. There’s a blog on there on MK4 or MK7. What’s better for bones? There’s blogs on diet and exercise. My products that I formulated for my patients, this all started back in my medical clinic because I needed the dose in combination of nutrients shown in clinical trials to work for my patients, and they didn’t exist.  So I created the company to provide those products to my patients. And now we’ve shipped into over 35 countries around the world. So NBIHealth.com is where they can find that information and they can reach me through there as well. And also all our links to social media are on the website.

Dr. Weitz:                           Okay. Sounds good. Excellent. Thank you, doctor.

Dr. Neustadt:                     Thank you.


Dr. Weitz:                            Okay. 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 certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. That way more people will discover the Rational Wellness Podcast.  And I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions. Or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way.  And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective.   So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

 

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The Metabolic Theory of Cancer with Dr. Nasha Winters: Rational Wellness Podcast 322

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

1:30  Cancer is more likely caused by mitochondrial damage, often related to the metabolic environment in our bodies and related to the modern diet and toxins, et cetera, rather than primarily caused by somatic DNA mutations.  Dr. Theodor Boveri, a German zoologist, comparative anatomist and co-founder of modern cytology, first proposed the somatic mutation or genetic theory of cancer in 1914.  We have taken this theory and run with it for the last 109 years without really proving it. At about the same time, Otto Warburg had proposed the metabolic/mitochondrial theory of cancer and it was outpacing the somatic theory until the 1950s when Watson and Crick found the DNA helix and everyone went back to the genetic theory of cancer. Nixon launched the war on cancer 52 years ago but given the increase in the number of people being diagnosed with and dying of cancer continues to grow, we are sadly not winning this war.  We mapped the human genome and we hoped that this would provide more answers, but it really just raised more questions than answers. And clearly the one gene, one target, one cause is not what we had hoped it would be.  Also, multiple studies using a nuclear cell transfer have been unable to create cancer in a cell by transferring the nuclei out of a cancer cell into a healthy cell.  This demonstrates that cancer is not caused primarily by somatic mutations.

6:08  We have been able to show that the mitochondria not only make energy but are the protectors of our DNA and our genetic expression. Unfortunately, most of the therapies we use to treat our genes, like chemotherapy, only further damage the mitochondria, which then make us even more vulnerable to recurrence, progression, and even having a cancer diagnosis to begin with.  What affects the mitochondria are everything we put in, on, and around us, from food, to thoughts, to water, to the people around you, to the environments you live in, to the light you’re exposed to, to the chemicals you put on your skin and spray in your gardens.  Your mitochondria are signaling agents and they take in information and translate it into the body.  We can have a big impact on the environment in our bodies by how we lead our lives, which can either drive cancer growth or make it more difficult for cancer to thrive.  With the genetic theory, it’s just bad luck and there’s nothing that you can do about it.

12:11  Blood Sugar.  High glucose levels can increase free radicals and lead to DNA mutations. Sugar in the body creates glycosylated end products, which essentially means that you are oxidizing or rusting your innards.  Hemoglobin A1C is a blood test that measures this glycosylation.  We can also measure certain cytokines that direct the inflammation.  When glucose is high, it stimulates cortisol and estrogens and these things impact glucose as well.  High insulin levels also blunt your immune response.  We can literally treat disease by what is on the end of our fork.

15:15  New targeted therapies.  For decades conventional cancer care has consisted of chemo, radiation, and surgery. But now we have newer more targeted therapies, including immunotherapy, CAR T-cell therapy, etc.  Before commenting about the new therapies, Dr. Winters pointed out that there is a better way to utilize the standard of care like chemotherapy.  When you pair metronomics with chemotherapy at a dose less than 20% and pair this also with natural stressors, like fasting, hyperbaric oxygen, and other natural therapies, you get more effectiveness with fewer side effects. This is using chemo smarter.  When it comes to the newer therapies like immunotherapy, it’s interesting that Integrative doctors like Dr. Winters have been recommending therapies to stimulate the immune system for decades, such as Mistletoe, though it is only now being embraced by the conventional cancer care community.  While we have heard of some miraculous successes with some of these new drugs, including the checkpoint inhibitors, the PD-1/PD-L1 inhibitors like Keytruda and Opdivo, these drugs only work about 20% of the time.  Unfortunately, there are unfortunately terrible side effects to these drugs most of the time.  In 2018 MD Anderson came out with a prognostic score for who would be a good candidate for these drugs based on seven questions: 1. Are you over age 52?, 2. Do you have elevated neutrophils?, 3. Do you have low lymphocytes?, 4. Do you have elevated LDH lactase dehydrogenase? 5. Do you have elevated platelets?, 6. Do you have a poor ECOG score?, 7. Do you have elevated liver enzymes?  If you have 3 or more yeses, you should probably avoid these drugs.  We also know that these immunotherapy drugs are worthless if you’ve had a bout of antibiotics in the last six months prior to taking them, so we know they are working through the microbiome.  As Integrative practitioners, we need to make sure to address the microbiome to allow these drugs to work better. Also, these drugs are better suited as first line therapies instead of as last line, but this is because they are expensive and insurance companies don’t want to pay for them until cheaper chemotherapy drugs fail first.  But even with these new immunotherapies, we have not extended life much more than 2-3 mths for stage 4 cancers, so we have to do better.

24:35  Cancer Stem Cells.  

 

 

 



Dr. Nasha Winters is a Naturopathic Doctor and a Fellow of the American Board of Naturopathic Oncology.    And she is also a cancer survivor herself.  Dr. Winters is a sought-after speaker and an authority on integrative cancer care and she is currently involved in research on using Mistletoe Extract, hyperthermia, cannabis, the ketogenic diet, and IV Vitamin C to treat cancer.  Dr. Nasha is a co-author of the best-selling book, “The Metabolic Approach to Cancer” and in 2021 she published Mistletoe and the Emerging Future of Integrative oncology.  Her website is Dr. Nasha.com  and she is focused on educating practitioners about the metabolic approach to cancer.

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. Dr. Weitz is also available for video or phone consultations.

 



 

Podcast Transcript

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

                                                Hello, Rational Wellness podcasters. Today our topic is an integrative approach to cancer with Dr. Nasha Winters. Dr. Nasha Winters is a licensed naturopathic doctor and a fellow of the American Board of Naturopathic Oncology. She’s also a cancer survivor herself. She’s a sought after speaker, an authority on integrative cancer care. She’s the co-author of the bestselling book, The Metabolic Approach to Cancer, and in 2021, she published Mistletoe and the Emerging Future of Integrative Oncology. Dr. Nasha is on a mission to educate and empower the nearly 50% of the population, unfortunately, expected to have cancer in their lifetime. Prevention is the only cure. Dr. Winters, thank you so much for joining us today.

Dr. Winters:                        Oh my gosh, Ben, it’s great to be back with you and your tribe, so thank you for having me.

Dr. Weitz:                            Thank you. Thank you. So let’s explain what causes cancer and why you feel it is more likely caused by mitochondrial damage, often related to the metabolic environment in our bodies related to the modern diet and toxins, et cetera, rather than primarily caused by somatic DNA mutations.

Dr. Winters:                        I love it. So that’s a perfect way to start. Back in 1914, Dr. Theodor Boveri is considered the father of modern day somatic mutation or genetic theory of cancer. And that just got thrown into the universe, a theory. And shortly thereafter, in the early 1920s, Dr. Otto Warburg also started to explore other theories of cancer. And for him, it was not about the DNA damage that started the course of cancer, it was what happened upstream from that, which is at that mitochondrial level. And so, many of your listeners might’ve heard about the concept of the Warburg theory, and we’ll talk a little bit more about that in a moment. But what I think is really interesting about this is these are theories that were thrown out there that we have since, like some of them we’ve just adopted like the somatic mutation theory. We have just taken that and run with it for the past 105, 106 years without really, really proving it.

                                                And then, what’s very interesting is that at the same token when the metabolic theory or the mitochondrial starting points of cancer of Otto Warburg, who later won a Nobel Prize for his work, it was cranking along. It was actually outrunning, outpacing the somatic theory during its time until the 1950s when Watson and Crick found the good old DNA helix, and basically, everyone was kind of looking over here and went back to the old genetic ballroom. And so, that energy is where we put all of our focus.  And so, just so your listeners have a big construct of this is that we claimed the war on cancer in 1971. So that was the year I was born. So 50, almost 52 years ago, Nixon said it’s claim the war on cancer. And sadly, at the start of this, you introduced me as talking about that nearly 50% of people affected by this diagnosis. In fact, just this week, it is one in two people are expected to have cancer in their lifetime. So the studies are now outpacing cardiovascular disease as the number one cause of death, and that we really are looking at a one to two chance of having cancer in your lifetime. So clearly, we’re not winning any wars here. So that’s a big one.

                                                And then the other interesting thing that was coming out of this as we mapped the genome and we thought this is where all the answers are going to be for us, and all as it did was basically say there’s a lot of genes, there’s a lot of what they call junk DNA, we don’t really know. We have more questions now than ever before, but clearly the one gene, one target, one cause is not the holy grail that we were hoping it would be. The other thing is that for decades, not once, not twice, but many times over, we’ve done multiple studies where with what’s known as the nuclear cell transfer studies. And this is where you take two cells, one of them is a cancer cell, one of them is a healthy cell, non-cancering cell, and inside each of those cells is this nuclei, which think of that as like the hard drive, the brain, the important, this is where all the magic and all the communication, all the signaling theoretically happens from.  If this was a cancer caused by a genetic somatic DNA mutation as the primary cause, if you took the cancering nuclei out of the cancer cell and you replaced the healthy nuclei of healthy cell, if this was somatic genetic, you would turn on cancer, and vice versa. If you took the healthy out and replaced the unhealthy nuclei of the cancer cell, you should make a healthy cell. That does not happen over and over and over and over and over again. We’ve shown that.  So in essence, we’ve come up with multiple studies that show that this is not a somatic mutation.

                                               However, what we have been able to show and the research is luckily catching up with us, is that when the mitochondria, those little powerhouses that we were all taught in, what, sixth grade biology, that we only thought their only function was to make ATP, the energy source of our cells and our bodies, it does so much more than that. We now understand that the mitochondria are the sort of protector of the DNA, of our genetic expressions. And so, it’s whatever we’re doing to encourage the health or the disease of our mitochondria, that is the precursor of protection or destruction of our DNA.  So we needed to back it up a notch. And yet, in standard of care today, we are still fighting hard for the concept that this is a genetic disease. We’re still spending billions of dollars of resources every year trying to find ways to silence those genes, splice those genes, replace those genes, gene, gene, gene all the way along. And yet, ironically, most of the therapies we even offer to treat those genes, to destroy those genes, to go after that will only further damage the mitochondria, which then make us even more vulnerable to recurrence, progression, having a cancer diagnosis to begin with.

                                                And then, all of the things we’ve since learned that affect the mitochondria, just everything we put in on and around us, from food to thoughts, to water, to the people around you, to the environments you live in, to the light you’re exposed to, to the chemicals you put on your skin to spray in your gardens, all the things directly impact our mitochondria. And just simply put, think of your mitochondria as just signaling agents and antennas. They’re taking in all the information, they are translating that information, and they’re sending signaling pathways back out into the body. So when you mess up there, you mess up everything.

Dr. Weitz:                            Another interesting thing is that when DNA is the cause of our cancer, of our health problems, we no longer have any agency in that. It takes the blame away, but it also means that we really have no say in the matter. It has nothing to do with what we’ve done or say or anything else. And therefore, the only possible treatment is something that somebody else can put on us or do to us.

Dr. Winters:                        Yes. Yeah. I really love that you brought up this idea of agency, of personal responsibility, but also of personal empowerment. I mean, to me, the message that there’s something happening at the mitochondrial level versus at the DNA level is frankly much more hopeful at its core. It gives us a lot more opportunity to realize we are far more powerful than we’re led to believe. And really, in the moments when there is a true genetic deficit defect problem, that’s happening in the cancer realm less than 5% of the time. Even standard of care acknowledges that and says that 90 to 95% of all of our cancers are actually caused by dietary and lifestyle influences. What they don’t say is what those diet and lifestyle influences are doing. They’re imparting their wisdom, if you will, their input into our mitochondria. And so, that is where it gets funky.

                                                So it’s like they’ll tell you that, but they don’t really put the dots together of what’s going on. And so, I like you really appreciate the part about the agency and about how this changes it into our court. One thing I’d like to also offer to people, because sometimes there are people, especially if they’re in a state of duress or stress or anxiety, they may take that message wrong or take it into a system that’s quite wounded and fearful and that, “Oh, you’re saying this is my fault.” So let me reframe that while we have this opportunity.

                                                You don’t know what you don’t know until you know. So you could not have known. 99.9% of the people that have ever seen me or one of my colleagues that have trained will tell us that they were healthy until they got cancer. That is impossible. You may not be aware of all the contributing factors that allowed for this process to take off in your body, but once you do have that awareness, then it does become, for lack of your fault, it’s that you knowingly have this information now, and yet you still choose to abuse those mitochondria for whatever reason.

                                                So if you’re still spraying the glyphosate on your gardens, you don’t want to bend your ass over and pull weeds out of the ground, that’s a problem. That’s cognitive dissonance at its best. And so, these are the pieces where my work and the work we’re doing in the research world, in the metabolic oncology world is understanding some of the unknown offenders and drivers and doing something about them. So it really is about an education and an empowerment process to help you make different choices to better your ability to prevent this from every landing in your body and expressing in your body, and to prevent it from ever progressing or mutating or prevent it from ever recurring.  And so, those are the types of things that we can impart this knowledge into the population to empower them instead of having them believe that a lot of the researchers, and I guess the main belief systems out there still today, unfortunately, the dominant paradigm is that this is just bad luck, that you’re just a sitting duck, there’s nothing you can do about it, it’s just your genes, and just go on blindly doing all the things that are causing harm to your body.

Dr. Weitz:                            Right. And really interestingly in your book, I was reading it for the second time, you argue that high glucose levels can actually increase free radicals and lead to DNA mutations.

Dr. Winters:                        Yeah. So it does a few things. So it does that, it creates, and in fact, what we know is sugar in the body creates these things called glycosylated end products, very fancy name for basically rusting your innards. Would that be a fair description?

Dr. Weitz:                            Oh, yeah. Most people know what hemoglobin A1c is, and that’s a perfect example of it.

Dr. Winters:                        Yeah, you can literally measure how quickly you are oxidizing or frying or rusting your innards with this blood test that shows you the average of your glucose over three months. So it’s not like a one and done, like you had a bender over the weekend with your friends and now your glucose is really high.  It’s the average of that glucose in your body over those three months, which is the idea that we need to temper what we’re being exposed to, so it does that. It also just directly increases inflammation, both secondarily from that glycosylated end product, but also directly by increasing certain cytokines, certain inflammatory molecules that just keep you in a state of inflammatory process. It definitely changes your metabolic expression, so it affects your hormones. So when glucose is high, it stimulates cortisol, it stimulates estrogens and vice versa. All those things impact the glucose as well.  Just being even under stress will affect your glucose. A poor night’s sleep will increase your insulin, which will affect your glucose. Then, the other thing that having a high sugar intake or a high glucose, high insulin in your diet does is it blunts your immune response. So it has such so many levers and so many triggers that we have to be mindful of this, and ultimately it should be foundational. Since we can literally treat disease or create disease by every single thing is at the end of our fork, we need to be taking advantage of using our food strategically.

Dr. Weitz:                            A good way to think of glycosylation is imagine if you could open up your cell phone and pour a bunch of honey in there and see how well it works.

Dr. Winters:                        That is a really good analogy, or even putting a bag of white sugar into your gas tank.

Dr. Weitz:                            Right.

Dr. Winters:                        Right? That’s the thing. I remember I heard my mom talking about growing up that that’s what they would do, like toilet papering houses and pouring sugar in a gas tank. That will destroy the engine. That’s what we’re ultimately doing to ourselves. We are destroying our own engine. We are destroying our own hard drives in our cell phones and our computers or whatever, our bodily ones when we ingest too much carbohydrate.

Dr. Weitz:                            Now, when it comes to conventional cancer care, for many, many decades we’ve had chemotherapy and radiation and surgery, but now we have all these newer targeted therapies, immunotherapies, CAR T-cell. What do you think about some of these newer therapies and how should we think about them? How do they interact with diet and lifestyle differently than say chemotherapy does?

Dr. Winters:                        Gorgeous. So a couple of things here is first of all, one thing I want to also put out into your community is that there’s a way to use standard of care better.  So we can be doing, not to say chemo’s bad, but we certainly can know exactly what somebody’s cancer cells are going to respond to.  So we can do testing that is FDA approved and insurance covered to know what targets that person’s cancer type has, and that tells us then what are the best suited therapies for it.  We have this now, and yet it’s rarely actionable, like really do we do anything with that data, which is really sad, but we could take that information and say, okay, we now know that this person has these targets, so let’s approach it with this tool.  But the best part is when we lower the dose of that tool.  So chemotherapy, oftentimes patients will have to lower the dose a little bit. If their treatment’s just been too harsh, we might lower it 25%, maybe upwards of 50%. But what’s really cool is when you pair metronomics, so chemotherapy at a dose less than 20% with some stressors into the system such as being in a fasted state or with hyperbaric oxygen or with other integrative natural therapies, you can actually potentiate the fact that that 20% of chemo to drive it directly into the cancer cell while protecting the healthy cells. This is using chemo smarter. That’s one example.

                                                The next example that you mentioned are the new hot to the market immune therapies. I’ve been at this for over 30 years. It was not, but a couple years ago where literally the entire, I was the charlatan, I was the quack for even mentioning, for even whispering that the immune system might have anything to do with the cancer process. And so, now that it’s a trillion-dollar industry, now everyone, they’ve all invented sliced bread themselves. And so, the irony of these therapies is we actually have many of these therapies that have co-evolved with us.   One of the most simple is just fever. Our internal favoring process is a strong immune reaction, which ironically is what a lot of these pharmaceuticals will induce is a favoring process. We have in the latter part of the 1800s into the 1900s, we have the Dr. William Coley from Sloan Kettering of all places, where to this day they give a Dr. Coley award for medical innovations, and yet nobody seems to understand who this person was. They don’t even know their own medical history to know that this man was the first man who was giving patients injections of an infection, so of a bacteria, that then stoked this massive fever experience that reduced the tumors.  This was used in standard of care oncology until the 1960s. Then, we just pretend that didn’t exist. And then you have mistletoe, which is one of my favorites. You mentioned my book in the beginning with co-authors, six authors including a hematology-oncologist and conventional medical doctors, other naturopaths, like a whole mix of us. We’ve all brought our well over 100 years of experience with this plant to a book that’s a best practices for physicians and a great resource for patients to educate their doctors on this therapy. That’s the most studied integrative therapy out there. It’s been used continuously as an injection of an extract of the Viscum album or the mistletoe plant for a treatment of and support of other cancer therapies since 1917. So we have, this is between Coley’s toxins, between fever therapies, between mistletoe, we’ve had immune therapies available to us and working beautifully for some time.

                                                When we brought out this whole new checkpoint inhibitors, the PD-1/PD-L1 inhibitors like Keytruda, Opdivo, we brought on the drugs like the CTLA-4 and 6 inhibitors, when we brought on the CAR T that you mentioned, these drugs even by all of standard of care work at best about 20% of the time. And when I say work, that means response. That does not mean cure, that means response, meaning it’s going to give some tangible shrinkage of the tumor itself or the tumor load, the burden itself. The bad news is that over 80% of the time, there are terrible side effects, no effects or death, really harsh. These guys are really harsh. And the thing that was so crazy is as an integrative oncologist, I knew upfront what was going to make somebody respond well to those drugs and what wasn’t going to respond well to those drugs.

                                                And even in 2018, MD Anderson came out with their own prognostic score to show who’d be a good candidate or not for these drugs. Seven simple questions. Are you over the age of 52? Do you have an elevated neutrophil level? Do you have a low lymphocyte level? Do you have an elevated LDH lactase dehydrogenase? Do you have elevated platelets? Do you have a poor ECOG? So daily function score, and do you have anything going on in your liver? If you answer three yeses or more to that, you probably should reconsider bringing on one of those drugs because they can have a holy hell nightmare in your body that is far worse than the cancer process.

                                                And so, what’s cool is somebody like me is we can actually get those yeses to nos with our integrative therapies to make a drug like this work better. And just like I talked about the metronomic dosing of chemo, we can also do that with immune therapies. And even better, the latest studies, which we’ve also known is that the immune therapies are basically worthless if you’ve had a bout of antibiotics in the last six months. So that right there gives us indication. And the studies are showing us that the microbiome is integral to receiving and using these medicines. And the craziest part is these medicines, immune therapies, they’re best-suited as a first line versus how they’re often given today as a last line because you have to have at least some amount of immune system left for these drugs to play with. And so, a really good example-

Dr. Weitz:                            But the reason why that’s not happening?

Dr. Winters:                        Because we’re blasting the crap out of them. Well, money.

Dr. Weitz:                            Because of money, because the insurance companies run the healthcare system and they want to use the cheaper therapies first.

Dr. Winters:                        And that’s a very good point, because a CAR T therapy can be upwards of $1 million. A typical KEYTRUDA is like 10 grand a month for those injections. So these are expensive, and so the patient may not see it directly because their insurance covers it, but it’s crushing our medical system, the expenses of this. And so, here’s the other thing to tie in the standard of care approach is in the last 17 years, there was a study that came out a couple of years ago that showed that the 96 new drugs that have come to the market in the last 17 years specific to oncology, so specific to treating cancer, when you put them on a bucket at best, and you probably know this study, you probably run across it, but guess what the overall survival rate is of what we’ve brought to market in the last 17 years.

Dr. Weitz:                            3%.

Dr. Winters:                        Well, 3%, but overall, 2.4 months. That’s what it’s giving us.

Dr. Weitz:                            Oh, yeah. Okay.

Dr. Winters:                        Right? I mean, and to your point, statistic of the 2 to 3% is actually these studies have been repeated over and over about the actual efficacy of chemotherapy, which is about 2 to 3% depending on the study. At the time, and there’s only a handful of cancers, testicular, some lymphomas that are actually responsive to chemotherapy. The rest really aren’t. It’s like it’s moving the paper around the desk until the immune system figures out what to do with it on its own. And that’s why when people finally end up in an immune trial or an immune therapy is offered, they’ve obliterated what little bit of functioning immune system they had with those standard of care therapies. And at best, modern day oncology is bringing us 2.4 months extended overall survival. These are all studies that I’m not, this isn’t a naturopath’s opinion. This is just the reality, and this is why it is time for us to be having conversations like this with 50% of us going to face this in our lifetime. We have to do better. We have to do better.

Dr. Weitz:                            Yeah, no, absolutely. I’ve seen plenty of those studies where the result was an increase in lifespan of two months, four months, something like that, and then the stock shoots up. The drug is lauded as the next billion dollar drug.

Dr. Winters:                        Exactly, exactly, exactly. Yeah. Yep.

Dr. Weitz:                            So what are cancer stem cells?

Dr. Winters:                        So I’m going to simplify this. Dr. Mark Rosenberg, who’s an integrative oncologist down in Florida, I heard him present at a conference a few years ago, and he described it really elegantly, the stem cells. Think of the stem cells as the sleeping mother cells. They’re just taking a nap. The active cancer cells are the daughter cells. These are the ones that are proliferating, mutating. They’re the ones that are active. Those are what the conventional therapies like chemo, radiation, surgery target, they target the active proliferating cancer cells, the daughter cells. The stem cells wait and rest. They’re waiting out in a state of quiescence, not doing anything until we over harvest, over-treat, over stress, things like the good old mitochondria and over-treat all those daughter cells to the point of harvesting them down below 20% of what’s left in the body.

                                                At that point, mama bear wakes up and she’s pissed. That’s the stem cell. That puppy wakes up. It’s a different personality, a different behavior, and a different aggressivity, and it’s less responsive to therapy. In fact, that’s the time you must consider a different approach because if you’d been on, let’s say, carboplatin and Taxol for your ovarian cancer all along, which was going nicely after your daughter cells and you over-treat, and so somebody like me, I can tell on the labs, I can tell with the patient, I can tell immediately when they’ve been over-treated, right? Maybe there’s no evidence of disease on scans or CA 125 is now normalized.

                                                But they say, “We’re going to give you a couple more for good measure.” That’s called the maximum tolerated dose approach. When that happens, you now push those far enough down that the mother wakes up, she sprouts up, she’s no longer responsive to that CarboTaxol. In fact, if you give her more of that, she will eat it like candy and she will make it her bitch and she will turn it into new cancering processes and be much more aggressive and much more difficult to deal with. It creates a drug resistance and it creates a stem cell and cancer persistence that’s really difficult to treat. And so, that’s why a lot of people were like, “I had a really good response my first round of chemo, but then the second round, not so good. And then the third round even less, and then the fourth round even less,” because our response gets shorter and shorter as we wake up more and more of those stem cells.

Dr. Weitz:                            I’m sure cancer researchers are aware of stem cells. What have they been trying to do about this?

Dr. Winters:                        It’s hilarious. So in 2013, I was speaking to the concerns of stem cells and seeing this in my practice and talking about it, and everyone, literally, every oncologist I ever encountered was like, “Bah, humbug, hooey. This is BS. This doesn’t exist. There’s no such thing as stem cells.” I’m like, I’m quoting them from Dr. Wicha’s research and Dr. Dean’s research, all of these big institutions that are sounding the alarms of, “Hey guys, when we over-treat, when we see patients having recurrences or we see them becoming drug resistant, this is what we’re seeing. This is the actual reality.” They literally couldn’t see the writing for the wall. Again, once we had some therapies that are worth millions, if not billions of dollars come out of the market theoretically targeting stem cells, now they’re talking about it. Well, now we can test for it. Okay, great.

                                                They make fun of us when we tried to run our CTC testing, our circulating tumor cell testing saying, “Those don’t exist. That doesn’t exist in nature.” It’s so weird what a decade difference will make when you’re saying the exact same thing that whole time and until you have a profitable treatment for it that’s patented and owned, then and only then will they take interest. And so, what’s crazy now is what I have patients do is I want them to ask their physician, “What are you going to do for my stem cells while we’re treating my cancer? While we’re treating those active cancer cells, what will you be doing to support my stem cells?” And I explained to them that this is a really good filter for you. If that doctor looks at you like you have 10 eyes, tells you that’s bullshit, that doesn’t exist, it’s time to get a different doctor. That’s how much we’ve learned. That’s how much the data backs it, and that’s how much we can even test even-

Dr. Weitz:                            What could a conventional oncologist offer?

Dr. Winters:                        Exactly. So what a conventional oncologist could offer is what is an emerging approach in the oncology world, which is known as the adaptive theory or the adaptive approach of cancer, which people like Dr. Gatenby at Moffitt University and oh gosh, I can’t believe his name just left my brain, but he is a really well-known researcher in University of Arizona, these guys talk about we want to just push back just enough, so get the patient out of harm’s way. So let’s say we’ve got a massive tumor burden, like a very high elevated tumor marker. We’ve got a big, big mass somewhere in the body. Maybe it’s starting to push up against some valuable real estate of our blood vessels or organs. Maybe it’s pushing against our colon and causing us problems.

                                                So we definitely need to debulk that. We need to take some of that tumor volume out of the body, so it has a time and a place to use some of these targeted therapies, immune therapies, chemotherapies, radiation therapy, surgery to do that. But you just want to take it back enough so that you don’t further harm the terrain or further harm the mitochondria. And then, you want to bolster the immune system and the mitophagy of our healthy cells, the new creation of healthy mitochondria that can scooch out the cancering process and hold it at bay. Either treat it like a manageable disease process, just like something like diabetes, or actually getting into remission.

                                                In my world, I don’t shoot for remission with patients. That’s a great side effect if that happens. In my world, I treat this like a manageable disease process because what happens when people think that there is a start and an end point to cancer, that is where your most dangerous thought process happens. When you ring that bell at the end of your chemotherapy or the end of your radiation, what I tell people is you’re not ringing in the end of a treatment, you’re ringing in the beginning of what actually needs to happen to help you prevent this from coming back or progressing further. And so, these are the ways we are thinking about this differently. You can push back just enough and then take much needed pauses and breaks and don’t bring on more aggressive therapies unless the cancer’s getting more aggressive. And so, it’s this just gentle pushback so that you can actually bring in all of the other resources both within and outside of you that helps stave this cancer off even further.

Dr. Weitz:                            And what are some of the integrative approaches to cancer stem cells?

Dr. Winters:                        Wow, high dose IV vitamin C. That’s one of our best. The other one that’s one of our best is good old intermittent fasting, therapeutic ketosis, which can be achieved through fasting, can be achieved with a high fat, low-carb diet, can be achieved with just carbohydrate restriction, can even be achieved with some pharmaceutical interventions such as metformin, things along those lines. So ways to get that, and in fact, there’s some really compelling study of both metformin as well as its herbal counterpart berberine that have some direct influence over the stem cells as well.

Dr. Weitz:                            Cool.

Dr. Winters:                        Yeah. Very cool.

Dr. Weitz:                            Let’s talk about cancer and diet.

Dr. Winters:                        Ding, ding, ding. Here we go into the danger zone.

Dr. Weitz:                            Okay. Vegans over there. Carnivores over there.

Dr. Winters:                        Yeah, exactly. Duking it out.

Dr. Weitz:                            I did solicit some questions from our functional medicine group and one of the questions was about methionine restriction from Mark Simon. I know that you generally tend to recommend a lower carb approach for most patients.

Dr. Winters:                        Yeah. I would say all patients need to be on a lower carb approach. And let me just bring, so I love this because I almost brought on Dr. Ahmed Elsakka last night just to have this piece, because I saw that on your forum about the methionine question, which comes up. If I had a dollar for every time it comes up, I could probably retire. But I like the questions coming up because it’s a very compelling piece here. But what happens is people don’t understand what it means. So people when they think, so I know Dr. Hoffman’s research, gorgeous. This man is brilliant. I have his textbook. I understand this is a real thing. But even that, what happens is even though he’s sharing this knowledge, the average lay person and the average physician is misinterpreting the state.

Dr. Weitz:                            You know what? Let me just back up a second.

Dr. Winters:                        Sure.

Dr. Weitz:                            So I’m thinking if somebody’s not familiar with what we’re talking about, I jumped just right into methionine. In the context of what kind of diet is best, there’s concerns about carbohydrates and glucose and the metabolic concept of cancer. There’s a number of researchers who claim that protein, especially animal protein, leads to cancer possibly through increasing IGF-1 levels, other ways in which it promotes growth. And then, some researchers have focused on specific amino acids, which are the building blocks of proteins and have targeted those and said, “Okay, methionine. If you can reduce methionine, that’s going to help with cancer. If you can reduce glutamine, that can help with cancer,” and so, in this context.

Dr. Winters:                        Gorgeous. So big picture, cancer is opportunistic. It will go after whatever is overly abundant in the system. Pretty straightforward. We can simplify that right there. So if you have an overabundance of glucose, it will go after that. If you have an overabundance of trans-fatty acid, like really toxic high omega-6 fatty acids, the linoleic acid, it will go after that. If you have high levels of glutamine when there’s been a metabolic shift into a cancering process, that can be problematic. If you have high elevations of methionine in certain situations, that can be problematic. Arginine is another one. Cysteine, which is actually more related to the methionine piece as well.

                                                So to your point, there’s this way that people are like, if you look in a Petri dish and a cell line, there’s a lot of theoretical things that are happening. If you look in an animal study that is a rat or a mouse that has very different metabolic needs and dietary like normal genetic dietary requirements, they’re not as effective. When you look in the models like dogs, they also get naturally the types of cancers we do as humans, those are a closer fit. So you can see a little bit more translational information. So I want folks to have that context first. Number two, methionine is… So you’ve got your healthy metabolism like a normal, you’re not cancering, everything is good, and you have your cancering metabolism. These two are very different animals themselves.

Dr. Weitz:                            And by the way, I love the way, the fact that your cancering as opposed to having cancer, and I know that you say that very deliberately.

Dr. Winters:                        Thank you. I appreciate you pointing that out because we all have cancer cells all the time, all of us. It’s when they hijack the metabolic processes that it can get out of hand.

Dr. Weitz:                            In fact, we all have hundreds or even thousands of cancer cells, right?

Dr. Winters:                        Some say even upwards of a trillion.

Dr. Weitz:                            Why?

Dr. Winters:                        [inaudible 00:37:14] know what to do with it. That’s the beauty is when you have functioning mitochondria that can take in all the information from its environment and send off signaling, your mitochondria are what are in charge of apoptosis, the programmed cell death. So if they sense something awry, they’re going to take it out. They know what to do. But if you’ve damaged it over and over by excesses of anything or deficiencies of anything, you make them vulnerable and you make them less likely to respond and react to those cells that need to be removed.

Dr. Weitz:                            We just have to equip on mitochondria with these new baby AR-15s.

Dr. Winters:                        Yeah, exactly. Nice. I like your brain. You’re thinking in this. So here’s what happens with the methionine piece. So in healthy metabolism, this is one of our nine essential amino acids, essential meaning you have to have it to live, period. So that’s one thing to remember. The other thing to remember is that it is so integral in the repair and cleanup of all of our healthy DNA. It is literally what’s helping our immune system function, our adrenals function, our neuroendocrine systems function. It is absolutely required for you to live.

                                                So one thing I want your listeners to listen to or hear is that when we start to get so myopic and say, “We’re going to put in this pharmaceutical or this drug or this herb or this dietary intervention to starve something,” when you understand that it is just as integral, if not more so to survive to help our healthy cells survive, it should probably give you a moment of start to realize the way you use these therapies need to be very judicious, because we can fall into the same trap we do in standard of care oncology that you over-harvest, over-treat, over-push the system in one direction or another. That is a bad idea. Think always of the teeter-totter of balance. If you’re like, “I’m going to methionine restrict, I’m going to want carbohydrates…” You got to keep focusing in the center of this teeter-totter, because it’s a dynamic flow.

                                                So that being said, there is some interesting biochemistry that happens at that cellular level, especially in our methylation pathways where we should have a normal process, we should have homocysteine turning into methionine and off we’re running into health creation. When there’s a metabolic shift in the cancering process, that clock goes backwards. So methionine goes into homocysteine and then becomes this bastardized process that can definitely influence cancer cell progression and proliferation. So I want folks to know that yes, it’s real. Yes, it can happen. But here’s what they don’t get told by the researchers is that we have a very simple means of knowing when and where that is appropriate.

                                                And the one thing about methionine restriction is it should never be done as a long-term lifestyle. It will kill you. It will absolutely kill you. You change your methionine process within a matter of days when you methionine restrict, days. So literally, the concept here is what I tell people is instead of fighting over, like you said, which diet, which camp is right, the most effective therapy we have that gets everybody out of the way of their own bullshit, excuse me, I get really passionate about this, is fasting. So when you put things head to head and you’re like, “I’m going to carbohydrate restrict, I’m going to methionine restrict, I’m going to glutamine restrict,” and you look at any of those by themselves, yes, all of them will have some pushback in the cell line studies.

                                                When you take methionine restriction and you partner it with carbohydrate restriction, you get a massive synergistic approach that pushes back even harder. But what wins hands down out in front of all of these strategies is intermittent fasting. So that’s the simple answer for people. But here’s the place here. If I have a patient with an elevated homocysteine, so for me, my normal range is seven. If it’s a tiny bit higher than that or a tiny bit lower than that, I’m watching it. If I have it a little bit higher than seven, I put a patient on a methylation support supplement, pretty high doses for anywhere from six days to two weeks, so a week to two weeks. Then, I retest that homocysteine.

                                                If the homocysteine stays exactly the same or gets worse, I know we have a methionine problem. If the homocysteine gets better, we just have a simple methylation problem. Maybe you’ve got MTHFR, MTR, MTRR, which are all methyl transferase receptor issues, and that it just means that you just probably should take a little bump of folinic acid or leucovorin on the pharmaceutical world or a B12 on occasion. Those are things that are very helpful.

                                                But if a patient is stalling and their homocysteine is high no matter what we do, then and only then is it appropriate to consider a short-term methionine restricted diet. But what I want to caution for folks is the BS that’s online and that influencers have taken on is they tell people a methionine diet is a vegan diet. So I want to throw that, I want to kick that one out of here, because you can actually put a link in there of the top 10 methionine-rich foods. And yes, animal proteins have a lot, but so do vegan proteins, tofu, quinoa, many of the nuts and seeds, but especially Brazil nuts and beans.

                                                So what does that tell you right then and there? You’re going to have to fricking starve yourself to avoid methionine. And then the people, like a colleague of mine who is really promoting of the NORI diet, a lot of people will just get on fruit. What I just explained to you will kill you, because fructose is definitely a problem in the cancering process. And carbohydrates are definitely a problem in the cancering process. So even if someone’s going to do a methionine restriction because they have all the parameters that say, “Hey, this is a therapy that’s suited for you,” it must also be done in carbohydrate restricted. They have to go hand in hand.

                                                And then what happens is once you get that process and you’re using the homocysteine testing to know, you then literally wean them off methionine, restricted diet, back into a carbohydrate restricted diet only, and then you only pulse the methionine restriction if and when it’s warranted. I have been at this for a very long time, and because I test homocysteine levels on every patient every month, I’ve had three patients that needed methionine restriction. All of them were able to get that process down, and all of them were able to go back into just a restricted carbohydrate lifestyle with intermittent fasting. That is the simple strategy that gets everybody out of their own way of fighting each other of what’s right and what’s wrong. And what’s-

Dr. Weitz:                            Another thing you pointed out in your book, which I thought was really interesting is making sure you consume some organ meats, because those contain the B vitamins that help balance out the high methionine levels in the muscle meat.

Dr. Winters:                        Yeah. And so, that’s also, think about that as your master methylaters, and it’s helping you in that process is it’s helping keep the chain, the circle moving in the right direction. But again, we don’t have to guess here. We don’t have to assume. It’s a simple blood test and it can be run regularly. In fact, it can be run every week if you wanted to watch the process. And a lot of us are doing that, and we’re doing some research in this field. And so, there is an absolute time and place for this, but it’s far less common than people are led to believe, and it’s not meant to be on long-term. In fact, the longest anyone’s ever… has been on and should be on a methionine restricted diet is two to three months maximum. But I will tell you, I’ve never had a patient get that far because they start to get very cachectic and very sick pretty quickly.

Dr. Weitz:                            And this is all in the context of the fact that losing weight for cancer patients is not a good thing, that once they start losing a bunch of weight, that’s really bad for survival.

Dr. Winters:                        Well, there’s a difference between losing weight and becoming metabolically cachectic. So cachexia is a type of sarcopenia, type of muscle wasting that is not caloric-specific. It will never respond. You could give that patient 20,000 calories and it will not stop this process. It’s a metabolic process. And cachexia is driven by two things very simply, inflammation and sugar. So the worst thing you can tell a patient who’s losing weight with cachexia, by the way, we can start to see cachexia not by how a patient looks. I have a lot of morbidly obese patients in cachexia, because you would never look at them and think, “Oh,” and I have patients who look like walking skeletons that are not in cachexia.

Dr. Weitz:                            And the first recommendation, of course, is Ensure.

Dr. Winters:                        Which is only going to ensure your untimely death, and not which is like, it’s just-

Dr. Weitz:                            Because it’s loaded with sugar.

Dr. Winters:                        Yes, and really high linoleic acid, corn syrups and corn bits and… Talk about, so Ensure is super high in methionine. That’s what they’re bringing into the patient. So if a patient has a homocysteine that’s elevated along with cachexia and they’re put on Ensure, it’s going to ensure that a lot of processes are going to feed and fuel that cancer and that patient’s going to be dead. So the cachexia is you have to take… I mean, I literally had patients in cachexia do better in a deep fasted state to reverse their cachexia than patients who’ve even tried to do a high fat diet, like a high protein or high fat diet.

Dr. Weitz:                            Wow. Interesting. Say that one more time. So we’ve got patients who are in what we often refer to as the wasting stage, where they just start losing their muscle, their cheeks get hollow, they start looking really bad, and say again, what you found.

Dr. Winters:                        And this is again, under deep, we’ve got medical, we’re taking labs, we’re staying in close contact with this patient, so this is medically supervised, but we will fast those patients for 5 to 10 days, and they will actually reverse the cachexia. The inflammation drops and the glucose and insulin drop. And then, because what happens after about five days into fasting is you start to build your muscle mass again. And so, we’re having-

Dr. Weitz:                            Now, that’s pretty scary though, right?

Dr. Winters:                        Well, of course, it is because we’ve been told by, I mean, we fasted patients in the oncology world into the early 1970s when someone said, “Oh, that just seems really cool to do this to them as well.” And yet, now you’re seeing this is probably one of our most powerful tools. In fact, in 1909, Dr. Moreschi was able to debulk all of the tumors in his patients with deep fasting anywhere from 10 to 30 days, medically supervised fasting. And basically patients would go in, I’m pretty certain as an accident because I had a bowel blockage at the time of my diagnosis in 1991, that the very thing that turned around my cachexia of severely cachectic that dried up my ascites, I had a belly the size of a nine-month baby, despite every time they kept pulling the fluid out, it would fill right back up. And because of the bowel blockage, I could not eat for two months.

                                                And so in that, that’s probably accidentally why I’m here today, because that means I starved arginine and glutamine and methionine and brought down my insulin, and I had all kinds of the polycystic ovarian syndrome metabolic patterns that were prior to my diagnosis. I took away all the inflammation, which was the drivers of both the cachexia as well as the ascites. I accidentally cured myself, not cured, but stopped this process from going off a cliff. So we have known this for millennia. Hippocrates fasted his patients. Many have over time. You want to be doing it in a supervised state. I accidentally, unbeknownst to myself, did it by myself back then. I do not recommend that. I luckily was also studying herbology and things. I knew about electrolytes, I knew about herbal teas. I knew the things that I could take into my body that was helpful, but you have to do this with somebody who’s got some training in this.

                                                But yeah, we are really approaching this incorrectly, the world of cachexia, and we’re also really getting too dogmatic about our dietary. Even though my book came out and because of SEOs and whatnot, the publisher really wanted us to really highlight the ketogenic diet. What I really want people to hear that I do and that I really think is about metabolic flexibility diet is about approach the patient where they are in that moment and what is asking to be either nourished or depleted within them. And that’s what can lead to the fact that I will use a methionine restricted diet in certain situations. I will use a glutamine. Now, you can’t glutamine restrict in any diet. There’s no way to do this. People talk about that all the time. It’s literally impossible. Your body will start to auto digest your muscles to get glutamine because glutamine is absolutely critical for you to survive.

Dr. Weitz:                            Yeah. Thomas Seyfried talks about pulsing some glutamine restricting drug.

Dr. Winters:                        Yeah, exactly. And they’re harsh. That’s why they’re still in clinical trials, because they kill the patients. They’re tough. We’re coming up with new, there’s some really cool studies about new delivery systems and lower dosing and how to pulse press these up and coming pharmaceuticals. The same thing in the methionine restriction world, there are really cool ways to use methionine enzymes and things like that that we can use and target, get in, get out like a scalpel very gently. That adaptive approach we talked about earlier, instead of this like let’s lambaste you and [inaudible 00:51:35] on the field, which is what would happen if you got thrown on dawn, which is the glutamine suppressing therapy or put on some of the methionases that are the drugs that wipe out your methionine levels, you will die.

                                                But we do have kids who were born with issues in methionine metabolism that have to live on a restricted methionine diet, and they have to take a lot of other nutrients to offset that. And it’s a tough life for those littles. It’s really hard to grow and overcome that. Now, they’re not cancering, so it’s totally appropriate for those kiddos to be eating more fruit and the things like that, that are higher in sugar and higher carbohydrate because they’re growing their little bodies. But you reach a point where that will flip a switch and start to become problematic in all of us. And so, strategically, people are like, “Well, what diet should I do?” Well, the best would be start to play with intermittent fasting, and then when you do eat, eat real food, clean food. Stay away from the bars and the powders. Get to the real food. What did your grandparents or your great-grandparents eat? Get as close to the source as humanely possible of like, did it come from a tree, the earth, the ocean, the sky? What did it come from?

Dr. Weitz:                            It’s really hard. You almost have to grow it yourself.

Dr. Winters:                        100%. And this is what’s so crazy. Do you know they give people like me a diagnosis now of orthorexia because I so worry about where my food comes from and what is in it? And they’re like, “Well, that’s crazy.” Well, when you’ve kicked the can down the road for 32 years past your expiration date, you feel pretty passionate about knowing what you know from all the years of study, and all the studies continue to come out that we do need to take more attention to what we put in on and around our bodies and what’s going in on and around our soil, to our plants, to the animals, to the planet, to us. It is a constant chain of events. And if we don’t address all of them, the chain gets broken and we get problems.

Dr. Weitz:                            One last question. You’ve mentioned certain lab tests, and I know there’s a lot of lab tests that you like to do on a regular basis, but I don’t really want to go into the whole panel right now given the time, but you talk a lot about lactic dehydrogenase, and I’ve never really appreciated that marker. So can you make me appreciate lactic dehydrogenase and how important it is?

Dr. Winters:                        Ben, I love this question. This is a great way to end on this topic because LDH, talk about 15… Yeah, I know, right?

Dr. Weitz:                            You got to be a geek to think that-

Dr. Winters:                        You do. I like it.

Dr. Weitz:                            … lactic dehydrogenase is an exciting topic to end on.

Dr. Winters:                        It’s really exciting, sadly. It’s like, in fact, in the new book, the Mistletoe book, we have an entire section about this. So if people have that book, they can go to my lab chapter and read about this. But specifically, up until about 15 years ago, LDH was part of all of our complete metabolic panel testing. And then someone behind a desk decided, “Frivolous, we don’t need this test test.” But what I can tell you is it is literally the most important marker of our mitochondrial health. When you think about when you look at the Krebs cycle and you look at the pyruvate and the dehydrate, this is exactly where it interfaces. So when there is a respiratory chain problem in the Krebs cycle, that’s going to impact the expression of your LDH and at various tissues. You can even break down your LDH into the tissues. That’s-

Dr. Weitz:                            The isoenzymes?

Dr. Winters:                        Exactly. So you’d be like, “Oh, is this happening at the kidney level, at the liver level, at the bone level, at the marrow level?”

Dr. Weitz:                            Do you order the isoenzymes all the time, or do you just get to-

Dr. Winters:                        I do now because after, I’ll throw a little controversy into the mix, but after COVID, either the injection or the infection has changed a lot of LDHs, which tells me something right there, changed a lot of our mitochondria, which is probably not a good thing. But I can then go into the isoenzymes to know exactly what tissue took on the destruction, took the hit, if you will, and then support that and change that expression again. So it is such a powerful tool. It shows us your metabolic health. It shows us your liver health. It shows us your bone health. It shows us your kidney health. It shows us your bone marrow health. It’s so critical, and it’s so funny. It’s so not appreciated as you mentioned. When I have patients order this in far away places, most of the time they come back with an LDL because their doctor literally hasn’t a fricking clue what this test is.   And so, when they start to read, if you have, your listeners just go and run LDH as a prognostic marker in all cancer, a prognostic marker in chronic illness, you will be blown away at the utility of this. And by the way, it is the marker for multiple myeloma, leukemias, lymphomas, and melanomas. So it should be a standard test in every patient dealing with those diagnoses. And it rarely, if ever is. So it’s a doozy. My husband says if the LDH is on, so if it’s elevated, and elevated in my ranges, right?

Dr. Weitz:                            Okay. That’s what I wanted to ask you about is what’s the range that we should be concerned about?

Dr. Winters:                        So if you see the LDH on, you know the mitochondria are off, simply put. That can be your take home for this. But in the ranges, in the United States, LabCorp, they have a range from like, I don’t know, 50 up to 250. We want that one under 175. If it’s a quest test in the United States, they have a range that goes up to 450. We want that under 300. We want to be well in the middle of that zone or less.  Too low is also a problem. It can be a genetic issue, but it can also be sarcopenia and it could also be massive suppression of the marrow. And so, those are things too, that’s more rare, but it shows up on occasion. That’s why the isoenzymes are helpful. Even if you get a low or normal LDH, you can still see what tissues, because the LDH isoenzymes are the average that lead to that LDH. So you might have a really low LDH, but a really high bone isoenzyme. So that’s the average of that is the total LDH. So it’s a very important marker to be running on yourself and your patient population.

Dr. Weitz:                            Cool. That’s a great clinical pearl. I’ll have to add that to all the panels.

Dr. Winters:                        Right on. Perfect.

Dr. Weitz:                            All right, so I guess I also want to ask you about this center that you’re working on opening in Arizona. That sounds very exciting. This is going to be a cancer center hospital research facility that incorporates integrative care.

Dr. Winters:                        Yeah. A lot of our patients have to leave this country to go find seek treatments elsewhere. So if they want metronomic chemo, they have to go abroad, because the cost is pretty prohibitive in the United States of those who do offer it here. If they want to get hyperbaric oxygen paired with high doses of curcumin IVs, which is no longer available in the US unless you get it under the table, they have to go elsewhere. If you want to get photodynamic therapy injected right into your tumors, you have to pretty much go elsewhere. People are doing some of these things in the United States. They’re doing it quietly, they’re doing it underground, and it’s very, very costly for patients.

                                                So we’re building the first ever truly integrative oncology hospital and research institute on a 1,200 acre regenerative farm in southeast Arizona. This will bring in the best, as I mentioned, the metronomic chemos, the tissue assays, the thorough testing, the evaluations, the fractionated radiation partnered with hyperthermia. It’s going to bring the best of a modernized up-to-speed standard of care with all the proper testing to know how to use these other therapies along with the best vetted integrated medicine under one roof. It will be a training ground for physicians from all over the world. It will be a place where patients. We’ll have an 80-bed hospital to start. So it’ll be a campus that is people who are very, very sick and come and stay.

                                                It’s also going to be a wellness destination. There’s options on this that if you are just well and you want to just come and have a full assessment of your terrain, we can do that and help you fortify yourself a bit more and enjoy the beautiful nature that we’re offering and the bounty that we’re offering on feeding everyone who comes from the land of which we’re building this hospital. So we hope this becomes the model for a new global healthcare system and that this is our beta campus, and the plan is to see them perk up, pop up all over the world.

Dr. Weitz:                            And since it’s in Arizona, you can incorporate hyperthermia just by being there.

Dr. Winters:                        Exactly. Especially this summer there. Poor people. My God. Oh, yeah. We will harness all of what nature has to offer, including the sun right now. Holy cow.

Dr. Weitz:                            So I understand you’re not seeing patients anymore, but you’re doing practitioner training?

Dr. Winters:                        Yep. I’m treating physicians, but I will do consulting with the doctor of a patient. So if someone says, “I really want my doctor to consult with you on my behalf,” I still do that type of work. I also train now 155 physicians in 16 countries. Our eighth cohort starts in September. So if you are interested in joining this tribe, we need you. We cannot keep up with the demand. We get about 1,000 inquiries a month for people trained under this methodology. We can’t meet that need. We also have trained almost 300 patient advocates. That next cohort starts in November. So if you have a nursing degree, a nutrition degree, or just something in the clinical health coaching world, and you want to be part of this mission and vision, that next cohort starts as well. We have you being the beautiful liaison between the patient and the physician. So this is this beautiful system that we’re creating. We’re literally, we’re building a new model of healthcare and it’s really, really, really exciting.

Dr. Weitz:                            And where do we go to find out about that?

Dr. Winters:                        All of this we’ve talked about here between my books and podcasts and lectures and all the things we’re doing with that, to the hospital, to the data platform we’re building, to the lab, mitochondrial metabolic lab that we’re building, to the trainings are all on mtih.org, our nonprofit organization, the Metabolic Terrain Institute of Health. If you Googled that, you’d get there, but mtih.org should get you there.

Dr. Weitz:                            Awesome. Thank you so much, Nasha.

Dr. Winters:                        Oh my gosh, Ben, thank you. Really grateful.

 


 

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 certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. That way, more people will discover the Rational Wellness Podcast, and I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way.   And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

 

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Hyperthyroidism with Dr. Eric Osansky: Rational Wellness Podcast 321

Dr. Eric Osansky discusses Hyperthyroidism 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

3:51  Hyperthyroidism.  Hypothyroidism or Hashimoto’s is a lot more common than hyperthyroidism.  Hypothyroidism is when you have low thyroid levels and TSH or thyroid-stimulating hormone is elevated.  With hyperthyroidism there’s too much thyroid hormone and TSH will be low.  With such patients you might see an elevated resting heart rate, heart palpitations, weight loss, hair loss, and thyroid eye disease that may include eye bulging and double vision.  While the optimal TSH should be between one and 1.5 or 2, TSH below 1 and esp. at .5 or below is reason for concern for hyperthyroidism.  For most patients with Grave’s disease (Autoimmune hyperthyroidism) the TSH is undetectable.

7:54  Grave’s Disease.  Most patients with hyperthyroidism (at least 80%) have elevated thyroid-stimulating immunoglobulins (TSI), which means that it is an autoimmune condition that is referred to as Grave’s disease. 

9:13  Medical treatment.  The most common medical treatments for hyperthyroidism are the use of anti-thyroid medications including Methimazole or Carbimazole, which converts into Methimazole, and several other anti-thyroid medications, including Propylthiouracil.  The other medical treatments are radioactive iodine, which obliterates the thyroid gland, and surgery to remove the thyroid gland.  Some endocrinologists feel that the surgery is the way to fix the condition and that is their primary treatment for this condition.

11:25  From a Functional Medicine perspective, what happens is that the immune system is attacking the TSH receptors.  There are four main categories of triggers for such autoimmune diseases that we can look at: 1. Food sensitivities, such as gluten, dairy, and corn, 2. Stress, 3. Toxins, including environmental toxins, heavy metals and mycotoxins from mold, and 4. Infections that includes viruses like Epstein-Barr, bacteria in the gut such as H. pylori, Yersinia Enterocolitica, and potentially even parasites. 

14:02  Dr. Osansky was diagnosed with Grave’s disease in 2008 and got it under control without the use of surgery, radiation, or medications.  When Dr. Osansky sees a patient for hyperthyroidism, he takes a very thorough health history. Then he will run some lab tests, including a CBC, a comprehensive metabolic panel, vitamin D, iron panel, etc. Dr. Osansky also likes to look at adrenals, either through saliva or urine with the DUTCH test. He also likes to test hormones and run a comprehensive stool test and perhaps organic acid testing.  He also likes to test hair minerals, including heavy metals. When Dr. Osansky was diagnosed with Grave’s in 2008, he did salivary cortisol testing and found out that both his cortisol and DHEA levels were quite low most of the day.  Grave’s causes you to feel hyperactive, so he did not feel fatigued like patients normally do with adrenal fatigue.  He worked on improving his ability to manage stress, changed his diet, and he took certain herbs, including liquorice root and certain nutrients, which helped his recovery. 

20:49  Anti-thyroid nutritional strategies. While we are using the Functional Medicine approach to search for the underlying causes for their hyperthyroid condition, there are certain herbs and nutrients that can help to manage the excess thyroid hormone, including the herbs Bugleweed and Motherwort.  Bugleweed is an herb with anti-thyroid properties, that helps to lower the thyroid hormone levels.  Patients often get heart palpitations with hyperthyroidism and Motherwort is an herb that can help with that. It has been found to calm the heart, sort of like a natural beta blocker. Lemon balm can also have a calming effect. He prefers the liquid tinctures in an alcohol base and with a two to one ratio.  Dr. Osansky likes the MediHerb product with Bugleweed and Motherwort, but there are also products on the market from HerbPharm, Hawaii Farm, and Wise Women Herbals.  Dr. Osansky usually recommends taking the herbs 15-20 min prior to meals typically 1/2 to one teaspoon twice per day but they may need two teaspoons if taking a less potent product like HerbPharm, which is a five to one ratio.  Bugleweed dosage depends upon the thyroid testing, while Motherwort dosage should be titrated till the heart symptoms are calmed.  If Bugleweed doesn’t work, L-carnitine at a higher dosage–2 to 4 grams per day–has anti-thyroid properties and it inhibits T3 and T4 from getting into the cell nuclei, according to some research. If the symptoms are not under control with Bugleweed and L-carnitine, sometimes lithium orotate (low dose lithium) is helpful at a dosage of 5-10 mg.  Selenium may help to lower the TSI and TPO levels if elevated and it could help with thyroid eye disease.  He typically recommends a dosage of 200 mcg but may go up to 400 mcg. Dr. Osansky does not like using high dose iodine with patients with hyperthyroid, even though it may suppress thyroid function at higher dosages, but it creates a lot of oxidative stress, so he usually discourages his patients from taking iodine supplements or even eating a lot of seaweed.  Cholestyramine is a prescription binder often used in mold detox programs that can bind to thyroid hormone and help lower levels.  It is up for debate whether nutritional binders like activated charcoal and zeolite, etc., may be able to do the same thing to lower thyroid levels.  Low dose naltroxene (LDN) may also be effective though modulating the immune system.

 

 



Dr. Eric Osansky is a chiropractor and one of the leading experts on a natural approach to hyperthyroidism.  He was personally diagnosed with autoimmune hyperthyroidism, also known as Graves’ disease, and he was able to overcome it using a natural, Functional Medicine approach.  He avoided both the prescription antithyroid medications and the radioactive iodine treatment as well as thyroid surgery.  He has a Masters of Science degree in Human Nutrition and Functional Medicine, is a Certified Clinical Nutritionist, is a certified nutrition specialist and a certified functional medicine practitioner for IFM.  In 2011 he published his first book, Natural Treatment Solutions for Hyperthyroidism and Grave’s Disease, in 2018 he published Hashimoto’s Triggers on hyperthyroidism, and he is currently editing the third edition of his first book, to be released soon.  Dr. Eric Osansky can be found at SaveMyThyroid.com  and at  NaturalEndocrineSolutions.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. Dr. Weitz is also available for video or phone consultations.

 



 

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 listeners, I’m very excited today to be speaking about hyperthyroidism with Dr. Eric Osansky. We’ve had a number of discussions on this podcast about hypothyroidism, or Hashimoto’s Thyroiditis, which is a condition marked by underactive, sluggish thyroid, and this is the most common thyroid disorder. But some patients have an overactive thyroid, which we refer to as hyperthyroidism.   Like with hypothyroidism, most patients with hyperthyroidism have it as part of an autoimmune condition. Unlike hypo, when the body does not make enough thyroid hormone, in hyperthyroidism the thyroid produces too much thyroid hormone. Hyperthyroidism speeds up the body’s metabolism, and this can result in many symptoms, including weight loss, hand tremors, rapid heart rate, irregular heartbeat, anxiety, sweating, et cetera. Not too many functional medicine practitioners talk about hyperthyroidism, so I’m thrilled that we’ll be talking to Dr. Osansky today. Dr. Eric Osansky is a chiropractor, and one of the leading experts on the natural approach to hyperthyroidism. He was personally diagnosed with autoimmune hyperthyroidism, also known as Graves’ Disease, and he was able to overcome it using a natural functional medicine approach.   He avoided both the prescription anti-thyroid medications and the radioactive iodine treatment, as well as thyroid surgery. After seeing how well natural treatment methods helped with his autoimmune thyroid condition, Dr. Osansky began using these natural thyroid treatment protocols to help others with different types of thyroid and autoimmune thyroid conditions, such as hyperthyroidism and Graves’ Disease, and hypothyroidism, and Hashimoto’s Thyroiditis. While Dr. Osansky realizes that conventional medical treatment is necessary in some cases, there are millions of people with these conditions who’ve been told they need to be on prescription drugs on a long-term basis, or receive thyroid surgery or radioactive iodine, when this may not be the case.  Dr. Osansky has a Masters of Science Degree in Human Nutrition and Functional Medicine, he’s a certified clinical nutritionist, is a certified nutrition specialist, a certified functional medicine practitioner for IFM. In 2011 he published his first book, Natural Treatment Solutions for Hyperthyroidism and Graves’ Disease, and he’s currently editing the third edition, to be released soon. Dr. Osansky, thank you so much for joining us.

Dr. Osansky:                       Dr. Ben, it’s a pleasure being here, thank you for having me.

Dr. Weitz:                           Sounds good. So perhaps you might want to put a little more on the bones of explaining what is hyperthyroidism, what is Graves’ Disease?

Dr. Osansky:                       Sure, definitely can do that. As you mentioned, hypothyroidism is… First of all, hypothyroidism, Hashimoto’s a lot more common than hyperthyroidism. And so with hypothyroidism, that’s when you have low thyroid hormone levels, even though some cases of Hashimoto’s it’s more subclinical where they’re within the range but less than optimal. But typically, you’ll have thyroid hormone levels on the lower side or overtly low, and then there’s a thyroid-stimulating hormone, or TSH, that’s a pituitary hormone, that signals a thyroid gland to produce thyroid hormone. But with hyperthyroidism, as you mentioned, there’s too much thyroid hormone. There’s the excess secretion of thyroid hormone, and you could get multiple symptoms, you mentioned some of them.  So when I dealt with Graves’ Disease I had elevated resting heart rate, also known as tachycardia, had heart palpitations, I lost almost… Actually I lost 42 pounds, I have that specific-

Dr. Weitz:                            Ouch.

Dr. Osansky:                       I have that down, 42 pounds I lost, which was a lot more than I was hoping to lose. Because actually, prior to being diagnosed I was trying to lose weight, so that’s why I didn’t catch on right away. I was dieting and detoxifying, but yeah, I lost 42 pounds, had increased appetite, my stools were a little bit on the looser side. So yeah, the metabolism was sped up, accelerated, and hair loss is common, even though I don’t have a lot of hair. But again, I work with a lot of women who it’s really noticeable. And sometimes there’s thyroid eye disease, which is associated with Graves’ Disease, where someone could get eye bulging, double vision in some cases. And so on a blood test, that will present as elevated thyroid hormones, so T3, T4, the main thyroid hormones.  And I mentioned TSH, so with hypothyroidism TSH is elevated, with hyperthyroidism TSH is low. And the reason it’s low is because it’s trying to slow down the production of thyroid hormone, so TSH in this case doesn’t want the thyroid glands to produce thyroid hormone. But-

Dr. Weitz:                            So, what particular level of TSH do you really get concerned?

Dr. Osansky:                       Well I mean, I would say optimal TSH would be between one and 1.5, and even between one and two depending on the person. If someone’s like 1.8 and everything else is great, I might not panic. For hyperthyroidism, I mean, if it’s a little bit below the reference range, like if someone’s like .8, I wouldn’t be too concerned. But really, when it gets like .5, .6, I start paying attention. But I’ll say this, with most cases of especially Graves’ Disease, the TSH is undetectable. So by the time they’ve seen me, usually the patient has already been diagnosed. It’s a little bit different with Hashimoto’s, as you know with Hashimoto’s it’s a long process. People could go like five, 10, 15 years before getting diagnosed, they might attribute the symptoms like fatigue and brain fog and waking to something else.

                                                But when someone is having an elevated resting heart rate, and palpitations, and losing weight, it’s scary. So a lot of times they’ll go to the medical doctor not knowing what’s going on, get diagnosed. So usually, they’re already diagnosed when they see me. And then I’d say probably like 90% of the time, the TSH is non-detectable. There are some cases actually, I saw a patient today who had more sub-clinical hyperthyroidism, and the TSH… Actually, the recent TSH was undetectable. But more recently it was like .4 and .6 were some of the other readings. And I mean, that also is a little bit of a concern, but I mean, the thyroid hormones are to me more of a concern when they’re elevated. But yeah, like I said, a lot of people, arguably most people with Graves’ have undetectable TSH levels.

Dr. Weitz:                            And do most of the patients that you see with hyperthyroidism have the antibodies, the TSI?

Dr. Osansky:                       Yeah. I think you mentioned before, most of the time it’s autoimmune. So yeah, with hyperthyroidism most of the people who see me have elevated thyroid-stimulating immunoglobulins, or TSI levels. I do see some people with toxic multinodular goiter, where they don’t have the antibodies. And then there’s some other hyperthyroid conditions, like sub… Well, subclinical hyperthyroidism, even though you could have subclinical Graves’, where it’s not too common, where someone could have normal thyroid hormone levels, low TSH, elevated TSI. But yeah, to answer your question most people do test positive for TSI.

Dr. Weitz:                            Right. And so, would you say 80, 90% of patients with hyperthyroidism have Graves’?

Dr. Osansky:                       Oh yeah, definitely, I would say that, yeah. At least like 80, if not more, like [inaudible 00:09:04].

Dr. Weitz:                            Okay. And that’s basically when the TSI, when the antibodies are present, that’s when you diagnose Graves’, correct?

Dr. Osansky:                       That is correct.

Dr. Weitz:                            Right, okay. So what are some of the most common medical treatments for hyperthyroidism?

Dr. Osansky:                       Yeah, so typically most people with Graves’, hyperthyroidism will go to an endocrinologist, and there are three main treatments that they recommend. One treatment, anti-thyroid medication, and the most common medication at least in the United States is Methimazole. Some other countries will give Carbimazole, which converts into Methimazole. And then there’s another PTU, which is a different type of anti-thyroid medication. So a lot of endocrinologists will recommend the anti-thyroid medication, but then there’s two others. Another one is reactive iodine, which obliterates the thyroid gland. It involves a small amount of radiation, radioactive iodine. Well actually, the radioactive iodine does…

                                                It depends on how much they give, so they give enough to obliterate the thyroid gland. Unfortunately, some people need multiple doses of the radioactive iodine. But I was thinking, there’s also what’s called a radioactive iodine uptake test, which we could talk about. But that involves a small amount of radioactive iodine, the radioactive iodine treatment actually involves a good amount of radioactive iodine, which you need to destroy the thyroid gland. So, that would be the second treatment. And then a third treatment would be surgery, some doctors recommend thyroid surgery, and there’s some reasons why they might recommend surgery instead of radioactive iodine. Like if someone has thyroid eye disease, and they receive radioactive iodine, it’s more likely to exacerbate the thyroid eye disease.  So a lot of endocrinologists will not recommend radioactive iodine for those with thyroid eye disease, they’ll either give the person anti-thyroid medication, or if they think that… If the anti-thyroid medication isn’t tolerated, or if they just… It depends on the doctors, but some just are more aggressive than others, and some will just shunt to the surgery. So, depends on the-

Dr. Weitz:                            And when you say surgery, essentially you mean remove the thyroid gland?

Dr. Osansky:                       Exactly, remove the entire thyroid gland, mm-hmm.

Dr. Weitz:                            Right. So, what are some of the, from a functional medicine perspective, what are some of the most common underlying triggers, or root causes for hyperthyroidism? Because there’s a reason why the body’s gone wrong, why the immune system’s attacking the thyroid. In this case, attacking the thyroid TSH receptors, correct? Or thyroid hormone receptors?

Dr. Osansky:                       Correct, yes, exactly. So what happens is the immune system attacks those TSH receptors, and that’s… Yeah, so as far as… I’d talk about four categories of triggers or four main categories. So one, food, so certain foods can cause problems. Obviously we’re familiar with gluten these days, I’m sure your listeners… And same thing with Hashimoto’s, gluten can cause problems, and in some cases dairy, in some cases corn. I mean even salt, if you look at the literature, just with autoimmunity too much salt could raise Th17 cells, increase Th17 cells, which are associated with autoimmunity. So, food could be a trigger. A second one, stress. And when it comes to Graves’, there’s literature that shows the correlation between stress and Graves’.   And we can’t say the… Or stress, I think, is a factor with all chronic health conditions, but just the research, like if you do some research on the PubMed, some autoimmune conditions, there’s really no correlation, according to the research. Now again, we know even if it’s not in the research it could be a factor. And that was, stress was a big factor with my Graves’ Disease condition, and we could talk more about that if you like. A third potential trigger, environmental toxins, we live in a toxic world and it’s not getting any better, and there’s heavy metals such as mercury, there’s xenoestrogens, Bisphenol A, there’s… I mean, glyphosate, which disrupts the gut microbiome. And then a fourth category of triggers, we have infections.   So viruses such as Epstein-Barr, bacteria such as potentially H. pylori, Yersinia Enterocolitica, potentially even parasites. And it doesn’t mean that in everybody it’s a trigger, like we could have someone who has Graves’ Disease have H. pylori, and it might not be the trigger. But again, it potentially could be, and like I said there’s also literature to support that as well.

Dr. Weitz:                            So, patient comes in, you take their history, you go through. And then how do you decide which direction you’re going to go?

Dr. Osansky:                       Yeah, that’s a good question. I mean, I definitely do what I’d consider some basic tests, I do blood testing, complete blood count, comprehensive metabolic panel, vitamin D, need healthy levels of vitamin D to have a healthy immune system. I mean, even things like iron, like for example even though most people with hyperthyroidism, including Graves’, are women, men like myself could have Graves’. And when we think about iron deficiency, we might think of more cycling women. But we also don’t think of iron overload, which could cause oxidative stress, and also could be a factor when it comes to autoimmunity. And then I do look at adrenals, either saliva testing, or I’m sure you’re familiar with Dutch testing, dried urine testing.

Dr. Weitz:                            Sure, yes.

Dr. Osansky:                       So I look at adrenals, hormones, sometimes comprehensive stool testing, sometimes organic acids testing. So it does depend on… I can’t say I recommend all of these tests to everybody, but the basics like blood testing, saliva testing, I actually do some hair testing too, which goes back a number of years. Don’t rely on it completely when it comes to minerals and heavy metals, but I do still like looking at that. But yeah, sometimes I’ll do organic acids, sometimes I’ll do like I mentioned, comprehensive stool panel, I do a lot of those. And yeah, and sometimes other tests as well.

Dr. Weitz:                            Right, yeah. I saw where you’re doing that hair and mineral analysis, I remember doing that. We kind of went away from it, partially because I was concerned about the accuracy given all the exposure of hair products and everything else. But it’s also a little tricky, especially if you have somebody who doesn’t have that much hair, and now you’ve got to cut a big chunk out from the base of their neck or something. And then we tended towards some of these bigger nutrition panels, where they look at functional status of nutrients as well. So let’s start out with stress as a factor for hyperthyroidism. You said you like to do either the salivary adrenal stress testing, or the Dutch testing for that?

Dr. Osansky:                       Correct. When I was diagnosed with Graves’ back in 2008 I don’t think there was Dutch testing, if there was I wasn’t aware of Dutch testing. So I did saliva testing, and in my situation cortisol was low, like very low, DHEA, which is another adrenal hormone was low. I mean, everything was low. And the thing that-

Dr. Weitz:                            So, low the whole day, whereas it’s supposed to be elevated in the morning and then slowly come down?

Dr. Osansky:                       Correct, yeah. I mean, the first two levels were below the reference range, the third and fourth were on the lower side. But because, as you mentioned, yeah, it’s supposed to be lower later in the day it was still within range. But yeah, the first two are very low, and yeah, DHEA was also low. And I didn’t feel like that’s what some would refer to as like an adrenal fatigue pattern, when you have everything low. And I mean, probably because of the Graves’, again, I felt more hyper, I felt… Again, I didn’t feel low-energy at all. And so that’s why I’m a big believer in testing, and one could make the argument, “Well, maybe Graves’ is a little bit different because you have that hyper component, and you can’t always go by how you feel.”    But yeah, I did saliva testing. And then these days I still do saliva testing, but it depends. I mean, if someone wants to do a deeper dive into the hormones, and what I like about the Dutch is that it also looks at the metabolism of the hormones, so a real-

Dr. Weitz:                            You do that Dutch complete?

Dr. Osansky:                       Correct. When I do the Dutch, yeah, I will do that Dutch.

Dr. Weitz:                            So what did you do in your case when you realized that you had low cortisol levels?

Dr. Osansky:                       Initially I was in denial, so I was surprised that my adrenals looked as bad as they did. Because I knew stress was a factor, I just thought I was doing a good job of handling the stress, which is another reason to do the test. That sometimes you have to convince people that their adrenals aren’t looking good either, and that definitely was the case with me. So I definitely started blocking out time for stress management, I mean I changed my diet even prior to doing the adrenal testing. And I took certain herbs, I took liquorice root, which extends the life of cortisol, [inaudible 00:19:00] complex, I took nutrients that helped support the adrenals. So a combination of herbs, nutrients, diet and lifestyle.

Dr. Weitz:                            So it’s interesting, because it’s a little bit counter-intuitive, because as a functional medicine practitioner I’m thinking, “Cortisol in the morning is what gives you energy to wake up, you’ve got hyperthyroid, you’ve got too much stimulation, too much energy already.” This seems like it might make it worse, but actually when you go by the testing, and you see what the body needs, and you give it what it needs, things balance out.

Dr. Osansky:                       Yeah, exactly. Yeah, right. I mean, cortisol is supposed to give you energy, and I definitely had energy when I was dealing with hyper. It’s funny how it works though, I will say going back to the symptoms, I should say that not everybody… I do work with people with hyperthyroidism that do experience fatigue, and there’s reasons behind that. Like it does affect the mitochondria and depletes CoQ10 in a lot of people, which, that could lead to low energy. And I also should add, before I mentioned I lost 42 pounds, and we don’t have to get into great detail with this. But some people actually gain weight with hyperthyroidism. I mean, sometimes it’s due to the anti-thyroid medication, but sometimes there are other factors.   But yeah, getting back to the cortisol it’s just, you’re right. I mean, even though my energy levels were fine, increased cortisol could potentially increase even further. I think it played a big role in my recovery, and I can’t say I felt more hyper when addressing those cortisol levels.

Dr. Weitz:                            Yes, that’s really interesting. And so, while you’re searching for these underlying causes for their hyperthyroid condition, looking at stress, looking at toxins, looking at infections, looking at gut health, there are certain nutritional supplements and herbs that can help to manage the excess thyroid hormone, if you want to try to take a natural approach instead of either removing your thyroid or taking those drugs that block the thyroid.

Dr. Osansky:                       Exactly. So I mean, there definitely is a time and place for the anti-thyroid medication. And there are some people where the herbs aren’t effective, I’d say maybe like 20, 25% of the time. So if there’s a choice between taking the meds or receiving radioactive iodine surgery, I would say like go on the meds. But in my case, I took the herbs bugleweed and motherwort. And so bugleweed, it’s a herb with anti-thyroid properties, so it does help to lower the thyroid hormone levels. And so I started just with the bugleweed, but I was still experiencing some heart palpitation. So then I added the motherwort, and that did help with the palpitations. Motherwort focuses more just on the cardiovascular system. There’s lemon balm, which has a calming effect.

Dr. Weitz:                            I think in your book you describe motherwort as sort of a natural beta blocker?

Dr. Osansky:                       Yeah, it’s obviously a different mechanism than a beta blocker. But yeah, just to make a comparison, exactly.

Dr. Weitz:                            Right. And bugleweed is an anti-thyroid herb, right?

Dr. Osansky:                       You got it, yep.

Dr. Weitz:                            Now, what particular products do you like for this? I’ve used… Herb Pharm has a combo with bugleweed, motherwort, and lemon balm. But I know in your book you were saying that you’ve got to get the right dosage, and you like to see, I think you said sometimes a two to one ratio. And I noticed on the Herb Pharm, they don’t list the ratio.

Dr. Osansky:                       Actually, I think they… Well, they used to, it used to be one-to… It’s one-to-five, it should be, Herb Pharm. So yeah, I look for a one-to-two. It really depends on the person, I mean, there are people that, when they’re seeing me, the first consult they’re already taking something, because they just went online, and they got the Herb Pharm thyroid-calming formula, or someone’s… Actually someone I spoke with today, they were taking, it was something called Thyroid Soothe, which has the bugleweed, the motherwort, the lemon balm. And in this case, the person today, she seemed to be doing okay with that. So I won’t always switch into… The one-to-two is more potent, so it does depend on the person. And I’m a little bit biased, because that’s what I took when I was dealing with Graves’. I took the one-to-two extra [inaudible 00:23:49]-

Dr. Weitz:                            What product did you take?

Dr. Osansky:                       I took MediHerb, MediHerb has bugleweed and motherwort. But there are others, there’s Hawaii Farm has one that’s a one-to-three extract. And then yeah, there’s actually… There’s not a lot of, as you know, not a lot of companies that have bugleweed, because it’s not as popular as other supplements out there.

Dr. Weitz:                            Right. I saw Wise Woman Herbals has a combo product.

Dr. Osansky:                       Yeah. And one thing I should say too, which really, those were all formulas. But with bugleweed, or again, other herbal formulas, ideally you want to take the alcohol extract if you can tolerate it. Like, they use ethanol as a solvent, and if I have people… Like if someone goes to, let’s say some people, they might choose like Hawaii Farm because they have options for glycerine-based without the alcohol, but the alcohol extracts… It does a better job of extracting the phytonutrients, so it actually will do a better job. So if someone were to take an alcohol-free version of the bugleweed and it doesn’t work, it could be because it’s just not effective. Like maybe it doesn’t matter what bugleweed they would take, but it could also be because they took the glycerine-based version. So, that’s something for people to keep in mind as well.

Dr. Weitz:                            Oh, okay, okay, interesting. And what is the typical dosage, and how many times do you have them take it, and is it okay to take it in the evening, is it okay to… I guess it’s good to take it in the evening, because it’s going to be blocking the thyroid hormone. You want to take it apart from meals, before meals, after meals?

Dr. Osansky:                       Usually I recommend it 15 to 20 minutes before a meal, so away from meals. If someone can’t tolerate it on an empty stomach then they could take it with food, but it works a little bit better if the herb’s away from food. And then yeah, usually I recommend divided doses, like one in the morning, like one before breakfast, one before dinner. And then I mean, if someone’s having sleep issues also I might give lemon balm like right before going to bed, which has mild anti-thyroid properties, but just more of a calming effect. And as far as dosing, it does depend. Maybe an average dose would be a teaspoon twice per day, or five milliliters twice a day, sometimes I’ll give like half a teaspoon. And if they’re taking like Herb Farm, which is less potent, I might have them take two teaspoons, or 10 milliliters twice per day.

                                                At least with the bugleweed. The motherwort is more based on the symptoms, so the bugleweed, we’ll put someone on a dose, and then we’ll see what the next thyroid panel looks like and see if we need to adjust it, similar to like anti-thyroid medication. With the motherwort it’s more symptom-based, so if someone starts with let’s say half a teaspoon twice a day, and it helps with their symptoms, their palpitations, then they might be good with that dose. If they’re still experiencing palpitations, then they might need to go up a little bit.

Dr. Weitz:                            Okay. What other natural agents are there?

Dr. Osansky:                       For symptom management?

Dr. Weitz:                            Yeah, for symptom management. I know you talked about L-carnitine.

Dr. Osansky:                       Mm-hmm, yep. So L-carnitine, typically L-carnitine tartrate in higher doses. The literature shows between two grams and four grams per day has anti-thyroid properties. So, that’s what I’ll give now. Again, sometimes people… Like I just took the bugleweed when I dealt with Graves’, just honestly I didn’t know about the L-carnitine back then. But some people will take bugleweed and L-carnitine. I had someone just recently I consulted with that they’re just taking L-carnitine without the bugleweed, but yeah, L-carnitine is also another option.

Dr. Weitz:                            And so, in your book you explain how it inhibits T3 and T4 getting into the cell nuclei? That’s kind of interesting.

Dr. Osansky:                       Correct. Yeah, at least that’s from the research that I did, yes.

Dr. Weitz:                            Okay, yeah. And we know cardiovascular problems often go along with hyperthyroid, and L-carnitine seems to be particularly beneficial for cardiovascular health as well.

Dr. Osansky:                       Mm-hmm, yep, yeah. It has a number of different benefits. So you’re right, bugleweed, I mean, all herbs have multiple properties. But still, it’s really known for the anti-thyroid properties. But you’re right, L-carnitine does have other health benefits as well.

Dr. Weitz:                            Okay. What other things can help with symptom management, natural agents?

Dr. Osansky:                       Lithium, so I can’t say I give lithium. And it’s really just based on more a habit than anything, just because the other agents usually work. But lithium carbonate, now that’s prescriptions. I don’t give lithium carbonate, but they discovered years ago that giving lithium carbonate can lead to hypothyroidism. That’s how some functional medicine practitioners like myself recommend lithium orotate, and it’s like a small amount, like five, 10 milligrams. And that’s not my first go-to, it’s probably like my third go-to after the bugleweed, L-carnitine. But it is another option if for any reason someone is unable to get the bugleweed, or unable to tolerate the bugleweed, and for whatever reason maybe can’t tolerate the L-carnitine, even though that’s not too common.

Dr. Weitz:                            And it could be helpful for mood disorders as well.

Dr. Osansky:                       Yeah, yeah, exactly. Yep, yep.

Dr. Weitz:                            And you also mentioned selenium is having some benefit?

Dr. Osansky:                       Yeah. I wouldn’t say so much as like an anti-thyroid agent, but selenium is… And I’m sure you know this with Hashimoto’s too, just, there’s a good amount of research. First of all, there’s research that shows that it could help lower TPO, or thyroid peroxidase antibodies, and then there is evidence that it could also help with the thyroid-stimulating immunoglobulins, there’s evidence hoping that it could help with thyroid eye disease by helping to reduce those TSI levels. So, yeah.

Dr. Weitz:                            Yeah, there’s an oxidative storm that occurs when there’s a lot of thyroid being produced, and it helps clear out some of that excess oxidation too.

Dr. Osansky:                       Exactly, yeah. So selenium is something that I recommend to just about everybody, usually starting at like 200 micrograms. Sometimes I’ll go higher, I try not to go too high, just fear out of toxicity. Most people could tolerate between like two, 400 micrograms. Some people go higher, but again, I get a little bit nervous if someone’s taking six, 800 micrograms per day.

Dr. Weitz:                            Right. Now, what do you think about iodine? We know that iodine is an important nutrient for the thyroid, in fact the difference between the different thyroid hormones, T4 and T3, is based on the number of iodine molecules in that hormone. So, we know iodine’s really important. What do you think about using iodine in such patients?

Dr. Osansky:                       So there, it’s interesting with iodine. And again, I definitely have experience with iodine in the past. And so I’ll say this, iodine, as a mineral it’s important. Like you said, it plays a big role in the production of thyroid hormone. And when you think about that you might wonder, “Well, why would you want to take it for hyperthyroidism if it helps with thyroid hormone production?” And with hyperthyroidism, you want lower thyroid hormone levels. But actually in higher doses, it could suppress thyroid production. The problem with iodine, and again, personally I’ve had a good experience with… I have not had any negative experiences personally. But the problem with iodine, especially like higher doses of iodine, is it can cause a good amount of oxidative stress, which you mentioned before.

                                                And speaking of selenium, that’s why a lot of practitioners that recommend high-dose iodine will recommend selenium to try to offset that. But still, many times it’s not enough, and in some cases it could actually exacerbate hyperthyroidism, in some cases it could exacerbate the autoimmune response. So I mean, if someone is taking a multivitamin with iodine, I’m not going to tell them… I think that’s fine, I see most people doing okay with like a multi with iodine. If they’re eating regular food sources of iodine, I’m okay. If they’re eating higher dose, like sea vegetables, I’ll tell them to take a break from that. And again, everybody’s different. There are some people that eat seaweed, they do perfectly fine. But same thing with some people taking Iodoral, and they might do okay. But, just trying to be more conservative.

Dr. Weitz:                            So essentially, what you’re saying is, is taking what we would consider a modest amount of iodine, like 100 to 200 micrograms, MCG, is not a problem. But some who advocate higher dosages, say in a milligram level, that tends not to be helpful, is what you’re saying? In most patients.

Dr. Osansky:                       It could be a… Yeah, yeah, it definitely could be a problem. Again, I mean, when you say not helpful, like I said there are some practitioners who successfully use it as an anti-thyroid agent. And I guess you could make the argument that if someone is unable to tolerate the anti-thyroid meds, and the herbs aren’t effective, and they’re faced with taking high-dose iodine, versus radioactive iodine or surgery, I mean, I haven’t really faced that. There are other things like LDN, cholestyramine. But yeah, it is playing with fire. Again, I’m not anti-iodine, but it’s something where if someone takes especially like the milligram doses they could run into trouble.

Dr. Weitz:                            You mentioned cholestyramine, so that is binder that is sometimes utilized in programs to help bind to mycotoxins to get them out of the body when someone’s suffering from mold toxicity. If you could talk about that, and for those of us who can’t get a hold of cholestyramine because it’s a prescription, can other binders like nutritional binding agents have some benefit? And my understanding is the mechanism with the cholestyramine is, it’s binding to the thyroid hormone and reducing some of the levels?

Dr. Osansky:                       That is correct. So cholestyramine is, like you said, it binds to the thyroid hormone, and it could bind to mycotoxins. So you are correct, some practitioners who have prescribing rights might give cholestyramine in the case of toxic molds. And I will say this, if someone is listening to this, they have hyperthyroidism, and they can’t tolerate the anti-thyroid meds, and maybe the natural agents aren’t effective, if they go to the endocrinologist and they present the research, because that’s how I found out about cholestyramine. I don’t remember exactly, it probably was because I was looking into the cholestyramine and mold connection, and then just came across how it could help with people with hyperthyroidism.

                                                Up until then I didn’t know, it wasn’t in my first or second edition of the book because I didn’t know at the time. But if you showed the research [inaudible 00:35:47] endocrinologist, well they will recommend. Now, if you show him like my book or my website they probably won’t, because they don’t want anything to do with functional medicine. But again, I’ve had endocrinologists prescribe it to patients, and it does seem to be pretty effective. Now, as far as natural binders, I haven’t gotten too aggressive. I have used some things like activated charcoal and zeolite, and I haven’t seen the same effect. But to be honest, I haven’t had a person take really high doses of the binders.

                                                Maybe if I dramatically increased the binders, something that… Yeah, it’s one of those things where when someone’s dealing with hyperthyroidism too we want to try to lower the thyroid hormone levels as quick as possible. So I’ll give the bugleweed first, if that doesn’t work the L-carnitine. And again, I’ve tried regular doses of binders, like G.I. Detox, there’s different products out there. And I’ll go maybe like a capsule or two on an empty stomach, and I haven’t seen the same effect, maybe if I gave like five to 10 capsules [inaudible 00:36:54]-

Dr. Weitz:                            Yeah, yeah, you’ve got to use the powder, or yeah, give more capsules than that, yeah.

Dr. Osansky:                       Yeah. But it’s a good question, it’s something that I probably need to do more experimenting for for someone who is unable to… Where the bugleweed doesn’t work, and maybe the L-carnitine isn’t working either, maybe trying something like really high-dose binders, like natural binders for someone who either can’t take the cholestyramine or just doesn’t want to take the medication.

Dr. Weitz:                            Right. Somebody needs to do that study. And sometimes you recommend low-dose naltrexone? Or you’ve seen patients do well with that, because I know that’s a prescription?

Dr. Osansky:                       Yeah. I mean, it’s hit or miss. I mean, cholestyramine works with most people, anti-thyroid medication… I mean, methimazole, PTU work in most people, the problem is side effects are common. With LDN, low-dose naltrexone, side effects aren’t as common. I mean, some people will get insomnia, mild side effects. But it’s, again, a flip of the coin, maybe even less with Graves’. So LDN modulates the immune system and could be used for different autoimmune conditions, including Hashimoto’s. But again, there’s like an urgency to try to get the thyroid hormone levels down. And so usually if I recommend it, it’s when, again, someone can’t take the anti-thyroid medication and the natural agents aren’t working, then I’ll talk more about the cholestyramine, the LDN.

                                                LDN is easier to get usually, because you could even just hop on a phone. There are I guess like ldndoctor.com, there’s different websites where you can just schedule a consult with a practitioner and just get a prescription for LDN, where you can’t do that with cholestyramine. But the LDN’s typically not as effective, but if it works it works well, because it modulates the immune system, and obviously Graves’ is an immune system condition. So if someone takes the LDN and it works, then they might not need to take any of these other things that we mentioned while they’re trying to address the cause of the problem.

Dr. Weitz:                            So let’s go into some of the other root causes besides stress. We’ve got toxins, infections, gut health, take it where you want to go.

Dr. Osansky:                       Sure. I mean, let’s talk about infections. So just a few years ago we got hit with a big virus, and-

Dr. Weitz:                            Oh, what are you talking, about what virus? Oh.

Dr. Osansky:                       Well I mean, the thing is with the COVID situation, it actually… I mean, business definitely increased when it came to hyperthyroidism. And it’s in the literature too, where… And there’s Epstein-Barr, there’s other viruses too. But yeah, I mean, [inaudible 00:39:56]-

Dr. Weitz:                            Yeah, a little bit of stress too.

Dr. Osansky:                       Yeah. I mean, with that question, I mean, and that’s a good point. When someone has, whether it’s COVID in the past, whether it’s Epstein-Barr, these other viruses, I do think of them more as immune system problems. And usually it’s other factors dragging down the immune system, and they’re like the-

Dr. Weitz:                            I mean, think about the level of stress. “Oh my God, I’m going to die, I have to wear this mask, and gloves, and I have to wash my bags before I bring them in, I have to wash my Amazon box.” It was like, oh my God, it was crazy.

Dr. Osansky:                       Yeah, no, I get… Yeah, you’re right. I mean, the stress… Yeah, that was a big factor as well.

Dr. Weitz:                            I got stressed just watching everybody else being stressed out, and scared [inaudible 00:40:43] to walk down the block without a mask on. I mean, it was crazy.

Dr. Osansky:                       Yeah. No, I agree. I mean yeah, we definitely can’t discount the stress, as we just had that discussion earlier on. But then there’s other infections, there’s like I said, the literature, H. pylori, Yersinia Enterocolitica. I understand correlation doesn’t always mean causation, so as I mentioned earlier just because you have H. pylori doesn’t mean it’s a trigger. But if I encounter someone with Graves’ Disease, and if they test positive for H. pylori, at least up until this point I’ve been one to treat it, and I’ve seen people go into remission. Now, I’m not only getting rid of H. pylori, so I could make the argument, “Well, maybe it’s because I’m not just getting rid of the H. pylori, but improving their adrenals, and healing their gut, and doing everything else.” But again, that’s what’s worked with me, and-

Dr. Weitz:                            So you’ll do say like a GI map, and see an elevated H. pylori. Let’s say you see slightly elevated H. pylori, but no virulence factors. Well, is that something that you’ll consider targeting?

Dr. Osansky:                       Yeah. I mean, if it’s red flags, yeah. I mean, with GI map, as you know it’s quantitative PCR, so a lot of times I’ll pick it up, but it won’t be elevated. And [inaudible 00:42:02]-

Dr. Weitz:                            Right, so it’ll be above detectable levels, but it’s not in the red?

Dr. Osansky:                       Correct, yeah. So I mean, it’s great when I see it less than DL, less than detectable limits. But yeah, if it’s above the range I’ll treat it. But again, it’s like the treatment’s going to be… It’s going to be like probiotic therapy, some herbal therapy, I definitely wouldn’t… I’m not advising the person to get the triple therapy with two antibiotics and the PPI. I mean, some people opt for that, and usually I’m telling them, “Well…” I mean, the thing with the natural approach, it does take longer and it’s not always effective. But the problem with the medication, as you know, it disrupts the gut microbiome, and it’s also not always effective. That’s why they use two antibiotics with H. pylori.

Dr. Weitz:                            Right. So you’re going to typically use some product that has mastic gum in it?

Dr. Osansky:                       Correct, yeah, exactly. So mastic gum, use some probiotics in there as well, use some other… Black cumin is one that works good, I mean, even garlic. Not supplement-wise, but there’s some evidence and research that eating raw garlic, like a few… I think it’s like two cloves twice a day, which I did try on patients. And sometimes if they’re symptomatic I’ve seen it reduce the symptoms, but-

Dr. Weitz:                            You don’t see fewer patients coming in after eating all that garlic? No, I’m just kidding. Okay, so we got gut health. Talk more about toxins, I mean infections. And you were talking about the big infection that we had, and it turns out that reactivation of infections that are sitting there, like Epstein-Barr, turns out to be one of the things that’s involved with long COVID.

Dr. Osansky:                       Yeah. I mean again, Epstein-Barr, cytomegalovirus, I mean, as you’ve mentioned, yeah, those-

Dr. Weitz:                            HSP, yeah.

Dr. Osansky:                       Yeah, so all those could potentially be factors. Parvovirus in the literature, hepatitis C, there’s some evidence with hepatitis C, and I believe both Graves’ and Hashimoto’s in the literature. So yeah, I mean, again, a lot of people have… I mean, everybody has viruses, most people have Epstein-Barr. So again, we can’t always make that relationship. And like I said, it’s different with H. pylori because I can’t say I never use antiviral, like natural antiviral agents, but most of the time I’m just looking at the weaknesses in a body, like trying to focus on improving adrenal health and gut health, reducing the toxic load rather than trying to directly attack the virus.

Dr. Weitz:                            So will you, say, order a viral panel?

Dr. Osansky:                       Yeah. I mean, usually I’ll… I mean, I’ll test for Epstein-Barr. It depends on the person too, sometimes they won’t want to test, sometimes they’ll just test Epstein-Barr. But I don’t go crazy with all the viruses, because like I said it doesn’t necessarily change my approach. Like Epstein-Barr I’ll test for, just because it’s notorious when it comes to being a potential factor when it comes to Graves’. But I can’t say like I have everybody test for all the viruses I mentioned, everybody test for Hepatitis-C, and Parvovirus, and all these other viruses.

Dr. Weitz:                            Right, right. Yeah, some of the companies offer like a panel of a number of the most common viruses, like we use Vibrant a lot.

Dr. Osansky:                       Yeah, I’ve used medical… If you’re familiar with Medical Diagnostic Laboratories, they also look at viruses. I’ll use them more if I’m thinking maybe the person also has Lyme, or Bartonella, which also could be potential triggers too. So then I’ll-

Dr. Weitz:                            Right. What’ll tip you off that maybe that’s a factor?

Dr. Osansky:                       Well, I have a history of chronic Lyme. In 2018 I was diagnosed, and it was tricky because I didn’t have the classic Lyme symptoms. Mine was more neurological, there was no evidence of a tick bite. So in my case, I wasn’t sure at first if it was Lyme, but it just was atypical symptoms. Like I was having neurological symptoms that was jumping around in my body, and with Lyme you get the… Usually it’s the pain, like the migrating muscle and joint pain. With me it was more the migrating neurological symptoms, and I spoke with a few practitioners that I knew, and I thought maybe it was MS. They were like, “No, it doesn’t sound like MS.” And then yeah, so I ended up testing for Lyme. I was thinking, “Well, maybe it is Lyme.”

                                                And sure enough I tested, I tested positive for Lyme, Bartonella, a few other things. So with a patient it’s similar, like most people I’m not going to test for Lyme. But if they’re having some unusual symptoms… I mean, if they have like a history of a tick bite… Again, even then I can’t say I always test for Lyme, but that would be a red flag. But if they’re having some type of neurological symptoms, and things that just doesn’t tie into the hyperthyroidism, the Graves’ Disease condition, then I’ll at least bring it up as a possibility, if they’re having… Just because someone has neurological symptoms doesn’t mean they have Lyme or Bartonella, just because someone doesn’t…

                                                If they have even fatigue with migrating muscle and joint pain, I’ll highly suspect Lyme, but it doesn’t guarantee. Today, one of the patients I spoke with, they had… In the middle of the night they woke up with night sweats, but they were drenched in the middle of the night. And she has subclinical hyperthyroidism, so her thyroid hormone levels are normal, TSH is low, which again, most of the people I deal with that’s not the case. So I didn’t think in her, I don’t think it’s the hyperthyroidism causing that. It could be hormonal potentially, she’s in post-menopause. But again, Babesia, if you’re familiar with Babesia parasite, that could also cause that too. So that was like, I was thinking, “Ah.”

                                                You know, I wasn’t pushing it hard and saying, “Yeah, you definitely have Babesia.” But I’ve mentioned it to her that it could be a possibility, it could be hormonal, possibly thyroid, but just because her thyroid looks good… But yeah, so those are some of the things I look for.

Dr. Weitz:                            So in that case, you might do say like a Lyme and co-factors panel?

Dr. Osansky:                       Exactly, it’s something at least I’ll bring up, like when sending her followup recommendations. I mean, I spoke with her about it during the consult, I’ll bring it up with the followup again, and really leave it up to her. She might decide to look more into the hormones, but yeah. So it’s a possibility, is what I left it at with her. So [inaudible 00:48:52]-

Dr. Weitz:                            And how did you treat the Lyme in yourself?

Dr. Osansky:                       With the Lyme, when I dealt with Lyme I did panic a little bit, and I underwent IV ozone. I should backtrack, so first I thought it was acute Lyme, so I did take the doxycycline for a few weeks, which, I regret taking that. But a few weeks prior I was in upstate New York with my dog, and my dog was all over me that night, we were at a park, and I thought I got bit by a tick. Even though there was no evidence of tick bite I was putting the pieces together, because I developed like a low-grade fever right around that time. And I’m like, “Okay, this must be acute Lyme.” And of course I try to avoid the antibiotics, but one thing… Up until that point I was terrified of getting Lyme, and I’m like, “All right, I don’t want to take the doxy, but I don’t want it to turn into chronic Lyme.”

                                                It turned out it was already chronic Lyme, so maybe it was like a reactivation or something of a past Lyme infection that I wasn’t aware of. But when I was diagnosed I worked with a functional medicine practitioner who was a Lyme specialist, and she told me I could take like long-term antibiotics, which I don’t want any part of, and she was talking about the ozone. And prior to my Lyme diagnosis I was doing research on ozone, and I was already sold. I knew it wasn’t a cure for the Lyme, but I was just looking to get aggressive, to try to make sure it didn’t turn into a real bad case of chronic Lyme. So I got IV ozone and UV light for a few months, and I took some homeopathy, I took herbs as well.

                                                If I had to do it all over again… I mean, I can’t say I have regrets because everything turned out okay, but I probably would have been okay just the herbs, the homeopathy. I mean, I was already eating somewhat clean, the stress. I mean, stress is always going to be a factor, but based on my Graves’ experience I thought I was doing a better job of managing the stress and all that. So, that’s why I probably got aggressive with the ozone, because I felt like I was doing a lot of the things based on the Graves’ disease diagnosis, I was still doing things to maintain my health and I was like, just I want to… Yeah, so anyway I wouldn’t say it’s something that everybody should get, but that’s the approach I took.

Dr. Weitz:                            So let’s hit on the toxins a little bit.

Dr. Osansky:                       Sure. So heavy metals, mercury is probably the biggest culprit in the literature. I mean, aluminum is known to stimulate the immune system, but as far as like a relationship between Graves’ and aluminum there’s nothing in the research showing it. But I will say in hair testing though-

Dr. Weitz:                            I just want to make a comment, it was really annoying. I take a lot of supplements, and some of the companies put an aluminum little cap, when you unscrew the cap there’s an aluminum sealing thing. And you have to rip that off, and it’s so annoying handling aluminum. Anyway.

Dr. Osansky:                       Yeah. Yeah, no, I agree, yeah. But I was saying, hair testing, actually that’s one thing that it picks up pretty good. Almost everybody with the hair tests I do, it shows aluminum-

Dr. Weitz:                            Oh really?

Dr. Osansky:                       … which is interesting.

Dr. Weitz:                            Do you use Doctor’s Data, or who do you use for the hair testing?

Dr. Osansky:                       No, I use… I don’t know if you’re familiar with Analytical Research Labs?

Dr. Weitz:                            Okay, I’ve heard of them, I haven’t used them.

Dr. Osansky:                       Yeah, yeah, so they’re like almost everybody shows some levels of aluminum. I mean, not everybody like sky high, but it usually picks it up pretty well. So yeah, there’s mercury, there’s, again, aluminum that stimulates the immune system, cadmium, lead, arsenic. Again, not a lot of literature when it comes to thyroid and autoimmune with the other ones. With mercury there is, so if someone has mercury amalgams, again, I’m not going to push heavily to get them out. But I will bring it up, and talk about biological dentistry, and suggest even if they don’t get it out now something maybe to work on in the future. Like if they have like five silver fillings, even if they get out like one or two a year, before they know it they’ll all be out.

                                                Whereas if they don’t do anything, in a few years they’ll still obviously be present. And then xenoestrogens, so bisphenol A from plastic water bottles, and other endocrine-disruptors. Just even things like… I mean, we don’t tend to… I mean, I’m sure you think of it, just like I think of it. But like the mattress, trying to use more natural mattresses.

Dr. Weitz:                            Absolutely, yeah. They’ve got the flame-retarding chemicals that they [inaudible 00:53:45] mattress and the [inaudible 00:53:45].

Dr. Osansky:                       Yeah, exactly, those flame retardants, and bringing your clothes to the dry cleaner. I don’t do a lot of dry cleaning, but if I do it’s, we use an organic dry cleaner. And then of course in the house, just trying to use natural products like cleaners and fluoride-free… Even though fluoride is more associated with hypothyroidism, disrupting thyroid function, but still using a… So one could make the argument, maybe we should take fluoride if we have hyperthyroidism. So seriously, I do recommend avoiding the fluoride, since it’s also a neurotoxin. Yeah, I mean, glyphosate I mentioned earlier, glyphosate, which disrupts the gut microbiome, which is a factor with all different autoimmune conditions, not just Graves’ Disease. And just, unfortunately we can’t completely avoid glyphosate in this day and age.

Dr. Weitz:                            Well you know, the reason why some people advocate avoiding fluoride for the sake of hyperthyroid is, it blocks the iodine because it’s in that same family. So therefore, even more reason to avoid supplementing with a lot of iodine, if you have hyperthyroidism.

Dr. Osansky:                       Yeah, yeah. Good point, with the halides competing with each other. So yeah, that’s [inaudible 00:55:01].

Dr. Weitz:                            Right, yeah. Consume more bromide on purpose.

Dr. Osansky:                       There you go. But yeah, just again, as you know… So there’s no shortage of environmental chemicals, and there’s so many we’re just not aware of also. So we’ve just got to do our best, and most of the things we can do are in our own home. Once we step outside, there’s not a whole lot we can do.

Dr. Weitz:                            Yeah. Vibrant Labs offers this Total Tox-Burden test through urine, that includes heavy metals, environmental toxins, like 30 different ones, as well as mycotoxins.

Dr. Osansky:                       Oh, interesting, okay. So it includes the mycotoxins too? Yeah.

Dr. Weitz:                            Yeah.

Dr. Osansky:                       Because I know Great Plains out there, Mosaic Diagnostics I think, they changed their name. But they-

Dr. Weitz:                            I think they got bought out, yeah.

Dr. Osansky:                       Oh, did they get bought? Okay, I didn’t know they got bought out. But anyway, so you have to purchase… I think you could get them as a bundle, but they have the separate mycotoxins test. But also it’s interesting, which I’m sure you know, they also now… They have Cyrex Labs, that does like immune system testing for environmental chemicals, to see your immune system response [inaudible 00:56:15].

Dr. Weitz:                            Sure. Yes, yeah, yeah, yeah. You can do immune system reaction to foods, to chemicals, to toxins, to infections, yeah.

Dr. Osansky:                       Yep, yeah. So there’s a lot more options these days than there was 10, 15, 20 years ago.

Dr. Weitz:                            Yeah. In testing, tests don’t guess. So, yeah. I think we’ve covered the topic pretty well. There’s any final thoughts you have for our listeners and viewers?

Dr. Osansky:                       Well, I would just say for those listening who have hyperthyroidism, I mean, the big thing initially is to be safe. You want to make sure, whether it’s the natural agents, or if you absolutely have to take the medication, just do what’s necessary to make sure those thyroid hormone levels are lower. So, you don’t have a resting heart rate of like 120 or 140. And it also affects bone density, we’ve got to keep that in mind when the thyroid hormone levels are too high. And then while you’re addressing the cause, whether it’s doing it naturally or even if you have to rely on a medication, obviously you want to do things to find and remove those triggers, correct those underlying imbalances. Because again, [inaudible 00:57:32] and thyroid surgery, I’m not saying there’s not a time and place for surgery. But, it’s not doing anything for that immune component of Graves’.

Dr. Weitz:                            You know, we should cover one more thing real quickly. We didn’t really talk about diet for hyperthyroid, and I know that that’s something that you take seriously.

Dr. Osansky:                       Yeah, no, that’s right, we didn’t cover… I spoke about food when we talked about triggers, but I just spoke about gluten and common food allergens, but you’re right. So yeah, diet when it comes to really any autoimmune condition, yeah, there’s no single diet that fits everybody perfectly, and I think you probably would agree with that, Dr. Ben. But yeah, I mean, I will say I do like paleo, I do like autoimmune paleo, but they’re starting points, they’re not… And we don’t want anybody to get really stressed out, so if I talk about autoimmune protocol, because it is quite restrictive. And the goal is not to reduce calories, that’s the last thing we want to do with someone, especially someone who is in a similar situation that I was when I was losing a lot of weight.

                                                We don’t want someone to think that they can’t eat, they can hardly eat any food. So if they’re following AIP, assuming they’re not vegan/vegetarian, if they are that’s a whole different story. But yeah, definitely make sure you’re getting enough protein, eat a decent amount of meat if… And also I recommend vegetables, fruits. But some people do fine on paleo, where they’re eating eggs, they’re eating some nuts. Of course avoiding refined foods, sugars, the allergens that I mentioned like gluten, dairy, corn, avoiding nightshades, also something that not only I recommend but a lot of people when it comes to autoimmune. But yeah, I do recommend more of a paleo, AIP-type diet. If someone is vegan/vegetarian I’m not completely opposed to them modifying that, where they’re eating some pressure-cooked legumes to make sure they’re getting enough protein. Because a big problem with hyperthyroidism, you’re losing a lot of muscle mass too. So, you just want to make sure you’re getting enough protein.

Dr. Weitz:                            There’s certain foods, like cruciferous vegetables, that are considered [inaudible 00:59:53], that they block thyroid hormone. Is that a good idea in the case of hyperthyroid, to consume a lot of [inaudible 01:00:05] foods, like broccoli?

Dr. Osansky:                       Yeah, I’ve actually spoken about this, I think I mentioned in the book too. But on my website and in the podcast, I think I mentioned it in an episode. I tried intentionally to… Especially with pregnant women in the past, when working with pregnant women, and ones who didn’t want to take the medication, and they can’t take things like bugleweed.

Dr. Weitz:                            Herbs, yeah.

Dr. Osansky:                       And yeah, so and then even L-carnitine, there’s no research taking like two to four grams, like that high of a dose, I’m more conservative with a pregnancy about doing things like that. So I actually experimented, I figured there’s no harm in having them eat a lot of cruciferous vegetables to see if that will lower thyroid hormones. And honestly, it didn’t have much of an effect. So I would say, go for it if that’s what you want to do, but I wouldn’t expect that alone to have a significant impact on the thyroid hormone levels.

Dr. Weitz:                            Right. Actually, there is some interesting data on the benefits of L-carnitine for pregnancy, and I know Metagenics now includes a separate L-carnitine supplement as part of their prenatal.

Dr. Osansky:                       I guess the high dose is what I was referring to, like I don’t know, probably 500 to 1,000 milligrams, yeah.

Dr. Weitz:                            Yeah, yeah, yeah. I think they’re recommending like five [inaudible 01:01:22] yeah, yeah.

Dr. Osansky:                       Yeah. But like 2,000, I mean, honestly it probably would be okay if they took like 2,000. I just don’t know, that’s the-

Dr. Weitz:                            Yeah, I don’t want to take a chance with pregnancy. Okay, great, excellent. So you have two books out, right?

Dr. Osansky:                       Correct, so Natural Treatment Solutions for Hyperthyroidism and Graves’. As you said, I’m currently as of recording this getting ready to release the third edition. And then Hashimoto’s-

Dr. Weitz:                            When is that going to be released?

Dr. Osansky:                       I’m hoping by September, September 2023.

Dr. Weitz:                            Oh, okay. Are you self-publishing?

Dr. Osansky:                       Yes, yes, mm-hmm.

Dr. Weitz:                            Okay, great. And where will that be? Will that be available through Barnes & Noble and all the booksellers, or where?

Dr. Osansky:                       Yeah, that will be… You could go online to Amazon Online, Barnes & Noble. So yes, they could… Yep.

Dr. Weitz:                            Good. And then you have another book on hypothyroid, right?

Dr. Osansky:                       Correct. So in 2018 I released the book Hashimoto’s Triggers, which you could also… Actually, I don’t know if that’s on Barnes & Noble’s. I know that one’s, Hyperthyroid, but I think this one I just… Again, I self-published this as well, but this also is… I think this one is just on Amazon, both print book and Kindle.

Dr. Weitz:                            Okay, great. And how can listeners and viewers get a hold of you if they want to find out more, or possibly work with you?

Dr. Osansky:                       Well they could visit savemythyroid.com, and they could click on Work With Dr. Eric is probably the best way if they want to work with me. Or if they’re still not sure, they could click on Podcast, listen to some of my podcasts, and read my books. But yeah, I would say that would be the action they would want to take if they do want to work with me.

Dr. Weitz:                            Excellent. Thank you so much, Dr. Osansky.

Dr. Osansky:                       Thanks, Dr. Weitz. Appreciate your time, and thank you so much 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 enjoyed listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. That way, more people will discover the Rational Wellness Podcast. And I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way.  And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So, if you’re interested please call my Santa Monica Weitz Sports Chiropractic and Nutrition Office at 310 395 3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

 

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Reversing Alzheimer’s Disease with Dr. Dale Bredesen: Rational Wellness Podcast 320

Dr. Dale Bredesen discusses Reversing Alzheimer’s Disease at the Functional Medicine Discussion Group meeting on July 27, 2023 with moderator 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

5:35  Alzheimer’s disease is now optional, because Dr. Bredesen’s precision medicine approach can help to prevent and reverse Alzheimer’s and it is hoped that this approach can be extended to all of the major neurodegenerative diseases.  Dr. Bredesen and his group have published over 220 peer-reviewed papers on the underlying mechanisms of neurodegeneration.  On the conventional treatment front, so many amyloid antibody drugs have failed including bapineuzumab, solanezumab, gantenerumab, and crenezumab.  The newest drugs include aducanumab, which has a minimal effect, and lecanemab (aka, Leqembi), which does have a measurable effect.  But these new drugs do not make anyone better, but instead they lead to a slowing of the progression and they often have some negative side effects like brain bleeding and brain swelling and several patients have died. 

7:40  Homotaurine. This is currently a nutritional supplement that is currently in clinical trials. It prevents the oligomerization of A-beta, so it looks like it may be a very interesting adjunct to other parts of the Bredesen protocol.  The dosage used was either 100 mg three times per day or 150 mg twice per day. [Manzano S, Agüera L, Aguilar M, Olazarán J. A Review on Tramiprosate (Homotaurine) in Alzheimer’s Disease and Other Neurocognitive Disorders. Front Neurol. 2020 Jul 7;11:614.]   Combined metabolic activators (CMA) shows benefit in improving cognition in patients with Alzheimer’s disease. CMA dosage includes:  12.35 g L-serine (61.75%), 1 g nicotinamide riboside (5%), 2.55 g N-acetyl-L-cysteine (12.75%), and 3.73 g L-carnitine tartrate (18.65%). AD patients received one dose of CMA or placebo daily during the first 28 days and twice daily between day 28 and day 84. [Yulug B, Altay O, Li X, et al. Combined metabolic activators improve cognitive functions in Alzheimer’s disease patients: a randomised, double-blinded, placebo-controlled phase-II trial. Transl Neurodegener. 2023 Jan 26;12(1):4. ]

8:39  Dr. Bredesen is starting a randomized controlled trial of his ReCode system with six absolutely fantastic clinicians: Craig Tanio down in Hollywood, Florida, Nate Bergman in Cleveland, David Haase in Nashville, Kristine Burke in Sacramento, Kat Toups in the East Bay, and Ann Hathaway in Marin County. 

9:25  KetoFlex.  Dr. Bredesen’s recommended dietary approach for Alzheimer’s disease, the KetoFlex and he worked with Nutrition for Longevity, a group founded by Dr. Valter Longo, to develop KetoFlex meals for home delivery, which is now available.

11:30  New lab tests for help with analyzing Alzheimer’s disease1. p-tau 181, 2. p-tau 217 is coming soon, 3. Abeta 42:40, 4. Neurofilament light, and 5. GFAP (glial fibrillary acidic protein), which will be available soon. P-tau 181 lets you know that you have the specific signaling characteristic of Alzheimer’s. The Abeta 42:40 test lets you know whether you are making Amyloid beta protein, which is typically associated with inflammation and with Alzheimer’s. Neurofilament light is not specific for Alzheimer’s, but it tells you that you do have neuronal damage.  This also goes up in frontotemporal dementia and ALS and certain other neurodegenerative conditions.  GFAP lets you know that you have reactive astrocytes in the brain, which can precede Alzheimer’s disease. 

16:00  When you compare the state of the treatments for Alzheimer’s disease, with no treatment the patient’s MOCA score will decline by about three and a half points and if you take the Lecanemab, which is the newest drug given FDA approval that costs about $40,000 per year, of which the person on average will end up paying $10,000 per year after Medicare, and it will slow the decline by 27% in men or 12% in women. Only Dr. Bredesen’s ReCode precision medicine approach will result in a gain of about 4/30 points in cognition.  

 

18:27  The standard of care for patients with cognitive impairment is inadequate.  If you go to a memory center of excellence, they will likely tell you that they are only going to treat you if it gets pretty significant.  There’s no attempt to identify the cause of the problem and they adhere to this outdated claim that nothing can prevent or reverse Alzheimer’s.  If you’ve got someone in a nursing home with Alzheimer’s, they don’t tell all the children that they should be on active prevention. The average patient spends an average of $350,000 before they die, with most of that on nursing homes.  The only treatment offered is mono pharmaceuticals.  Such a treatment approach is out of date.  Telling a patient that they only have mild cognitive impairment is analogous to telling them that they only have mildly metastatic cancer.  Unfortunately, once a patient has mild cognitive impairment, it is a relatively late stage of the underlying pathophysiology. 

There are four stages of Alzheimer’s:

1. Asymptomatic.  Stage one is when you are asymptomatic but you can see abnormalities on spinal fluid, PET scans, and on those blood tests that were mentioned, like p-tau 181. 

2.  Subjective Cognitive Impairment.  If you don’t do anything about it and continue to go downhill, you start to develop subjective cognitive impairment (SCI), which is stage two, when you have some changes in cognitive function, though you may still score in the normal range on a cognitive questionaire. 

3. Mild Cognitive Impairment. Stage three is mild cognitive impairment (MCI) and now your cognitive testing is abnormal, though you can still perform you activities of daily living.  Even though this is called mild, it is actually a relatively late stage of the disease.

4. Alzheimer’s disease. Each year 5-10% of those with MCI go on to stage four, or Alzheimer’s, which is the stage of dementia.  The diagnosis of Alzheimer’s is typically made 20 years after the initial biochemical changes occur. 

 

21:35  When you look at scans of the brains of patients with Alzheimer’s, you can see significant differences. The brain shrinks and the sulci widen and you can see differences in the ventricles.  The first area of the brain that shows damage in Alzheimer’s patients is the locus coeruleus in the brain stem, which literally means the blue spot.  Damage to this area results in people losing their way, losing their verve, losing their interaction. 

22:39  Amyloid protein and phosphorylated tau.  If you look at the brain under a microscope you can see collections of amyloid protein and you can see neurofibrillary tangles from phosphorylated tau.  There is inflammation in the brain, so you can see reactive microglia and reactive astroglia.  This is part of the model to explain Alzheimer’s, but none of this led to any approach that resulted in effective treatment.  When you simply remove the amyloid, you don’t get much of an effect in clinical trials.

23:25  There are actually a large number of risk factors for Alzheimer’s, including low vitamin D, type II diabetes, metabolic syndrome, menopause, chronic infections like herpes, and genetic risk factors like ApoE4.

25:20  Prionic nature of amyloid and tau.  Dr. Stanley Prusiner won the Nobel Prize in 1997 for his discovery of prions and Dr. Bredesen trained with him as a post-doc.  When amyloid and tau proteins get into the brain, they tend to accumulate and beget more of themselves much like prionic proteins. 

27:30  When you have infections, inflammation, and toxin exposures in your brain, your brain goes into a downsizing, protective mode and amyloid protein proliferates as a protective antimicrobial peptide, as Professors Robert Moir and Rudy Tanzi from Harvard published several years ago: Moir RD, Lathe R, Tanzi RE. The antimicrobial protection hypothesis of Alzheimer’s disease. Alzheimers Dement. 2018 Dec;14(12):1602-1614.   

29:57  Alzheimer’s disease is a chronic disease marked by a signaling imbalance much like osteoporosis. In osteoporosis, you have an imbalance between osteoclastic activity, which is greater than osteoblastic activity. In Alzheimer’s you have synaptoclastic signaling outweighing your synaptoblastic signaling.

 



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

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.

 



 

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 everybody, welcome to the Functional Medicine Discussion Group meeting tonight with Dr. Dale Bredesen on how to prevent and reverse Alzheimer’s disease. I’m Dr. Ben Weitz. I want this meeting to be interactive, so please participate by typing your questions into the chat box, and then I’ll either call on you or ask Dr. Bredesen your question when it’s appropriate. Thanks for joining our Functional Medicine Discussion Group monthly meeting, and I hope you consider attending some of our future events on August 24th.

                                                Dr. Tom Fabian of Diagnostic Solutions will be talking about the link between dysbiosis, mast cell activation and IBS. And on September 28th, Dr. Peter Bongiorno will be discussing an integrative approach to depression and anxiety. We also have a closed Facebook page for practitioners only, the Functional Medicine Discussion Group of Santa Monica that you should join. I’m recording this event. I’ll include it in my weekly Rational Wellness podcast, which you can subscribe to on Apple Podcast, Spotify, or YouTube. If you enjoy listening to it, please give me a five star ratings and review on Apple or Spotify. Our sponsor for this evening is Integrative Therapeutics. Steve, are you on the call?

                                                Steve said he wasn’t sure if he was going to be able to make it, but I want to tell you about a couple of Integrative products. Steve wanted me to emphasize, Integrative makes a highly absorbable form of curcumin called Theracurmin. And there was a study published in 2021 done at UCLA in which Theracurmin improved memory and mood in patients with age associated memory decline. And there’s a current study that showed that Theracurmin stabilized progression in loss of cognitive function. And so Theracurmin is a water-soluble form of Theracurmin, and the effective dose is only two capsules. It’s a highly effective product for reducing inflammation.

                                                Our speaker for this evening needs no introduction, but I am going to try to introduce him anyway, Dr. Dale Bredesen. Dr. Dale Bredesen is a neurologist and an internationally recognized expert in the mechanisms of neurodegenerative diseases like Alzheimer’s disease, and he’s the Chief Science Officer at Apollo Health. He’s the author of three bestselling books, The End of Alzheimer’s, The End of Alzheimer’s Program, and The First Survivors of Alzheimer’s. Dr. Dale Bredesen’s career has been guided by a simple idea that Alzheimer’s as we know it is not just preventable, but reversible. Thanks to a dedicated pursuit of finding the science that makes this a reality, the idea has placed Dr. Bredesen at the vanguard of neurological research and led to the discoveries that today underlie the ReCODE Report.  Dr. Bredesen offers training for doctors and practitioners in his ReCODE system at his website at Apollo Health.

I’d like to say one more thing, Dr. Bredesen before you get started. On behalf of the functional medicine community, if I may be so bold, I would like to thank you. There are many giants in the functional medicine community, including the father of functional medicine, Dr. Bland, Dr. Pizzorno, Dr. David Jones, Dr. David Perlmutter. So many others have mapped out many of the scientific bases of functional medicine. Dr. Mark Hyman has brought functional medicine into the Cleveland Clinic.  But really you, Dr. Bredesen, have really published some of the most important academic research and academic journals proving for the first time that a functional medicine approach is an effective first-line treatment for such a serious condition as Alzheimer’s disease. And this is really a landmark accomplishment. So from the functional medicine community, I thank you.

Dr. Bredesen:                    Thanks so much, Ben. Thanks very much everybody for having me. Please forgive me if I’m a little bit slow tonight. I’ve just had surgery and I’ve got a surgical drain in currently, so I’m a little bit out of it at the moment, but hopefully we’ll get through everything. But I think this is great timing. I’ll show you why. Let me just share the screen here. There’s just so much amazing stuff going on, and so I’m really thrilled. There’s just so many good things. So you can see this, okay, hopefully.

Dr. Weitz:                          Yes.

Dr. Bredesen:                    We’ve really gotten to the point that Alzheimer’s is now optional, and I’ll show you why. And what’s exciting is we hope now that we’re going to be able to extend this to all of the major neurodegenerative diseases and that these will really be, they’re going to literally we’re in a period in which we will see these transform from impossible to treat terminal life sentences, terminal illnesses, which they’ve always been. Lewy body disease, frontotemporal dementia, ALS, Alzheimer’s. These are all terminal illnesses. We’re seeing them right before our eyes transform into illnesses that are preventable and reversible. So let me show you why we believe that. We spent 30 years in the lab. We published over 220 peer-reviewed papers on the underlying mechanisms of neurodegeneration. And then back in 2011, 2012, we started to translate these into ways that you can actually make people better.

                                                And as you mentioned, we are seeing this again and again. So lots new going on. Let’s talk about that first. A lot of people have heard about lecanemab now called Leqembi as the trade name, and now donanemab, another one coming down. So what’s happened is after all of these different antibodies failed, bapineuzumab, solanezumab, gantenerumab, crenezumab, all failed, aducanumab had a minimal effect, and now lecanemab has a measurable effect. But as I’ll show you, what it does is it doesn’t make you better, it doesn’t stabilize you, but people with Alzheimer’s early on, people with MCI that what it’ll do is it is a 27% slowing, and actually if it’s a female patient it’s only 12% slowing.  So it’s a very minimal effect and unfortunately has some negative side effects like brain bleeding and brain swelling, and in a couple cases death. But there’s been so much PR around this without recognizing the fact that there are lots of things that are actually better. Homotaurine, I don’t know if anybody uses this, but it’s been very interesting. It prevents and is currently in clinical trials. It prevents the oligomerization of Abeta. So it actually looks like it may be a very interesting adjunct to other parts of the protocol. And then-

Dr. Weitz:                          Doc, is that a nutrient or is that a pharmaceutical?

Dr. Bredesen:                    Actually, it’s a supplement. So you can get Homotaurine as a supplement. Now they’re trying to do a precursor of this that will probably be sold as a drug. It’s in phase two trials right now. If this all works out, they will probably try to turn it into a drug. We’ll see. But you can use Homotaurine right now as a supplement. And they were using either 100 milligrams three times a day or 150 twice a day. Then you may have seen the paper on combined metabolic activators. Very interesting. And as you’ll see, it makes perfect sense based on the research that we published. And then we are just starting a randomized controlled trial. You can look at our proof of concept trial, which is freely available online. We published last year in the Journal of Alzheimer’s Disease. Very successful, 84% of the people actually got better.

                                                The randomized controlled trial, very excited about that. It’s with six absolutely fantastic clinicians. Craig Tanio down in Hollywood, Florida. Nate Bergman in Cleveland, David Haase in Nashville, Kristine Burke out here in Sacramento. Kat Toups, who’s over in the East Bay, and then Ann Hathaway, who’s right near here in Marin County. So very, very honored to be working with this absolutely great group of physicians. And then one of the big complaints we’ve had is, hey, it’s not that easy to get the right food, to get the right organics, to get the right plant rich ketogenic diet, make sure it has the right sourcing and so forth and so on.

So we worked with KetoFLEX, with a group from Nutrition for Longevity. This is Jennifer Maynard and her group.  This was a group founded actually by Valter Longo. It’s been months and months and months. And finally they’ve actually got this, it’s now ready for delivery. I’ve had it myself. It’s actually quite delicious. So they did a great job. So they have a KetoFLEX, 12/3 that’s available for delivery. And this is in the 48 states, so you can’t yet get it yet in Hawaii or Alaska, but you can get it everywhere else in the country.

And then you may have seen an interesting paper from a few months ago. This is the work of Professor Rick Johnson in Colorado. And David Perlmutter and I were co-authors as well as several other people. And what he showed was quite interesting, and he’s been working on fructose mechanisms for years. And what he found is that fructose, because it’s associated with massive amounts of fruit intake in the fall, it actually is getting you ready for winter. So what it does is it turns down your energetics, turns down your ATP.

                                                And as I’ll show you, the two big players in cognitive decline are energetics and the innate immune system, essentially inflammatory pathways. And so that’s the last thing you want to do, is turn this down, it makes things worse. And he has a very interesting point where he just listed all the different characteristics of Alzheimer’s and all the different characteristics of what happens to your biochemistry, your cellular biochemistry and mitochondrial biochemistry when you have large amounts of fructose, and they line up remarkably well. I think he’s onto something important. I don’t think it’s by any stretch the only cause of Alzheimer’s, but I think it’s a relatively common contributor.

                                               And then interestingly as you may have seen, there is a whole new set of blood tests. People in the past have had to do spinal taps or PET scans to determine where you stand with your Alzheimer’s disease and do you really have it or not?   Now you can do blood tests. P-Tau 181 is already available. I believe it’s now available from LabCorp. P-Tau 217 is not yet available, but it’s coming soon. Both of them very helpful. What they’re really telling you is that you have the type of signaling that is associated with Alzheimer’s disease, so you don’t have to do the spinal taps, you don’t have to do the expensive PET scans. Abeta 42 to 40 ratio also helpful, and that’s available from a couple different groups. And then interestingly, Neurofilament light, also online is available. And then GFAP, not yet available, but is coming. Now, they each tell you something different. So the pTau is telling you that you have the associated signaling of Alzheimer’s. It’s relatively specific. Same thing for 217.  Abeta 42 to 40 is telling you whether you have a condition where you are making Abeta, which is typically associated with inflammation and Alzheimer’s. Neurofilament light, not specific for Alzheimer’s, but it is telling you you actually have neuronal damage from whatever. It goes up in frontotemporal dementia, it goes up in ALS, things like that. And then GFAP again is complimentary, is different. It’s not as specific at all. It’s just telling you you have reactive astrocytes, but it’s very sensitive. So you see changes first in GFAP. So my feeling is anyone who’s 40 or over should find out their GFAP, and it’s going to be available presumably within the next few months, because you can get an idea, am I heading toward anything? The future is going to be, none of us is going to wait to have dementia.

                                                Frankly, it’s just so silly the way medicine is currently practiced where people wait and wait and wait and wait and wait, and then finally say, oh yeah, you got dementia. There’s nothing we can do. You can see this coming years and years ahead of time. And we’ll talk about the four major stages. And then it’s interesting you mentioned Santa Monica, Ben. We are just going to open later this year, the first precision medicine program for neurodegenerative disease in the world. So we’ll allow people to send people from all over the world who have various neurodegenerative diseases, be they Alzheimer’s, frontotemporal dementia, ALS, Lewy body, what have you, and have real hope.      And this is going to be at the Pacific Neuroscience Institute, PNI, within one of its centers called the Pacific Brain Health Center. So very enthusiastic about that. And I’ve been working with-

Dr. Weitz:                          Is that affiliated with Providence Hospital?

Dr. Bredesen:                    Yes, yes. Will be affiliated with Providence. Yes. And you probably know Dan Kelly, who’s the neurosurgeon who runs PNI and David Merrill, actually one of the guys who took our training early on has been doing a great job and founded the PVHC. And so I’ll be working with David and his team and we’ll be now adding new features there. So very enthusiastic about that.

Dr. Weitz:                          That’s great.

Dr. Bredesen:                    So as I said earlier, we are literally witnessing the transformation of neurodegenerative diseases. For my whole career and for my whole time in the lab, there’s nothing you could do about these things. And we’re seeing them go from hopeless to preventable, reversible, and ultimately optional. We’re far ahead on Alzheimer’s. We’ve got some good results with Lewy body. We’re beginning to see some good results with dry macular degeneration. But I hope that we’re going to now see the same sorts of things with ALS, with frontotemporal dementia. We’ve got an interesting case, for example, with Dr. Craig Tanio down in Florida, and he’s had some wonderful results with a person recently who has corticobasal degeneration, which is a death sentence.  This person had already been told, get your affairs in order. There’s absolutely nothing to do. And Craig has had wonderful results. Similarly, posterior cortical atrophy, which is one of the presentations of Alzheimer’s, which Kerry Mills Rutland, you may know from New York, has a patient with PCA, just beautiful results, doing very, very well. It’s so wonderful to see these things which were simply never possible before.

So as I mentioned earlier, it’s important to compare what actually happens with these drugs and the one that’s just been given FDA approval and the reason that for all of us who are paying Medicare, we’re all going to be paying more because this is a multi-billion dollar drug, it will cost the patient about $40,000 a year. Medicare will be picking up 80% of that. The person will still end up paying close to $10,000 a year.   So here’s lecanemab. What it does is if you have no treatment and you have MCI or Alzheimer’s, you go downhill about three and a half points on a 30 point scale per year. Lecanemab slows that up by 27%. As I said, if you’re a woman, it’s 12%. In our trial that we’ve published, you can see here, we actually made people get better, didn’t simply slow their decline. So huge difference.

Dr. Weitz:                          Essentially Dale, what they’re saying with that drug is that your mother is going to spend a longer period of time in the memory care center. The goal is to get her out of it and not spend more time there.

Dr. Bredesen:                    It’s really impressive to me. The PR for this, it just keeps saying, well, there’s nothing else you can do. Well, there’s published results that say the opposite of that, but they just literally just ignore published results. So it’s interesting to me, this has really been many, many, many millions of dollars paying consultants to write good things about this drug, which is really not such a great drug. I think as we’re all aware, we are seeing the kind of medicine that I learned many, many years ago back in the 70s and 80s, literally the Titanic of mainstream medicine is going down right in front of us, sunk by the iceberg of chronic illnesses. You talk about Alzheimer’s or vascular disease or ALS, you just go right down the list.   And we saw this with our own daughter years ago who developed early lupus, and we took her to two world experts on lupus who said, yeah, she’s got early lupus, nothing you can do. When she gets worse we’ll give her some steroids. And we said, well, why did she get this? And they said, we don’t know. Nobody knows. So we then took her to a functional medicine physician who said, yeah, I know exactly why she got this and I can do something about it. And she’s had virtually no problems in the last 10 years. And it really shows that the new era is about why did you get these problems?

                                               But as you know today if you go to a standard of care doctor, you go to a memory center of excellence, what they tell you is it is probably not Alzheimer’s. We’re only going to treat you if it gets pretty significant.  They get small data sets. There’s no attempt to identify what’s actually driving the problem. They adhere to this outdated claim that there’s nothing will prevent or reverse or delay Alzheimer’s. If you’ve got someone in a nursing home, they don’t tell all the children, hey, wait a minute, all of you should be on active prevention. Why are they not doing that? And the statistics show that the patients spend an average of $350,000 before they die. Most of it on nursing homes of course. And of course this insistence on treating with mono pharmaceuticals, this stuff is really, really out of date unfortunately. One of the big problems is people say, you only have mild cognitive impairment. This is a analogous to telling someone, don’t worry, you’ve only got mildly metastatic cancer. This is a relatively late stage of the underlying pathophysiology.

                                                So you go through four stages when you get Alzheimer’s disease. Phase one, you’re asymptomatic but you can already see abnormalities on spinal fluid and PET scans. And the good news, you can now see the abnormalities on those blood tests that I just mentioned. So just as everybody, we all want to know our blood pressure, our HRV, our lipid panel, we should also want to know our Alzheimer’s panel. Really good idea. If you don’t find that out and you continue downhill, you start to develop some, what’s called SCI, subjective cognitive impairment. And by definition, this means that you’ve got some changes where you notice there’s something that’s not quite right. Often your spouse and coworkers may notice that something’s not quite right, but you’re still capable of scoring in the normal range.

                                                The good news, SCI lasts about 10 years on average, and it’s 100% reversible. We see these people reverse all the time. So if we could get everybody to come in for active prevention, I.e phase one, or even before phase one or phase two with SCI, there would be virtually no dementia. Now if you don’t do something about this, this you then progress to mild cognitive impairment, which as you can see is a relatively late stage of the disease. So it’s too bad they called it mild cognitive impairment. By definition now your cognitive testing is abnormal, but you can still perform your ADLs. Five to 10% of those people convert each year to stage four, with phase four, which is Alzheimer’s. And by definition, that’s really the dementia phase of Alzheimer’s. It’s all Alzheimer’s, but this is the dementia phase.  And so that means your activities of daily living are affected. And so what that means is the diagnosis of Alzheimer related dementia is typically made about 20 years after the beginning, biochemical changes. And that’s well documented. So we can do so much better if people simply won’t wait.

                                                And I don’t know how many people have looked at the brains of Alzheimer’s patients, but you can see striking differences. One thing you can see, for example, here are your SCI here, and you can see here that they widen. You can see right here versus here. And then interestingly, of course the brain shrinks. You can see the huge difference in the ventricles here, here versus here.  And then interestingly, the very first area that is damaged even before the entorhinal cortex, which is often said to be the first area, happens to be this locus coeruleus, which is in the brainstem right here, which literally means the blue spot. And this is the site where there is noradrenergic projection to your cortex. And so no surprise, one of the things you see early on is people lose their way, they lose their verve, they lose their interaction. And one of the things we hear commonly when people are starting to get better, is that their spouse will say, wow, they’re just more engaged. They’re really more with it.

                                                And then of course, if you look under the microscope, we’ve all heard about amyloids. You can see here collections of amyloid. This is largely from a peptide called amyloid beta. We’ll talk about that in just a second. You can see here these neurofibrillary tangles, and this is where you find the phosphorylated tau. So these are two different pieces here, the amyloid and the tau, and then of course there’s inflammation. So you see reactive microglia, and you also see reactive astroglia as well. So these are all part of this. So if we want to ask, well, what is this thing? And this is basically what we spent all these years in the lab looking at, because all these models that had been generated, none of them led to any approach that actually gave you good treatment. So we have to explain a lot of things to explain this disease.

                                                We have to explain why it is hugely different risk factors, whether it’s a change in your oral microbiome with P. gingivalis or type 2 diabetes or metabolic syndrome or menopause, low vitamin D, herpes simplex, mycoplasma, APOE4, which is the common genetic risk, down syndrome, just on and on and on. These risk factors are so different. So whatever we come up with has to explain those. There are about 100 risk associated genes, as I mentioned, APOE4 being the common one, but there are many, many. Why is that? What does that mean? The fact that amyloid is in the brains, it’s been implicated repeatedly, and yet when you remove it, you don’t get much of an effect in clinical trials. Why is that? The age associated risk, this dramatic increase as you get over 65.

                                                And by the way, we’re seeing a lot of people in their 40s and 50s now get diagnosed with Alzheimer’s. When I was training, we never saw people in their 40s or 50s with Alzheimer’s. And in fact, the epidemiologists have pointed out that this is what’s been on the rise more than anything else in Alzheimer’s. It’s the 40 somethings and the 50 somethings that are really increasing. And then there’s a very interesting mouse that has in its genome the instructions for a monoclonal two nerve growth factor. So what it does is it reduces the nerve growth factor, not to zero, but it reduces it. And interestingly that mouse develops Alzheimer’s pathophysiology. Why? Again, we got to explain that. And then all these aggregated proteins, so many people just say, Alzheimer’s, all it is aggregated proteins. Well, there are lots of aggregated proteins in the disease, but it doesn’t tell you what the disease is.

                                                And then of course, the remarkable failure, greater than 400 clinical trials, the prionic nature of Abeta and tau. So I trained as a postdoc with Stanley Prusiner, who won the Nobel Prize in 1997 for his discovery of prions. And it turns out that Abeta and tau both have this phenomenon where they are proteins that beget more of themselves. And then the high incidence and prevalence, about 15% of the population will die of Alzheimer’s. We’ve had over a million people now die of COVID-19 in the United States. But if you look at the in country as a whole of the currently living Americans, about 45 million of us will die of Alzheimer’s if we don’t have a better treatment and prevention. So this is a huge area.

Dr. Weitz:                          Hey doc, could you just clarify what you mean by the prionic nature of amyloid and tau?

Dr. Bredesen:                    Yes, absolutely. So what this means is if you put these into a brain, they will beget more of themselves. So they act like infectious particles, even though they have no DNA or RNA. That was the big finding that won Stan the Nobel Prize. He pointed out that these are infectious agents. In this case it was a prion protein, PrP, which he discovered, cloned, characterized, et cetera. And he showed that this begets more of itself. So if you put this into a brain that has PrPC, the normal isoform, you will get this abnormal isoform. And the same thing happens with Abeta and tau. You put enough of it in a brain, it will beget more of itself. Now the good news is if you don’t have too much, you can actually damp it down and you will then lose. You won’t go on to have this prionic effect.  So that’s one of the things we want to do. We want to remove all the things that are driving it, and then we also want to remove the prions themselves. So the point here is that any model that you come up with has to be predictive. It has to say, okay, this clinical trial’s going to work and that clinical trial is not going to work, and it has to be consistent. These other models that just say, well, this works for this group, but it doesn’t work for that group, that really doesn’t help us.

                                          Okay, so what we want to look at is under the hood, let’s look at what actually happens here. This is amyloid precursor protein. This is just now a diagram here of a single cell. So we’re looking at one neuron and we’re looking at the membrane here.  This is a protein that’s in neurons and other cells, but mostly neurons and mostly at the synapses. And this is the parent of the amyloid that you’re going to make. Now, what happens is really interesting. This stuff acts like a switch. This molecule sits, and you can see most of it is outside the cell, a little bit of it is inside the cell. It’s literally crossing the membrane. Now, when things are good, this thing literally recognizes that and is cut at a single site to give you two peptides, sAPP alpha and alpha CTF, and these things tell your nervous system things are good, grow, maintain, make new synapses, et cetera. Very much like what happens in our country, when things are good, the stock market is good, people are paying their taxes, et cetera. Then you build new bridges, you build new interactions with other countries, et cetera.

                                                On the other hand, when things are bad, for example, with the pandemic, we were told, hey, we’ve got an insult. In that case, SARS-CoV-2, we’re going to pull back and put our resources into protection. People aren’t going to go to work, they’re going to stay home, they’re going to socially distance, et cetera. And of course what happens, we go into a recession. And that’s the same thing that happens in your brain when you’ve got infections, inflammation, toxin exposure, all these sorts of things, your brain changes into this very interesting downsizing protective mode. So this amyloid, here it is right here. The amyloid peptide, which has been vilified in Alzheimer’s, is really a protective antimicrobial peptide. And Professor Robert Moir and Rudy Tanzi from Harvard published this several years ago, showing that this is actually a protective antimicrobial peptide.   It’s very different. This thing will literally switch from one mode to the other, and that this is the one on this side that’s associated with Alzheimer’s. And so now we understand what this is all about. This is not just trying to give you Alzheimer’s, it’s trying to protect you from these various insults. Okay.

                                                 So what that means is just as for these other illnesses, osteoporosis, right? We all know you have an imbalance between your osteoclastic activity, which is greater than your osteoblastic activity. Similarly for cancer, your sideroblastic cell signaling exceeds your cytoclastic cell signaling, so you make more cells. And we call that cancer. Well, what we found in the lab is that Alzheimer’s is no different. There’s a whole set of signals that are synaptoblastic that are going on that side of the APP that I mentioned.  There’s a whole set of things that are synaptoclastic, and Alzheimer’s is nothing more than you’ve gone to the synaptoclastic side. So what that means is it’s a network insufficiency. It’s your synaptoclastic signaling outweighing your synaptoblastic signaling. And the good news is it’s really about four major things, inflammation, toxins, energetics and trophic activity, and really the vast majority, and this is the take home lesson which will help you treat every patient with cognitive decline or risk for decline. Alzheimer’s is pretty much boiled down to just two things. The innate immune system, so ongoing inflammation and energetics. And so normally you’ve got low inflammation and plenty of energetics, good blood flow, good oxygenation, good mitochondrial function, ketone your metabolic flexibility, you can burn glucose, burn ketones all good.

                                                But of course what happens with patients over time is they started getting some inflammation from many different sites and they start going down on the energetics. They may have poor blood flow, they may have sleep apnea, they may have poor mitochondrial function, any of these things. And so now they’ve switched into this mode of downsizing. So it’s really important with all these people to look at what’s the energetic status? What is the inflammatory status? Bring the energetics up, bring the inflammation down, figure out why those two were abnormal and fix that. Do they have a chronic infection? I mentioned this patient with a posterior cortical atrophy. She’s done really well. Well, she had to be treated for herpes simplex. She had to be treated for Bartonella. It turned out she had a chronic bartonella infection she didn’t even know about.

                                                She had to be treated for mycotoxins. And then interestingly she started really improving when she did EWOT exercise with oxygen therapy. So as with so many other patients, she had multiple contributors when they were addressed, voila, she starts getting better and she’s continued. And her MoCA has gone from 21 to 29. Her symptoms have gotten much better. By the way, her MRI just spectacular improvements. Her parietal lobe went from less than first percentile to the 23rd percentile. So just dramatic improvements, because Kerry was actually able to find out what was driving this. And what that means is, yes, if we’re going to develop a perfect Alzheimer’s drug, that’s fine, but it’s going to have to do all these things.

                                                But what we really want to do is combine one or a few targeted drugs with a functional medicine or precision medicine approach. That’s clearly the way to deal with this complex chronic illness. So we’ve been telling people for years, imagine you have a roof with 36 holes that came from the early research that showed there were 36 different mechanisms. We know of a few more now, but it’s not thousands, it’s dozens. So we can address those, we can identify those. And of course, as I mentioned, the most common risk factor genetically is APOE4. And for years people didn’t know why that was. About two thirds of Alzheimer’s patients have APOE4. In fact, if you have zero copies, which is three quarters of our population, your lifetime risk is about 9%.

                                                If you’ve got one copy and that’s 75 million Americans, your lifetime risk is about 30%. And if you’ve got two copies and that’s seven million Americans, unfortunately most don’t know it, your lifetime risk is about 70%. Most likely you will get Alzheimer’s disease. And there’s a wonderful website, which is called apoe4.info, started by a woman whose APOE4 herself, had symptoms, has done beautifully. She’s been on the program for now over 10 years. She’s gone from 35th percentile to 98th percentile in her cognitive testing. She’s just amazing. She actually wrote a part of the second book, and her story actually appears in The First Survivors of Alzheimer’s. And so she’s got a wonderful website where people share information who are APOE4 positive. I think they have now something like 7,500 people on that site.

                                                So the problem had been how does this work? Why does this thing that simply carries fat? It’s like your butcher. It’s the guy who carries the fat around. How the heck does that give you Alzheimer’s? And so we launched a project, now it’s over 10 years ago in the lab. And all we found is really fascinating. And this is a thing that turns out to have to do with our evolution as hominids. And so up until five to seven million years ago, of course there were simians, but there were no hominids. And the first hominids appeared about five to seven million years ago. And what’s interesting is our DNA is very similar to the simians. There aren’t that many changes. It’s over 98% similar genes. And interestingly, the genes that did change between the simians and the hominids, many of them, outsized proportion of them were related to being pro-inflammatory, including APOE4.

                                                APOE4 appeared and was the primordial gene for the hominids, and it is a pro-inflammatory gene. And interestingly, why would that be? Well, as Professor Tuck Finch from USC pointed out, it allowed us as hominids to come down out of the trees to walk around the Savannah, to puncture our feet, to get infected, to eat infected meat full of microbes, to fight with our brethren, to fight with our food. We’re very good when we’re APOE4 positive, at healing, very good at dealing with infections because of this pro-inflammatory state. But it also because of the ongoing inflammation is associated with heart disease and with Alzheimer’s later in life. So just recently then, so you can see here, God came down, changed a few genes, and of course we ended up as amazing hominids.

                                                So if you look at the original APOE4, you can see here, it looks like columns on a house. And that’s because this arginine 61 and the glutamate 255 interact, the arginine has a positive charge, the glutamate has a negative charge, and they interact here. And this was actually shown by the discoverer of APOE. And then on the other hand, just 220,000 years ago, APOE3 appeared. And now what happens? Cysteine 112 appeared as a mutation, interacts with arginine 61. So now this swings free. And Dr. Mey Lee, the discoverer of this, called this domain interaction. So you can see they’re quite different. So for 96% of our evolution, everybody’s been APOE4 4. Just in the last 220,000 years, APOE3 appeared. And then just in the last 80,000 years, APOE2 appeared.

                                                So to make a very long story short, what we found is APOE4 does something really interesting. It had been known, it binds to a number of receptors like LRP, for example, on your cell, enters the cell. But what we found is that it interacts with a pro-inflammatory molecule called Rel. This is part of NF-kappa B, and it enters the nucleus and it interacts with 1700 different gene promoters. And if you map those out, you could not tell a better story for Alzheimer’s disease. So it has to do with synaptic changes, it has to do with CT, for example. It has to do with inflammation. It has to do with glucose homeostasis. So it’s really changing. So it’s not just your butcher that’s carrying around the fat, it’s also your senator that’s making the laws land.

                                                Literally APOE4 reprograms your cells toward a more pro-inflammatory state. So when we look for these different things, we now start looking at them, identifying them, and actually addressing them. We see some remarkable examples. So let me just give you a couple examples here. Here’s a 68 year old woman presented with cognitive decline. Her first thing was she started making paraphasic errors. She also had some depression, struggled with computer work. She couldn’t complete a gingerbread man. She confused clock hands, forgot to pick up her granddaughters, which really scared her. She went in, she had an amyloid PET was positive. She was APOE4 single copy, had a MoCA of 24, so already well into MCI, that third of four phases. Hippocampal volume was already down. This is a professor. Hippocampal volume was already down to the 14th percentile. So her diagnosis was MCI due to Alzheimer’s disease.

                                                She actually went on a clinical trial for an anti-amyloid drug. And interestingly, as we’ve seen with some other people, she got worse with each injection instead of getting better. So after eight treatments, she said, I am not doing this anymore. She quit the trial and she actually contacted me at that time. So we looked further. I worked with her physician actually. She failed her visual contrast sensitivity. Her C4a was high, her TGFβ-1 was high, MMP-9 was high. Her urinary mycotoxins were increased. She was MARCoNS positive. Her hsCRP was a little bit up 1.1. Triglycerides were very low as we often see with people who have mycotoxin related cognitive decline. Her zinc was also very low, another thing we see. So she began on the ReCODE protocol. She did great. She’s actually now seven years into this. Her symptoms resolved. She could speak again, tell time, build a gingerbread man, no longer problems with her granddaughters.

                                                And by the way, she’s actually part of a documentary that’s called Memories for Life: Reversing Alzheimer’s. It’s come out from the Japanese NHK that’s making its rounds around the country. It was just at the Manhattan Film Festival a couple of weeks ago. Her MoCA score became a perfect 30. Hippocampal volume went up to the 28th percentile. She’s remained stable. As I said, she’s now in her 7th year, so she’s done absolutely great. Here’s a 66-year-old man family history. Both parents died with Alzheimer’s. Single copy APOE4, amyloid PET markedly positive. So classic case of a guy with Alzheimer’s disease. You can see why his homocysteine is high. His hsCRP is very high, vitamin D is low. His testosterone’s low, his free T3 is low. He responded metabolically, cognitively, volumetrically to ReCODE. His neurologist said he’s now normal. He’s done very well.

                                                You can see here his MRI hippocampal volume went from 17th percentile to 75th percentile. So he’s done very, very well. And you can see his hsCRP is still not perfect. His fasting insulin is still not perfect, but it’s so much better than it was. And we see this commonly. His gray matter volume went up by 23%. So just say a little bit about the trial that we published last year. You can read the details in the Journal of Alzheimer’s Disease. So instead of predetermining a treatment, we just flipped the script here. As you know with all these trials, people say ahead of time, we’re going to treat with X. We said, instead of telling you ahead of time what we’re going to treat with, we’re going to look to see what’s causing it, and then we’ll address those things.

                                                You can see it on clinicaltrials.gov. We were denied for this trial in 2011, again, in 2018. We finally got approved in 2019. Small proof of concept trial with 25 patients. We compared personalized precision medicine approach for nine months to historical controls. And looked, again, just a standard a functional medicine approach. Looking at what’s actually driving this. We used MoCA scores. We used CNS Vital Signs because it’s more sensitive. So we got a good dynamic range. The MoCA scores were better for people who were farther along. And the CNS Vital Signs were better for people who weren’t so far along. People had MRI with volumetrics, they improved their neurocognitive index. You can see here, actually the pandemic started right here. So we had a few people who actually stopped doing things and were not doing as well. But actually they still showed improvement overall.

                                                And these are highly statistically significant. You could see improvements in hsCRP, hemoglobin A1C, the HOMA-IR a little improvement, but we didn’t have enough data on that. And so it didn’t reach statistical significance. Triglyceride HDL ratios, homocysteine, vitamin D, all of these were statistically significant in their improvements. So all of these things, MoCA, 76% improved. Neurocognitive index, 84% improved. Improvement on subtests, improvement in a change scale where you ask the spouses if they’d improved or not. That was statistically significant as well. All of them improved on their brain training. Their MRIs, interestingly their gray matter, which even in normal aging slowly shrinks and with Alzheimer’s rapidly shrinks, these people actually increased their gray matter size. And then their hippocampal volume had a minimal decline.

                                                But again, it was actually less than normal aging and far less than Alzheimer’s. So lots of improvements in these people. And interestingly when you look at patients as a whole, the ones who tend to do the best are the ones that come in a little bit early. As I mentioned, SCI, they all improve. People with MoCA scores of 18 or above are easier to improve. We had a couple people in the trial who went from MoCA scores of 18 to perfect 30, clearly addressable metabolic abnormalities. That tends to be easier when you can actually find what’s causing the problem. If you find a chronic infection, if you find specific toxins. The ones who had supportive families and work with health coaches, the ones who had a positive attitude and actually were compliant, the one who just continued, they didn’t give up, okay, you make them a little better, now You keep looking at how can we make this better and better. So keep tweaking, keep optimizing, and they do better.

                                                The ones who did get into ketosis, whether endogenous or exogenous, tended to do better. The ones who didn’t have massive amounts of toxicity tended to do better. And the ones who had symptoms for less than five years. So again, we encourage people, please, please don’t wait. Come in early if you can. And then the ones where we did see improvement in their metabolic markers. And on the other hand features associated with continued decline, poor compliance, lack of interest, so we had one person in the trial, one of the few in the trial who didn’t get better, was someone who turned out to have massive mycotoxin exposure in their house and just said, I’m not leaving and I’m not remediating. I’m just going to sit here. And no surprise, she did not improve.

                                                Severe toxicity, continued exposure. MoCA scores less than 10. They’re tougher. We have had people with scores of zero who do improve, but they don’t go all the way back to 30. We’ve seen them go from zero to nine, and we’ve seen them go from 18 to 30. My goal is can we ultimately get someone to go from zero to 30? Haven’t done it yet. It’ll be interesting to see what does it take to do that? Does it take stem cells? Does it take intranasal peptides? We don’t know yet. Many years of decline also tougher. Lack of support from family and health coach. I see this almost every day. I just got an email today from a woman who said, in fact, actually she posted this on Facebook. That’s right. There is a woman who said, I’m trying to help my mother, but the rest of the family just says, forget it. There’s nothing you can do.

                                                She’s gone through the whole protocol and said, let’s do the right things. And everyone says, no, no, no, no, no. Let’s just give her some hot fudge sundaes and let her go. So yeah, when you don’t have support, that doesn’t work as well. I do think health coaches are really important and really helpful. And then finally, failure to identify key contributors. Many times we’ve had someone who improved and then after a few years started to have a little bit of sliding and we say, wait, what’s been missed here? And then you find something new and now they go right back again. And that’s really important. So don’t give up. And again, some surprising responses people, I got an interesting email from a guy a couple years ago whose wife had a MoCA score of zero, and he said she’s in a nursing home, but she’s responded beautifully.

                                                She’s part of the family again. She talks to us, she dresses herself again. She’s doing so much better, but she’s still in the nursing home. She still has dementia, but she’s much more interactive. So can we now make this optional? We got to encourage people to come in earlier. We encourage everyone, please get a cognoscopy at the age of 40, just like you’re going to get a colonoscopy at 50, and identify factors and get on active prevention, those people who then fall through the cracks. Okay, it’s a multi-tiered approach now, if you now start developing symptoms, get in with at SCI. And ten if the people continue to fall through the cracks, you want to do a more and more extensive evaluation so that we can really make a big impact on a whole population.

                                                And then ultimately over time, AI will help us to identify what are those things that are making the biggest difference and what are the things that are making the least? And I mentioned the KetoFLEX. So we want, here’s the critical paradox, and this is something that many people don’t recognize. So it’s important to know this. The disease is a network insufficiency, so something is not enough. You don’t have enough support, blood flow, oxygenation, whatever it is. On the other hand, it started often by excess because you had lots of carbs and you developed insulin resistance. So you’ve lost the ability to burn the glucose and you’ve lost the ability to make and burn ketones. So we want to get both of those back to normal. So we want to be careful.

                                                If we starve people to get them to be insulin sensitive, that often makes them worse. So which is why I usually say just start, give them some ketones at the beginning. Give them some exogenous ketones for a couple of months. And during that time, you can restore their insulin sensitivity. Now they’re doing better. Be careful for the people who are frail. This is a common problem. If they don’t have fat to burn, to make ketones, help them out, give them some ketones. So that’s the important paradox. And this is why we work with Nutrition for Longevity, to make it so that they made appropriate meals, appropriate sourcing, appropriate organics, appropriate ability to get into ketosis, all the appropriate things to get the best outcomes, appropriate caloric income, et cetera.

                                                So we want insulin sensitivity and ketosis, I.e metabolic flexibility. We want to plant rich, mildly ketogenic diet with fasting periods 12 to 16 hours. You want to be careful, you go too long, you’re getting back again into insufficiency. High fiber, high phytonutrients, anti-inflammatory, et cetera. High fat, intermediate protein, low carb, no simple carbs. And many people like to cycle off once per week or twice per week. That’s fine. No problems. Grains and dairy, we stay away from. Wild cat fish, great pastured eggs, great pastured chicken, grass-fed beef, all of those are fine. As I mentioned, this says coming soon, but it’s actually here. So as you know, a couple of books on this that are available. And just to finish up here, the ARC project, very excited about this.

                                                And so the idea here is to take people with different neurodegenerative diseases, and we’ll be doing this at this new group at Pacific Neuroscience Institute as well. And then to do deep dive looking at genomes, looking at epigenomes, looking at all the things that are driving these in just a couple of people, hence ARC, like two by two by two, so that we can actually look to see what is driving the problem in each of these diseases, and then address those things. I’m very enthusiastic that we should be able to prevent and reverse many different neurodegenerative diseases in the near future. I recognize, I’ve been doing this for a long, long time, I’m an old guy now, I’m now 71. So as they say, you’re not expected to complete your life’s work during your lifetime. Neither are you excused from it.

                                                I recognize it’s you guys that are going to be doing this. It’s you guys that are going to be taking this forward and making it better long after I’m gone. And I really hope that we will see a world with far less neurodegenerative disease, because it’s been a huge problem. I’ll end there. Happy to take some questions. How are we doing on time here?

Dr. Weitz:                          We’re doing fine. We have as much time as you want. I wanted to ask-

Dr. Bredesen:                    Would love to answer questions, and I think we’ll stop sharing there.

Dr. Weitz:                          I wanted to ask a question about the use of statins and about cholesterol in general. We know statins have been a huge benefit for reducing cardiovascular risk and we know that blood flow is really important for brain function. And this is important also because recently in the medical community, it’s been a big push to really try to drive cholesterol levels down as low as possible. There’s a prominent practitioner who has a very popular podcast, and he said that we should drive LDL down below 40 and we’ll eliminate all heart disease. And he also said that we don’t have to worry about these drugs that reduce cholesterol affecting the brain, because the cholesterol in the brain is made in the brain.  And yet we know that at least 25% of the cholesterol in the body exists in the brain. And I’ve looked at some of the studies, and there’s at least, there was a study a couple of years ago that showed that PET scans showed that there was a decrease of blood flow to the parts of the brain that are associated with Alzheimer’s in those particularly who took lipophilic statins.

Dr. Bredesen:                    Yeah, no question. There’s a nice study from UCLA that showed that lipophilic statins were associated with brain atrophy and with a greater likelihood of developing dementia. I assume you’re referring to Peter Attia who’s pushing.

Dr. Weitz:                          Yes.

Dr. Bredesen:                    I get it. He’s very concerned about heart disease. Fine. Of course, Dr. Esselstyn, Caldwell Esselstyn has done a great job with showing that, hey, if you don’t have any fat around, you can’t make those plaques. Unfortunately you can make dementia. That is the problem. So if you look at the literature, you’ll see half the papers saying that statins reduce your risk of dementia, and half the papers saying that it increases your risk for dementia. How can that be? And the reason is because they have both a positive and a negative effect. So sometimes one wins out, sometimes the other wins out. So for example, they have an anti-inflammatory effect, great, but they also reduce your cholesterol so much that you can increase your risk for dementia.

                                                My argument is why don’t you get the best of both worlds, use other anti-inflammatories, use appropriate diet and exercise and lifestyle approaches to get your cholesterol lined up. And if you need a little help, then there are other things you can do. There are other ways to go about this. You can even try with these PCSK9 inhibitors like Repatha. That’s another way to consider, probably better for you. But here’s the problem, when we’re seeing people coming in with cognitive decline, we see that they’ve been overtreated with these statins, and they come in with total cholesterols of 105, 110. Anything below 150 is associated with brain atrophy. And in fact, interestingly, you may know Dayan Goodenowe, who’s an excellent biochemist. He’s the one that developed the plasmalogens and initially found that people with Alzheimer’s disassociated with people with low plasmalogen levels.

                                                And he pointed out the healthiest profiles he sees are when people end up with total cholesterols 220, 225 that’s kind of typical. So you’re right, we want to look at the critical ones like LDL particle number, small dense LDL, oxidized LDL. ApoB now has become probably the most common one. And actually something that my wife, Dr. Lasheen taught me about months ago, and saying, hey, ApoB is really the way to go. So, okay, fair enough. I’m agnostic, whatever helps people to get better outcomes. And I totally understand we don’t want to have myocardial infarctions, so we recommend that people get calcium scores or get CT angios. So you make sure you’re okay. But if you’re looking good, if your score is zero and you’re developing some cognitive decline, you should be thinking way more about your brain than your heart. You’re probably going to do fine with your heart.

                                                There’s a lot you can do for your heart. So again, this is why I like to, if possible, avoid statins or at least minimize the statins and do the things that are good for you for the statins. Things like anti-inflammatory, you can do that with lots of other things. Curcumin is one of many. Cat’s claw is another one. What’s really interesting to me as someone interested in cell biology, is that the amyloid that we make in our brains is part of your innate immune system. It is part of your body saying, oh, I’ve been invaded, something is not quite right here. So it actually it makes perfect sense. And interestingly, if you look at what part of the innate immune system it is, it is part of your innate system’s memory, and your memory lives in three places. It used to be thought your innate system didn’t have a memory, your adaptive system had the memory.  But it turns out your innate system has a memory as well, and it lives in three sites. It lives in your bone marrow, it lives in your endothelial cells, which is why these people unfortunately get increased thrombosis and poor blood flow. And it also lives in your tissue macrophages, which is why you end up having this in your microglia as well as your neurons.

Dr. Weitz:                          Interesting.

Dr. Bredesen:                    So it’s very interesting system, and when you understand Alzheimer’s in this way, that it is a physiological response to these insults, suddenly everything makes sense. You can see how to prevent it. You can see how to treat it and reverse it, and all these crazy ideas. One of the standard things they say is amyloid is the thing that causes Alzheimer’s. Then they found out that it’s an antimicrobial. They said, well, sometimes it’s good and sometimes it’s bad. It just like it is hand waving. Whatever you come up with has to make sense in all situations. And this model does.

Dr. Weitz:                          Lynn asked, why are we seeing an increase in dementia in 40 to 50 year olds, in younger patients?

Dr. Bredesen:                    A great question. The answer is nobody knows for sure. No one’s proven it. But the leading contenders are the changes with ultra processed food. The fact that everybody’s, so many people now have metabolic syndrome. We have something like 80 million Americans with metabolic syndrome, that dramatically increases your risk for Alzheimer’s disease. And interestingly, the ones I see in their 40s and 50s are usually associated with toxin exposure. It’s this overwhelming toxin exposure. It’s the mycotoxins, it’s the air pollution, it’s the mercury, it’s the organics. When you look at these toxins that are associated with cognitive decline, they come in three groups. Inorganics like air pollution and mercury and heavy metals. Organics like glyphosate, toluene, benzene, formaldehyde. And then thirdly, biotoxins.  So many people without knowing about it, as you know, they either live in or work in an area that is just filled with mycotoxins and they don’t know it until they start having cognitive decline. And when you start detoxing them from those mycotoxins, they start to get better.

Dr. Weitz:                            And when you mentioned metabolic problems, we now know there was just recently a study published showing that statins increase your risk of diabetes.

Dr. Bredesen:                    Absolutely. And that’s another big issue. And of course diabetes just gives you increased risk for cognitive decline.

Dr. Weitz:                          Let’s see, you mentioned exercise with oxygen. Can you explain what that is?

Dr. Bredesen:                    Yeah, that’s one of my favorite things now because we’ve had such good responses to this. So again, as we get a little older, we are perfusing areas of our brain less perfectly than we did. We’re getting a little less blood flow, a little less oxygenation. Some of us developed some sleep apnea or some upper airway resistance syndrome. We’re just not quite firing on all cylinders and we may notice it. What does EWOT do? Well, you’re now combining exercise with oxygenation. So you get this wonderful benefit where you’re perfusing areas of your brain and you’re providing oxygenation. And people have done very, very well with that. Now, some people like to use HBOT instead. Great.  But HBOT, it’s expensive and it’s not active. It’s a passive form. So you’re not getting that exercise to help with the circulation. Yes you are getting more oxygenation, no question. You now got it under increased pressure, but the two have somewhat similar effects, but one of them is a more active and one of them is more passive.

Dr. Weitz:                          What exactly is the device? And this is something that you’re turning up and down as you’re exercising.

Dr. Bredesen:                    So the device is, and you can get it from different groups like MaxO2 or LiveO2 or things like that. So this is basically, it’s basically an oxygen concentrator. So you basically do 20 minutes of exercise with this pure oxygen. And some people like to do it with stationary bikes. Some people like to do it with cross country. Any sort of exercise that you do. Now, to be fair, it’s missing one thing. It’s better to do your exercise outdoors than indoors, unless you live in a place that’s heavily polluted, you want to get out of those mycotoxins in the house. So that’s the one negative. But yeah, hey, you could put it out on your balcony if you want to do something like that. But getting that oxygen with the exercise, again about 20 minutes and then it will run out, is actually quite helpful.

Dr. Weitz:                            Somebody asked, would you be willing to share your slides with us?

Dr. Bredesen:                    Oh yeah, sure. You can have a copy of the slides. Can I send them to you as a PDF? Is that okay?

Dr. Weitz:                          Sure, yeah.

Dr. Bredesen:                    I’ll send you a PDF of the slides.

Dr. Weitz:                          Okay. Great. Somebody asked that, Dr. Sherry Viensech said that she’s a certified ReCODE practitioner and she’d like to connect with other ReCODE practitioners. Do you have a Facebook page or something like that just for ReCODE practitioners?

Dr. Bredesen:                    Yeah, just go on the forums. We have the forums at Apollo Health. Just go on the forums, there are other practitioners there, so you’ll connect with them there.

Dr. Weitz:                          Somebody asked about book suggestions. Well Dr.Bredesen has three of them.

Dr. Bredesen:                    Someone asked for book suggestions? The first one was really about how we came to this conclusion. That was The End of Alzheimer’s and that’s in 33 languages. Then the second one we got, people said, we’d like more day-to-day specifics. Where do I buy the food? Where do I do this? Where do I go? And so I actually worked with the woman I mentioned earlier, who’s Julie G, and my wife, Dr. Aida Lasheen Bredesen. And they wrote a whole section of essentially a handbook. And this was called The End of Alzheimer’s Program. So now this was the program for that. That’s the second book. Came out in 2020. And then the third one is The First Survivors of Alzheimer’s. And these seven different people talk about their own stories.

                                                And then there’s going to be a book coming out by Dr. Heather Sanderson. And by the way, she just did a trial, which came to very similar conclusions, used the same approach. She was one of the first trainees when we first started training people back in 2016. And so she’s now done a trial, as I said, reached very similar conclusions. She did take people all the way down to MoCAs of 12. Although to be fair, what she found was the ones below 16 didn’t do as well as the ones above 16. So that’s something we really need to work on to understand how do we do better for people who are in those later stages. And hers is also freely available online also in the Journal of Alzheimer’s Disease, as you’ll see.

Dr. Weitz:                            And check my podcast, last week I had a wonderful interview with her.

Dr. Bredesen:                    Great, great. I should also mention Marama. So she opened an assisted living facility in San Diego and it’s been fantastic, because people in the assisted living facility for the first time, they’re not getting worse. Some of them are getting better, some of them are very stable, but nobody’s getting worse, and it’s really striking. That’s just unheard of in assisted living.

Dr. Weitz:                          I don’t know if you might want to comment on this, but I just got an email a couple of days ago from a group called the Alzheimer’s Centers of America, and it’s run by a guy who ran Pizza Hutt.

Dr. Bredesen:                    I know the group well.

Dr. Weitz:                          It looks to me like this is part of what I have seen is I think a poor trend or dangerous trend, which is financial firms buying or starting medical centers with the wrong incentives in place, and it looked very much like that sort of place.

Dr. Bredesen:                    You know what, this comes up a lot. People say, I’ve got something that’s really great. Okay, show us your peer-reviewed published data and all these business things just shrink right back. And they say, well, we’re going to publish it someday. We’re going to do this. When you do it, please contact us.

Dr. Weitz:                            Okay, great. Sarah asked, how do we get the testing? Sarah, are you talking about getting it for you or are you talking about for your patients? Are you there, Sarah?

Sarah:                                 Yes, I am. For myself, yes, and also for my patients.

Dr. Bredesen:                    Easy. So just go to mycognoscopy.com and you can actually do this over the internet and you don’t even have to go to a specific physician. You can get a report. And again, happy to go over the report with anyone. But that also shows you where the trained ReCODE practitioners are. So you can see that. The health, the coach network, all that stuff is online. And by the way, one of the most valuable things I think is over a hundred guides that have been written, again by Julie and my wife. Really, really helpful to look at what are the things that actually work the best. So those are also available online through Apollo Health.

Sarah:                                   Wow, thank you so much. And also had another question. Do lesions and or ischemic changes on an MRI represent potential for future AD, Alzheimer’s?

Dr. Bredesen:                    That’s a really good point. It depends on what kind of lesions, and this is again why I think all these things like the blood tests are going to be very complimentary. If you’ve got a couple of lesions, but your GFAP is normal, your phospho tau is normal. Your 42 to 40 ratio is normal. Your NFL is normal. These are probably inconsequential lesions as far as any cognitive change. If you’ve got lesions on the other hand and these things are starting to change, you’re moving the needle there, then there are things that you should address further. So as you know, you kind of alluded to there, these can be ischemic, these can be white matter changes, these can be autoimmune, these can be beginning of MS, there all sorts of different things that can be seen.

                                                And as you know, one of the most common findings on MRIs is so-called unidentified bright objects, UBOs, you see them on a lot of these MRIs. And we’re starting to understand better this white matter disease is often part of Alzheimer’s disease, often part of cognitive change. So great idea to know and to quantitate that. So you should have the radiologist give you a physica score, which is zero, one, two, three, or four, that tells you how significant the white matter lesions are.

Sarah:                                   So helpful. Thank you.

Dr. Weitz:                            Sherry, you want to jump on? You have a question here about Dr. Ray Dorsey, substantia nigra in Parkinson’s disease due to poor myelination of highly branched amino acids, juicy damage of the substantia nigra with the toxic type of Alzheimer’s.

Dr. Bredesen:                    Great point. I know Ray and I love his book, A Prescription for Action, which is all about ending Alzheimer’s. In fact, he told me that they wrote that book about ending Parkinson’s based on what I’d published on ending Alzheimer’s disease. So love that. I’d love to see less Parkinson’s. There are about a million Parkinson’s patients in the United States. There are about a million Lewy body patients in the United States. Of course with Lewy body, you have parts Alzheimer’s and part Parkinson’s, essentially. Typically you don’t see damage. But again, what we’re finding, what we’ve separated as, okay, this is Alzheimer’s and this is Parkinson’s. With the classic presentations, you don’t see damage to the substantia nigra in Alzheimer’s.

                                                You do see it in Parkinson’s. But here’s where things get a little bit tricky. It’s been shown now that when you look at alpha-synuclein, so this is Lewy bodies, which are the hallmark of Parkinson’s. You see Lewy bodies in over half of Alzheimer’s cases now. They’re not in the substantia nigra though, but they’re around the brain. So Lewy body disease, which essentially sits in between Alzheimer’s and Parkinson’s, is often a toxin driven type of cognitive decline. And in that case, you do see changes and you do see sometimes changes in the substantia nigra. So these things, it depends. And we’re starting to be able to look at these. You have to remember, all of these have been defined based on pathology.

                                                This all comes from the 19th century pathologists. People like Charcot who are saying, okay, this is what we’re going to call this diseases, we’re going to call that disease. Okay, great. But now we’re looking much more at metabolics, metabolic profiles, epigenetics, genomes. So we’re going to get I think, a reclassification of these diseases. And as you alluded to, what we see is that a toxic form of Alzheimer’s type three often looks more like Lewy body disease and a little bit less like classical Alzheimer’s disease.

Dr. Weitz:                            David Trader asked about Parkinson’s disease. I wanted to point out, we had Dr. Karen Duncan at our meeting several months ago, and you can see the recording on the YouTube channel or listen to it. And she’s talked about how she’s using a functional medicine similar approach for Parkinson’s disease with really good results.

Dr. Bredesen:                    Fantastic. I have to say, there’s nothing better than hearing about someone who has a neurodegenerative condition, which typically you’re told there’s nothing that can be done, and now they actually are getting better. It’s just so fantastic to see. Now, in the ARC project we’re looking at all neurodegenerative diseases, so that will include Parkinson’s. However, it wasn’t one of the early ones we approached for the simple reason that all the others have nothing to offer from classical medicine. So there is nothing to do, even for age-related macular degeneration, dry macular degeneration, it’s AREDS 2, which has virtually no impact on it. For Lewy body, nothing. For frontotemporal, nothing. For ALS, nothing. But for Parkinson’s, that’s the one where you actually have a pretty good pharmacological armamentarium.

                                                You can make people better. You don’t change the disease outcome, you still are losing your substantia nigrostriatal pathway, but you at least have some positive impact. And even things like glutathione can be very, very helpful. So that wasn’t one of the earlier ones that we did, because there’s an alternative, but we will include that with this new center that I mentioned earlier.

Dr. Weitz:                            Let’s see, Shadi, any idea of certain types of dementia like frontotemporal or primary progressive aphasia are more challenging to reverse?

Dr. Bredesen:                    I should mention this other part about how long did it take people in the study to see improvements? We saw statistically significant improvements within three months. We saw better improvements at six months and still better improvements for the ones who stayed on the program at nine months. And we’ve had people where even after two or three years, they’re continuing to get better, tweaking, tweaking, getting better and better outcomes. Now, as far as others, primary progressive aphasia, as you know, is interesting. That can be due to frontotemporal dementia or it can be due to Alzheimer’s and sometimes neither. But those are the two common ones. We definitely see improvements with PPA, primary progressive aphasia in Alzheimer’s, and with PCA in Alzheimer’s as I mentioned earlier, posterior cortical atrophy.

                                                With frontotemporal dementia we have very little outcome data yet. It’s much less common than Alzheimer’s disease. And so we just don’t have the data yet. My hope is as we study it further and as we understand better what’s actually driving the process, we’ll begin to see some improvements, but we just don’t have the data yet. So if it’s PPA associated with FTD, don’t know yet. If it’s PPA associated with Alzheimer’s, yes, we’ve seen some good improvements.

Dr. Weitz:                          David asked about a test from LabCorp. David, what test are you talking about?

Dr. Bredesen:                    Maybe Phospho Tau 181. That’s a new LabCorp test. One of the ones-

David:                                Yeah, that’s the one that you mentioned.

Dr. Bredesen:                    Yes. And we’re using that on everybody now. And we are seeing what you’d expect. People where we thought it was probably not Alzheimer’s tend to be as low, I think the upper limit of normal in that particular test is 0.95. We see people up above two who clearly have an Alzheimer’s associated dementia. Now, what we’re really interested in seeing is that the reason that your tau gets phosphorylated, is because you are telling your tau, I want to pull back my neurites. I’m under stress, I’m under assault, so I am now going to phosphorylate my tau. The tau is what holds the microtubules steady. Basically it supports them. So just like if you want to tear down a part of your house and you’ve got all these rafters, you got to take off the bolts. And so when you phosphorylate the tau, it pops it off the microtubules, which can then collapse.   So what you’re really seeing with that increase in tau, is you’re seeing your brain tell itself, pull back, pull back. Now what we’d like to see is as we treat people, it goes down. And interestingly, I just got an interesting email from a woman who did go on our program partway. Unfortunately she didn’t go on the whole thing a few years ago, and so she’s now looking to do more. But what happened was she had a high phospho tau, when she went back after being on the program it was much lower. We’d like to get it completely down to completely normal if we could, time will tell. So our current trial that we’re doing is looking at phospho tau throughout the trial to see whether we can bring that back down. It takes about six months to show some improvement. It doesn’t happen overnight. But you’re looking at that change in the brain signaling to tell you, is your brain signaling synaptoclastically or is it signaling synaptoblastically?

Dr. Weitz:                          David, what are you asking about phosphorylated tau from LC?

Dr. Bredesen:                    LabCorp, yeah, that’s the one. So they have Phospho Tau 181. I suspect they’ll come out with 217 at some point, but I don’t think it’s available yet.

David:                                Okay, cool. I just want to know which lab test it was from LabCorp.

Dr. Bredesen:                    PTau181.

David:                                   Awesome. Thank you.

Dr. Weitz:                            And Karen wanted to know, have you had success helping to reverse tremors so that patient’s writing improves?

Dr. Bredesen:                    That’s interesting. With this corticobasal person recently, Craig Tanio has some wonderful results where one of the things that improved the alien hand that they have. Tremors in general, of course they are different. Are you talking about a sustention tremor, an intention tremor, or a Parkinsonian tremor?

Dr. Weitz:                          Karen, are you there? You want to unmute yourself?

Karen:                               Yeah, I am here. It’s an intention tremor, when they go to write, when go to eat, any purposeful movement.

Dr. Bredesen:                    Those are not typically part of Alzheimer’s disease. But yeah, there are multiple things you can use. People use everything from primidone to propranolol to clonazepam, to all sorts of things you can use for those sorts of tremors. You want to make sure it’s not a resting tremor obviously, because that’s associated with Parkinson’s disease. But those tremors tend to respond pretty well. It can be of course benign essential tremor. You can hear it in their speech typically. You can see it sometimes in their heads as well as their hands. And those tend to respond to simple pharmaceuticals like those.

Dr. Weitz:                          What peptides have you been using on patients? Have you?

Dr. Bredesen:                    Good point. And it just depends, again, on what we believe is driving the problem. But people have used thymosin alpha 1 and thymosin beta 4. Epitalon has turned out to be quite interesting. And so again, as you know, there are hundreds of these things. So it’s going to be what do you think is driving the problem? I’m interested, is Cerebrolysin going to be turning out to be something really good? One of the ones I’m most excited about failed in its trial, and that’s davunetide, which is an ADNP derivative. So ADNP activity derived activity dependent neurotrophic peptide is extremely potent in the brain, really helpful. And yet, I think because they used it as a monotherapy, it just didn’t move the needle. And so I’m hoping it’s going to make a comeback at some point because I think it could be very useful.

                                                And then of course there’s intranasal insulin. There’s also non peptide synapsin, which is another nice intranasal approach. Intranasal glutathione, there’s so much that can be done with intranasal treatments because you get such good brain penetration. I’m hoping at some point that someone will come out with a derivative of Netrin-1. We actually worked on that in the lab for a while and developed a little peptide that works like netrin, full length netrin, no penetration, just doesn’t work. It’s just too big. Does not get into the brain if you use it intranasally. Of course there’s intranasal insulin as well, but you have to be careful about insulin resistance. So those are just some of the many that people are using and I think are going to be very valuable.

Dr. Weitz:                            Lynn is raising her hand. Go ahead Lynn.

Lynn:                                     I was just interested, talking about central tremor and the tremors. What do you feel about deep brain stimulation?

Dr. Bredesen:                    I think for people who are literally incapacitated due to severe uncontrollable dystonia or tremors or hemiballismus or severe Parkinson’s, things like that, that’s where deep brain stimulation really works well. For people with Alzheimer’s, yes, there’s been a report. I don’t think you need to go there for most. I think there’s so many other things that are better that I wouldn’t go there unless everything else had failed in someone with cognitive decline. So far it’s better for movement disorder, severe uncontrollable movement disorders.

Dr. Weitz:                            What about some of the other forms of brain stimulation, like different colored lights and similar type approaches?

Dr. Bredesen:                    Absolutely. So one of the things, again, going back to this is about energetics and this is about inflammation. And one of the ways to do both. That you can reduce some of the inflammation with red light, for example, and you can enhance support. So absolutely, we have a whole section on brain stimulation, and it includes everything just from brain training, which was developed by Professor Mike Mesnick, has been very helpful. We use it in our trials to MeRT, Magnetic e-Resonance, which works very well. Transcranial magnetic stimulation, microcurrent, all of these things have their place and people are getting good results with them.

Dr. Weitz:                          Thank you so much for your time, Dr. Bredesen. This has been awesome.

Dr. Bredesen:                    Great to talk to you guys. And Ben, give you some followup. I’ll send you the slides and let me know if anything else comes up. Okay?

Dr. Weitz:                          Great. And we’ll see everybody next month. Thank you.

Dr. Bredesen:                    All right, take care guys. Bye-bye.

 


 

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 certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. That way more people will discover the Rational Wellness podcast. And I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way.  That usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing. And we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

 

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Healing Reflux with Dr. Steven Sandberg-Lewis: Rational Wellness Podcast 319

Dr. Steven Sandberg-Lewis discusses Healing 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

2:50  Heartburn.  Heartburn is a subjective sensation of burning, usually over the sternum, and it can be intense and sharp. People can even feel like they are having a heart attack.  Not all patients who have heartburn have reflux, though the majority do have reflux.  Regurgitation is when fluid or food comes up into the throat or mouth and this can be related to reflux.

4:57  Reflux.  Reflux can have to do with any fluid going through a tube in the wrong direction.  When the contents of the large intestine move from the large intestine to the small intestine instead from the small intestine down to the large intestine, this is called cecoileal reflux or ileocecal reflux.  If things move from the small intestine up into the stomach, that’s called bile reflux. If things move from the stomach into the esophagus, that’s called gastroesophageal reflux disease, GERD.  There is also GER, which is a normal reflux that occurs say three times after every average meal when some food or fluid from the stomach will move up into the lower esophagus and it doesn’t cause symptoms.  This is not a disease and considered normal.  Reflux doesn’t have to cause reflux disease, but it can if it’s prolonged or if the esophagus is not able to protect itself with various protective factors. Normally our saliva, which is slightly alkaline and which is being swallowed every minute and helps to neutralize any acid that comes up. There are secondary contractions that contract the lower esophagus to move things down. There’s also mucus production that coats the mucosal membrane of the esophagus.  If these mechanisms fail, then you can get Gastroesophageal Reflux Disease.  Therefore it is important to naturally bolster the protective factors in the esophagus.

7:32  What causes reflux?  For one thing, while it is often called acid reflux most patients do not start out having too much acid production.  In fact, many of them have too little stomach acid production. But after being on proton pump inhibitors like Prilosec, AcipHex, Prevacid, Protonix, and Nexium for a while, if they stop them even for short period of time to get the Heidelberg test that Dr. SS-L often performs, they will often get a rebound hypersecretion of acid, which makes it difficult to accurately test their acid levels in their stomach.  While the proton pump inhibitor is preventing the parietal cells in the stomach from making acid, the body keeps secreting more and more gastrin to stimulate those parietal cells to make acid.

10:25  The major causes of GERD include a sliding hiatal hernia.  This is when the upper 2-3 cm of the stomach slides up through the diaphragm that engages the lower esophageal sphincter that normally protects from reflux.  When the stomach moves up, you lose a lot of that anti-reflux muscle function.  Another reason is people who overeat or who eat rapidly will more likely have reflux.  When you eat too quickly, you don’t get the signal to your brain that you’re full.  Overeating or anything that causes distension of the stomach, such as gas, will lead the lower esophageal sphincter to relax and stay open for up to 20 seconds.  This is why SIBO can be a trigger for reflux.  Food sensitivities can also lead to reflux. Atrophic gastritis, those who don’t make enough stomach acid, can lead to heartburn symptoms. 

18:25  H. Pylori is generally protective against reflux.  H. pylori is a bacteria in the stomach that is a major cause of ulcers and many feel that it is a cause of reflux. While H. pylori can cause a type of lymphoma in the stomach called MALToma and it can cause gastritis and it can increase the risk of stomach cancer. H. pylori can live in the entire stomach or just in the antrum, or bottom part.  Since H. pylori was discovered in the early 1990s the dictum is to test and to treat, though Dr. SS-L generally does not agree with this.  H. pylori is treated with two antibiotics and a proton pump inhibitor.  But H. pylori is actually part of the microbiome of the stomach and it has a lot of benefits, including protecting against allergies, eczema, asthma, hay fever, and it also is a major protector against reflux and the complications of reflux, which include Barrett’s esophagus and cancer of the esophagus.  80% of the time H. pylori is all over the stomach and these patients usually make too little acid, but if H. pylori is in the antrum, which is 20% of the time, that tends to trigger gastrin secretion and increased acid production, which can cause ulcers in the stomach or the duodenum. 

24:52  How to examine, analyse, and work up a patient with heartburn or reflux symptoms.  If the patient has been to see a gastroenterologist and had an upper endoscopy, you should get the results and the biopsy report and look at it and get used to reading them. There are cases of erosive esophagitis where there are erosions of the membrane in the esophagus and then there’s NERD, non-erosive reflux disease.  If the patient has also had a Bravo pH monitoring test you can determine the degree of erosive esophagitis–grades A, B, C, D.  Patients with grade D should definitely be on a proton-pump inhibitor medication.  These are patients who are having severe damage and at strong risk for Barrett’s esophagitis, which is precancerous.  If they are NERD or Erosive grade B or A and are willing to change their diet and make lifestyle changes, we have them start with all the basics listed in Dr. SS-L’s book, including eating slowly and mindfully and not eating within three hours of going to bed. If they are a side sleeper, there’s less reflux if they sleep on their left side because of the shape of the stomach and the esophagus. You should be well hydrated, but ideally you should drink most of your water away from meals. If food is well masticated by chewing 20 or 30 times, you should not need water to wash it down. In particular, you should not drink ice water while eating, since cold will slow down gastric emptying.  It is more likely to cause reflux if you only chew four or five times and then take a sip of water to wash the food down.

34:31  Let’s continue discussing our patient with reflux.  Let’s say we found out they’re sensitive to tomato or we found out they’re sensitive to gluten and removing that could be enough to normalize their vagus nerve connection.  Then let’s say that we do labs and find out they have high blood sugar or high hemoglobin A1C.  If your blood sugar is too high, your digestive tract can malfunction and this can lead to reflux.  We should also do flexibility testing to see if they are hypermobile.  Such patients with ligamentous laxity tend to have a high incidence of sliding hiatal hernia and laxity of the ileocecal valve.

 

                                                What if they don’t make enough stomach acid like 50% of people after age 60? And some younger people too, especially younger kids with asthma and many people with autoimmune disease. So there are lots of ways to deal with that. If you know that they have frank hypochlorhydria, you can use betaine hydrochloride and you can actually test during the Heidelberg test. You can give the person a capsule of betaine hydrochloride or you can give them bitter herbs and see what does that do to the pH? Was that enough? No. You give a second one and then it brings it down where it should be. So betaine hydrochloride capsules when it’s indicated. People can use different kinds of bitter herbs. Gentian is one of the most bitter herbs, but fenugreek, bitter orange oil, there are many different ones.

Dr. Weitz:                            People will drink vinegar.

Dr. Sandberg-Lewis:          You can use one or two teaspoons of apple cider vinegar in a quarter cup of water, 10, 15 minutes before meals when you’re preparing your food. These are all things that can really help reflux and can really help the pH of the stomach if the person doesn’t make enough stomach acid. Now, if someone has that little test with drinking one to two teaspoons of apple cider vinegar and water, that’s a good little test. If your patient has erosive esophagitis, they’re going to tell you, “Wow, I’m never doing that again. That was like putting fire in there.” So you get a little clue. It’s just the opposite situation.

                                                And then there are people that if they’ve had their upper endoscopy, like you said, one thing you want to ask if you know your patient’s going in for upper endoscopy or you’re referring them for one, please ask the gastroenterologist to give you a reading of what’s called the gastric flap valve, gastric flap valve. It’s also called the hill criteria, H-I-L-L, and it’s just a way to grade how well the lower esophageal sphincter stays closed. And sometimes you read an upper endoscopy report and it says the lower esophageal sphincter was gaping or the lower esophageal sphincter was open, and you know there you can’t fix their reflux unless you do something about that lower esophageal sphincter. A number of things you can do. You can work with the vagus nerve. I’m sure those doctors out there know about different exercises people can do for their vagus and of course take care of their blood sugar if it’s off because that really damages-

Dr. Weitz:                            Yeah, we’ve been experimenting with an electrical vagal nerve stimulator. I’ve also used infrared light on the vagal nerve.

Dr. Sandberg-Lewis:          Yeah. And lots of simple exercises people can do too, but those are great.

                                                Another important piece here when the lower esophageal sphincter is open, is loose, is hypotonic, is to strengthen the diaphragm. Remember I said the lower esophageal sphincter is surrounded by the diaphragm muscle and it really is like… The diaphragm’s like the outer half of the lower esophageal sphincter. And if the diaphragm’s hardly ever being used because your patient doesn’t do diaphragmatic breathing, they’re always breathing shallowly in their chest, which also triggers the sympathetic nervous system and decreases vagal tone. If you can train them to do slow, full diaphragmatic breathing exercises every day, over time, the diaphragm gets really strong.

                                                There’s a great little exercise that I love to show patients where you stand a foot away from the wall and you put a single sheet of toilet paper on the wall, and then you take a nice slow abdominal breath and you breathe out with pursed lips. And you keep the toilet paper on the wall. And you do that every day and see how long you can do it because it takes a good diaphragmatic tone to keep that pressure of the air coming out for a long time. It’s a fun little exercise. Kids like it too, but toning the diaphragm, really, really important. Singing from the diaphragm. People know how to use their diaphragm to sing loudly, that’s a really good exercise for the diaphragm. Lots of things you can do.

                                                On the other hand, you can also work through the parasympathetic nervous system to tone the lower esophageal sphincter by using huperzine A, which is an extract of Huperzia serrata, an herb that has anticholinesterase activity, so it decreases the breakdown of acetylcholine in the body and raises acetylcholine. In addition, you can use [inaudible 00:41:40]-

Dr. Weitz:                            By the way, typically part of a brain formula.

Dr. Sandberg-Lewis:          Yeah, because people that get dementia don’t have enough acetylcholine in their brain either. And then you can also use things like phosphatidylcholine or acetyl-L-carnitine to support the choline production as raw material to give the choline to make acetylcholine. So that combination of… I usually use 420 milligrams of phosphatidylcholine twice a day with meals and huperzine A anywhere from 50 to 200 micrograms twice a day with meals. I haven’t done that with hundreds of patients, but when I know that they’ve had this hill criteria showing a real laxity of the LES, I’ve seen that work beautifully in six or seven patients that I’ve tried it with, especially younger patients.

Dr. Weitz:                            I know you’ve mentioned the use of demulcent herbs.

Dr. Sandberg-Lewis:          Yeah, well, there’s the other world you can go into and that is, can the lower esophagus protect itself from any normal reflux even, gastroesophageal reflux, GER, that’s going to happen after every meal? Can the lower esophagus protect itself? So what’s important there? Melatonin, one of the most important things for protection.

Dr. Weitz:                            In this context, is melatonin taken just as a capsule? Is it more important as part of a formula? Is it a similar dosage for sleep? Melatonin is… A lot of discussion about melatonin recently especially.

Dr. Sandberg-Lewis:          Yeah. It’s hard to say at this point except that we know that if you give rats melatonin supplements, it does concentrate in the esophageal mucosa. So it does get there where you want it, and it raises their blood level as well. Probably the best way to have normal melatonin is to sleep well, and it is proven that research shows that sleeping less than six hours is a risk factor for Barrett’s esophagus, which is one of the precursors to esophageal cancer in patients who have reflux. So getting seven or more hours of sleep, eight hours is ideal they say for most people, that’s real important. But of course, without going into adrenal function in a big way, high cortisol and/or low DHEA from the adrenals is a major way to suppress melatonin production because as cortisol…

                                                Cortisol is high in the morning, comes down, plateaus in the afternoon and gets to its nadir at midnight. As it’s going down, cortisol going down, that allows melatonin to come up and stay up during the night. So they have this dance where cortisol is doing this in the day, melatonin’s doing this at night. And they trade off. As the melatonin’s dropping in the morning, the cortisol is coming up to its peak. So, so many of your patients have an imbalance between cortisol and DHEA. They have high cortisol levels or they have very low DHEA levels. That’s going to suppress their melatonin. That’s going to be a risk factor for heartburn. So that’s just one of the things, but you can also do protective things like demulcents.

 



Dr. Steven Sandberg-Lewis has been a practicing naturopathic physician for nearly 40 years and he teaches gastroenterology at the National College of Natural Medicine.  Dr. Sandberg-Lewis: is a well-received presenter at educational seminars around the world and he has authored or co-authored multiple articles and is frequently interviewed on digestive health topics.  Dr. Sandberg-Lewis: wrote the second edition of his textbook, Functional Gastroenterology in 2017 and in 2023 he published Let’s Be Real about Reflux: Getting to the Heart of Heartburn, intended for the general public as well as practitioners. You can find out more information about him at FunctionalGastroenterology.com and at his office website, HiveMindMedicine.

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. Dr. Weitz is also available for video or phone consultations.

 



 

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 listeners. Today I’m very excited to be speaking with Dr. Steven Sandberg-Lewis about reflux, which is a very common, mostly functional gastrointestinal disorder. Heartburn is the main symptom in reflux and is often described as a discomfort or burning pain felt in the chest or throat. It occurs at least once a week in about 30% of most Americans, and in up to two third of those with IBS. Heartburn can be caused by reflux of the gastrointestinal contents up into the throat or esophagus, or it can occur without reflux. Other symptoms of reflux include: regurgitation, chronic cough, sore throat, vomiting, hoarseness, chronic throat clearing, et cetera. Reflux is often used interchangeably with gastroesophageal reflux disorder or GERD, but there are other forms of reflux, including bile reflux and silent reflux, which is also known as laryngopharyngeal reflux.  The NIH website has now introduced a new term, G-E-R as distinguished from G-E-R-D to confuse us even further. This condition is very complex and confusing, and I’m hoping that Dr. Steven Sandberg-Lewis will help bring some clarity on this topic for us.

Dr. Sandberg-Lewis has been a practicing naturopathic physician for 40 years. He teaches gastroenterology at the National College of Natural Medicine and lectures around the world, and he wrote an awesome medical textbook, Functional Gastroenterology, which is now in its second edition, and everybody in the functional medicine world should have. And his new book is, Let’s Be Real About Reflux, Getting To The Heart of Heartburn. Dr. Steven Sandberg-Lewis, thank you so much for joining us today.

Dr. Sandberg-Lewis:          You’re very welcome, Ben. It’s good to be here.

Dr. Weitz:                           Great. Steven, let’s start by explaining some of the terms. What’s heartburn? What’s reflux? What’s GERD?

Dr. Sandberg-Lewis:          All right. So heartburn is a subjective sensation of burning, usually over the sternum, somewhere over the sternum. It can be really intense and sharp. People can feel like they’re having angina or a heart attack, and it has to be differentiated from that sometimes. It can also just cause chest pain. So some people, if they’re truly having some kind of distension of the esophagus, can either feel it as burning or as chest pains, just kind of depends on their nervous system. So that’s basically heartburn.

Dr. Weitz:                           And some of these patients are often wrongly diagnosed as having heart problems.

Dr. Sandberg-Lewis:          Or as having reflux when they really don’t.

Dr. Weitz:                           Right.

Dr. Sandberg-Lewis:          Probably the majority do have reflux, but there are many different types, so we’ll talk about that. But regurgitation is when fluid or food actually comes up into the throat or even the mouth, and that can be related to reflux. Of course, if material from the stomach is, that’s the next thing, reflux. If food or fluid from the stomach is moving up into the esophagus, if it continues to go up into the upper third of the esophagus or the throat, that’s regurgitation. People sometimes mistake that as vomiting, but vomiting is actually a whole separate thing. It’s a big process, but you can have regurgitation, which is kind of like when babies burp up their milk. That’s just called regurgitation and it’s a more minor kind of a thing, but can be quite disturbing.

Dr. Weitz:                           Okay. What are some of the causes of reflux and GERD?

Dr. Sandberg-Lewis:          All right, so you asked me to try to keep this simple.

Dr. Weitz:                           Yeah.

Dr. Sandberg-Lewis:          So tell me if I’m going off the deep end. So again, reflux can have to do with any fluid going through a tube. We talk about reflux, like you said, from the large intestine to the small intestine. That’s called cecoileal reflux or ileocecal reflux. Things moving backward toward the mouth instead of down toward the anus, which is the normal flow in the digestive tract. If things move from the small intestine, the duodenum, into the stomach, that’s called bile reflux. If things move from the stomach into the esophagus, that’s called gastroesophageal reflux, GERD.

                                                And the thing is, like you said, there is a term G-E-R, there is normal reflux that occurs. Some books say three times after every average meal, some food or fluid or gas from the stomach will move up into the lower esophagus and it doesn’t cause symptoms. So they don’t put the D on the end GERD, they just call it gastroesophageal reflux. Physiologic, it’s normal, but the saliva being swallowed every minute, a liter or more a day, excuse me, a liter or more a day of slightly alkaline saliva, pH seven and seven and a half, that helps to neutralize any acid that comes up. There’s also something called secondary contractions that contract the lower esophagus to move things down. There’s a lot of protective factors. There’s mucus production that coats the membrane.  So reflux doesn’t have to cause reflux disease, GERD, but it can if it’s prolonged enough or there’s enough volume of it, and especially if the esophagus and its lining is not able to protect itself. So that’s a lot of what I… You noticed I talk about that a lot in the book. Bolstering the protective factors in the esophagus.  So what causes reflux? Boy, I have that picture that I make. It has about 10 different things pointing all to heartburn and reflux-

Dr. Weitz:                           And by the way, it’s commonly referred to as acid reflux, but you’ve pointed out in your book and in your talks that only 20% of patients that you test actually have hyperchlorhydria or increased acid production.

Dr. Sandberg-Lewis:          Yeah, I got to say, not to make it more complicated, but I have to say when I do the Heidelberg test, I am noticing more people that make too much acid. But there are almost always people that have been taking proton-pump inhibitors and we have them stay off their proton-pump inhibitor whenever you’re doing any kind of acid testing, at least a week before you do the test. And I’m finding that so many of those people have rebound hypersecretion where they make too much acid now because their gastrin levels are so high from taking proton-pump inhibitors for a long time. It’s a real problem that I’m finding.

Dr. Weitz:                            Meaning the medication is trying to decrease the body’s production of acid. The body knows it needs acid, so it’s secreting the precursors to create more acid even though the drug is telling it not to.

Dr. Sandberg-Lewis:          Yeah. The proton-pump inhibitor prevents the parietal cells in the stomach from making acid. It blocks the proton pump in them that does that. And so the body, in its wisdom, it knows how important acid is in the stomach, will trigger the production of more and more of a hormone called gastrin. And gastrin, its job, its major job is to trigger the parietal cells to make more acid so that the gastrin level in the blood goes higher and higher and higher, but it can’t do anything because the parietal cells are inhibited by this medicine. You take the medicine away for a week and then do a test and all that gastrin is now stimulating a lot of acid production and it looks like they make too much acid. So what do you do? Oh, you better go back on that medicine because you make too much acid. Well, yeah, you do. It’s a real catch-22. So I prefer to mostly test people that have never taken proton-pump inhibitors because I think I’m getting a more realistic picture.

Dr. Weitz:                           There aren’t too many people like that with reflux now because that medication is handed out like candy and it’s over the counter now.

Dr. Sandberg-Lewis:          It is. I tell my students that it’s basically prescribed for any problem above the umbilicus. It’s not really a joke.

Dr. Weitz:                           No, I know.

Dr. Sandberg-Lewis:          So the major causes of GERD, let’s just make a little list here. A big one would be sliding hiatal hernia. And that of course is when the stomach, the upper two centimeters or three centimeters of the stomach on the average move up through the diaphragm into the chest that just engages the lower esophageal sphincter that normally protects from reflux. It moves it up a couple of centimeters, and now it’s not engaged with the diaphragm. The diaphragm is a muscle, if people don’t know that. It’s a big flat dome-like muscle, and it’s very important for a lot of things. Of course, it’s the separation between everything that’s in the chest or thorax from the abdomen.

                                                And the digestive tract travels through the chest, the esophagus, and then has to meet up with the stomach, which is below in the abdomen underneath the diaphragm. And so that diaphragm muscle is supposed to hug that connection where the esophagus meets the stomach, it’s called the lower esophageal sphincter, and that’s a really important relationship. So when you move the stomach up, you don’t have that anymore. You lose a lot of the muscle function of the anti-reflux valve.

                                                Another common reason is people who overeat and people who eat rapidly. And I guess part of it is when you eat rapidly, you can overeat because you don’t get the signal to your brain that you’re already full. But overeating or anything that causes more distension, rapid distension of the stomach, especially if there’s gas production in the stomach, people who have enzyme deficiencies and bacterial overgrowth in the small bowel or the stomach. When there’s more gas in the stomach, that valve, that lower esophageal sphincter will open to let the gas come out as a burp. That’s called a transient lower esophageal sphincter relaxation. It’s got that lower esophageal sphincter right in the middle of it. And when that happens, that valve can stay open for up to 20 seconds.

                                                Now, normally that valve is closed all the time, it’s right at the top of the diaphragm. It’s closed. The food moves through the esophagus, takes less than 10 seconds to come down. When it gets to the lower esophageal sphincter, it opens up, food moves through, it closes, a second, maybe two. But when it stays open for 20 seconds or up to that amount of time, and it does that periodically to let the gas out and people are burping, burping, you can have a lot of intense reflux during that. So that’s another important point.

Dr. Weitz:                            This is also why SIBO can be a cause because you get all this gas.

Dr. Sandberg-Lewis:          Yeah, there’s a whole chapter on that in my book about the differential and pressure from all those parts per million of gas below the diaphragm pushing things up.

                                                I’d say another important reason why people get reflux is food sensitivity. So individual food sensitivities. For one person it might be white potatoes. For somebody else it might be corn. For somebody else it might be dairy products. And if they find out what they’re sensitive to and remove it, they don’t have reflux anymore. So those are some common reasons. There is, of course, the whole question about is it acid reflux? According to some pathology books, over age 60, the incidence of atrophic gastritis in the US is over half the population. That means those people don’t make enough stomach acid in atrophic gastritis, chronic atrophic gastritis. And even so, you can have just the same kind of heartburn symptoms with not enough acid as you can with too much acid or normal acid. Most people have normal acid that have reflux. It’s not that they have too much acid, it’s it’s getting up into their esophagus, and if their esophagus doesn’t have the protective mechanisms to protect itself from that, they can have all kinds of severe heartburn and even esophagitis.

Dr. Weitz:                           And how many of them don’t have enough acid, so the food is not getting properly broken down?

Dr. Sandberg-Lewis:          Well, again, it depends. When we do a Heidelberg test, there are two kinds of hypochlorhydria, two kinds of not enough acid. There’s what we call frank hypochlorhydria, which means on a Heidelberg test, the patient swallows a capsule. The capsule has a low frequency radio telemetry device in it, and it feeds the pH of the surrounding solution in the stomach to a computer and we see the readout. If the patient swallows a capsule… Like the other day, I had a patient, he swallowed the capsule, the pH was 5.5 or six, stayed right there. Well, we could have said, all right, you don’t make enough acid because the pH should be definitely less than three. And usually it’s less than one. Very acidic. Seven is neutral for those that aren’t familiar with the pH scale. So what we do is sometimes when you see that, you have to give the patient one piece of popcorn to eat and have them swallow it with a little water because-

Dr. Weitz:                           One piece of popcorn.

Dr. Sandberg-Lewis:          … popcorn is… They’re fasting, so there’s no food in their stomach. One piece of popcorn when you swallow it with a little water will move the capsule down out of the esophagus into the stomach. It’ll plop into the stomach if it’s stuck in the esophagus. And that’s what we saw there. It works every time. It’s really great. So all of a sudden it goes from 5.5 or six, dunk, goes down to 0.5. It’s now in his stomach and he makes plenty of acid.  So then we periodically give him a small amount of bicarb solution to neutralize the acid and bring the pH… As soon as it changes, we see the pH go back up to six and we see how long it takes him to make enough acid to bring the pH back down to where it was at the first of the test. And if it takes longer and longer, and sometimes eventually it takes 20 minutes, 30 minutes, it’s just staying neutral at alkaline, that’s when we know that they have what we call hidden hypochlorhydria. So you can have frank hypochlorhydria right away, or you can see it when you test the stomach to see how well it can make acid and it fails to do it after a couple of challenges. So I’d say that’s the 40 to 50% of the population that has low acid production.

Dr. Weitz:                            Okay. One of the things I wanted to bring up is this concept of H. pylori, which I know you’ve discussed in the past on other podcasts. H. pylori is this bacteria in the stomach, and it’s common to think that this might be playing a role in acid reflux because the theory is that this is a major cause in increased acid in the stomach, and that’s how it leads to potentially ulcers. And therefore there’s this concept that we should test for H. pylori, and if we see it, we should try to eradicate it and that this might be beneficial for reflux.

Dr. Sandberg-Lewis:          Yeah. There’s a little bit of truth in that about increased acid production, but that doesn’t necessarily mean reflux. So the most important thing to understand is H. pylori was discovered as a cause of peptic ulcers, stomach and duodenal, especially duodenal. It can also cause a few other diseases, and it’s kind of a long list, but the major ones can also cause a type of lymphoma that occurs in the stomach called MALToma, and it can cause gastritis of course, and it can increase the risk of stomach cancer. So the thing that most people and most doctors don’t realize, and this is all over the research for H. pylori, is that H. pylori, it lives in the stomach. It can either take up residence in the entire stomach or just in the antrum, which is the very bottom.

                                                Usually it’s in the entire stomach. And we think until probably the 1920s or so, a hundred percent of the world’s population had H. pylori in their stomach. Since antibiotics were invented in the ’20s and ’30s, and more and more generations have lived through being treated with antibiotics throughout their lives, H. pylori has dwindled somewhat. And now since it was discovered in the early 1990s and now the dictum is test and treat, meaning if you test somebody and it’s positive, you find H. pylori, you kill it with usually two antibiotics plus a proton-pump inhibitor.   And the problem is H. pylori is actually… If you read the research on H. pylori’s protective effects, H. pylori is the major bacteria in the gastro biome, in the group of bacteria that live in the stomach. There’s esophageal biome, there’s gastro biome, there’s a small intestine microbiome and a large intestine microbiome, and there’s oral biome. There’s different bacteria and viruses and fungi in different parts, and they belong there. And H. pylori is the central bacteria in the gastro biome in the stomach.  It’s really important for newborns and kids in their first couple years of life to fully mature the immune system in their gut. And it turns out that besides protecting against allergies, eczema, asthma, hay fever, H. pylori in the stomach is a major protective factor against reflux and the complications of reflux, which include Barrett’s esophagus and cancer of the esophagus. So H. pylori is really important in reflux because it protects against reflux, not because it causes it. And the research is all clear about that.

                                                On the other hand, remember I said you can either have H. pylori living in the whole stomach or just in the antrum, the very end of the stomach. When it’s antral predominant, which is maybe 20% of the time, that can trigger more gastrin production and stimulate more acid to be produced. In that way, it can be a cause of stomach ulcers or duodenal ulcers from too much acid. The other 80% or so of people, they actually make too little acid.  And actually, according to the research, everyone when they first get H. pylori, which you should get when you’re a kid, but most people don’t anymore, they make too little acid for the first three months. They’ll make hypochlorhydria, too little acid. And then depending on whether it’s in the antrum or the whole stomach, they’ll either make too little, most people, or too much about 20%. So the people that have the antral type are more prone to ulcers. And the people that have what’s called pangastritis, their entire stomach having H. pylori, they’re more prone a slight increased risk of getting gastric cancer, stomach cancer later in life. And they’re more likely to possibly develop reflux from not enough stomach acid. Again, you can get reflux from too much or too little, but H. pylori in general is protective against reflux and its complications.

Dr. Weitz:                            So now I’d like you to do a little exercise where we go through a patient who comes into your office with heartburn reflux symptoms and how you would work them up. And then also keeping in mind that you’re a gastroenterologist. Most of the listeners are not, and if we’re practitioners, we’re often on the functional side of things and maybe the patient has seen a gastroenterologist who’s done maybe an endoscopy and maybe typically doesn’t see any erosive damage.

Dr. Sandberg-Lewis:          All right. First of all, if the patient’s already had an upper endoscopy, please get the results and look at them. And get