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Dr. Maggie Ney discusses Bioidentical Hormone Therapy at the Functional Medicine Discussion Group meeting on April 25, 2024 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

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Dr. Maggie Ney is a licensed naturopathic doctor and a Menopause Society certified practitioner. She’s the director of the Women’s Clinic at the Akasha Center for Integrative Medicine in Santa Monica, California, where she has been supporting women through perimenopause and menopause since 2006. Dr. Ney is co-founder of HelloPeri, (TheHelloPeri.com) an online resource for women going through perimenopause, and she’s been featured on The Doctors show and Goop for expertise on women’s health and hormones.  Her website is DrMaggieNey.com.

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

 

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Podcast Transcript

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

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Our two sponsors are Integrative Therapeutics and DUTCH Testing. And if you’re not aware, Integrative Therapeutics is one of the premier,, professional brands of supplements available.  we use a lot of their products in our office. One of their,  most exciting products is their specialized form of curcumin called Theracumin, Theracurmin.  And now they have an even more specialized, more highly absorbable form called Curalieve. They have many other products that can be helpful for hormonal balance as well.

 

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And now we have our other sponsor for this evening is, Dutch Testing, Precision Analytical Labs. And so we have Noah Reed here to tell us a little bit about Dried Urine Testing:

Noah Reed: Yeah, thanks for having me.  I came down from Oregon, so glad to be here with you today.  DUTCH stands for Dried Urine Testing for Comprehensive Hormones, so that’s what the acronym DUTCH stands for.  It’s a four spot dry urine test, so waking two hours later, dinner, and bedtime.  It gives you the average of the sex hormones throughout the day, so it can mirror 24 hour urine, but it’s a little bit easier to collect, because it’s just on a little filter paper. that the patient takes at home, gives you the metabolites, so how the body is detoxing the hormones. You also get adrenal health with that, so you can be able to see the four points of the cortisol curve throughout the day land you see the metabolites of cortisol, how much cortisol is being made and how the body is processing it.  It gives you a little bit of an interesting view there, and then a very small organic acid panel, , gives you melatonin production through the night and 8 hydroxy 2 deoxyguanosine, or 8 OHTG, which is the oxidative stress marker, all in one, easy to use, test that the patient does at home.  We do have doctors on staff, 12 doctors that can walk you through the interpretation as well, so that you can become the hormone expert for your patients.  So that’s a little bit about the DUTCH test. If you have any questions, I’ll be here.  I’d love to answer any more questions for you.  We do kind of pride ourselves on the three things that make us unique.  Our comprehensive, a comprehensive report that’s visually appealing for you to be able to understand your patient’s story. , the support from our clinical clinicians on staff. , and then everything that we do is backed in peer reviewed journals. , so every analyte that we have on our test is actually put in a peer reviewed journal.  Our most recent one that we’re proud of is we were published in the journal Menopause, so we were the first functional test, , to actually be published in the journal Menopause, , showing the efficacy of testing and monitoring, , hormone replacement therapy, , as a part of your patient, , experience.  So, that was a big feather in our cap to be a part of that, and we’d love to talk more about it if you have any questions. 

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Dr. Weitz: Thank you so much, Noah. Our speaker for this evening is Dr. Maggie Nay. She’s a licensed Naturopathic doctor… Unless you want to introduce yourself?  That’s fine. Yeah. Okay. Okay.

Dr. Maggie Ney:  Hi, everybody.  Hi. I’m so excited to be here.  I’m really passionate about women’s health and perimenopause in particular. I find it a very underserved area in the market. So I love to educate women and practitioners, and would love for this to be interactive if you guys have questions, but, I’ll start a little bit about introducing myself.  I’m a naturopathic doctor. I graduated from Bastyr University in Seattle in 2006. I currently co direct the women’s clinic at the Akasha Center for Integrative Medicine, which is like a few blocks away. Thanks I recently co-founded Hello Peri, which is an online resource really devoted to educating women about perimenopause.  I’m a certified practitioner by the Menopause Society. And again, I just really like to help women thrive through the perimenopausal period with a sense of empowerment. I’d like to provide the resources, tools, strategies needed to support hormones and for women to truly feel incredible because I do think this is the time when women can absolutely get after all their dreams, right?  This is the week in Chinese medicine, right? The second coming. You can choose your own path, write your own script, but gosh, it helps to feel really good to be able to do that.

Speaker: Yeah, I don’t think so. You know what? I’ll, I’ll, and she’s like, well,

Dr. Weitz: I can do it. I’ll, I’ll do it. I got it. I got it. I’ll do it. I’ll do it for you.

Dr. Maggie Ney:  Thank you.  I use so many pronouns, so I do just want to just really quickly say however you identify your patient. I do, I do use she/her to identify women, but I know that, you know, everyone identifies a little differently.  But just for the sake of being clear and not too wordy, as you can know, I chat a lot. So. We’re going to, everyone is included. However you or your patients identify yourself. Just want to put that out there. Alright, we can move on. Okay.

So really briefly, let’s just review the four basic hormonal stages that women go through.  So first we have the pre menopause time, which is basically from when you get your first period up until when you start perimenopause. Perimenopause is this time when our higher quality eggs start to decline, and we begin to experience more fluctuating hormonal levels. So women can start to have, , women can have the regular period, but start to have these symptoms, which we’ll get into, and you can still get pregnant.

But the regular rhythmic flow that women used to experience with the regular upping of the estrogen, the decline, progesterone being produced during the second half of the cycle, doesn’t happen as predictably. Menopause, technically, it’s one day, it’s the one year anniversary since your last menstrual period.  And then everything after is the post is post-menopause. I prefer to use post-menopausal years because we get a little hung up on, I’m after menopause, it’s done, it’s over, I’m through it.  But really, once you’re in post-menopause, the hormones are low and you’re going to have low hormones till the day you die.  So it’s not like you’re through with it, you’re in it, really. Symptoms can absolutely change, though, throughout that time.

Okay, so let’s talk a little bit about the unique needs of perimenopausal women. So, again, this is the period of time leading up to menopause. Hormones can start to fluctuate and symptoms can occur in your 30s. For some, sometimes late 40s, and perimenopause is not always a con Do you guys hear me okay?

Perimenopause is not always a constant symptomatic phase. Symptoms can flare with times of higher stress, and this is a hallmark, is that during this perimenopausal time, hormones become even more sensitive to stressors. Right? So if you’re Whatever could be situational, lack of sleep, poor diet, if our body’s at all under stress, our hormones are more easily affected.  Symptoms can last really on average between four and ten years. And I just want to just highlight that. If you’re feeling like crap, I mean that’s a very long time. And once a woman has gone a full year without a period, they’re in menopause. And again, it’s the one year anniversary without a period and patients that are post menopause.

And lifestyle changes become more important than ever during this time, right? Sleeping, hydration, nutrition, movement, dress management, quality relationships, can dramatically affect how a woman experiences perimenopause, right? I always say to my patients, Yeah, in college you can stay up all late, you can drink beer, eat pizza at midnight, wake up and like, go to classes and feel like, happy on your A game, but that just doesn’t happen.

How are you? It’s not like, I would say again, like, you can continue to age with the same level of energy and vitality, even more so than when you were younger, but how we treat our body matters, and it matters more now.  Okay, so I didn’t really say this, but I am going to focus here mostly on hormone therapy, because this is an area that is really not understood most of the time.  Practitioners and women don’t feel like this is an option during the perimenopausal period, so I like to educate on this. But again, if you have questions about some of the other treatments, please ask me.  okay, so, yeah, so, again, we focus on the lifestyle piece. There are vitamins, there’s minerals, there’s herbs, there’s homeopathy.  I know you guys are well trained in this area. That can be helpful. But a lot of women do need that extra hormone support during this time to really feel their best. And most important, all women need to have a conversation. Right, I, this is what fuels me, is that women are denied the option. Women aren’t given the full amount of choices that they can use during this time.

So the benefits of HRT really is greater than the risk for most [00:10:00] symptomatic women. Currently, I think the most recent numbers is like 4-5 percent of women are on hormone therapy, when really upwards to 80 90 percent would be excellent candidates. Doctors and other healthcare practitioners are not getting good training in their schooling to be able to recognize and how to use hormone therapy safely and comfortably. I talk to a lot of doctor colleagues, they just don’t, they know it’s okay, but they don’t feel comfortable.  Okay, so, again, just again to speak about the unique needs of a perimenopausal woman, I’d just like everyone just to be aware of, perimenopausal women are usually in the sandwich generation, right?  They’re at a time in their life where they’re experiencing these hormonal fluctuations that can affect all aspects of our body, mood, brain health, energy, and the ability to manage stressors. At the same time that our lives are often more demanding and stressful. Many women are at the key of their career while also taking care of their own children and aging parents.

And this is a time for patients really to focus on lifestyle more than ever and prioritize personal health and hormone education so they can really show up As their best version of themselves. And for many women, it’s simply a perfect storm. That the hormones and life stressors are happening at this exact time that hormones are shifting.  So, a comprehensive approach to perimenopause. We’re looking at, well, we definitely want to get a very good past medical history. A thorough understanding of their current symptoms, family history, lifestyle. So important to know our patient’s health goals. Because that can help individualize our treatment plan.  And focusing on things like nutrition, hydration, movement. And for the perimenopausal women, it’s really about getting good cardio resistance, right? Lifting weights is more important to build that muscle because we lose more bone mineral density as we go through the perimenopausal journey, so we need to focus on building muscle because it’s good for muscle, it’s good for bones.  Women need to focus on balance and stretching. For nutrition, keeping blood sugar stable, metabolic flexibility, optimizing protein intake, but again, all the other things, morning sunlight, quality relationship, joy, stress management, addressing gut health, supporting detoxification pathways, targeted supplements, and hormone therapy, and if you can include all this in your plan, you’re doing comprehensive, perimenopausal care.

So, I, a few points I want to make that come up to me as a naturopathic doctor. Gosh, I, I’m a natural, I like to call it naturally, they do things naturally. I want to support the natural process of my body and I’m supposed to go through menopause. Why don’t I just honor that and accept it? It makes sense, but we all need to question what is natural these days.

Like, are we supposed to live to 80 and 90? Are we supposed to be? You know, super physical and active mentally and physically. I mean, I know I want to be. I want to be super active and having fun and hiking up until the day I die and, and we’re living longer than ever. We used to die just past menopause and now we’re living, you know, up to half of our life after menopause and to have an expectation that we can do that with the same level of energy and vitality As we did when we were younger, it’s not realistic for most people if they’re not using phones.

For some, yes, again, it’s individualized, but we just need to be aware of this. And there are risks, I’m not quite done, there are risks to not addressing our patient’s health as well. Hot flashes and night sweats aren’t just annoying. They’re not just something you need to embrace and move through. There are consequences to it.  We know that it obviously can disrupt sleep, which can affect every aspect of our life. But there’s also more vascular inflammation when women experience hot flashes and night sweats, which does put them at higher risk of heart disease and dementia.  also for women, Depression and suicide rates are skyrocketing for mid life women.

It is true that [00:14:00] suicide rates for mid life women is, it peaks then. And if a woman is presenting for the first time during this time period with new onset depression or reoccurrence, then it really truly needs to be taken very seriously and we need to recognize and, and discuss the hormonal component as well.

So what’s happening hormonally specifically during perimenopause? So, basically, our estrogen starts to behave a little bit more erratically. So, during the pre menopause years, our estrogen in the follicular phase basically starts off low and basically steadily increases. It gets to a certain point where it signals to the brain to release luteinizing hormone, which triggers the egg to be released, so we ovulate, there’s a little dip in estrogen, and then it boosts back up again, and then it drops.  And then,  during perimenopause, that estrogen just doesn’t really have rhyme or reason. I mean, some months it can [00:15:00] go regularly just like that, and other months the estrogen is just up and down and up and down and up and down throughout the cycle. And women feel it because our brains like stable hormones.

They just do. We do better. That’s why women, have a little mood issue. Sometimes we’re out of population and obviously during the premenstrual time when we’re PMSing, it’s because of these drops in hormones that trigger changes in our neurotransmitters that can affect our mood. So, again, these estrogen fluctuations can lead to more unpredictable mood changes.

70 percent of women in period menopause have mood changes. Anxiety, depression, irritability, moodiness, less able to manage day to day life and depression. And stressors feeling less resilient. So, the stressors that we used to be able to handle with ease can just feel too much. Estrogen fluctuations can also be a trigger for headaches, more aches and pains, and night sweats and hot flashes.

And then, as [00:16:00] progesterone starts to decline, so often during early period menopause, it’s progesterone, which is the first hormone to drop. That will show up in our clients and our patients as difficulty sleeping, difficulty turning our brains off at night, feeling more anxiety on edge, and then having shorter cycles.

So, if you were a 28 day girl, maybe you’re more 27, 26. Which is why it’s really helpful for our patients to track their cycles so we can begin to recognize those subtle shifts.  heavier cycles and more spotting between periods. So these are separating a hormone and getting an idea of what symptoms can be related to what hormones.

And because perimenopause can really be a decade, I do think of it as early versus late perimenopause. Where the earliest symptoms really are the symptoms of that lower progesterone, which we just spoke about, where periods can start to come a little early, sometimes you’ll have two periods in one month, you have heavier periods, [00:17:00] clottier, heavier flow, lower libido, ruminating thoughts, anxiety, depression, less resilient, sleep issues.

And then the later period menopause, you were really starting to see women skip their cycles. You just know you’re kind of later in the transition, you know, maybe go three months, four months.  and then you’ll have more likely women will experience those typical symptoms that we think about. Palm flashes and night sweats that don’t dryness.

So why, I think this is important just to highlight, why? Why are we not talking about this? Well, first, there’s just a lack of training. As I said earlier, there was a recent study that a lot of OBs said that they got maybe an hour of training on how to support menopause, not even perivenopause. So, I always tell my patients who come in, they’re so upset because they feel so ignored and not heard by their doctor that their doctors are probably pretty well intentioned.

They’re just not educated.  there’s certainly a [00:18:00] lack of research and there’s an under representation of women in medical studies.  due to historical biases and also a lot of women have been excluded from studies simply because their hormonal fluctuations are just too hard to control. So let’s just not include them at all because men are much more stable.

And I think it was only in, up until, I might be butchering this, it’s like the early 90s when women had to be included in studies for,  medications to be approved. So that’s all very recent. What doctor do you see? Seriously, if you, if you’re depressed, you’re anxious, you’re having heart palpitations.

You’re irritable, you have headaches, I mean, who do you schedule with? There’s not really one central hub of a person. So that’s why so many people see their therapist, a nutritionist, their primary, a neurologist because they’re getting headaches and tingling, a cardiologist because they’re getting heart palpitations.

And women don’t feel heard or answered. And then there’s simply a shifting narrative. Our narrative of aging has changed. We are not [00:19:00] just going to slow down, right? It’s the 50s, it’s the new 20s, like we, we’re not slowing down, we are active. And our, so our expectations of ourselves We’re not willing to slow down, but there’s just no support, really, in the medical, conventional medical community of how to keep up with that changing narrative.

I just think this is really important because there’s so many symptoms associated with perimenopause. So the most common one are period changes. It’s one thing you can ask from your clients, like, have your periods changed? Some people don’t know, which is why it’s important to track your cycle so you can begin to see mood changes.

Over 70 percent of women experience mood changes during perimenopause. And there was a study that came out a few years ago. They actually studied the term I don’t feel like myself. I mean, how many times have we heard that from our patients and clients? I don’t feel like myself. This was actually studied, I think it was published in Menopause.

I don’t actually know what exactly it was, but it was studied, I mean published, but they studied that and over 70 percent of women [00:20:00] said I don’t feel like myself more than 60 percent of the time over a 12 week period. So, it’s really common. And then so we have the period changes, the mood changes, And then the menopausal symptoms like hot flashes and night sweats and vaginal dryness.

But these other ones are important, and we’ve touched upon them, but less resilient, more irritable, mood swings, heavier menstrual cycle, irregular cycles, tender breasts, headaches, fatigue, brain fog, we, I know we’ve heard that, right? Lack of focus, forgetting where you put things, decreased libido, anxiety, weight gain, worsening PMS, hot flashes, dry skin, changes in body odors, bloating, insomnia, night sweats.  Burping, constipation, worsening allergies, ringing in the ear has been associated.

Dr. Weitz: I thought weight gain was caused by Ozembic deficiency. Ha ha.

Dr. Maggie Ney: Rowdy nose, post nasal drip, hair thinning.  hair loss, more facial hair, heart palpitations, achy joints, [00:21:00] frozen shoulder, right, things that come up in, you see it more in menopausal period, menopausal women, burning tongue is another one, more frequent vaginal infections like yeast or vector vaginosis, not recovering as well after exercise, itchy skin, problems in skin sensations, dizziness, and electric shock sensations.

I list them out because there’s so many. And I always say, like, you need to go get worked up and other things ruled out, but once you do, then you focus on the peri.  and so perimenopause is a clinical diagnosis based on symptoms alone and ruling out other causes. It’s really important because I see people come in, they say, my doctor took my blood and it’s normal, so I’m not in peri.

How often have we heard that, right?  our hormones just fluctuate too much throughout the cycle and cycle to cycle to really be, it’s just, it’s just not based on labs. So we can do a [00:22:00] blood test and rule out peri. You can certainly do a blood test and I think there’s a later slide and it’s suggestive of perimenopause.

We’ll get into that. But, it’s really based on how are you feeling, tracking your cycles, recording your symptoms, and then labs to rule out other causes of your patient’s symptoms. So the main ones, right, that overlap most of the ones, of the symptoms I talked about, are your thyroid, anemia, and autoimmune disorder, vitamin D, B12 deficiency.

So conventional guidelines, true, perimenopause. Hormones change throughout the month and throughout the day, and this is all true, and I share that with my patients. But! There’s really no controversy about testing hormones for fertility, right? Our patients go day two, day three of their cycle, get their FSH tested, maybe get an AMH, get an estradiol, and that speaks to their egg quality, right?

If you do fertility, you’re familiar with it. If, like, this third day of your cycle, your FSH is high, that’s saying low, poor egg [00:23:00] quality. So Anyway, you can kind of extrapolate from that, that maybe you’re more in, in the period zone. But, normal hormones, normal other labs do not exclude perimenopause. They simply provide a little bit more information.

Okay, so, basically, things that are suggestive of perimenopause, but not diagnostic.  and again, I, day 2 or 3, if your FSH is above 10, it could be suggestive. Estradiol above 60 with an FSH could be suggestive of perimenopause. And AMH under 1, suggestive of perimenopause. And then as long as you’re getting those basic, you might as well get a baseline of your other hormones too.

And this is through blood.  Okay, I think I said that. So, oh, so what hap This is important. The definition of menopause is, is, I think, horrific. Right? It’s based upon if you’re getting your period. There are so many women who don’t get their period. Either they have an [00:24:00] IUD, or they don’t have an IUD. They have a hysterectomy.

They have an ablation. So how do you know if you’re in menopause? Well, it really doesn’t matter, right? Menopause is just that one day. But what are some, what are some suggestive? So an FSH above 35 and an estradiol less than 20 on two separate occasions is suggestive of menopause. An AMH less than 0. 2 is suggestive of menopause.

Speaker 6: The slide before, you said it was FSH above 10, but an estrogen above

Dr. Maggie Ney: Yeah, so basically, it used to be that we just checked FSH. And so, if your FSH was a seven, that would be great, you’re good, you’re not impaired, you shouldn’t get pregnant, you know, from a fertility perspective. But, because estradiol, which is released by our ovaries, is the, is the hormone that the brain picks up, To say it doesn’t need to make FSH.  So FSH is the hormone the brain releases to tell the follicles of the ovaries to grow to make [00:25:00] estrogen. So during perimenopause, when things are a little erratic, our estrogen can actually be high on the second day of our period when it really should be low. And if it’s high because of just being in perimenopause and lower egg quality, then it can falsely lower that FSH.  Does that make sense? Yeah. Okay. That’s true.  I mean, this is just comprehensive blood work that I will do if someone’s in, you know, who’s seen me, who’s not, I don’t feel like myself. So, basics. And then we have the Dutch test, which,  I wanted just to give a shout out to. And again, just another way to assess hormones and how you’re metabolizing hormones.

Speaker 7: Yeah, we didn’t quite get that. Oh, sure. Okay.

Dr. Maggie Ney: So basically,  I can talk [00:26:00] about this for a second, but CDC, you want to look at ruling out anemia, your metabolic panel, that’s the basics, your glucose, your electrolyte, your liver, kidney function, basic lipid panel, maybe you guys know, in functional medicine, we’re often doing more of the detailed lipoprotein particle size, but just the basic lipid panel.

Inflammation with your HsCRP, your SED rate, homocysteine is, again, a marker for vascular inflammation. I like always to get a fasting insulin for a metabolic health marker. Your hemoglobin A1c, which is that three month average of blood sugar. TSH is the overall thyroid health marker.  Free T3, Free T4. Sometimes I’ll order the antibodies.  Sometimes I’ll order the reverse T3. Not every single person gets that. A vitamin D, a magnesium, maybe 12, a folate, ANA if you’re presenting with more of those joint pains, and,  fatigue even, and then the hormone testing that we’ve spoken about. I didn’t mention this, but progesterone is a hormone that’s only produced when we [00:27:00] ovulate, so it’s always going to be really low that first few days of your cycle.

You know, if you get your hormones done day two, three, your progesterone’s always going to be low. So, you only produce progesterone after you ovulate, so just the last two weeks of your cycle. So, if you want to get an idea of where your progesterone is, you would time your Dutch test, you know, a week before you expect to get your period, or a week after you ovulate, or you would do your blood test, again, a week after you ovulate, or a week before you expect to get your period.

Dr. Weitz:  I just wanted to point out, for patients where you’re not sure where they’re at, their hormones are fluctuating, Dutch offers a cycle mapping, so you can test your hormones every day, during the course of a month, and kind of see what’s going on.

Dr. Maggie Ney: Yeah, so if you’re a period, you can see some of that more erratic estrogen.

Speaker 7: Yeah? How about if someone is already in their menopause and you want to talk to tweak their hormones? I mean,

Dr. Maggie Ney: personally, I don’t, I go by symptoms. I go by symptoms. If they’re in menopause, they’re not bleeding, I [00:28:00] go by symptoms, I see how you’re feeling, and I might do a blood test to make sure your number’s, number’s not too high, or if they’re not feeling optimal and their levels are very low, then I’ll increase.

Speaker 6: For the Dutch panel, do you order that at the beginning of treatment or is it like, throughout treatment? I don’t,

Dr. Maggie Ney: I mean, I think the Dutch panel is amazing. I don’t necessarily order on every single person, to be honest. It’s not mandatory.  I do discuss it with my patients if they’re curious to dive a little deeper or if they’re having any of the symptoms that I think I would need further support with looking at the,   Metabolizing hormones.

But I would say I like to, when I, I, I think if I’m going to like choose a time to do it after they’re on the hormones. ’cause I want to see how they’re metabolizing the hormones and make sure they’re going down the good pathways because you can feel amazing. It’s true. And still be maybe pushing it down before pathway, right?

For hydroxy estro pathway where you would want to do some more antioxidant work and try to push more towards the two pathway. So [00:29:00] I, if I get them stable on a good dose of hormones and I then I really want to dial in on.  for their support of how they’re metabolized, because it’s not just about how much hormones you make that control how you feel, but it’s also how you metabolize and clear hormones.

So let’s talk a little bit about hormone therapy, because there’s so much confusion. So let’s just get really clear on a few things. HRT stands for hormone replacement therapy, and it’s an umbrella term. It includes bioidentical hormones and synthetic hormones. And so, bioidentical hormones, I mean, I think it’s, it, it has been considered now kind of a marketing term.  That’s what a lot of the conventional doctors will say. It’s marketing, and, and I sort of agree, but it does, it does have a meaning. It means that the hormones have the same molecular structures as our own hormones. And they

Speaker: don’t come from

Dr. Maggie Ney: horses. They don’t come from horses, right, like primarians, and we’re going to talk about that.

But, oh, I mean, I need to, no, that’s a legal question.[00:30:00]

So HRT is the umbrella term in cough. It stands for hormone replacement therapy. Technically, when you’re talking about using hormone therapy for perimenopausal women and menopausal women, the correct terminology is MHT, menopause hormone therapy. Hormone therapy is another term that is kind of the correct usage and the reason usage because HRT technically is about replacing lost hormones.

So if you’re 27 and you’ve gone through early menopause, premature menopause, then you would be on HRT. You would be on a much higher dose of estrogen to replace it. But we’re really using low dose hormone therapy, and it’s a technicality like tomato tomatoes, but I want you to be aware of it because it’s slowly changing.

when people are talking about hormone therapy. So HT is used a lot, like hormone therapy,  ET, EPT is estrogen and progestin gin. So progestin gin is another umbrella term that includes [00:31:00] bioidentical progesterone or,  progestin. So it’s an umbrella term. And then BHRT is bioidentical and then, you know, HT, HRT, MHT are often used interchangeably.

So synthetic hormones, they’ve just been chemically older. They’re not identical. To human hormones.  so let’s just talk about what are some examples of the synthetic hormones. So there’s Premarin, which is what Ben was just talking about, conjugated equine estrogen.

Speaker: Come about? Let’s give, , horses hormones to women.

Dr. Maggie Ney: Well, okay, it actually came about because they used to,  grind up human ovaries to start, and then they would use pregnant women’s urine. And that was got, like, you can’t produce so much of it, so then they, the horses were the next one, so.  Oral birth control pills, it has ethanol, estradiol, which is a synthetic estrogen.

[00:32:00] A marine IUD contains a synthetic progestin, right, it has the levonorgestrel. And, I mean, this is nitpicky, but it’s true, just because something’s synthetic doesn’t make it natural, right? Horse urine is, it’s still natural. I just, I’m just putting, it definitely elicits the ick factor, but as we were talking about correct terminology, it just means that it’s chemically altered.

It’s not identical to our own hormones. And then bioidentical has the same molecular structure as our own hormones. So, bioidentical hormones are plant derived, so they’re made from soy or Mexican wild yams. They’re converted into hormones in a laboratory that have the same molecular structure as our own hormones.

There is no soy or yam in the final product. But because bioidentical hormones look and behave like our own hormones, They can naturally integrate into our own body’s physiology to help restore hormones balance better.  and then there’s, and this is important. There are [00:33:00] FDA approved bioidentical options, meaning you can get them at CVS and RiteAid bioidentical hormones or compounded hormones.

So let’s talk about the FDA approved bioidentical hormones. This is an area, I’m telling you, people are really confused. They want to talk so much about, I want to go bioidentical, I want bioidentical. I see patients come to see me. Asking for bioidenticals, and I say, what are you on? I’m on the patch. I’m on the estradiol patch.

That is a bioidentical hormone. So, again, it’s about just clearing up the misinformation, educating our patients, and together coming up with the best choice for them. So FDA approved means the hormones are evaluated for safety and effectiveness. All the FDA approved bioidentical hormones are dispensed with package inserts, containing extensive product information with detailed risks, potential side effects, they’re commercially available, you can get them at any pharmacy.

And so, some examples of FDA approved bioidentical hormones that are available right now are the estradiol [00:34:00] patch, the gel, there’s a spray, there’s a ring, there’s an oral tablet, there’s vaginal estradiol cream that works locally, not systemically, there’s progesterone capsules, and there’s DHEA vaginal inserts.

So those are all the bioidentical, FDA approved. So let’s talk about the compounding hormones. So the advantages of using compounded, they allow for different routes, dose, formulations. They’re just not available through a regular pharmacy. You can,  allows for products with the fewest ingredients. So commercial products tend to have more inactive ingredients.

I will say, like, vaginal estrogen is so important for women, like, everyone should be on it as they go through menopause because most, I think, 100 percent of women have some sort of vaginal dryness that can affect the genitive urinary syndrome, right? More frequent urination, more prone to UTIs. [00:35:00] And I prescribe vaginal estrogen all the time.

It’s definitely underutilized, but the commercially available one has parabens in it. It just does. And I I don’t, it’s one of those things when I talk to people or I’m out in the medical community, it’s like, it’s so underutilized. It’s like taking food away from starving children and saying, oh, but it’s not organic.

It’s, it’s kind of like that in my mind, so I want it out to everyone. I, but to savvy functional medicine practitioners, like, that’s just something to be aware of, that the vaginocin does have parabens. So I will let my patients know. I mean, some of them don’t care, you know, that’s fine. And some are like, I do everything I can to avoid parabens in my skincare, so can we get this calm?

 and then if you have like,  mast cell sensitivity patients, people who have really reacted just to everything, then I go towards the compounding pharmacies. So what are the common compounded hormones? So we’re going to talk a little bit more about testosterone, but there is no FDA approved testosterone hormone for women.[00:36:00]

So you can get a compounded. Estriol is a weaker form of estrogen. It’s great for vaginal dryness and there’s some great studies on it. Sometimes I’ll get compounded estrogen and testosterone. We talked about how everyone should be on estrogen cream, but there’s a boatload of androgen receptors in the vaginal tissue that respond very well to testosterone.

 there’s VIAS, which was really popular after the Women’s Health Initiative study, if you remember all that study that came out in 2002. We can talk more about that if you’re curious. And then progesterone capsules, the pharmaceutical ones, have peanut oil, so you can get it compacted without peanut oil.

You can get a sustained release, because it helps with sleep. So, you know, some people are like, I’ve been sleeping better, but gosh, it’s not lasting through the night. Then I’ll think about using the sustained release. So what are the FDA approved indications for hormonal therapy? That means there is no controversy.

Like, you can just go ahead and do this. You don’t have to, you don’t need a consent form. You don’t have to be worried about anything. If you’re [00:37:00] struggling with any of these symptoms, this these are FDA approved reasons for using it. If you’re having hot flashes and night sweats, low bone density, so if you’ve been diagnosed with osteopenia, the hormones are FDA approved for that.

Premature hypoestrogenism, that’s just if you go through menopause before age 50, everyone should be on hormones. And then genitourinary symptoms, so vaginal dryness, painful sex. Urinary frequency, frequent urinary tract infections these are all the FDA approved indications. But, hold on, we know from a lot of studies that hormone therapy can, these are studies to support it, can help with your mood, sleep, brain health, joint health, quality of life, and prevention of heart disease.

That is well known, and heart disease is the number one killer of women. So if we’re talking about FDA approved indications, do you know what’s most prescribed for hot flashes and night sweats? Do you guys know? SSRIs. And it’s an off label use of [00:38:00] SSRIs is to treat it for hot flashes and night sweats.

Depression that comes up during perimenopause. What’s the root cause? Probably the hormones, right? Oh, wait, wait, I just complained. So during perimenopause, as your depression, anxiety, more likely to happen, what’s most likely prescribed?  SSRIs. But, but, the root cause is hormones. But the thought of using hormones to address depression or anxiety during perimenopause is like the craziest thing.

Reckless thing because it’s an off label use. We use off label use of medications

Speaker: all the time. It’s being used for IBS. Yes,

Dr. Maggie Ney: yes Okay,

Speaker: so

Dr. Maggie Ney: These are symptoms where you think, maybe I’ll use some estrogen. Hot flashes, night sweats, depression, anxiety, irritability, brain fog, low libido, joint pain, menstrual migraine, super common. If someone gets a headache right around [00:39:00] ovulation, because we said there’s that little dip of estrogen, right before the period, on the first few days of your cycle, A little bit of estrogen can just kind of buffer that dip and can be, , make a profound difference for people.

 any skin changes. Oh, I’m so itchy, burning tongue, ear ringing, or any of the genital urinary syndrome, like any of the vaginal dryness. or urinary tract symptoms, you would think estrogen.

Speaker: Why is it known as atrophic vaginitis? This is a horrific

Dr. Maggie Ney: name.

Speaker: Oh,

Dr. Maggie Ney: okay. Atrophy. I’m sorry, can we just say men get ED as their rebranding?  From impotence to ED, right? Did you? That was like the most brilliant marketing campaign. But we got the suits, we got ED, right? No longer impotent. Like, that sounds horrible. Women go from atrophy, like they, I mean, to vaginitis. GSCAB, basically. It’s not quite as great as, like, Impotent to eat, but anyway.  So [00:40:00] again, these are things we’re thinking of using estrogen therapy for.  If you have a uterus, you always need to have a progesterone to be with it to,  protect the uterine lining. Yes?

Speaker 6:  for as far as, was there something that changed last year where insurances can cover, like, different diagnosis codes for, like, just primarily hormone deficiency or no?

Dr. Maggie Ney:  you mean to cover HRT?

Mm hmm.  HRT is usually covered by insurance. Like, it depends on your insurance if you use the commercially available ones.

Speaker 6: We’re a cash pay program, but, like, for patients that are applying for reimbursement, we’re just curious about doing that. If we gave them, like, a diagnosis code, could they

Dr. Maggie Ney: use that?

Oh, for hmm.  to get it through what, like, CVS?

Speaker 6: , so they pay, they pay us a membership fee for it, and we do, we do repellent screens, injections, and then all the labs, it’s like all included in the membership, the physician visits and stuff.  but I didn’t know if there was like a go [00:41:00] to ICD 10 code that you could use for them to submit that for insurance.

Dr. Maggie Ney:  I don’t know for sure. I think, yeah, I don’t, I don’t know actually to be honest with you. I think,  yeah, it’s a, it’s a subtle question. I know what you’re asking, but I don’t know. You can get

Speaker 6: to the fillable codes

Dr. Maggie Ney: to get it covered,

Speaker 6: just for the hormone deficiency, rather than

Dr. Maggie Ney: like those specific ones.  I mean, there are for office visits, but as far as medications, yeah, I’ve never had like a prior authorization for hormonal therapy. It’s just, it’s just covered. Okay. Not through compounding, but through, okay. So, progesterone, Progesterone. We know that the function, it helps prepare the uterus to accept an embryo, it protects the uterine lining from this unopposed estrogen, which can increase risk of getting,  dysplasia and initial cancer.

Progesterone is anti inflammatory, it’s [00:42:00] immunomodulatory, it inhibits urine contractions, it has a calming effect in the mind. You take it orally, it’s converted into the liver, into allopregnenol, which binds to the GABA receptors, so it does have that calming effect. And it does slow the gut, it can help with sleep,  causes of low levels, well, perimenopause and menopause.  And then the symptoms, we said it a little earlier, but really when you’re thinking perimenopause, you’re thinking your periods are coming a little closer together, multiple in a month, heavier cycles, spotting, insomnia, and anxiety.

Speaker: Do you ever just use progesterone for when you don’t want to take estrogen?

Dr. Maggie Ney: Yes. I do.  There are actually studies that say higher amounts of progesterone can help with cough flashes at night’s wise, like upwards of 300 milligrams.  but sure,  definitely for like the anxiety and the sleep, progesterone can be great. Sometimes I’ll use progesterone on testosterone and not the estrogen.  But let’s talk about testosterone. Testosterone is the most abundant hormone in women. We have more testosterone than estrogen. Plays a key role in muscle mass. Bone [00:43:00] health, confidence, and burning fat keeps our metabolism strong, our libido high. It does start to decline in our 30s, and 50 percent of women’s testosterone levels have been lost by menopause.  So some symptoms of having lower testosterone, low libido, lower confidence, difficulty with orgasms, fatigue, less muscle mass, and difficulty building muscle.  So testosterone therapy. So it’s not FDA approved for women, which is crazy, but it’s just not. Even though there is supporting evidence, we do need more research, but there’s supporting evidence for sexual desire, mood, confidence, energy, vitality, muscle health, possible adverse effects with testosterone. It is too much for your patient’s body.  You can have some acne, hair thinning, increased body hair, anger, irritability. for listening. But it is endorsed by a number of organizations to treat women who [00:44:00] experience, and this is the clinical diagnosis, is hypoactive sexual desire disorder,  in postmenopausal women, which is basically low libido that bothers you.  Alright, so if you have low libido, but it’s not really bothering you, and it’s not bothering your relationship, that doesn’t, you get the definition because it has to be upsetting to you.

Dr. Weitz: Let me just ask, progesterone is available as a supplement. What do you think about women who use something like that?

Dr. Maggie Ney:  yeah, it’s available as a cream, topical. Yeah. I think if you’re using it during perimenopause, that’s fine to see if it helps you, but I would not use cream to protect the uterine lining if you’re postmenopausal on extra due.   So DHEA, it’s also a hormone. It’s a bioidentical hormone, DHEA.  it’s produced by the adrenal glands. It starts to decline in [00:45:00] our 30s. It decreases by an average of 60 percent by the time of menopause. And DHEA is a precursor hormone. Our body turns it into testosterone and estrogen. Our vaginal and vulva tissues are loaded with estrogen and testosterone receptors.  Thanks. So, giving DHEA vaginally can be really effective, because then intracellularly, it’s converted into testosterone and estrogen. And again, there is one FDA approved, it’s called IntraRosa, DHEA that you can get through the pharmacy, but again, you can get it compounded as a DHEA. You can even take DHEA capsule at low dose and insert it vaginally.

Dr. Weitz: Do you like that Bezwecken cube?

Dr. Maggie Ney: I just, I learned that from you. I don’t have much clinical experience, but it sounds good.

Speaker 7: What do you define as low dose?

Dr. Maggie Ney: Like for, okay, so the studies say 6. 5 mg, so that’s like the commercially available one, so you either get it compounded, you can’t really, you can’t find 6.

5 mg, which are, you know, you just have to [00:46:00] see. Just a capsule, like the gel capsule you just A little gel capsule, I don’t, it’s more than dissolved. Instead of swallowing it. Yeah, instead of swallowing it, you can do it vaginally.  you just have to make sure it dissolves, so I would think a capsule may be better than a gel, but I could be wrong.

Just, as long as it stays in you, it doesn’t fall out.  so, yeah, there’s not a tremendous amount of studies, but there are some, and it’s safe to try, it is. I usually test women, and if they’re lower than 100, then I’ll start them on like 5 or 10 milligrams, just to see if they, they get a little better, and I have seen an increase in testosterone levels in the blood.

 So, bioidentical, I mean, I’ve said some of this, but,  here are the treatment options for estrogen that are bioidentical. You can get the patches, estradiol patches, estradiol gels, there’s estradiol tablets, there’s a vagal cream, a vagal tablet, there’s rings, and then you can get a compounded estradiol cream.

 and then we talked about estriol, which has, in the past, been paired with [00:47:00] estradiol in a form of bias. I really don’t do that much anymore. That really came out when we were scared of estrogen. We were scared of estrogen after the Women’s Health Initiative. So we came out with this bias because you can have estrogen and estriol, and estriol has a little estrogen effect.

So you can maybe reduce the estradiol and have more estriol, but estriol doesn’t have the studies to support the heart health and the bone health. So,  I just don’t think it’s needed. Our liver converts estradiol to estriol, so if you’re doing the estradiol, which has the potent effect, and give liver support, then your body’s turning it into estriol.

And then again for progesterone options the commercially available is oral micronized progesterone, also known as Prometrium.  again, you can get it compounded without the peanut oil, sustained release, and then there’s crinum gel, which is an FDA approved bioidentical progesterone gel that is used for fertility and has been looked at a little bit for uterine protection too.

 you, like I said, during, when you’re [00:48:00] menopausal and not bleeding anymore and you’re on estrogen, you have to be on progesterone. Most women love their progesterone. It’s like, helps them sleep, it’s calming, they feel like a warm, cozy blanket’s covering them. Some women feel nothing, they just have to be on it if you’re uterine infected.  And a small percentage of women do not like progesterone. It makes them depressed, weepy, bloated. It’s a small percent, but it’s always good to educate our patients on that. And if that’s the case, and I say, put it internally, you can get your progesterone, just do it vaginally.  the other options are like the Mirena IUD can be used if you can’t take it.  and then there’s other hormone options as well. So, it’s always just, there’s always options, right? There’s always options.  okay, so for

Dr. Weitz: By the way, do you cycle the progesterone or do you give it every day?

Dr. Maggie Ney: I give women the choice. I do educate. There’s really no studies that say cycling is better or safer. I know intuitively that maybe for some people this feels right. Okay. To take,  progesterone to match your cycle, so I fully support [00:49:00] that.  But some women love their progesterone so much, why would I deny it for them the first two weeks, right? If it really helps with sleep and mood and anxiety. So, I educate people. Like, I teach them. You get, progesterone is produced during the second half of the cycle, so if you wanted to mimic the cycle, which some people really are, that feels right to them, I get it.  Then I’ll support them with that.

Speaker 7: How about the impossible?

Dr. Maggie Ney: I don’t routinely do it, but I give women the choice. Same thing. I do give women the choice. I don’t say you have to do it one way or one way is better. I know people have, feel strongly about that, but I see people love their progesterone, so I don’t want to be like, you can’t take it.

It’s better. I’m not, I don’t feel like there’s enough research to support that it is better. In fact, most studies are done, well there’s been some cyclical studies, but it’s really just what the patient wants. I educate. I do. So for testosterone if you wanted to use an FDA approved form of testosterone, then you would prescribe a [00:50:00] man’s testosterone that is FDA approved.

 they come in like 50 milligram tubes, and you would make that tube or packet last 10 days. It’s one tenth the dose. That comes to about a pea sized amount. Or you can put it in a 5cc syringe and use half a cc a day. I don’t usually do that, to be honest with you. I have, like, done it once for someone who really wanted it.

So I usually get it compounded for women. And so, like, the average dose for menopausal women is five milligrams of testosterone, but I’ll usually start, like, at one and work up to see how people feel. So these are all your options.  like, if you’re getting in the weeds of prescribing or helping women through this, It is important to know, like, all the different options, because I’ve had patients who can’t tolerate bioidentical progestin.

They just feel awful, and they need it, and they can’t do it vaginally. And I will then look at some of the combination patches, which [00:51:00] is a bioidentical estradiol with a progestin.  so I’ll try that, or if I do,  a tablet. I mean, there’s just options for people. You just need to, there’s pros and cons.

That’s good. And if anyone has any like specific questions about the pros and cons of any of these options, I’m happy to go through them. But it’s just being familiar, and I don’t think we should label things as good and bad. It’s just the pros and cons, and what’s

Speaker: right for people. But from a functional medicine perspective, which one would you prefer the most of the synthetic progesterone?

Dr. Maggie Ney: Oh, okay, so from a sexual medicine perspective, I think the IUD is great, you know, like at the levonorgestrel, IUDs, localized progestin therapy is wonderful. That’s what I would say. And then you can be on any dose of estrogen and you’re getting the uterine protection. That’s what I would say.  yeah, so you can move on.

 I’m looking at time. So, [00:52:00] I, we can talk about this if you guys are curious about how did we end up to a place when. There used to be, like, 80 percent of women were on hormones and then it dropped to, like, 2%, now it’s, like, currently at, like, 4%, less than 10%. And it’s the Women’s Health Initiative. So, this was the biggest,  study that was done to look at hormone replacement therapy, because prior to this study, which started in the late 1990s, Most women would put on hormones because they saw that, you know, during perimenopause and menopause, women just felt so good, and women seemed to be living longer, and it seemed to, they had all these assumptions from observational studies.

Women lived longer, had less heart disease, they were doing great. So they’re like, alright, well, can we endorse this as like,  preventative medicine? Can we just say all women should go on hormones? I mean, that’s a lofty statement. So they, , put up this study, the Women’s Health Initiative, mainly to see, not a normal example of hot flashes or night sweats, but to see, do women live longer?

And can, is heart disease preventive? [00:53:00] So, this was the first, you know, double blind, randomized, controlled study that looked at two different groups. It had women with a uterus and women without a uterus. So women with a uterus, right, we said you need to take that progestogen to protect the uterine lining, so they used Prempra, which was Premarin, that’s the horse, the estrogen from the horse urine.

And Provera, which was a synthetic progestin, which,  We, we, well, I’ll talk about it a little later, but it’s just, it’s not the best, it’s like the worst progestin to be honest. It’s not metabolically friendly, it’s not breast friendly. But hey, they were doing, I always give people the benefit of the doubt, maybe to a fault, but they were doing the best they can with the knowledge they had at the time.

And then women without a uterus just were put on Pramerane. And then each one of those groups had a placebo. Well, in 2002,  I’m like, was that, was any, was everyone here alive then? No, I think so. Okay.  2002, [00:54:00] I mean, it was huge. The study was stopped short because of, I mean, the daytime television was interrupted.

The NIH president came out and said, you know, we’re stopping this study, sure, women on hormone therapy need to get off of it, there’s an increased risk of breast cancer, heart disease, and stroke. Holy, I mean people were so scared, this is how everyone learned about it. No one looked at the study, there was no, no doctor looked at the study.

Patients heard it at the same time healthcare practitioners heard it, and it caused such a media frenzy. Every newspaper, every news outlet, this was all over the world, the world, everywhere. And this was, I would say, well, many other people say it, in fact,  I’m blanking on his name, but a little bit later,  the greatest tragedy to women’s health was this, because it got women who were doing very well off their hormones.[00:55:00]

And, like I said, before anyone could really look at the data, and we’ll talk about some of the flaws, people that were excellent candidates were taken off their hormones. Women that were 37 who went through premature menopause were taken off their hormones. It was very sad. So,  I’m just going to say what we found, and this is with the PrenPro group.

The women who just took estrogen actually did very well, but this is the PrenPro group. So this is where the, all the fear that came out was based on these numbers. So there were 47 additional cases of gallstones and gallbladder disease and I’m going to just, I put in parentheses the reason why we saw that and that was because of the oral estrogen that was used.

 there were 9 additional diagnoses of breast cancer at year 5. I’m going to just reiterate this because that’s what everyone is so scared of is the breast cancer piece. This was what was found just in the PrEP program. And the women who took PrEP aren’t alone, so just the estrogen. There was 18 percent less risk of breast [00:56:00] cancer.

So there was a decrease, a clinically significant decrease risk of breast cancer in the woman who took estrogen alone. Yet, we are so scared of estrogen.  so it was, if you look at it like this, it was the progestin, the provera part that may have been the trigger for the breast cancer. But anyway, not to say that those nine additional diagnoses aren’t significant, they are, but that’s, that’s the way the media came out, made it seem like every woman had risk, like you were putting yourself at such huge risk.

And again, it’s diagnoses. They had better, the women who were diagnosed had better prognoses. They did not die anymore. No one died. They just had these incidents, I should say. There were eight additional cases of pulmonary embolism. That’s because of the oral estrogen that was used. There’s eight additional strokes.

That’s again has to do with oral intrusion and the timing. That’s another important piece. Seven additional heart attacks. That was due to timing. Six fewer cases of colorectal cancer, five fewer hip fractures, and zero additional deaths.[00:57:00]

Okay, so let’s talk about, let’s break down what was the problems with the study. Well, the age and health of the women study, so 70 percent of the women study. were over 60. Well, that’s not when we usually start women on hormone therapy past 60. We usually start when women are having symptoms, you know, 40s, 50s, early 50s.

The average age was 63. 10 percent of the women were between ages of 50 and 55. We know now, through all the retrospective analysis,  that timing matters when you start hormone therapy. Only oral estrogen was used. We know that oral estrogen is more inflammatory, so there’s higher risk of POTS. strokes, and gallstones.

And then the type of progestin used. So only Provera was used, which is a synthetic progesterone. It’s not metabolically or breast friendly. Women who took Premarin alone had 18 less, 18, 18 percent less breast cancer incidence. So that’s like the [00:58:00] breakdown.

Not if you start within that first 10 years. So if you start within the first 10 years of menopause, much higher chance of getting You get all the benefits, and you can continue taking it to the day you die, and you don’t increase your risk. There’s a slight increase if you start hormone therapy past that 10 year mark.

So you can still start hormone therapy, but the conversation’s a little different.

Speaker: Are you aware of this new study that came out in the Metapod’s Journal? Women over the age of 65 taking hormones, women who were taking estrogen, lower risk of not only breast cancer, but other forms of cancer, lower risk of heart disease, lower risk of all cause mortality.

Speaker 6: Would you say anyone who has a hysterectomy should be on just estrogen? Like, is there a reason why someone would not want to be on just estrogen?

Dr. Maggie Ney: Oh, they, [00:59:00]  yes. If you have a history of like endometriosis, progesterone is really anti inflammatory. If you have endo, it’s really not just a hormone thing or a uterus thing.

It’s really systemic. There’s more inflammation. There’s immune modulatory issues. So I would like to get. progesterone for that. Anyone who has insomnia, anxiety, they would benefit from that. Even if they don’t have a uterus. I don’t, I don’t necessarily put everyone without a uterus on progesterone, but it’s like, why don’t they have a uterus?

And then looking at that as a complete picture, because if it’s like very estrogen driven and, like I said, like endo, a progesterone can be really helpful. So basically, HRT is safe and effective for the vast majority of symptomatic women when starting within the first 10 years of menopause. I’ve given it to people past that 10 year mark.

It’s just a different conversation. All the benefits of heart disease prevention,  is a little different. Ok, so, ok, the study came out in 2002, [01:00:00] and then there was all these retrospective post hoc analysis done that did not make the news, right? There was no, no, nothing written up about this really important finding.

In 2007, it was declared that, when you started, within the first 10 years of menopause, women lived longer, decreased mortality, so less likely to die from all causes. There was improvement in hot flashes in the 90s, reduced incidence of osteoporosis, reduction in diabetes. In 2013, there was another post hoc analysis.

30 percent reduction in mortality. Women who started 60s, no effect with regards to heart disease and mortality, but women who started HRT in their 70s, there was a little slight increased risk of heart disease. And then in 2017, there was a follow up post hoc analysis. There was reduction in heart disease, decreased mortality, decreased osteoporosis, and decrease in reduction in diabetes.

This was, yes, they were looking at the same people, and they were looking at the data. [01:01:00] They, remember the data, the results came out in 2002. They just said it as it applied to everyone. Now they’re like, let’s take a look at this study. Who are these people that had higher rates of strokes? Well, oh my gosh, they were all 72.

Wow, in fact, no one in the 50 year range had a stroke. So that’s what they were doing. They were re analyzing the data through a different lens. Also,

Speaker 5: too, it could be other factors as they’ve aged. Totally. If they’re not overall,

Dr. Maggie Ney: you

Speaker 5: know.

Dr. Maggie Ney: Yeah, I mean big argument is also that women who are on hormones get their mammograms more often too.

So you’re more likely to diagnose a breast cancer as well. Anytime

Speaker 9: you’re in a better mood,

Dr. Maggie Ney: you just do things better.

Speaker 9: You do things better. Absolutely. You remember stuff. Yes, you remember to schedule those appointments.

Dr. Maggie Ney:  So, timing hypothesis. So when you start HRT within the first 10 years of menopause, the benefits outweigh the risks.

We already went through all the benefits. But when it comes to heart disease and dementia, it’s timing [01:02:00] that matters.  so again, why are we afraid of HRT? When you start, hormones matter. The form of hormones matter. So again, oral, more likely to get a clot, the stroke, the gallbladder issue. And really, it’s come down to this is the current reasoning, argument is timing.

The timing hypothesis, estrogen gives the greatest benefit, the most cardiac and cognitive benefits when given early in the menopause transition. And the healthy cell bias hypothesis, estrogen offers the most cognitive and cardiac benefits when the cells are healthy to start, not when disease has already set in.

Speaker 7: Question between the pill versus the patch.  is it true that you get more protection when you take the pill For the heart and the osteoporosis, compared to the patch?

Dr. Maggie Ney: Not with osteoporosis, and then when it comes to the pill, there’s like a little bit more of a reduction in, I think, an LDL, but when it comes to heart disease, same outcome.[01:03:00]

Same outcome. Mm hmm.  this is just a little bit of a summary. Ideally, you can start hormones within the first ten years of menopause, but the sooner the better. I mean, why wait until you’re like eight years post, unless someone’s come to you. But like, most of the time, these symptoms, you Start early and just straight.

It’s the, it’s the best for the vasculature. If you have a uterus, you have to be on progesterone, and  consider transdermal estradiol first if tolerated because it’s less inflammatory, less risk of clots, and she may be on, be on it for the rest of her life. A lot of people are like, I like the, I like Aurora, I want to just take a capsule, and honestly, if they were on it for five years, ten years, I mean, most people are fine.

Less risk of a clot than if you take birth control pills. It’s less of a risk. But because women, and now ACOG, menopause society, say that you can be on hormones until the day you die, and we know clot risk already increases as you get older, why not just start transdermally if you’re open to it?

Speaker 7: How about

Dr. Maggie Ney: Let me finish and then I’ll…I just want to say here, [01:04:00] there’s not a This is true.

There’s no family history that’s a contradication to starting hormones. So, someone could be like, I can’t be on hormones Aunt Sally, Grandma Sue, and my cousin Beatrice had breast cancer. That’s not true.

Speaker 5: Yeah, I’ve had an aunt who had breast cancer, and as soon as I mentioned hormones, all my credibility is gone.

Because their MD has terrified them. He factored on some kind of estrogen suppression. But they won’t talk, they won’t even

Dr. Maggie Ney: know. That’s a little different. I was talking about family history, like mom. But personal history, that’s where things are shifting though. It’s true because, you know, so, so often now breast cancer is caught so early, you know, you get it younger and it is, it is considered a contraindication, you know, I’m, I’m telling you with a date, like, non controversial, like, I mean, this is just the facts now, there’s no family history, but breast cancer is still [01:05:00] traditionally, like, a contraindication, but You know, so much is caught early, and what?

So women are getting breast cancer and cured, let’s say, in their 50s, and then dying from heart disease earlier. Having painful sex, they can’t urinate, they’re seriously depressed. So, again, and I, I come back to, it’s shared decision making, it’s informed consent, it’s patients, if you give them the right information, in a safe place, can make the best decision for themselves.

So things that it would be helpful if you have a family that has heart disease, diabetes, osteoporosis, colon cancer, we know hormone therapy has. Helps to reduce that.  failing history of Alzheimer’s. So there’s been a study that if you have the ApoE gene allele starting estrogen early, the menopause transition seems to be neuroprotective.

But yes, we need more. There wasn’t a lot of research there. Who should not go? I’m just, this is like, we could talk about the nuances, but this is just the facts. Personal history of a lung clot or pulmonary embolism. A personal history of an unprovoked blood clot. So, unprovoked meaning you’re watching TV and [01:06:00] out of nowhere you get a clot.

Where it’s provoked, like you’ve had surgery or you’re in a car accident, that’s provoked.  if you’re homozygous or factor V laden, if you have a personal history of a heart attack, stroke, or if it’s stemmed in place, obviously if you’re pregnant, if you have any unexplained vaginal bleeding or untreated endometrial hyperplasia, if you’re actively undergoing chemo, if you have active breast cancer, and then that’s where I said the prior history of breast cancer.

It is a contraindication, but the conversation is changing.

Speaker 10: Is that lung clot due to oral estrogens? I mean, is, is Is, is that where that comes from, or?

Dr. Maggie Ney: It comes from, yeah, that you already have, like, you have to figure out why you had that in the first place, but, yes, if you have had a history of a clot, then, then hormone therapy is usually contraindicated.

If it’s not, if it was unprovoked, meaning, right, like, the clot that travels from the leg, like, what, what caused that to happen in the first place? Okay, I think this is the final slide. It’s the most important one, and I’ve said it a few times, but The patient and healthcare practitioner, their [01:07:00] team. And patients really should be the CEO of their own health.

Not everything is black and white, especially when it comes to period menopause and menopause care.  there’s nuances. And risk and benefits of hormonal therapy need to be weighed against quality of life. All of this needs to be discussed openly with the patient to make them feel supported and heard.

Is there anything else?

Speaker 9: That’s it. I

Dr. Maggie Ney: can take questions I can ask. This is where you can find me.  you asked about all this, I have to answer your pellets. So, they’re very popular. I don’t recommend them. We have a new practitioner in my office who does do them. We just had, I just presented with her,  kind of like comparing, contrasting, but honestly it’s not, it’s, it’s, it’s important that patients know there’s safe options, like there’s FDA approved insurance covered options.

They need to know all their options. A lot of times women choose a pellet because they didn’t get any answers from their healthcare practitioner [01:08:00] and they’re searching and searching. Someone mentioned pellets. They have it. It’s, it tends to give, like, more super, super physiological doses. There’s benefits to it.

I know women feel amazing on them, many do. I haven’t found that I’m lacking anything in my toolkit with therapies that I talked to you about. They’re

Speaker 5: bioidentical. So

Dr. Maggie Ney: they

Speaker 5: could have a

Dr. Maggie Ney: free Yes, and the downside, yeah, they’re, they’re no creams. You don’t have to worry about transferring a cream to someone else.

If you’re working with a very skilled practitioner, side effects are very little, but I’ve seen in my practice women who have super physiologically high doses of testosterone, I’ve seen voice changes, clitoral enlargement that are permanent, and I’ve seen people feel horrible and I can’t do anything to help them.

Because it’s,  it stays in you. You support them, you can help with liver detox, you can do all those things, but I don’t like a therapy [01:09:00] I cannot take back if someone’s having a side effect.

Speaker 5: They

Dr. Maggie Ney: have to write it out. Why, why do, I mean, there’s arguments. I have my, like I said, my new doctor in our office is doing them.

I just, why? I don’t know. I have safe, effective insurance cover options. My patients feel amazing. Like, I don’t, I don’t need to go there, personally.

Speaker: Yeah, I think that’s, that’s one of the complaints about pellets. You get them in, they’re, it’s too high a dosage. You have to wait for them rather than, you know, using other forms.

So you can slowly titrate up the dosage to get the desired effect.

Speaker 7: Right. Two questions. I’m sorry. So there are standard doses you can’t

Dr. Maggie Ney: For pellets, I mean, you have like one pellet has a certain milligram of dose, and you can, and so titrate up. Basically, yeah. So

Speaker 7: there is that option. Yeah, you can have

Dr. Maggie Ney: a low dose, you can have a [01:10:00] high dose, but even a low dose is, can be high.

Speaker: Or if you start with a low dose, now you’ve got to wait 90 days to increase the dosage

Speaker 6: Versus like cream, do you have a little more flexibility in the dressing? Because you

Dr. Maggie Ney: can, yeah. Totally, I just like to have a little, my patients have a little bit more control. Ooh, a lot. A lot more control. Oh wait, I, you had a question, yeah.

Speaker 7:  how often do you do mammograms on your patients that are on hormones?

Dr. Maggie Ney: I mean, generally once a year, one to two, every, every one to two years. And I like the Sonocini too, that, that’s out of network, but,  it’s a really detailed breast ultrasound, basically. Mm hmm. It’s a nice thing to pair with the Mammos.

Speaker 9: Yes? Are there, , like nutrient depletions to consider with hormone replacement, or like, lifestyle? How do you support your patients going through with lifestyle and nutrition, basically?

Dr. Maggie Ney: Yeah, I mean, that’s a huge part. And sometimes it can help just to get their hormones down so that they’re feeling better and more motivated.

But,  I mean, I do individualize it, but the [01:11:00] overall thing is like, real whole foods first. Get rid of the old processes, and then you can more tweak it. So I do work on upping protein,   upping fiber, metabolic flexibility, meaning if someone, someone should be able to fast a little bit, you know, and not feel dizzy and lightheaded.

And when you incorporate the higher protein, the less processed carbs, you can do that better. More easily switch from burning fat for fuel to burning sugar for fuel. So metabolic flexibility, blood sugar stability, and increasing protein are the three pillars. to supporting women during this time.

Speaker 9: Okay.

There’s not the same, like, you know, oral contraceptives we see, like, you know, B vitamin depletion. Oh, no, there is not

Dr. Maggie Ney: that seen. Yeah. Right. Okay.

I like to test with,  Dutch test to see. Sometimes I’ll go off by simping because they’re having a lot of breast tenderness and clots, but, you know, the tests don’t get, like, not everyone benefits from DIMM because it does lower serum estradiol [01:12:00] levels Boo! So, but if I see someone who is not pushing down the 2 pathway for phase 1 liver detoxification, and they’re heavily in the 16 or 4, I’d like to give it to them.

Implant?

I haven’t seen that a lot, I just don’t have a lot of patients that have been on that. So, but I would say really just to support gut health and liver detoxification would be huge.

 I know people really love it. I, I, I just haven’t gone there. I just, I don’t feel too comfortable with all the safety data. I just, I always say like, I’d like to learn about it. I’d love to get more studies. My patients feel so good. I don’t feel like I’m missing, that doesn’t [01:13:00] appeal to me to like add in my toolkit right now,  because my patients are just doing so great with everything else and, and there is some concern with using it.

And I am a little bit more conservative than maybe some other functional medicine doctors.  but I, , the principles of functional medicine like addressing root cause, gut health, liver correction deficiencies, I mean, I’m so passionate about that. But then I do, I am also a research junkie and I do need to, like, see some safety data before doing some of these other therapies to feel comfortable doing it.

Speaker 7: What is your therapeutic dose for, to start, for esrivalin for testosterone?

Dr. Maggie Ney:  it depends who I’m treating, but if it’s peri, like early peri, the depression, the irritability, they’re still getting their period, I do tend to start at the lowest of. So generally, like, if you’re doing a patch, it’s the 0. 025 milligram patch.

If you’re doing a cream or a gel, it’s the 0. 25. So I start low with the, with the early peri, and then menopausal or late [01:14:00] peri, I do typically start at 0. 375. Sometimes 0. 05, 100mg, but I’ll go up to 300mg sometimes.

Speaker 7: When you go up, can you go down afterwards? Yeah. There’s no

Dr. Maggie Ney: Yeah, go by how you feel,

Speaker 7: yeah. Do you give menopausal women a higher

Dr. Maggie Ney: dose?

Speaker 6: Typically, yes. Of estrogast?

Dr. Maggie Ney: I do.

Speaker 6: What is the conversation you have with your like mid 60 patients that come in wanting to start HRT? You said the conversation was a little bit different.

Dr. Maggie Ney: Conversation’s different with regards to benefits and risks. You’re not going to get this. It doesn’t seem to get the same cardiac benefits or cognitive benefits.

Your risk of getting a clot is higher,  in the first six months. Not forever. Really, it’s that first six months. We’re,  because our, like, the vasculature, our blood vessels do better when they haven’t taken a break from seeing estrogen. So if there’s any, like, plaque that’s developed, estrogen, which is normally anti inflammatory, can be a little bit more [01:15:00] pro inflammatory when given, you know, after that 10 year mark.

The risk isn’t huge. It’s just the, the, you’re going to have heart disease, the prevention of heart disease, the number one killer of women, I cannot say if you’re in their 60s.

Speaker 6: Probably no studies on this, but like, aesthetics wise, like, we have so many female patients that want to, like, improve, obviously, their skin, their elasticity, like, does that improve?

Is that a reason that, like, a 65 year old woman would want to go on it versus

Dr. Maggie Ney: Yeah, better to start younger before all the sagging and, I mean, there’s such a dramatic drop in collagen and elastin as we go through perimenopause and menopause.  yes, hormones are great for the skin, even topical estrogen, you know, if you use what you use for your vaginal area, just put a little bit under your eye, that’s been great.

There are some of those, like, telemed companies need that are now giving estriol face cream. Compounding pharmacies are making estriol face cream. But anyway, that wasn’t really your question, but yes, even just hormone therapy is good for your skin. Again, not FDA approved, but, you know, we can, something, it does help.

Speaker: And Dr. Del Rizzi [01:16:00] now is giving women in their 60s It’s in 70s or, you know, it’s protocol for patients with dementia or Alzheimer’s.

Speaker 6: Replacing that.

Speaker: What about for

Speaker 6: the osteoporosis? ,

Speaker: estrogen and progesterone.

Speaker 6: For osteoporosis, is it, would you have to have testosterone to see if it’s like a significant benefit with reversing osteoporosis?

Oh, estradiol

Dr. Maggie Ney: is only with, not osteoporosis actually,  to be honest, it’s, it’s, it’s osteopenia. Like, it’s not, once you have osteoporosis, maybe estrogen’s helpful, but it’s, it’s most helpful if you can catch it before osteoporosis. When you’re in osteopenia.

Speaker 6: What about testosterone? There’s

Dr. Maggie Ney: been no studies.

But, we know it’s good for muscle, and what’s good for muscle is good for bone, so, yes, we need that. But it is good for musculoskeletal, for sure, testosterone. It’s just

Speaker 6: like most women take estrogen [01:17:00] Left out to dry or like just left off? It’s horrible. We

Dr. Maggie Ney: forget about testosterone. It’s so important. You

Speaker 6: would put, like, recommend to all of them?

Dr. Maggie Ney: I mean, I never like to, I’m never like black and white like that. But yes, testosterone would be a nice thing to add to support bone health if you’re like osteopenic. But I always, with testosterone, it is a controlled substance, so you do need to do a lab test. Unlike estrogen or progesterone where you can really go by symptoms.

If you’re going to prescribe testosterone, you need a blood test.  you need to, and then you need to check again six months after, and then every six months thereafter. You can’t, you can’t prescribe it if your numbers are already high. That’s not right. For

Speaker 7: testing, so you start off with a block, and then do you do the dutch test every six months to see where they’re at?

Dr. Maggie Ney: I mean, I don’t. I think that’s a personal preference. I, I go, I really, again, I really meet the patient where they’re at and what they want.  I don’t know, my patients, some of them are very data driven and want the, lots of testing done. I go by how they feel, [01:18:00] I go and make sure their numbers are safe, you know, maybe a, a Dutch test at one point, I mean, some people say every year,  just to make sure they’re metabolizing everything well, but,  I don’t do a lot of recurrent testing if they’re feeling good.

Speaker 7: And, and when they’re on progesterone and estrogen, they shouldn’t be bleeding at all? No. So if they’re spotty, then

Dr. Maggie Ney: So if you start hormone therapy and you haven’t bled, you know, if you’re, and you haven’t been,  if you’re kind of post menopausal, anything can happen when you’re still peri, right? So let’s say you’re post menopausal, you start on hormone therapy, the first six months, you can bleed, it’s not a red flag, you know, we’ve always been taught post menopausal bleeding is a huge red flag.

You can bleed within the first six months, you don’t have to get nervous or anything like that, but,  that can just happen. But after that, then after that, you would want to work it up. And in which case, yes, sometimes lowering the estrogen or increasing the progesterone would help with that.

Speaker 10: Would you comment on testing topical [01:19:00] hormones during salivary testing?

Dr. Maggie Ney: Yeah, I mean, listen, you could talk to a number of different doctors and get a different response. I, I don’t do a lot of saliva. I mean, I rarely, I just don’t. That’s not what I do, but doctors do do it in love and independence. You kind of do what you’re used to doing. I don’t do the saliva. I tend to, well, use mostly blood.

Okay. I, I get the pros and cons of all of it.  I like the dutch test to add in to see how people are metabolizing and I go by how people feel. I haven’t found that I needed to do like a saliva test to tweak a dose or this or that. I, I haven’t had that issue. I hear my patient, I listen to their symptoms, I look at all their other markers, we do all the lifestyle stuff, so.

I don’t know, I think it’s a tough, you gotta be careful. There’s practitioners out there that really like, I don’t know, do all this testing, all this saliva testing, then I’m going to tweak your dose based on this and come in every three months. I just, I feel bad for the patients. Like, I don’t think it’s always necessary.

It’s like a money maker for the labs, for clinicians, but I don’t [01:20:00] really think it’s necessary. I feel bad. Patients need to know there’s options, right? You know, if a patient wants it, great, they don’t need

Speaker 7: it. How about women with hyperlipidemia? Yeah. Is there any contraindication that you No, in fact it can

Speaker 8: help, can reduce it.

Speaker 5: But my lipid numbers went up and in fact, had nothing to do with my food or eating. Oh sure, it’s genetics mostly. Yeah.

Dr. Maggie Ney: So I do like to have, especially for women like in her 60s and want to start a tournament, I’ll get a coronary calcium score. Let’s get a look and see the artery, the, any calcification.  Make sure that’s okay. You know, that, that’s what I would look at as we individualize and discuss risk. And so if someone has high, really high cholesterol it’s usually genetic and you know I like to look at the arteries of the heart to see if there’s any plaque deposits.

Speaker 7: Is that a,  that’s a,  scanning?  It’s a CT scan. It’s a CT scanning, right? [01:21:00]

Speaker 9: Yes? So I guess this is going off the same type of question but let’s say someone is over 60, you know, 10 years past. menopause coming in, would you personally say the benefits still outweigh the risks, or is it kind of dependent on the person? Yeah, I think they usually do what the patient’s

Dr. Maggie Ney: experiencing, but yeah, the risks are very still slim.

 

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Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast. I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation.  Some of the areas I specialize in include helping patients with specific health issues like gut problems. neurodegenerative conditions, 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.  Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111. And we’ll set you up for a new consultation for functional medicine. And I look forward to speaking to everybody next week.

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Dr. Allison Siebecker discusses Controversies in SIBO Testing and Treatment with Dr. Ben Weitz.

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

 

Podcast Highlights

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Dr. Allison Siebecker is a Naturopathic Doctor and Acupuncturist specializes in the treatment of Small Intestinal Bacterial Overgrowth and she teaches advanced gastroenterology at the National University of Natural Medicine. She has the most incredible resource of research articles and information about SIBO, siboinfo.com. 

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

 

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Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast. Hello, Rational Wellness Podcasters. Today, we’ll be speaking with Dr. Allison Siebecker, one of my favorite people, about controversies in testing and treatment for small intestinal bacterial overgrowth.   Dr. Allison Siebecker is the Queen of SIBO. She’s a naturopathic doctor and acupuncturist specializing in the treatment of small intestinal bacterial overgrowth. She teaches advanced gastroenterology at the National University of Natural Medicine. She has the most incredible resource of research articles and information about SIBO at her website, siboinfo.com. Dr. Siebecker has been participating in the SIBO SOS program, which is another incredible resource of courses and information about SIBO. Allison, thank you so much for joining us.

Dr. Siebecker:                    Thank you so much for having me.

Dr. Weitz:                           So let’s start off with testing for SIBO. So which SIBO tests do you currently recommend?

Dr. Siebecker:                    Right, because we have some new additions in here.

Dr. Weitz:                           Yes.

Dr. Siebecker:                    Well, I still like the standard test that most of us have been using, which is a test for hydrogen and methane and uses lactulose. I like it three hour, and I like it when it has… The most samples that it can come with typically on the market is 10, meaning 10 tubes or bags or collection items. So that’s the standard for a very long time, and I still really, really like that. But we do have some newbies. Gemelli Labs has Trio-Smart. That’s been out about three years now, I think, but it still feels new, right? For a lot of us.

Dr. Weitz:                           It’s only available in the United States I think at this point, right?

Dr. Siebecker:                    I think so. Yeah. That one tests for hydrogen sulfide. We were all really excited, waiting for that. I like that test too because it tests for hydrogen sulfide. Then I feel a little bit bad to share this just with the public but I will is that I have a hydrogen sulfide study group that we assembled a bunch of practitioners to basically study when the Trio-Smart came out and help each other with what we were all seeing. From that group, many of the doctors in there, they shared that and basically they saw when they would compare the test against the standard hydrogen methane test because they would run too often on one person that the methane sometimes was lower on the Trio-Smart than on the traditional test.  So some of the docs there, they just felt that it may be under-reported methane, the Trio-Smart. Now when the studies are done, studies were done to validate Trio-Smart against the standard machinery. The studies were great, so it doesn’t line up. This is more of like a clinical happenstance. Studies are great. So just passing that along. Because of that, it’s really hard to explain why I haven’t switched fully over to Trio-Smart, because I’m always very concerned about missing anybody with SIBO. I want to be sure that I find it when it’s really there. By SIBO, I mean the methane type of SIBO as well.

Dr. Weitz:                           How valid do you think the flat line is as a way to diagnose hydrogen sulfide?

Dr. Siebecker:                    Well, this is really interesting. So for years, that’s what we use. We still use it. I found it very effective in that when you treat people with treatments for hydrogen sulfide and they have a flat line, they respond. They get better. You can often see the next, the retest perform like you’ve seen, they’ve gotten better. Meaning it won’t be a flat line anymore. Also, one of the directors of one of the breath testing labs, for years, I had been gathering symptoms that my patients had that they told me they had when they had a flat line. I was able to come up with this little group of symptoms that to me indicated hydrogen sulfide. I shared that with anyone who wanted to know in all my lectures and things.  So the director of this lab started using that and he got back to me and said he found an excellent correlation with this and that people would really respond to treatment. So here’s this clinical data that seems good. But then my friend who’s does a lot of research, Dr. Josh Goldenberg, he and I and several others, he really led the effort, did a survey. In that survey, so this is low quality evidence, but here it is. We actually found that when people compared the flat line with the Trio-Smart. So do people with a flat line actually have hydrogen sulfide gas? There was a very poor relation. What is a flat line then if it’s not actually hydrogen sulfide? I don’t know. Is this definitive? No, because this is just a survey. It’s not good quality evidence.  But it made us think, “Huh, maybe the flatline isn’t what we always thought it was,” except I don’t care. Because when we treat it like it’s hydrogen sulfide, people get better. But that is an interesting thing that we don’t often see. I’m sure other people will have their own evidence, but someone with a flat line testing positive for hydrogen sulfide on our Trio-Smart. I don’t know why.

Dr. Weitz:                           Have you found that the Trio-Smart also has a relatively small number of positive hydrogen sulfides?

Dr. Siebecker:                    Yeah, I mean that makes sense. Hydrogen sulfide is going to be the least common type of SIBO, the least common gas. Never expected.

Dr. Weitz:                           I’ve heard 10 to 15%.

Dr. Siebecker:                    Yeah, I think so. Maybe less. I mean, it’d be interesting to hear what Dr. Pimentel says, who’s probably got the most experience at saying what the percent is, but that makes sense to me. Pretty low, right? So yes, but the thing is it can be this tricky thing. I think where we want to bring in for sure testing and make sure we’re not missing it is in cases that are challenging. If everything’s going great and you’re treating and there’s no issue, you don’t have to think about it.  But what if somebody still has symptoms and you don’t know why and their test looks negative or things like that or the treatments you’re giving for hydrogen or methane aren’t quite working? Geez, maybe they have some hydrogen sulfide there you don’t know about because clearly there can be hydrogen sulfide without there being a flat line. Then you would need to shift your treatments.

Dr. Weitz:                           Now explain why you feel it’s important to do three hours. Because if on average after 100 minutes or certainly 120 minutes, you’re now in the colon. How are we diagnosing a small bowel issue with a three-hour test?

Dr. Siebecker:                    Because we have these three types of SIBO, hydrogen, methane, and hydrogen sulfide. Methane even now is not really considered a type of SIBO, though I still consider it that way because that’s so long I’ve thought of it that way. So it’s intestinal methanogen overgrowth. Well, it’s only the hydrogen that is small intestine only. So both methane and hydrogen sulfide, those organisms overgrow in the large intestine as well. On our breath test interpretation, we use the whole three hours for the interpretation. So this is why it’s so important. I mean, I have example after example where we could miss somebody’s methane or hydrogen sulfide if we only had 90 minutes or two hours.

Dr. Weitz:                            So if you see a dramatic rise after 120 minutes, you would still consider that positive in either methane or hydrogen.

Dr. Siebecker:                    Not hydrogen, methane or hydrogen sulfide. That’s the thing. That’s the thing. It’s only hydrogen that we’re using the first two hours. But for methane and hydrogen sulfide, we need that third hour, because it’s not just yes or no because the level of the gas influences our treatment choices. Because amongst our different choices, we may choose a treatment that is better at reducing more gas more quickly. Also, it informs our prognosis because we know most people will need multiple rounds. We know on average how much each treatment lowers gas on average.  So we can calculate how many rounds might be needed by seeing how high the gas goes. So we need that information. The other thing is why wouldn’t you just get all the information that would help you if the person’s going through the test? So it really irritates me when manufacturers only offer two hours or less. It’s like you’re shorting us out here. I mean, the person is going through the effort. They did the prep diet, they’re doing this whole thing. What is one more hour? Let’s get all the information we need.

Dr. Weitz:                            Now, isn’t another argument though that the issue about SIBO is that if this bacterial overgrowth occurs in the small intestine and gas is produced, you’re going to have all these symptoms? But if that same gas is produced in the colon, you’re not necessarily going to get those same symptoms because the colon is this very extensible tube and it easily expands. There’s always bacteria producing gases in there, and that doesn’t typically create symptoms.

Dr. Siebecker:                    I don’t think that’s true. I don’t know. I haven’t read studies to prove this one way or the other.

Dr. Weitz:                           But isn’t fermentation very common in colon and isn’t that good, actually healthy?

Dr. Siebecker:                    Yes, at a certain amount. So I think it’s about the amount. It’s about how rapidly the gas is created and how much. Actually, this is the whole basis of the FODMAP diet is just that rapid and excessive gas creation in the larger intestine leads to a lot of symptoms. It is completely my understanding that you would not escape symptoms if there was a lot of gas in the large intestine.

Dr. Weitz:                           Okay. I thought the purpose of the low-FODMAP diet was not to feed the bacteria in the small.

Dr. Siebecker:                    Yeah, they did have SIBO or the small intestine in mind in some of their early papers but barely. Their main target was the large intestine actually, believe it or not. Also, inflammatory bowel disease. Now it’s changed since then. They’ve morphed, but that was the original intention. What I love about that diet is they’re like, “We don’t know what’s causing it. We’re not even going to try and think about it. We’re just trying to help symptoms.”

Dr. Weitz:                            Some doctors, for example, Dr. Hawrelak likes to use different substrates for the SIBO prep test. He told me that he regularly will have his patients do a test with lactulose, a test with glucose, and a test with fructose.

Dr. Siebecker:                    Yeah, I love this. So this is great. This all came out of a conversation he and I had at a conference when we were lecturing. Because long ago, he was a fan of glucose, and I was never a fan of glucose as a substrate because I knew it absorbed pretty quickly, pretty high up in the small intestine. So it couldn’t test the whole rest of the small or the large intestine. We were just talking about how important that is. So I said to him, I said, “Could you give me more information about the comparison between glucose and lactulose? Tell me what you think.” Well, he’s a researcher. So he’s fabulous. He went in his office and he did this in-office study over years. He didn’t publish it, but then as soon as it was ready, we came and I featured him giving out a class on this.  He’s been telling everybody. He came out with the most fascinating information. He found that, well, glucose was the worst at finding SIBO in somebody who had it. So he ran, like you said, each one of these substrate tests on the same person. Lactulose was second best. Fructose was the best and best of all was lactulose and fructose. He ran these on different days. So I brought up the statistics so I could tell you from a study. So glucose was 67% of a diagnostic rate, lactulose, 73%, and fructose, 85%. When we did the fructose and the lactulose together on separate days, it was 96.5%. So this just blew me away and has changed my mind about a lot of things. So what I’ve been doing is recommending to practitioners who are having trouble getting a lactulose test.

                                                There are companies where you can get the lactulose test, but not everybody knows that or wants to do it. So they can order fructose. This made me feel comfortable, recommending fructose as a substrate. It’s interesting, because in my early testing, I did test people with different substrates. This is like 14 years ago or whatever. I didn’t do as many as Dr. Hawrelak. He did 130. I have it written down here, 130. I didn’t do that many. So you need a lot to figure things out, but I often found that people were not positive on a fructose test who were positive on lactulose. So this really surprised me, and that’s the value of doing a bunch of these. Now I have something else to tell you. Dr. Nirala Jacobi, another one of our colleagues, she has a lab in Australia also.  She is now checking this out for herself, and she is running a lot of these lactulose and fructose. She’s only in preliminary data, so it is too early to speak. Please keep that in mind, but she isn’t finding fructose to be better than lactulose. She didn’t tell me if it was the same or worse, just not better at this point. She’ll come out her with her findings, but I still feel confident based on the data from Dr. Hawrelak. So I think it’s a wonderful thing to think about. Something else that he discussed is that he found people who would be negative on lactulose but positive on fructose. I mean, obviously, that’s the difference between that 73% and 85%. So it’s something to keep in mind if you really feel like somebody, you really suspect SIBO and you test them and they’re negative.  You could run a fructose just to see. That’s also the place where you might want to test with the trio if you weren’t to see if there was hydrogen sulfide, if something’s in your mind going, “But I really feel like they have it.” So I’m generally in favor of it. I haven’t switched over to it.

Dr. Weitz:                           Interesting. So one of the issues for some patients and some practitioners is that… I don’t know if this is across the whole country, but lactulose is considered a prescription drug. I know in California-

Dr. Siebecker:                    It’s so irritating. Oh, no, the whole country.

Dr. Weitz:                           The whole country, okay.

Dr. Siebecker:                    It’s a mistake that it’s on there. I’ve talked to so many people about this, but the problem is it would cost a lot of money to get it off the formulary. So it’s going to stay there and it’s a terrible mistake. It shouldn’t be. So then non-prescribing practitioners technically can’t order it, but there are labs you can order it from. Basically, I can just speak about labs because there’s no CE. So Genova offers it and that you can get that also through Rupa Labs, True Health Labs, direct labs.  So they’re the main way. The other thing is that a lot of times, a patient’s primary care, they can give them a prescription for lactulose as a laxative. It’s often used in veterinary medicine. So you could get it and then you could buy a no substrate or a glucose test kit and then substitute it. But here’s now the fructose as a potential option.

Dr. Weitz:                           Is it the same amount as lactulose?

Dr. Siebecker:                    No, it’s 25 grams. Let me just make positively sure that I got that right. I have a little note. Yeah, 25 grams for fructose, 10 grams for lactulose

Dr. Weitz:                           Mixed in eight ounces of water?

Dr. Siebecker:                    Mixed in eight ounces of water. It has to be diluted. Same with lactulose. Isn’t that fascinating?

Dr. Weitz:                           That is fascinating.

Dr. Siebecker:                    Did you have him on to speak about it?

Dr. Weitz:                           Yeah, we did speak about it.

Dr. Siebecker:                    Yeah, fascinating to me.

Dr. Weitz:                           He continues to use all three.

Dr. Siebecker:                    He says sometimes he uses just two, unless he’s changed. Last I heard he had dropped glucose, but he might. Who knows?  He might’ve brought it back because he’s like, “That’s out.”

Dr. Weitz:                           So what do you think about the new SIBO testing device, the FoodMarble?  Is this threatening to disrupt the whole SIBO testing industry?

Dr. Siebecker:                    Right. I forgot. This is the other newbie on the block here, so I have so many thoughts.

Dr. Weitz:                           For those listening, you might not be aware. There’s a home SIBO testing device. It’s known as the FoodMarble, and you can use it over and over again at home. You can test yourself in whatever way you want exactly. You just breathe into that. It measures hydrogen and methane. I think they’re working on a version that’s going to include hydrogen sulfide, and you could duplicate a SIBO breath test. You could do lactulose or fructose and then do it every 15 or 20 minutes, or you can just see how you react to different foods.

Dr. Siebecker:                    Exactly. Yeah. I think that the original intention was just to help you figure out your dietary triggers really. People love it for that. They just test after eating various types of meals and they see where their gas levels are. The gas report comes as a fermentation score, which goes as high as 10. They’ve now broken out the different hydrogen or methane, and they let you know. So it’s not parts per million like it is in a breath test. It’s just to give you a sense of what’s going on, but it works with an app and it’s very user-friendly. On the app, the challenge function is how you do a formal breath test and then you choose whatever substrate you’re going to use. Like you said, you could just buy glucose or fructose or if you can get a prescription for lactose.

                                                So I think it’s amazing because it’s inexpensive and I love that. So because they claim that this device is able to do accurately many, many, many breath tests, I think 40 or more. I think it’s more than that. So that’s for the price of one. It costs about the same as doing a breath test, and then you can run multiple, multiple tests. That’s just incredible because the budgetary concerns are sometimes the biggest impediment in the whole treatment process with SIBO. I mean the treatments can cost a lot too, but I’m a physician who likes to retest a lot. Otherwise, I just feel blinded. You can’t really judge my symptoms very well. What the heck is actually going on with the overgrowth levels? Because they don’t correlate perfectly.

                                                So this can solve the budgetary issues, the retesting issues. So that’s incredible. It’s also so user-friendly. Anyone who’s ever tried it or used it, they love it. I’ve tried it. I think it’s great. It’s so easy to use. Now the issue is what about the validity? This is what everybody wants to know. Just like Trio-Smart, they have done studies that are great and show excellent validation against our standard testing machinery. A colleague of mine, the one who I did that hydrogen sulfide study with, he said he likes the studies. He feels good about the studies. Everyone has to decide for themselves, but I like that a colleague who was a researcher felt good about the study. So that’s good. So that’s good. Now, what about in real life, right?

                                                So in practice, sometimes we see some odd things like an occasional really high level of gas that just blips up. That’s hard to make sense of. Is it correct? It has an opportunity to potentially be more sensitive and more accurate because it’s analyzing the breath instantly, instead of being shipped off for a week in transit and then being analyzed. Because of that, the FoodMarble has a trend I think to have slightly higher gas levels, probably because it’s being analyzed immediately, although there could be other reasons for that. But a number of us have done side-by-side testing. Whenever we do that, by the way, Dr. Pimentel has recommended giving five minutes apart when you’re breathing into two different devices.

                                                The technicians and the scientists at FoodMarble say even two minutes might be enough, just letting you know for anyone who wants to do this, because you need the gases to be able to equilibrate again. You don’t want to have them completely blown off from one test to the next. So anyway, when we’ve done comparison side-by-sides, people are finding different things. I find in the ones I’ve done only I think one or two of them lined up correctly perfectly. Then I’ve seen it all different ways where hydrogen or methane was higher or lower in my side-by-side tests. I haven’t really quite decided what that means and what I think about it. I can say that I have colleagues who don’t feel good about it because of that, because it’s not perfectly lining up.

                                                So they want to stick with what they’re used to. I have other colleagues that love it and they don’t care if it lines up or not. They feel like the advantages are so great, the studies where they’re validating it, that they’re just using it and they’re recalibrating their clinical sensibilities to the device, to the new data. For me, I’m used to just a lot of data, because as a SIBO specialist, I ran tests all day long every day. I need to see a lot more of their tests until I decide fully what I think of it, but I’m favorable towards the advantages that it has to offer. So what do you think, Ben? Have you tried it?

Dr. Weitz:                            I’ve got one now and I just started fooling around with it. I don’t know yet. I have a couple of patients that are going to be doing side-by-side and I’m curious.

Dr. Siebecker:                    Me too. The other thing that people should note is that to get the parts per million, practitioners can get that. You just have to ask them and sign up for the clinician’s dashboard, I think it’s called. So that’s a website you can go to that’s connected where you immediately see the results in parts per million. They have graphs and things like that, because otherwise, you’ll get the fermentation score. So that’s the one drawback for patients who are using it. If they do a formal SIBO test, they’re only going to see a fermentation score. Someone needs to be a practitioner to get that clinical dashboard and see the parts per million. That’s a limitation that I’m not fond of but they know that, and I’m sure they’re doing whatever they need to do legally. Who knows? Maybe it’ll change.

Dr. Weitz:                           Do you often order a stool test as well to look at the microbiome with your SIBO patients?

Dr. Siebecker:                    Well, I’m not in practice now, but when I was, I wasn’t running microbiome tests. It was like before that became a big hot thing. But I did run functional stool tests a lot, but not microbiome once. Tell me where you’re heading with this one. Have you been doing it? Are you correlating things?

Dr. Weitz:                           Yes, I do. I regularly do a stool test and I like to see what else is going on in their gut. It seems to me a lot of patients with SIBO also have other issues.

Dr. Siebecker:                    Well, that’s for sure. I mean, personally, I think when someone comes in and you suspect that they would have SIBO, you should run expanded screening blood work, the SIBO test, and a stool test. To me, that’s just the fundamentals. It would be sure great if you could also run a really good hormone test.

Dr. Weitz:                           Right, absolutely.

Dr. Siebecker:                    But for certainly stool and breath, because yeah, we have to see what’s happening in the large intestine as well.

Dr. Weitz:                           Yes, exactly. So I talked to several practitioners who feel that the bacteria that caused SIBO are migrating up from the colon. It’s my understanding that Dr. Pimentel originally felt that that was the case, but that current data doesn’t really indicate that that’s the case. What do you think about that?

Dr. Siebecker:                    Yes, that’s my understanding. Ben, I just have to say for anyone watching, I don’t know why my face looks so red. I see it on the screen, and Ben was saying he looks orange. We tried to adjust our light beforehand. I don’t know what’s happening. So sorry about that.

Dr. Weitz:                           It’s okay.

Dr. Siebecker:                    Because I just looked over and saw myself. I’m like, “Literally, I have a sunburn.” I don’t know what’s happening. Totally, that’s my understanding. I was never of that belief that it was a back migration. Even though so many articles and studies said it, that just didn’t make sense to me. Then as Pimentel’s research continued, he came to the same conclusion just as you said. At one of our SIBO symposiums, we used to have SIBO symposiums each year at NUNM where I teach. He said that. He said, “Now I think the majority is it’s there in the small intestine already at low levels and then it overgrows.” So I was thrilled because I felt validated. That is my understanding. It is possible some could come up, but I don’t think that’s the majority of what’s happening. So yeah, I think it’s just overgrowing. It’s already there.

Dr. Weitz:                            There seems to be some studies correlating some of the bacteria that appear in the mouth with the bacteria that end up that caused SIBO.

Dr. Siebecker:                    Yeah, that’s interesting. I’m so sorry. I forget the main researcher’s name. There’s one researcher that’s been working on that premise the whole time I’ve known about SIBO like 15 years or more, and now others have been following in his footsteps. So there’s some little group that is into that thinking. They like to separate oral-like bacteria SIBO from small intestine bacteria SIBO. I don’t think Dr. Pimentel is on that train. I don’t think he’s thinking that way. So that’s like an offshoot of a different thinking. Think it’s Dr. Bohm. We had him come speak at one of our conferences one time. So very, very interesting.

Dr. Weitz:                            Currently, what are the best ways to stimulate GI motility? Do you have any experience with Dr. Satish Rao’s vibrating device?

Dr. Siebecker:                    Oh yeah, that is the coolest thing. The vibrant capsule is just so amazing.

Dr. Weitz:                           Which I don’t think is on the market yet.

Dr. Siebecker:                    It is.

Dr. Weitz:                           It is on the market.

Dr. Siebecker:                    Yeah, it is on the market. I can’t remember exactly when, but it’s been out for a good while now. I haven’t used it, but I’ve talked to a couple colleagues who have. As with anything, some people have amazing results and other people it just didn’t do the job. For anyone who doesn’t quite know about this, this is a non-drug treatment for chronic constipation, really meant for the patient where typical treatments don’t work. Actually, laxatives don’t work. Various medicines don’t work. Prosecretory agents, Amitiza, they’re just not doing the job and you’re at your wits end. You could bring this in. Now, I think you could bring it in even before that. If somebody really has chronic constipation, how nice for them not to have to swallow anything.  So this little pill, it’s timed and it’s timed to just give this very gentle vibration when it would be hitting the large intestine. So anyway, in one patient for a colleague of mine, it was an absolute miracle game changer, insane constipation that nothing would do anything about. This gave her the urge and she goes naturally now normally. Another colleague, it just didn’t work for them. So I guess you have to find the person it’s going to be right for, but I think it’s so great we have this option. So that’s a wonderful thing for stimulating large intestine motility. Yeah.

Dr. Weitz:                           How long does it work for?

Dr. Siebecker:                    Oh, I think you take it five. There’s five capsules you take in a week.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    So it’s almost like a daily thing.

Dr. Weitz:                           I see. Okay.

Dr. Siebecker:                    Yeah. It’s not inexpensive either. I know they had an introductory price. Since it’s new, it hadn’t yet been covered by insurances. So I know that I think in both these cases they were paying out of pocket. So let’s hope it gets covered by insurance and the price becomes better, but in a certain situation, it’s going to be the right fit for some people.

Dr. Weitz:                           What would you say is the most effective drug for motility and nutritional product for motility?

Dr. Siebecker:                    I guess it depends on what kind of motility we’re talking about.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    If we’re talking about large intestine motility meant to create a bowel movement, in essence, a laxative, I have my favorites, my favorite supplement. It’s not a stimulant laxative. So it’s not actually creating movement. That would be magnesium oxide or magnesium citrate. I like osmotic laxatives for actually stimulating movement in the large intestine. Many people like the prosecretory agents, Trulance, Ametiza, Linzess. They’re tricky. So magnesium can be tricky too. You have to make sure you’re getting the right dose at the right time or it could be too strong, but some people, that’s a game changer for them. I’m not the hugest fan of stimulant laxatives that are natural, but many people do like them, senna, cascara, aloe, rhubarb, things like that.  But then we could move to the class of drugs that are prokinetics and they’re really aimed more at and natural agents, the upper GI. So more like the esophagus, the stomach, and the small intestine. So those are used more for achalasia, gastroparesis, and for the migrating motor complex in the small intestine. I mean it’s hard to say a favorite, but I would say probably the most effective would be prucalopride, which is still this Motegrity in the US. Amongst all the gastroenterologists I’ve spoken to, they say it’s the best they’ve ever used. Almost no side effects. I mean, people can have reactions, but no adverse concerning side effects.

Dr. Weitz:                           It certainly seems to be Pimentel’s favorite.

Dr. Siebecker:                    Yeah, many, many gastroenterologists I’ve spoken to. Yeah, because many of our prokinetics that were available had cardiac risks and extrapyramidal symptoms, all sorts of awful things. There’s so many practitioners that think prokinetics as a category is dangerous and that’s not so. There are safe options, but that’s really probably the best there. Naturally, the main things we have is Iberogast, which is like a combo herbal product. Actually, there’s like a dupe now for that because it can sometimes be hard to get.

Dr. Weitz:                           Yeah, very hard. Yeah.

Dr. Siebecker:                    That’s by Heron Botanicals, which is a company from fantastic herbalist and naturopathic doctor. They have a product called Gut Motivator, and it uses pretty much all the same ingredients, except I think there’s fennel instead of something else. I can’t remember.

Dr. Weitz:                           Oh, interesting. Gut motivator.

Dr. Siebecker:                    Gut motivator. It’s in glycerin base, which is nice because it’s easier to take straight from the dropper and it tastes a little sweeter. The only problem with it is that they’re still ramping up. They grow a lot of their own herbs and they’re so ramping up their supply of Iberis amara, the main ingredient that gives its name. So they’re only selling to practitioners at this time. So it’s not ready for the general public, but it will be eventually.

Dr. Weitz:                           Is that available through Fullscript?

Dr. Siebecker:                    No, not yet. I’ve asked them to carry it, but you have to get it from Heron Botanicals right now. So just so people know there’s another option. Some of my colleagues are reporting very good results with it, so I’m glad to hear that. But the other really nice prokinetic is for the upper GI’s ginger. So many studies on that. By the way, so many studies on Iberogast. I mean, it’s been around for a long time, amazing studies where head to head against Cisapride and metoclopramide, other prokinetics where it did just as good, if not even better. So amazing. But then ginger also has excellent prokinetic ability, and we have all of these companies now that put it in their formulas. I call them the ginger-containing prokinetic formulas. There’s six of them.

Dr. Weitz:                           Yeah, we use motility activator a lot.

Dr. Siebecker:                    Yeah, that’s a good one. There’s a lot of good ones. So those are some options. I mean, there’s probably other options, but that is generally good.

Dr. Weitz:                           So we know that patients with IBS, 60 to 70% have SIBO. Then the question is what about the other 30 or 40%? So how often do you think patients have SIFO or fungal overgrowth, and what’s the best way to diagnose that?

Dr. Siebecker:                    I think a good amount do. I can’t remember the statistics from Dr. Rao’s studies on this, but I think it was at least a third also have it, if not more. It depends on your patient population, but I think a lot of us see that a lot. When I was first practicing for SIBO, for years and years, I was looking for yeast and a majority of my patients did not have it at the same time as SIBO.

Dr. Weitz:                           How were you trying to look for it?

Dr. Siebecker:                    Okay, so I don’t think the testing options are great. The gold standard is going to be endoscopy, which is impractical.

Dr. Weitz:                            Right.

Dr. Siebecker:                    Yeah, but I was honestly running three tests because people were coming to me as a specialist. I was running the urine organic acid test. That can’t distinguish between small or large intestine, but it can show indicated and overgrowth by metabolites. Then I would run a functional stool test and look for actual overgrowth in the stool, and then I would run a blood test. The Candida Immune Complex and Antibody test, Quest and LabCorp have that. So I would run all three. Then with the blood test, it doesn’t really tell you whether there’s an overgrowth. It more so tells you if there’s a hypersensitivity. There could be an overgrowth, but it could also be that there’s a normal amount of yeast and their immune system has decided to react against it.  So you are telling different things from this, but I lost confidence in doing those tests. I never felt very sure about what was the best and right way. I can say that you recently had Dr. Morstein, I know. She likes to use the questionnaire from The Yeast Connection, the old Yeast Connection book by Dr. Crook, which I think you can see the questionnaire online. She likes to say that it has been shortened. That questionnaire has been shortened to five questions or seven questions, and she doesn’t think that’s adequate. So she likes just use the questionnaire. I always like to ask other practitioners what do they feel confident with in testing. I don’t think we have a perfect way to test.

Dr. Weitz:                            Well, I feel like with the stool test, since it usually does not come positive that when it is positive, I feel pretty confident that there is candida there if it comes up on the stool test.

Dr. Siebecker:                    I would agree.

Dr. Weitz:                            Organic acids seems to come up too often positive potentially. I’m a little skeptical. I haven’t used … I know Dr. Ilana Gurevich, she loves the candida antibodies test.

Dr. Siebecker:                    The blood one. Yeah.

Dr. Weitz:                            Yeah. I haven’t done that test though.

Dr. Siebecker:                    Yeah, I mean, I used to run them all. I can’t remember what happened, but I think I had somebody with a yeast overgrowth infection vaginally and the organic acid test, maybe it wouldn’t because maybe that’s only telling you the intestinal situation. I don’t know. Then the blood test didn’t come positive and I just thought, “Oh, this is hard.” Maybe it wouldn’t, but I don’t know. Just somewhere along the line, I lost confidence and I stopped doing them all. But I do think that to your point, what are the other things that can be IBS that aren’t SIBO?  A lot of times people have other things at the same time. Yeast is really common. I mean, I’m saying that without having a proper way to diagnose it, but it’s like because then you treat it and they get better. Then parasites also I think are very common. I mean, I’ve written differential diagnosis charts on this, and you just get tired of including things. It’s like 40-

Dr. Weitz:                           By the way, I just saw or listened to your podcast that you did with Nirala Jacobi.

Dr. Siebecker:                    Is it out? I didn’t even know.

Dr. Weitz:                           It’s out. I listened to it this morning and it was great podcast. Nirala Jacobi was really good too.

Dr. Siebecker:                    Oh, good. I really enjoyed that.

Dr. Weitz:                           You guys went through all of these different possibilities, and you made a really profound statement, which was that you find that practitioners often find what they look for.

Dr. Siebecker:                    That’s exactly right. It’s like, “Well, what are we testing for? And then what do we know?”

Dr. Weitz:                            I’m a mold expert. I’m looking for mold and I’m finding mold.

Dr. Siebecker:                    That’s right, because it’s what we choose to test for. But then, of course, what if our tests don’t turn anything up? Well, then we got to look over in the area we don’t normally look, but I mean, what are you supposed to do? Also, you can’t test for everything. People can choose their own path where they want to put their attention first. If that works out, great, and if it doesn’t, then we have to look other places.

Dr. Weitz:                            A similar question, which is it’s known that so many patients who get treated with rifaximin or herbal antimicrobials don’t get completely better after one round. Why do they need multiple rounds? Is it because we haven’t effectively reduced the microbes, we haven’t killed enough of them, or is it that they grow back? Is it because there’s biofilms and we can’t get to them? Is it because there’s layers of problems like you’re mentioning other things? So maybe they have SIBO and they have dysbiosis, and we have to correct both of those. Why do we think it takes repeated rounds?

Dr. Siebecker:                    I mean, all of that can be true. So yes, yes, yes. But I think predominantly, what my experience has been is it’s just that it’s different when we have an overgrowth versus an acute infection that we’re used to thinking of where there’s a prescribed acute infection and we know 10 or 14 days of an antibiotic is going to take care of it. Because here in SIBO, we have these levels of which the overgrowth can be and we can see the gas can be 150 or something. In another person, it’s 20. So it seems to correlate the amount of rounds with the overgrowth amount. The gas is a representation of how many bacteria are grown. So I think it just takes time. Basically, it’s thinking of a chronic infection, even though it’s not technically an infection. We treat until we get effects.

                                                We just have to keep going and going at it. So then the question is why can’t we just use one treatment and then just treat for however long it takes until it goes down? For some people, that does work, but unfortunately, what I found happens so often was the treatment would peter out. Its effect would peter out and it would stop working. You’d know because they would have had some improvement and then their symptoms would come back while they’re even taking it. So it’s like it just couldn’t do anymore. It did all it could do. So then you just stop. At that point, I would retest, but you have to switch. You use something else. Thank gosh, we have a lot of tools in our toolbox.

                                                So then that’s the next round. If a patient is sensitive enough to pay attention to these things, some people are, some people aren’t. I think great. If they’re still getting effects, you can keep them on something until it’s not working anymore. But not everyone is paying attention like that or wants to. So that’s why we need, I think, the multiple rounds. Now, what about the biofilms, anti-biofilms? I think that that’s another thing to think about for sure. My experience was that I used a lot of anti-biofilm products for a long time treating SIBO, and then I wouldn’t use them in other people. So I had a good comparison and I was only using the enzyme-based anti-biofilms and the EDTA type of products. I could detect no difference at all in anything at all.

                                                Really, my intention in using them was to try to prevent as much relapse. That’s what I was hoping for, and that was a bust. But I can tell you that Dr. Ruscio did an in-office study on that and presented this at one of our SIBO symposiums. He found that statistically on paper when using the anti-biofilms, it reduced hydrogen gas a little, but he could not detect that clinically at all. There was no clinical representation of that. It was a statistical on paper thing. So just continuing down with this story, I was just very disappointed in anti-biofilms. But then I spoke to Dr. Paul Anderson, this was years and years ago, and he’s an anti-biofilm expert.

                                                He had treated a lot of conditions with very serious infections, and he had done a lot of research and found that bismuth thiol products were very good anti-biofilms and he thought the best. Now, he has an over-the-counter option, but at that time, he just had a prescription formula. So I used that in some of my patients and I found it made a difference. Where it made the difference was in relapse. I didn’t necessarily see as much of a difference in not needing multiple rounds. I think theoretically, it could make a difference. I just didn’t observe that at the time. So I like to recommend if you’re going to use anti-biofilm in SIBO that you use the bismuth thiol. I just couldn’t see any effect for three years of using the other products.  Maybe other people have different experience, but it was a dud for me. So I would say it is definitely worth an option and maybe it could reduce. I know when you’ve had Pimentel on your show in the past, he’s talked about, and even just recently I was doing a Q&A with him, finding that some of the overgrown microbes live in a biofilm along the lining. I know you’ve asked him and I’ve asked him, “Well, then what about anti-biofilms?” I think he’s waiting until he would present research whether it would be truly effective or not.

Dr. Weitz:                            I know particularly the methanogens seem to live in this mucus layer, which is a biofilm that it’s got to be hard to get to those. We know that treating methane seems to be more difficult than hydrogen.

Dr. Siebecker:                    What has your experience been with anti-biofilms?

Dr. Weitz:                            Sometimes I think we get a benefit and other times we don’t. So I haven’t done any systematic analysis of it, but I get the impression that we get some benefit from it.

Dr. Siebecker:                    That’s good. Do you use all the different types or just the bismuth ones?

Dr. Weitz:                            Yeah, no, I use the enzymes. I often start with the enzymes and then use the bismuth ones depending upon exactly what’s going on. I’m a little nervous about using bismuth for long because it is heavy metal.

Dr. Siebecker:                    Yeah, that’s right. We talked about that before. The good news with the bismuth thiol is… Well, this is in the context of treating hydrogen sulfide SIBO is bismuth helps with that, but the bismuth thiol are a much lower dose than what has been studied bismuth for hydrogen sulfide. So I like that we can use a much lower dose with those bismuth thiol ones.

Dr. Weitz:                            Speaking of treating hydrogen sulfide, in fact, any new treatments for especially herbal nutritional for treating SIBO? The traditional antimicrobials that are used are berberine, oregano, allicin. Any new guys on the block that seem to be hitting the radar?

Dr. Siebecker:                    Well, I’d say that bismuth. I mean, that’s not really that new, but it’s worth really mentioning. Other than that, well, Atrantil, we’ve been using that for years. That’s a combo product for methane. I did a bunch of before and afters. That’s not really new, but just mentioning it, right?

Dr. Weitz:                            Correct.

Dr. Siebecker:                    I haven’t really been using anything new, but Dr. Hawrelak has reported using perilla and tincture of oregano, which we already were using oregano, but he actually was reporting that he found that that worked on methane. I had used oregano for methane. I thought it was going to give me a result, and then in the end, it didn’t pan out. So I just wonder, “Huh? Could the tincture be the difference?” Because I really never did see much of an effect from oregano for methane, but perilla is a new one for me. I haven’t used it. So he’s using that one too, but he’s using that only when the standard things aren’t doing the job.

Dr. Weitz:                            Then some of the products have oregano and they also have thyme. The thyme oil seems to be… I find sometimes very beneficial.

Dr. Siebecker:                    Yeah, I mean, that’s a potent.

Dr. Weitz:                            It’s potent. Yeah.

Dr. Siebecker:                    The one problem with that is like what’s in the CandiBactin AR, but the one problem with that is if you’re using CandiBactin AR and BR, that’s great. You’re using berberine and oregano, which is our classic thing that we always use for hydrogen, but there’s nothing in there for methane. So always remember you have to add something in for methane, which would be the allicin-

Dr. Weitz:                            Like allicin.

Dr. Siebecker:                    … or the atrantil. Yeah.

Dr. Weitz:                            Right, absolutely.

Dr. Siebecker:                    If you have hydrogen sulfide, you add in bismuth. We also found high-dose oregano works good for hydrogen sulfide, but you’d probably want that separate then.

Dr. Weitz:                            Right. There are so many patients in this country right now taking GLP-I agonists like Ozempic for weight loss. We know that the way this works is by slowing GI motility. So when all these patients are done, when they’re now suffering with POS, that’s what I call post-Ozempic syndrome. Now their weight is ballooning up because they never changed their diet. Are we going to have a tsunami of patients with SIBO? By the way, I asked Dr. Pimentel about testing patients with Ozempic, and he said, “It’s just a nightmare. Their microbiome is so messed up.”

Dr. Siebecker:                    He said the same thing the other day when I was interviewing him also, I asked him the same question. I wanted to know what he thought. What is he seeing? Yeah, he said, it’s really hard to test it because nothing leaves the stomach. Dr. Morstein had said she is testing… Because she’s a diabetes expert, and she had said she’s testing patients the morning of the day they were going to do their next dose. So it’s like it’s been a week since they’ve taken their dose and on that morning, and she says it’s going fine. I asked Dr. Pimentel about that, because when you look at the studies, it takes weeks before the medicine becomes steady state or leaves the body.

Dr. Weitz:                            So Mona is giving him a SIBO test?

Dr. Siebecker:                    Yes.

Dr. Weitz:                            Okay.

Dr. Siebecker:                    Yeah, yeah, a SIBO test. Yeah. So my concern is, is that enough time? She said, “That’s working for her,” but Pimentel said, “Well, no, the reason you give the dose on seven days before it gets too low, you don’t want people bottoming out.” So he has a very hard time getting accurate results testing anyone on Ozempic. To your point, yeah, there’s a real concern that people could develop SIBO. Of course, we have no data on us at this time, but it’s a real concern. The thing that it seems to do is slow the stomach. Does it also slow the small intestine?  I think so. But the stomach itself, the migrating motor complex, one of the forms or I guess one of the types of migrating motor complex starts in the stomach and continues through the small intestine. That is, from what I’ve read, the more powerful migrating motor complex. That’s our protective wave. That’s our number one body’s protection against SIBO is the migrating motor complex in the small intestine. So I believe it will turn that off. So it’s a real concern. It’s a real concern.

Dr. Weitz:                            Does the motility come back to normal typically with patients once they stop Ozempic?

Dr. Siebecker:                    I don’t know. I don’t know that. I don’t know if anyone’s looked at that. I bet you there’s people that could report about that just in their sensibilities, but I would think it would. Because when you hear about people’s hunger comes back after they get off.

Dr. Weitz:                            That’s why we tend to gain weight again.

Dr. Siebecker:                    On the other hand, you have to weigh it out against what someone’s facing. I would never want anyone to have SIBO, good lord, but diabetes can be fatal. So it depends on how much it’s needed. I guess also how it’s affecting that person. I know there’s people doing things with compounds where they’re going much lower and still getting good effects on blood sugar and things like that, but these are early days, but it’s a real concern. One thing I want to share that I heard from one doctor who said about the people gaining weight afterwards is that what they’ll do is they’ll just give people a much, much lower dose and help them to hold their weight for… If I’m not mistaken, I think she said one or two years.  It might’ve been two, because that’s how the body sets its set point. So if you could hold that, your goal weight or whatever for one or two years. I’m sorry, I don’t remember exactly. This was an expert on this, a doctor, and then they’ll take people off, but they’ll put them way low. That was a fascinating thing to hear about, just to try to work against that problem.

Dr. Weitz:                            One more question on the treatment, a lot of functional practitioners, some of them will also incorporate an immunoglobulin product as part of their SIBO protocol. Some do it specifically because I tend to use it when I see that the secretory IgA is low on the stool test, but some will use it all the time automatically, something like SBI Protect or MegaMucosa. These are also known to bind with the endotoxins and potentially might help with the eradication.

Dr. Siebecker:                    I think it’s a great idea. I love serum bovine immunoglobulins, or for people who are vegetarian, they can do colostrum that has high IgG. I love it. I spent some time really looking into all the studies and just as you said, excellent for LPS. It has straight antibacterial properties. It can prevent food poisoning. I had an experience where I was traveling in Mexico, my husband and a group. We took it the whole time and we didn’t get food poisoning when the other people in our party did.

Dr. Weitz:                            Oh, interesting, because that question comes up a lot is I’m going to Mexico or wherever I’m going and I want to try to avoid getting food poisoning again. Dr. Pimentel’s answer is just to take antibiotics.

Dr. Siebecker:                    Take a half a pill of Rifaximin is what he recommends. I’m not sure that what I did is enough for everybody. What other colleagues will say is take one Allimed pill or two Allimed pills.

Dr. Weitz:                            Yeah. I’ve had patients take one Biocidin.

Dr. Siebecker:                    Yeah, yeah, yeah, things like that. But this worked for me and I was so grateful. It does a lot of amazing things. I mean, it can help with lipids, the IgG. I mean, it’s just so important, anti-inflammatory. It’s expensive is the problem, but I think if someone can afford it, it’s a great thing to have on board for so many reasons. Not just SIBO.

Dr. Weitz:                            What about the use of probiotics for SIBO? A number of practitioners use probiotics. We both know one prominent practitioner who says that’s the first line treatment. Everybody should get three probiotics, Lacto bifido, Saccharomyces boulardii, and a spore based. Some practitioners feel spore based is good because it won’t add to the bacteria in a small intestine. They’re concerned that even giving antimicrobial herbs or antibiotics, we might damage the microbiome. So why don’t we try to beef up the microbiome at the same time? And then we have Dr. Hawrelak who found specific strains like Lactobacillus reuteri, DSM 17938 that reduces methanogens.

Dr. Siebecker:                    Yeah. Okay. So here’s the deal. It’s all good. Then of course, we didn’t mention this. I think still Dr. Pimentel is not a fan of probiotics.

Dr. Weitz:                            Not at all, but part of the reason he’s against probiotics is because of all these meta-analyses that lump in all these different studies on probiotics, and they’re all using different probiotics. They don’t even report on which particular strains. You certainly wouldn’t throw in all antibiotics and say, “Antibiotics are effective for SIBO.” You test a specific one, and here we’re throwing in all these probiotics as if it doesn’t matter which strains and how much of each. Then we go, “Oh, probiotics work.” So he has a problem with that.

Dr. Siebecker:                    I would agree. That is a strange thing, isn’t it?

Dr. Weitz:                            It is.

Dr. Siebecker:                    Okay. So we’re fortunate in that we have a whole bunch of studies on probiotics and SIBO. I mean, right now, I haven’t counted recently, but there should be about 35, maybe even more than 35 studies, which is a surprise to a lot of people that there’s that many. There’s been reviews of these. The most recent one was I think 2017. So this gets quoted a lot, and it’s really astounding what it showed. It showed like a 53%, even with some products, actual eradication rate of SIBO. So this gets everyone excited. Oh, my God. Can I use probiotics for my main treatment of SIBO? The issue with these studies is a lot of them, and let me just preface, here’s the problem, is that clinically, it’s pretty rare for any of us to see those types of results. That’s frustrating.  We want to see these results. Even if you go out and you get the exact same product that was used in a study that had a fantastic decontamination rate, we don’t get those same results. It’s really frustrating. So one thing is that a lot of these studies were small. A lot of them were done on certain conditions with certain age groups. Just as an example, pediatric short bowel syndrome. That may not translate to an adult with IBS SIBO, who doesn’t have an altered anatomy. So maybe that’s what some of the differences, but one way or the other… There haven’t been any duplication studies on any of these.

                                                Maybe that’s why we’re having a clinical difference, but the evidence in the studies is excellent. Certainly, it shows that probiotics can lower gas levels, can lower symptoms, and may even be able to eradicate SIBO. What probiotics? In these studies, just as you said, for the general IBS studies, they use every different type, all different kinds of lactobacillus, all different kinds of bifidus, all different kinds of spore bacterias, and Saccharomyces boulardii. Here’s the thing, all of those different types showed benefits. As you mentioned, Lactobacillus reuteri, everyone says it different. That was amazing for methane. I think it’s like 55% at eliminating methane, but that same strain has been studied to help diarrhea.  So we think of methane with constipation. That same one was also studied, showing reduction of SIBO when you’re on a PPI. So really, really interesting. Bacillus clausii, the spore has excellent studies for hydrogen. Then there’s a lot of studies on combinations where they use yeast and lactobacillus and bifidus or spore and everything. But what are we supposed to do when we try it and then it doesn’t work? So basically, the study also for IBS, they’re pretty good too. I think it’s fine. A good idea to try probiotics, first line, I guess you have to decide where you are in the patient in the journey, because first line, I think that’s a great idea for someone who’s having digestive trouble.  But if they’re suffering with really bad symptoms for really long time, you may not want to do that first. A lot of the studies show that it takes three months to get these results. Well, if someone’s in real acute distress, we may not want to wait that long. So it probably depends on the circumstance. For some people, I think it would be a great first line. I think it’s a great thing to throw in and try at any point. I personally like to try probiotics before I’ve gotten somebody all the way better and they’re all perfect.

                                                I know that what most of our training is the four Rs, and you do the probiotics when you’re done at the end. I did that in the beginning when treating SIBO and I had a lot of problems because of all these multiple rounds that I needed to do, it could sometimes relapse and it would take me a while to get someone all squared away. It might take me a year and then I give them probiotics. It’s like I rock the boat and they would oftentimes have a bad reaction. I don’t want to rock the boat when it’s all good. So I like to start them on probiotics during treatment, or at least before I’m all finished with everything. People have a different ideas about that, but I just think if you do it, then if somebody has a reaction or something’s not right, you have time to fiddle.

                                                You’re in the middle of using antimicrobials. So then which ones? I don’t know. So many different ones seem to have worked in these studies. That’s probably why Dr. Ruscio likes to give those three all three together just in case cover all your bases. The problem also that I didn’t mention is that many people have a bad reaction to probiotics. So that’s where it is probably a good idea to make sure you’re trying the different ones. It might not have a bad reaction to yeast or to spore if they had Lactobacillus.  A lot of people have histamine intolerance and then there’s all people talk about, “Oh, well, there’s some probiotics that are safe for people with low histamine producing,” but then even they can still react. Dr. Hawrelak generally recommends bifidus for people who are sensitive to histamine, but probably that’s going to be very individual. I mean, we know how an individual it is with histamine sensitivities. So that’s an issue too, is that a lot of people can’t handle them, but then they may be able to handle them as they move along in their treatment. So that gets us going on the topic. So tell me what you think.

Dr. Weitz:                            So I was trained with the four R protocol from going all those seminars with Dr. Bland for all those years. I really do miss those. I used to listen to his functional medicine update. We used to get these little cassette tapes and then they were CD of DVDs we would put in the car. Anyway, so I started off doing a four R and then I decided to start adding in probiotics as part of the protocol because I wanted to make sure I didn’t damage a microbiome. That wasn’t really working.  So I went back to the four R program, and it’s a two-phase thing, which is we do the eradication first. Then when we feel like we’ve got the symptoms under control, we start microbiome restoration, rebuilding the gut, rebuilding the gut wall, and use those products. I usually start with the spore-based probiotic. That seems to be the safest. Then gradually expand to other prebiotics, probiotics, and at the same time, we’re slowly expanding the foods that they can eat as well.

Dr. Siebecker:                    That sounds great. So that’s gone well. You haven’t had too many reactions with that.

Dr. Weitz:                           Yeah, that seems to work pretty well, especially when the patients comply.

Dr. Siebecker:                    I mean, my problem is that I saw extremely sensitive patient population, and even the spore ones were… I mean, I used to make a joke about a very popular spore-based combination probiotic, and I said, “It should just be relabeled die off because my patients would react so intensely to it.” But that’s just the sensitive group. So it’s good to hear that your patients are tolerating that well.

Dr. Weitz:                           I know Pimentel had a negative report about lactobacillus.

Dr. Siebecker:                    Well, yeah, they found in one of their studies when they were really assessing what was overgrown in the microbiome, and then they figured out this new assessment for an imbalance or dysbiosis in the small intestine microbiome where they identified disruptors, basically certain bacteria that if they would get too overgrown, they would disrupt the entire ecosystem. They classified lactobacillus one of them. It was just this one little sentence in one of these studies, and we all noticed it. We all started asking about it, and that’s all they can say. They haven’t said anything else.  So all these years following this research as it comes out, I don’t get too excited about one thing or another. I just wait until more information comes out. I mean, look, we’ve been using lactobacillus in our patients forever with good results, unless they have a reaction and then we don’t use it. I’m not worried. We’ll just see what the research shows in the future. Maybe there’ll be some very specific things, but otherwise, I’m not going to worry about it.

Dr. Weitz:                           I was reviewing some of Pimentel’s recent papers, and one of them was the one where he looked at the methanogens and hydrogen sulfide producing bacteria. There’s this interesting information, I wonder if we have anything to do with it, which is that there’s certain bacteria that produce the hydrogen to feed the methanogens. So we have Ruminococcus, Christensenella, and then we have these Enterobacteriaceae that feed the hydrogen sulfide bacteria. It seems like something important, but is there anything we can do with that?

Dr. Siebecker:                    Yeah, this is key. These are the syntrophys. So this is basically what is creating the hydrogen for methanogens or hydrogen sulfide. They call them the syntrophys. What’s really amazing about this is that I and they, everyone just assumed it was the overgrown standard hydrogen bacteria, E. coli and Klebsiella. So we thought, “Okay, we’re aiming at that.” So basically, this is a new target for our treatment, and I haven’t actually spent time going through PubMed looking at various articles on what kills those things, what MIP levels. I haven’t done it yet because what we have works. So we’ve been using it for so long of all the before and after tests.

                                                We already know it works, but what I think is going to happen is, well, I know they’re doing research on it, Pimentel and Rezaie and all that. I think they might have something at this DDW, which is the big gastroenterology conference that happens every year in the spring. So 2024, I think they might have, we’ll see, some treatments to reveal aimed at those. If it’s not this year, it’ll probably be next year. I’m so glad you brought it up. I think that this is going to be the wave of the future. We probably get more specific at targeting when we’re treating methane and hydrogen sulfide, what treats, what aims at those syntrophys. Then they had a paper that came out in December and I don’t have all these organisms memorized, but they had this sequence now where it’s like this leads to this leads to this. It was like a further piece.

Dr. Weitz:                            Really?

Dr. Siebecker:                    Yeah. So sorry I didn’t bring it up in front of me or I could read it to you. For anyone who’s interested, I do a quarterly newsletter. You could just sign up at SiboInfo and I put all the research and I put comments. So I put a big thing all about it, because it was really fascinating. I have yet chance to speak to Dr. Pimentel to ask him to publicly to explain this, because that seems like another target actually. They’re just learning more and more of the specifics of what is overgrown. The whole point is this is going to refine our treatments.

Dr. Weitz:                            Right. Yeah. I’ll make sure to review that next time before I talk to Pimentel. I think they dropped the statin for methanogen.

Dr. Siebecker:                    He’s still working on it.

Dr. Weitz:                            Oh, he’s still working on it. Okay.

Dr. Siebecker:                    Yeah, he hasn’t fully dropped it. It was a disappointment, but so for anyone who doesn’t know, he was working on enterocoded, not exactly like a statin that wouldn’t absorb into the blood. So that you wouldn’t get all those other effects. Statins, it works like Atrantil. It inhibits methane production. It actually disrupts an enzyme in the methanogen, so they can’t make methane. So this was another way to treat, but it just didn’t give them the results they wanted, but they are still working on it.

Dr. Weitz:                            I wonder if any natural practitioners are using red yeast rice for the same purpose.

Dr. Siebecker:                    Oh, yeah. We asked Dr. Rezai about that, and then he said that in a few patients it does work and then in others it doesn’t.

Dr. Weitz:                            Oh, interesting.

Dr. Siebecker:                    Yeah, exactly. That’s all the first thing we think about. Could we just use red yeast rice for this, like an alternate? Atrantil does the same thing.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    Yeah.

Dr. Weitz:                           Interesting.

Dr. Siebecker:                    Actually, I find Atrantil to be very hit or miss, probably just like red yeast rice. It’s in some people it hits like a miracle.

Dr. Weitz:                           Are you using a recommended dosage or are you using a higher dosage?

Dr. Siebecker:                    Using four to six a day.

Dr. Weitz:                           Oh, I think the recommendation is two a day.

Dr. Siebecker:                    Oh, yeah. So yeah, two is what we use for maintenance. Once you get your effect, then anywhere from one to three as your maintenance, because you still need to keep inhibiting that enzyme. Keep inhibiting the methane production.

Dr. Weitz:                            So you’re doing two or three twice a day.

Dr. Siebecker:                    Yeah, that’s right, for standard treatment round for a month. But here’s the thing, I’ve seen before and afters where that just works like a normal herbal antibiotic lowering methane in the same way you would expect, but there’s also these miracle cases that sometimes happen. The real miracle cases that I see are probably going to either be with Rifaximin or Atrantil and then they don’t work like that for the majority, but you get these miracle cases. You always remember them. But what will happen is for some people within just a few days, usually within four to five days, the Atrantil just has removed all constipation just completely. I mean, people in their 70s constipated for they’re entire lives gone in four days.

Dr. Weitz:                            Wow.

Dr. Siebecker:                    But then I find that the miracle, if it’s going to be a miracle like that, it’s usually pretty quick. My frequent educational cohort, Shivan Sarna, she interviewed Ken Brown. She interviews him a lot. He’s the creator of that. He said that he’s seen miracles happen months on. I haven’t. Usually, when you’re doing it for me, when I see him doing it over months, you’re just getting those incremental reductions in gas like you would anything else. I don’t consider that a miracle.

Dr. Weitz:                            Yeah. I haven’t seen any miracles.

Dr. Siebecker:                    Complete and fast. So maybe red yeast rice is the same. It’s like either it works or it doesn’t. That one particular approach I find is a bit more hit or miss.

Dr. Weitz:                            Right. If it lowers your cholesterol at the same time, probably not a bad idea.

Dr. Siebecker:                    You can get other benefits.

Dr. Weitz:                            Have you used any peptides? Some people use BPC 157 supposedly to help heal the gut lining, to help heal leaky gut.

Dr. Siebecker:                    I haven’t used it in patients, but when I found out about it years ago, I was enthralled and I brought in a whole bunch of people to interview for various summits and educational events, Dr. Bar and others speaking.

Dr. Weitz:                           I know he was using it a lot.

Dr. Siebecker:                    He was, speaking very favorably about it. I mean, when you read about it, it seems like a perfect match. Again, it’s expensive, right? I’ve heard some people say it was wonderful for them and not much for others. So I don’t have a ton of experience with it. I was very interested. Did you try it a whole bunch?

Dr. Weitz:                           No, not a whole bunch because of the expense. If I already have patients on four or five different products and then you throw in a product that’s $150 to $300 for a month’s supply-

Dr. Siebecker:                    It’s a lot.

Dr. Weitz:                           It’s a lot.

Dr. Siebecker:                    Yeah. I haven’t heard enough feedback to make me think that’s worth it full bore for most people.

Dr. Weitz:                           When I’ve used it, I found around four capsules a day was about the right dosage, but that means you’re going to go through a bottle in two weeks, so that’s 300 bucks a month.

Dr. Siebecker:                    I mean, I tried it on myself. I always try everything almost, and it was meh, but that’s one person.

Dr. Weitz:                           Yeah, I know. I use it for healing for musculoskeletal injuries as well. I wouldn’t say I’ve seen a lot of miracles, but there seems to be some benefit.

Dr. Siebecker:                    Yeah, and I guess I’ve heard some cases that responded really well.

Dr. Weitz:                           Right. All right. This has been awesome, Allison.

Dr. Siebecker:                    We talked about a lot of different things.

Dr. Weitz:                           We did. Thank you for being so generous with your time.

Dr. Siebecker:                    Oh, it’s been such a pleasure.

Dr. Weitz:                           Tell the viewers about some of your courses and how they can sign up for them.

Dr. Siebecker:                    Oh, yeah. I have a bunch of trainings. If anyone’s interested in learning more about SIBO, I have a full length SIBO training, very comprehensive, 22 hours, got mini trainings on SIBO and testing. I’m doing a testing masterclass here soon. You can find all of this on my website, siboinfo.com that has a lot of information. Of course, signing up for my newsletter. I always send my quarterly newsletter has all the studies. If there’s ever any treatment updates, like in the January one, there was different antibiotics that people are using. I put that in there. So anyway, I’d love for anyone to join me for a training.

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

Dr. Siebecker:                    Thank you so much, Ben.

 

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Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. So many areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, autoimmune diseases, cardio metabolic conditions, or for an executive health screen.  To help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way, please call my Santa Monica Weitz Sports Chiropractic and Nutrition Office at 310-395-3111. We’ll set you up for a new consultation for functional medicine, and I look forward to speaking to everybody next week.

 

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Dr. Nalini Chilkov discusses An Integrative Approach to Cancer at the Functional Medicine Discussion Group meeting on March 28, 2024 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

4:08  The relationship between cancer and obesity and glycemic control is huge.  Patients who are obese, have hyperglycemia, and hyperinsulinemia have a 40% increased chance of being diagnosed with cancer and have a 40% increased chance of a cancer recurrence.  Both insulin and insulin-like growth factor that are actually proliferative signals.  And tumor cells have more glucose, more insulin-like growth factor receptors, and more insulin receptors than normal cells.

7:34  The United States is a sugar nation and diabetes and obesity continue to rise here.  Obesity accounts for 14% of cancer diagnoses in men and 20% in women, and its higher in women due to the estrogenic effect of fat.  Some cancers are more directly linked with these signally pathways, including GI cancers like colon, gastric, gall bladder, and pancreatic cancer, liver cancer, endocrine cancers, Hodgkin’s Lymphoma, Multiple Myeloma, and renal cancer. There are biomarkers that we can measure to evaluate the cancer terrain in the tumor microenvironment. By identifying these signally patterns, including glycemic control, inflammation, and obesity and making changes to their diet and lifestyle, we can help patients to have better outcomes and have less chance of recurrence. 

 

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Dr. Nalini Chilkov is the founder of the American Institute of Integrative Oncology Research and Education and the creator of the The OutSmart ® Cancer System.  It is her mission to change the face of cancer care so that every patient has a plan for their health and not just a plan for their disease at every phase of the cancer journey. She is committed to training front line clinicians worldwide to become skilled and confident in serving the health needs of patients whose lives have been touched by cancer by utilizing her OutSmart Cancer® System. She is the author of the best seller, 32 Ways to Outsmart Cancer_How to Create A Body Where Cancer Cannot Thrive and is recognized as an authority and pioneer in the fields of Integrative Cancer Care, Cancer Prevention and Immune Enhancement. Dr. Chilkov has lectured worldwide and at the Schools of Medicine at UCLA and UC Irvine and is a frequent expert resource to the media.  Her websites are Nalinichilkov.com and the American Institute of Integrative Oncology.

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.

 

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Podcast Transcript

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

                        I want to introduce our speaker, Dr. Nalini Chilkov. She’s the founder of the American Institute of Integrative Oncology Research and Education, and she’s a creator of the OutSmart Cancer System. It’s her mission to change the phase of cancer care so that every patient has a plan for their health and not just a plan for their disease at every phase of the cancer journey. She’s committed to training frontline clinicians worldwide to be skilled and confident in serving the health needs of patients whose lives have been touched by cancer by utilizing her OutSmart Cancer System. She’s the author of the bestseller, 32 Ways to OutSmart Cancer: How To Create A Body Where Cancer Cannot Thrive. And she’s recognized as an authority and pioneer in the field of integrative cancer care, cancer prevention, and immune enhancement. Dr. Chilkov has lectured worldwide and it’s a frequent expert resource to the media. Thank you, Dr. Chilkov.

Dr. Chilkov:        So, we’re going to be an intimate group, so I’m going to ask you to move to the center. I’m going to ask you to come so I can just look at one place and we can have eye contact and since it is a small group, we can be more interactive. So, while I’m lecturing you have a question, just raise your hand and I’ll be happy to answer it. Otherwise, I’ll also leave time at the end. So, we’re going to talk about cancer, and insulin, and obesity. And I particularly like to give this lecture to primary care clinicians because we have such an epidemic of metabolic syndrome, and obesity, and diabetes in our country. And this really causes a large group of patients to be at high risk. So, we’re going to talk about that and then some of the interventions that I use and some of the assessments that I use. And I think it’s really important in a primary care practice to be aware of this.

                        This is part of a online training that I have for primary care and frontline clinicians. So, if you get really inspired tonight, you can reach out. We’re happy to talk to you about my course. It’s self-paced. And then I also have a mentorship group for those people who want to have you review your cases and help you through them. And it’s a pretty engaged group. It’s a wonderful community that we have once a month online together. And also you can have a big discount by attending this. So, if you’d like that, you can just email us. I’ll give you my email address if you want to get the PDF of this lecture or you want more information about the course with the discount. And also, do you give people a PDF of the lecture?

Dr. Weitz:          What’s that?

Dr. Chilkov:       Do you give them a PDF copy?

Dr. Weitz:          I can.

Dr. Chilkov:       Yeah, so you can have the lecture slides. And I have this little handout that’s really nice to give to patients so that they can understand how to eat if they’re diagnosed with cancer. And so, it’s just like a checklist. It’s a one-page handout. If you’d like to have that for your practice, then you can have that, too.

Dr. Weitz:          All right, yeah, please give me your PDF, I’ll put it in my list.

Dr. Chilkov:       Well, I have one so we can send it to you.

Dr. Weitz:          Okay.

Dr. Chilkov:       We can just send it to you.

Dr. Weitz:          Okay, sounds food.

Dr. Chilkov:        All right. So, if you memorize this slide, you got the lecture. Okay. So, the relationship to cancer, obesity and glycemic control is huge. Patients who are obese, patients who have hyperglycemia and hyperinsulinemia have a 40% increased chance of being diagnosed with cancer and they have a 40% increased chance of having a recurrence. So, it’s a teaching moment for people. And people come into our practices at every stage of their cancer journey. So, wherever they come in, it’s a teaching moment as far as I’m concerned. So, if you look at these relationships, of course lifestyle is a contributor to all of these. But when you have insulin resistance and hyperinsulinemia, you have this driving force that has growth factors. And so, it’s insulin and insulin-like growth factor that are actually proliferative signals. And tumor cells have more glucose, more insulin-like growth factor receptors than an insulin receptors than normal cells. So, that’s why cancer is exquisitely sensitive to changes in blood sugar and insulin.

Dr. Weitz:          There’s one thing missing from the slide. Where’s Ozembic?

Dr. Chilkov:        That’s a whole other discussion, isn’t it? But it is interesting. It is interesting because when people have more normal body composition, less percentage body fat, more glycemic control, more normal insulin, more normal blood sugar, they don’t have the signaling going on. So, that population, that obese and diabetic population, is not only decreasing their risk of cardiovascular disease, which has been in the news, but they are also decreasing their risk of cancer that is driven by these pathways. Not all cancers. And some cancers are more explicitly sensitive to glucose. I have some slides on that for you. But at any rate, so you can measure fasting insulin and insulin-like growth factor one when you do labs on people. And then of course we know that people who are diabetic and obese also have more inflammation. And we also know that there’s a hormonal component, which I’m going to show you that as well.  So, this is essentially what we’re going to talk about. And it’s pretty daunting the amount of people in the world that are impacted by this. And so, that’s why I think it’s really important for primary care and frontline clinicians to be aware of this. And what’s true is that one in two adults with diabetes is diagnosed. So, these people are running around with higher risk, many comorbidities. And so, I think it’s really important for primary care clinicians to be aware of this. And these are just some statistics that are so really depressing. I want to read them to you. But if you look at the darker colors on this, the dark countries, that’s where the highest rates of diabetes are. So, welcome to America. All right.

                        So, this is the curve of the acceleration of diabetes in this country. United States is a sugar nation really. We teach kids to have a sweet tooth, really young. And so, it’s really a problem. So, what we’re going to talk about is first obesity being a major risk for cancer. And of course that goes along with diabetes. But not always. Not always. So, obesity is related to 14% of all cancer diagnoses in women in and… 14% in men and 20% in women. It’s higher in women because of the estrogenic effect of fat. So, that’s pretty daunting. And also, I just want to point out this book. Although it was published a long time ago, I recommend it because it has this really clear explanation of the physiology that we’re talking about. So, if you just want a really good reference to read in more in detail these signaling pathways, it’s just really well-written basically.  And so, if you look at, these are the cancers that are most linked to obesity. But you can see it’s a pretty wide range of cancers. It’s not just one category. So, you’ll see that there are GI cancers there. You’ll see that there are endocrine cancers there, liver cancer, and you can see Hodgkin’s lymphoma and renal cancers. So, it’s a wide range of cancers. So, obesity by virtue of changing the hormonal milieu, changing the inflammatory milieu, this is part of driving cancer. And one of the things we talk about in an integrative approach is oncologists are fascinating by the tumor, but they’re not fascinated by the biosystem that’s hosting cancer. And that’s what we need to be interested in. And so, we want to be interested in what we call the tumor microenvironment or the cancer terrain, which is the signaling environment that will either be proliferative or supportive of carcinogenesis, and proliferation, and progression of metastasis.

                        So, there are biomarkers that we can measure to evaluate that cancer terrain in that tumor microenvironment. And thereby, put a treatment plan together for the health side of the cancer equation. And that’s really what I teach. So, my mission, if you will, is not to train integrative or naturopathic oncologists, but it’s to train people like yourselves, how to monitor patients at every stage of the cancer journey and put together health plans, and identify these signaling patterns in their biosystem so that they also have better outcomes from their treatments, they have less chance of recurrence. And then we can restore their health and give them a biosystem that is not going to be supportive or hospitable to cancer development or recurrence. So, that’s the framework. And so, thinking about glycemic control, and inflammation, and obesity, and body composition is within that framework. Yes.

Speaker 3:         Is there a certain BMI, like is it BMI number 25 that presents this increased risk [inaudible 00:10:56]?

Dr. Chilkov:        So, the question is what about BMI? So, there’s no hard and fast statistics on that. I really think more about body composition. We know BMI is a waffley way too. But you could say 25. You could 25 is where there’s too much body fat. And then you get into because there’s more body fat and less muscle mass, then we get into all kinds of other metabolic issues. And think of the age demographic as well. So, the age demographic for cancer patients historically has been people over 50. Now we’re having an epidemic of younger people under 50 being diagnosed.

                        And in the press right now in the medical community go, “We don’t know why that’s happening.” But that’s a pretty lame comment because of course it’s environment, it’s body composition, it’s the endocrine disruptors in our environment, it’s stress, it’s sleep cycle, it’s all the things we know cause health or the lack thereof, make you vulnerable to multiple types of chronic illnesses. And cancer is a chronic illness. Cancer is not an urgent care. Cancer is not a short-term crisis. It’s a long term metabolic problem. It is a chronic illness and it has to be framed as such.

                        And if you look at it through that lens, you’ll address the whole biosystem and all the signaling, and the way that you are trained to practice already. If you keep looking through that lens, understanding what to pay attention to. So, these are some of the things we want to pay attention to. So, these are the cancers that are most associated with obesity. And so, you can see that they’re also diverse. It’s not kind of one category of cancers. But it is very interesting. Also, I think gastric cancer should really be on this list because gastric cancer is becoming more common, especially in younger people. And it is a cancer where error in fatty acid metabolism is part of what drives the cancer. And so, for example, sometimes we use statins off label for these types of cancers. And so, this in our country where obesity is such a problem is an issue. And should therefore be aware that you might want to be screening people more for cancer if they’re obese or have glycemic control issues.

                        So, I have a lot of slides. This is a longer lecture typically, so I’m not going to read all the slides to you. But if you want to get a copy of them and read the details, I think our time is better spent in dialogue than in me reading slides to you. So, obesity is a risk factor. And there’s other things that go along with that. If you have surgery and you’re obese, you have more complications, you have poor wound healing, et cetera. So, you’re at risk for secondary malignancies when you’re obese. There’s a higher mortality rate in obese patients. So, I want to give you the big concept so you can think it through with your patients.

                        So, here again, we have just what is the physiology that drives this? So, of course we all know that if you’re sedentary, you eat too much, you get obese. But of course we also know that’s not the only reason. It’s not just calories in calories out. So, want to identify metabolic issues in our patients. But if we are able to lower fasting insulin and lower insulin-like growth factor, we do get more control of cancer. And you can do that pharmacologically, but you can do it with lifestyle as well. And so, for example, if you lower your animal protein, you can lower your insulin-like growth factor.

                        So, it’s this tricky thing now since Gabrielle Lyon published her book, if you read her book on muscle medicine, the need to have adequate protein, which as we age to maintain muscle mass and to maintain metabolic health. And also because of the age demographic of cancer patients, we have a population of people who are potentially sarcopenic. And the physiology of cancer itself drives sarcopenia. Sarcopenia, the loss of muscle mass actually starts when you have a solid tumor. And you can’t see it, you can’t measure it, but it’s actually happening. So, it’s very important since obesity and glycemic control are related to muscle health and muscle mass to realize that all cancer patients are at risk for sarcopenia. And that be thinking about that right from the beginning because the oncologist is not. So, we want to be the team members, the collaborative team members that have this health model for the patient.

Dr. Weitz:          But this is a big dilemma. We want to give the patients more protein. It’s a great way to control glycemic balance, insulin.

Dr. Chilkov:        So, the best way is to exercise and increase your muscle mass. And of course you have to have the signal to the muscle, so you have to have enough leucine. So, I find that a lot of my cancer patients are exhausted and overwhelmed typically. And so, they’re not that interested in cooking or eating sometimes, especially if they’re in the middle of treatment. So, I use free-form amino acid powders, particularly branched-chain amino acid powders to give enough leucine to signal the muscle. That’s what I do. And so, you’re able to get adequate amino acids into people who aren’t interested in food or might not want to eat a lot of animal protein.

Dr. Weitz:          I often hear from vegans arguing a particular amino acid is going to increase your cancer risk. And pick different ones, methionine, glutamine, leucine.

Dr. Chilkov:        All right, well, that’s a little bit of a tangent, but I’ll [inaudible 00:17:24]-

Dr. Weitz:          Okay, sorry.

Dr. Chilkov:        … For a minute because we got to get through this lecture. So, cancer cells are smart. They co-opt our normal physiology for their own survival. And so, they do that in a variety of metabolic ways. But not all cancer cells do all these adaptions. So, there is a fear of glutamine in the misinformed community. And glutamine is the most ubiquitous amino acid in the body. It’s stored in the muscle. And if a cancer cell wants glutamine, it doesn’t have to go anywhere to get it. It’s all around. And so, if we want to give glutamine in order to heal someone’s gut because it’s been eroded by chemotherapy, it’s not going to change whether or not the cancer cell has access to glutamine. So, you still have to think of the whole biosystem.

Dr. Weitz:          You have Thomas Seifried recommending glutamine blocking drugs as part of this protocol.

Dr. Chilkov:        So, there are subset of tumor cells that shift into glutaminolysis. But you can’t block glutamine. It’s like junk science. So, that’s my opinion. So, now that’s on tape. So, the other thing is methionine definitely has a role in proliferation. But again, it’s not every cancer, it’s not every tumor cell line. And going on a low-methionine diet is very risky thing to do. And I am not a proponent of it. And for patients who are at the end of the line, they’ve become treatment resistant and they’re desperate to try something. There’s a subset of patients who respond to low-methionine diets, but those patients become extremely sarcopenic. Extremely sarcopenic. And so, we have a colleague who is in LA here who’s a big proponent of low-methionine diets. And I think if a patient wants to try it, they have to cycle on and off of it because otherwise they just become ill. There’s too many things that are methionine dependent, including your mood. So, these patients become extremely depressed and then they can’t be compliant with an already difficult protocol.

Dr. Weitz:          Thank you. One more quick question. Is there lab test-

Dr. Chilkov:        You can’t keep taking off [inaudible 00:19:53], okay?

Dr. Weitz:          Is there a number for IGF-1 labs that you like to see?

Dr. Chilkov:        I like it to be below a 100.

Dr. Weitz:          Below a 100?

Dr. Chilkov:        Yeah. So, that’s hard. So, that’s hard. Nasa Winters, who some of you are interested in cancer may know she’s a colleague of mine. 125 is reasonable. That’s doable. Completely [inaudible 00:20:11].

Dr. Weitz:          Valter Longo says below 175

Dr. Chilkov:        No, no. Valter Longo doesn’t know anything about health. He is a lab rat. He’s a lab rat. He is theoretical. He’s completely theoretical. I was just on a stage with David Sinclair and he’s the same way. If you guys know who David Sinclair is, it’s a longevity. So, he’s a brilliant guy, he’s like reductionist. And so, we have to be whole systems thinkers. That’s what causes [inaudible 00:20:38], is to understand the whole system. So, it’s great to have people that go deep into research. But Valter Longo and David Sinclair don’t know anything about health. Nothing. Nothing. They know about their pathway. I’ve met him, I’ve talked to them. All right, let’s not get lost. I’m barely through my slides.

Dr. Weitz:          Sorry.

Dr. Chilkov:        All right. So, Ben and I have known each other a long time. So, control yourself. So, anyway, these are the things that we can intervene, help people metabolically, put them on anti-inflammatory diets, teach them how to sleep, teach them how to exercise, teach them how to have a good body composition. So, all the things we already do already become more crucial in cancer patients. All right. So, I have tons of references in here for you. So, these things occur together, obesity and cancer. And diabetes and cancer also occur together. So, in bold are the more glucose and insulin sensitive cancers. And so, people always ask me also about a ketogenic diet. And I am not a fan of [inaudible 00:21:57]. There is actually not a lot of research to support ketogenic diets except in brain cancer and pancreatic cancer, which are the more glucose and insulin sensitive cancers. But a ketogenic diet is not a healthy diet. It is a therapeutic diet. And some patients cannot be on if you have a severe osteoporosis, if you have kidney disease, you cannot be on a ketogenic diet. And it’s a hard diet to maintain.

                        And one of the things I’m very sensitive to is that cancer patients don’t have a normal life, they feel socially isolated, and I want them to be able to even their friends and their family. And so, I don’t want them to become more isolated. And so, I only prescribe ketogenic diets in pancreatic and brain cancers. And otherwise where the research is, where the research is solid, and thank you Walter Longo, is in fasting mimicking diets and in intermittent fasting. That’s where the research is solid, really solid.

Dr. Weitz:          What was the first diet you said, the?

Dr. Chilkov:        Ketogenic.

Dr. Weitz:          No.

Dr. Chilkov:        Fasting mimicking diet. That’s lingo that comes out of Walter Longo and his studies. But his fasting mimicking diet is an intermittent fasting diet and a low carb, low glycemic diet. And he’s marketed it and made a product, which I won’t name on tape, but I don’t like it. And because it’s not healthy foods. See these guys that do all this research, they don’t know what healthy food is. And so, you can’t just go on the ride with them. All right. So, glycemic control and body composition change the growth signal for cancer. That’s the big thing. And they change mortality, they change risk recurrence, they change occurrence of cancer. So, getting control of this is hugely, hugely important.

                        So, there’s also so many more. I mentioned so many surgical complications. So, my goal for hemoglobin A1C, which is probably consistent with the [inaudible 00:24:14] is between 4.8 and 5.2. That’s where I want people to be. And it’s totally doable. You just have to teach people how to do it. Realize cancer patients have high cortisol, they’re really stressed. That can push up their blood sugar and impair their glycemic control. So, realize that’s a contributor in this patient population. A lot of cancer patients have disrupted sleep cycles, which will impair their glycemic control. So, you have to do a very thorough analysis of root cause in etiology to make sure that you’re addressing where the impairment is coming from.

                        The other thing that happens to these patients is they become at risk for secondary cancers. Although I don’t see that a lot in my own practice. The research is there. So, here’s the other infographic that helps you see the big picture, the big picture of this physiology that we’re talking about. So, of course we have patients that are more genetically susceptible to developing insulin resistance and for glycemic control. We have patients that are more susceptible both from environmental signaling and genetics also to developing body composition with more fat. All of these patients have more inflammation. You get signaling from adiponectin and also from leptin that changes the signal to the tumor cell and that changes an environment to make it more hospitable to the development of progression of cancer. So, I actually measure adiponectin in leptin in all my patients, and you can do that.

                        And then when you have more inflammation, you get this sort of cytokine environment. The cancer cell itself will secrete inflammatory cytokines. And then the larger biosystem, if it’s more inflammatory, you get inflammatory both from the cell and from the biosystem itself. And so, this is a highly proliferative environment. And so, controlling inflammation, which we know how to do is really important. The oncologist does nothing on this note. And the oncologist is not interested in insulin or glucose either. And in some chemotherapy infusions prednisone is used to inhibit inflammatory reactions to the drugs. Mostly in platinum chemotherapies this is done. So, this impairs the patient’s ability to sleep, number one, but it also shoots their blood sugar up. So, I ask my patients to ask their oncologist to cut that prednisone in half, and I’ve never had anybody object to that. So, one of the things that I feel we should do is be resources to our patients to understand that they can ask for individualized care.

                        And so, if you know a patient already has glycemic issues, you want to remove the prednisone from their IV. And in fact, they also put antihistamines in the IVs. And so, sometimes that’s sufficient. So, if you think prednisone is a really bad idea for your patient, you can have that conversation with the oncologist. So, I think that’s part of our job, is to help the patient be an educated patient. Help them understand how to ask for care that’s more appropriate to them so that they don’t just get cookbook standard of care cocktails. All right. So, the other thing that happens, of course you have a change in liver physiology and gluconeogenesis. But then you also as you know, will have increased risk of fatty liver disease with all of this as well. So, thank you Peter and Tia do all that for us. So, that’s a factor in this patient population, too. So, we have to be mindful of their liver health in the face of metabolic issues.

                        And so, then what happens in addition to that is you have more body fat, you have more estrogen going on, and then you get changes in sex hormone binding globulin due to that. And so, this whole hormonal milieu and this signaling which becomes proliferative. We know that steroid hormones are proliferative hormones. So, we get this whole tipping of the whole metabolic milieu. And this becomes an environment that is able to host cancer development carcinogenesis, but also increases proliferation and metastasis because you get this going on where a vascular endothelial growth factor, VEGF, increases as does plasminogen activator inhibitor. And this increases coagulation. So, the tumor microenvironment is a microenvironment of thrombus risk. It is a microenvironment of hypercoagulation that’s a fact of cancer.

                        So, two things go on as soon as you have a solid tumor. You start to have sarcopenia signaling as a risk and you start to have hypercoagulation as a risk. So, you want to be mindful of that because 40% of all cancer patients have a thrombotic event. They will either have a thrombus or an embolism. And so, there’s no reason for cancer patients to suffer those if we can prevent it. So, I monitor fibrinogen and D-dimer in my patients. And you will see those go up. Those are markers of hypercoagulation in the cancer setting. Those are reliable markers of hypercoagulation. And oncologists are loathe to anti-coagulate their patients because the drugs are so strong. But we can do it with curcumin, and boswellia, and high doses of omega-3 fatty acids. You don’t want to anti-coagulate your patient, but we can inhibit platelet aggregation. It’s a little harder to inhibit fibrin clots. But that’s what cancer patients get.

                        So, if you see that a patient has high fibrinogen and high D-dimer, then you want to give them something like lumbrokinase or natokinase, which are able to act on the fibrin formation. So, the things we think of as anti-coagulants are the typical things are just inhibiting platelet aggregation. But the risk is fibrin clots and cancer patients need to be aware of that. We can so decrease patient’s risk. And if I see a patient with really high risk of thrombus formation. Like I had a patient come into my office and she had a port in her arm for chemo and she had a chain of lip clots below the port. Now I see the patient more often than the oncologist does. I was doing acupuncture weekly.

                        And so, I called the patient on my cell phone in front of the patient in my office while they were on my table and I said, “We need to anti-coagulate this patient. I’m going to send them over as soon as I’m done here.” And I wanted the patient to hear it, hear me say that to the oncologist. And so, we were able to identify that risk. The patient doesn’t know that shouldn’t be happening. And so, we tend to see our patients more often, more personally and observe them better so we can keep them safer. And what else do you tell a patient who’s got a risk of thrombus? You make them make sure they’re not too sedentary. You make sure they’re hydrated. You make sure they’re on an anti-inflammatory diet. And so, we can really keep people much safer. So, the first slide I showed you, the more general slide about obesity and cancer, et cetera. And then this slide, if you want to go back and really wrap your mind around all the factors that are contributing factors, these two slides really have everything that’s important to pay attention to.

                        And so, we know, again, I mentioned that there’s more insulin receptors on tumor cells and that’s why it’s really important to get control of insulin and blood glucose. Okay. So, there are other factors that drive obesity. We know that menopausal women tend to have different relationship to percentage of body fat. So, that’s the patient population that we’re typically working with in this age group. If you have a younger patient, it might actually be someone who had ovarian or endometrial cancer who had a hysterectomy. So, then she becomes in this group as well. As we always do, we always understand the patient’s lifestyle, which the oncologist doesn’t even ask about. And so, you want to be paying attention to that. So, you can see here that as I was talking about this estrogenic effect of obesity and we get changes in sex hormone binding globulin change in the ratio of free and bound hormone.

                        And so, we get changes in signaling and we get increased aromatase. And aromatase is an enzyme in the tissue that converts androgens to estrogens. So, you get more estrogen signaling. Which is why women who have estrogen-driven breast cancers are more at risk if they’re obese or have glycemic issues. It’s a high-risk population. Super high-risk population. A lot of them are in our offices because they want us to help them with their menopause. So, we got their ear. And so, we want to attend to this. And then because lifestyle runs in families, so do all these risk factors, it’s not just genetics. So, we have an opportunity to affect more people in one family if we do our patient teaching in that way.

                        All right. So, I want to hit the highlights so that we can just have a conversation. I think I made this point. But this is really interesting. Oh no, this isn’t the slide I want to talk about. But anyway, you can see that diabetes and glycemic issues are really a driver of breast cancer. But also say estrogen-driven cancers include other cancers. So, lung cancer can have estrogen receptors. Pancreatic cancer can have estrogen receptors. Colorectal cancer, brain cancer, prostate cancer. There’s a lot of cancers we don’t think of as hormonal cancers that have estrogen receptors on them. And so, you can request the pathologist to check.

                        All right. So, here’s what I wanted to talk about was the role of intermittent fasting and carbohydrate restriction. We know that this is a way to get glycemic control. But there’s all these studies on cancer patients and intermittent fasting. And so, I just want to say, there are historically what I call old naturopathic ideas about water fasting in cancer. That’s not what I’m talking about because that is too high risk for sarcopenia in this population. It’s just too high risk. And so, I don’t water fast people over 50 because they need their muscle mass. So, if you have a young patient who’s in good shape, they can tolerate some loss of muscle mass, they’ll get it back. But an older patient’s not going to get it back.

Dr. Weitz:          What about water fasting just before and just after chemo?

Dr. Chilkov:        I don’t want to put my patient at risk for sarcopenia, period. So, the question was what about water fasting before chemotherapy? The better question is what about fasting before chemotherapy? So, we know that there’s good studies that show if you stress tumor cells by making glucose unavailable to them, the cancer cells already stressed when the chemo is administered so you get a higher kill rate. So, it is well documented. However, I’m very careful. So, I look at the patient. If the patient is already underweight and undermuscled, I don’t do that. So, what I have that patient do is maybe drink bone broth or do a protein shake that has no fruit in it at all, and just get or just do branched chain amino acids, something to protect their muscles while we’re stressing the tumor cell does not get this impact. This stress comes from withholding glucose to the tumor cell.

                        So, if you can accomplish that and preserve muscle, that’s your goal. That’s my approach. Okay. That’s my approach. So, if I have a more robust patient, I’ll have them just do protein shakes or bone broth for 48 hours if they’re pretty robust. Some people will do it 24 hours. If somebody can only do it 13 hours, the data shows 13 hours enough to get a switch in the metabolism and have an impact. So, it depends how robust and also how psychologically motivated, and if somebody has experience with fasting and all of that. And they must be well hydrated. When you’re having an infusion of chemotherapy or anything else, you have to be well hydrated. You want to keep diluting what is coming into your system. And so, actually have people drink bone broth during their infusion. So, they’re getting fluids, electrolytes, and some protein. And that keeps them from getting into trouble with their kidneys also. Really, really protects the kidneys and the gut as well. Yes.

Speaker 4:         Do you recommend intermittent fasting for someone’s in remission?

Dr. Chilkov:        Yes. I actually think intermittent fasting as a lifestyle is really great, actually for everyone.

Speaker 4:         But how long?

Dr. Chilkov:        I think I have a study here. Let me see if it’s here. So, here’s the impact of carbohydrate restriction. And I do have sliding here somewhere on the study. So, there’s this balance between enough protein and lowering carbs. And what happens to people is they do need some dietary guidance. I have a nutritionist that works in my practice because when people just take their carbs out, they lose weight. And so, this patient population cannot lose weight. They need to maintain their weight unless they’re over fat, then we want them to lose fat but not muscle. So, if you take the calories out from carbs, you have to replace that with healthy fats with protein so that you maintain your weight. So, there’s some patient teaching that has to go on with that.

                        And I often will put a therapeutic shake into the protocol because again, these patients are not really that interested in food or in cooking for a lot of their treatment cycle. Afterwards, they may be. But during, they’re not, and they really need to be protected. So, they feel well also while they’re going through treatment and that they do well while they’re going through treatment, they have enough nutrients to repair the damage that the chemo causes. So, I do have a study in here, it’s coming up. 13 hours is out of it. 13 hours is out of it. Let me find that slide.

Speaker 4:         Like they do that every day?

Dr. Chilkov:        Yes. It doesn’t take much to fast for 13 hours. You eat breakfast a little later or dinner a little earlier. It’s not hard to do. It’s not to do at all. And if they wanted to have something in that window, they could have branched-chain amino acids during that time. It doesn’t disrupt this physiologic switch we’re trying to accomplish. So, it’s not hard to do. So, I actually recommend it to everyone who has cancer history, cancer risk, or is going through treatment. And then it becomes a lifestyle. So, I’m trying to teach people how to eat for their life, not for their key. And so, I think it’s really important that patients who are going through surgeries really need to keep their protein together and their gut together.

                        Just giving probiotics around any surgery decreases surgical complications in all patients, not just abdominal surgeries. Why? Because of its impact on inflammation and immunity. So, it’s really important and on mood as well, on neurotransmitters. So, at any rate, this is a classic ketogenic diet. And so, I don’t want to spend a lot of time talking about it. If you want to learn about ketogenic diets, I actually gave a really long lecture on one of the supplement companies that I can’t name during the recorded lecture, but I’ll tell you afterwards. There’s a long lecture on this online. Anyway, I don’t recommend it unless pancreatic with brain cancer. Or you could do a ketogenic diet for a couple of days before chemo. But you’re not going to get into full ketosis if you want to do for a couple of days. You only get a therapeutic mileage out of a ketogenic diet if you sustain ketosis.

                        It’s hard to do. You don’t feel well, people get diarrhea. It’s not an easy thing to do when you already don’t feel well. You already don’t feel well. So, I am very, very sensitive to what’s worth doing. What’s worth asking a cancer patient and a family to do cancer doesn’t affect just the patient, it affects their whole family. And so, it has to be sustainable over time. If it’s too hard, it’s not going to work. But anybody can do intermittent fasting and low-carb diet. Anybody can do that, teach them how to do it. It’s not hard to do. So, here is this study. This is a really cool study. It was done with a 13-hour window and it was done with thousands of breast cancer patients. It was a European study. And they found that it changed IGF-1 levels and that it was better than just calorie restriction itself. It was just better to do intermittent fasting.

                        And there’s a lot of different ways to do intermittent fasting. You can do low calories two days a week or like that. But that’s too complicated for people. Which days is it? What are they going to eat? Just fast. Just don’t eat 13 hours of every 24. It’s really easy for people to put that in their lives. So, I have some statistics here, let me find them. So, this was a cohort of 2,400 plus women in early stage breast cancer. And it was a wide age range, which I liked and it was a seven-year follow up. So, I liked this study. 21% lower risk of dying from breast cancer by doing 13 hours of fasting out of every 24. That’s pretty good solid motivation I think to integrate this. And then there were some more statistics, change rates of recurrence changes mortality, as well as recurrence. So, I like that study a lot.

                        So, now let’s just talk about interventions. So, those are the big physiologic functional ideas and we can talk about them more if you want. But let’s look at interventions. So, what time is it? [inaudible 00:44:31]. We’ve got time. Okay, so omega-3 fatty acids are very important in the tumor microenvironment for a variety of reasons. And so, not only for inflammation but also reduces tumor cell adhesion, which is another reason to really optimize omega-3s. I measure them. There’s LabCorp and West has the omega check test, which are sufficient. There’s more sophisticated tests. But those are sufficient to see if the dose of omegas that you’re giving your patient is optimized for them. And so, I tend to dose high on these. I give most of my patients get a minimum of four grams a day of omega-3 fatty acids. If you have a particularly inflamed person or a person with more brain inflammation, I like to use the pro-resolving mediators, the SPMs. Those really are powerful. And especially if someone’s feeling depressed, that also really helps them.

                        Remember that the blood-brain barrier is compromised in all cancer patients due to the high level of matrix metalloproteinases. And so, the SPMs are really great for the brain. Of course the EPA is also. But even better is the phosphatidylcholine-bound omega-3 fatty acids. Those get into the brain preferentially. And so, there’s a couple supplement companies that make phosphatidylcholine-bound, omega-3s. And anybody for example, who has an APOE4 allele, they must have those phosphatidylcholine-bound omega-3s because they have an error in transport of omega-3 fatty acids into the brain, which is why they’re at risk for dementia.

Speaker 5:         What does [inaudible 00:46:26] like for the SPMs? Do you do those in addition?

Dr. Chilkov:        Yeah, I’ll do them concurrently. Yeah, it’s too expensive to do just the SPMs by themselves. So, I’ll give four grams of the EPA, DHA. And then I’ll give two cats twice a day of the SPMs on top of that. And sometimes that’s just phenomenal what that can do for patients. It’s expensive, but it’s therapeutically very powerful. And then as I mentioned, I do a therapeutic shake. So, I wanted to show you what I put in that shake. And one of the things that I like to add, especially if people are having trouble getting enough calories and feel fatigued, you can put medium-shake triglycerides in there. And I really like to put carnitine into either the capsules or powder. A lot of the companies have stopped making powdered carnitine recently. And it makes the shake taste very sulfury. So, people don’t like it. But about two grams of extra L-carnitine, not Acetyl-L-carnitine, L-carnitine for the muscle and the mitochondria.

                        So, when you give that extra carnitine, you address some of the mitochondrial fatigue that cancer patients have, but you also address muscle physiology because you get better energy delivery and fatty acid metabolism in the muscle. And remember that the biokines that are secreted by the muscle also have an impact on immunity. And so, this whole idea of paying more attention to muscle-centric medicine I think is really important. I don’t know, when I went to school nobody ever talked about it. So, I think it’s really important. I think it’s a good contribution.

                        And then you want to make sure people are getting some soluble fiber. Patients think of fiber as insoluble fiber. And so, to teach them where soluble fiber comes from or give them powders to take so that their microbiome has some sustenance. That’s how I put that together. And also you can add more fatty acids to the shake, and add calories and more fatty acids that way. I find these dense shakes, if you put a half of an organic lemon with the rind into the blender, it just brightens up and lightens up the taste of the shake. That was the idea for Mark Kleinman. You can put half an avocado in the shake to give more calories. A lot of these patients are having trouble getting calories, because they don’t have any appetite, or they’re nauseous, or they don’t feel like cooking.

                        So, some people, especially after they have their chemo infusions, a lot of them don’t feel like eating for three to five days. They can live on two or three shakes a day and some branch chain amino acids, and bone broth until they feel like eating. As long as you put some greens powder or some greens into the shake and they’re getting some phytochemicals along with all of this. I also put in some of the Chinese mushrooms into the shakes. The only contraindication to using Chinese mushrooms in these patients is if they’re on PDL-1 and PD-1 blockers, the immunotherapies. Because these are therapies which take the breaks up the immune system. And so, we don’t want to be ramping up their immune system while the drug is doing that. We can cause a forest fire of inflammation where we only want an ember. And so, you want to be careful with Chinese mushrooms, and astragalus, and echinacea, these phytochemicals that push on the immune system. You have to be careful. In the same way, you have to be careful with autoimmune patients in that same way.

                        So, that’s just my shake recipe. Berberine is really great for this patient population because as you all know, berberine is very important. What is that? Oh, somebody opened the door. Okay. So, as you know, berberine is a good agent to use for glycemic control. But look at this slide. Berberine interacts with over 20 different pathways that infect cancer physiology. So, you want to look for multi-taskers. Phytochemicals are phleomorphic. They can bind to multiple receptors and influence multiple pathways. You guys are going to get the slides. So, anyway, berberine is in the news because glycemic control. But I simply want to point out that it’s really powerful in multiple pathways in cancer physiology. It is also like many phytochemicals, very important in changing the microbiome as well and changing how we utilize phytochemicals.

                        So, we’re running out of time. So, let me just go through these. Curcuminoids also have a big impact on glycemic control. They’re not usually thought of in that context. But I want to point out that they do have an impact on glycemic control. This slide also shows you that curcumin also actually affects the pancreatic beta cells. It affects adiponectin, triglycerides, and leptin, and liver fibrosis. So, I think that we tend to get a little siloed in our thinking about some of these phytochemicals. And I have to say, botanical medicine is my first love because of the fabulous multitasking and ability for molecules from nature to bind to multiple receptors and interact with multiple pathways. And so, curcumin is widely used in cancer as you all know. But you can see here there are certain cancers, it’s more powerful. And I use this in almost all of my patients.

                        There’s a subset of patients who get some enteritis from curcumin. So, if you have one of those, use boswellian instead or together. Resveratrol also exerts glycemic control. We don’t think of it that way, but it does. It also has an impact on fatty acids. And resveratrol interacts with multiple pathways that affect tumor cell metabolism. Green tea, you’re all familiar with that in terms of its impact on obesity and body composition. But it also of course has multiple signaling pathways for glycemic control as well. And ganoderma, which is reishi mushroom, also has a big impact on blood sugar. And it’s also one of the only Chinese mushrooms that has a lot of anti-inflammatory effect that you can use it in an autoimmune patient. You don’t have to be so worried about that. So, I really like it because it has this glycemic control, tumor control. Also, it has a big impact on mood. And in the Taoist culture it was used for meditation. And so, that’s why it’s so famous. Affects gastric emptying also.

                        So, let me just summarize because we have 20 minutes. We can have some discussion and you can look back at these slides. So, obesity is linked to cancer and diabetes. Chronic hyperglycemia, hyperinsulinemia and elevations in IDF-I facilitate tumor genesis and worsen outcome. Patients with diabetes really and hyperglycemia hyperinsulinemia need our patient teaching, and need to learn how to get it right. And because there’s this 40% increased risk of occurrence and recurrence in this patient population, there are obese or diabetic or both, the risk is really high and for the complications of traumas formation as well, and complications of surgeries and treatments. And so, we got their attention. We’re the ones that have their attention on this. So, I think it’s really important.

                        So, these are the things that we talked about today that I chose to include as interventions. So, you think about curcumin, resveratrol, green tea, berberine, ganoderma, the omega-3 fatty acids, put the SPM’s in there. And think about carbohydrate restricted diets, low glycemic diets, intermittent fasting and ketogenic diets where appropriate. You can also include the idea of fasting before chemotherapy adjusted to the patient, what’s appropriate for that patient. And that’s how you get a hold of my assistant. And I have a bunch of references in here for you. And then here’s this handout if you want it. And here’s this discount. If you’re interested in my course, if you just want to talk to me about the course, we have a payment plan. And it’s my legacy project is to pass on this out to our cancer system that I created to all of you. Thank you. We can take as many questions as you [inaudible 00:56:05].

Dr. Weitz:          What do you think about apricot seeds that make the blood?

Dr. Chilkov:        So, there’s a lot of cancer therapies that have been done for a long time. And I think what we need to do is be mindful of where the science is. So, there’s a lot of things that have been used in naturopathic oncology that don’t really have good science behind them. I think amygdala does, but it’s so toxic. And I think we have better choices. We understand cancer cell metabolism better. We don’t have to give people cyanide, which is what that is. There’s a better ways to manage cancer.

Speaker 6:         I have few questions.

Dr. Chilkov:        I don’t use it. So, I don’t use it.

Speaker 6:         Do you recommend that these will all be in the form of extra supplementation with supplements? Or can you get this for the diet? I always worry about [inaudible 00:56:50] supplement.

Dr. Chilkov:        So, great question. In order to change signaling in tumor cells, you have to give a pharmacologic dose. You cannot give a nutritional dose. So, you have to think high-dosing. And so, I’ll give two or three grams of berberine a day. I’ll give four to six grams of omega fatty acids a day. I’ll give three to five grams of resveratrol a day. You cannot change a cancer cell’s behavior or change the signaling in the cancer environment with a nutritional dose. Great question. Great question.

Speaker 6:         How do you feel about, I guess the senolytics are there too, but like senolytic or NAD, NR, NMN.

Dr. Chilkov:        So, all those things, yeah, all those things are important. I focused on the things that impact glycemic control. There are certainly multiple things that influence other pathways and cancer cell metabolism. But in that context, you think about mitochondrial function. If you widen your thinking out to mitochondrial function, you start to think about other things like nicotinamide, ribonucleoside, or NNN. Or you start to think about all the B vitamins that drive the cancer. You want to think about optimizing mitochondrial function in these patients, which is where [inaudible 00:58:13] contribution comes in. But he’s too narrow. And [inaudible 00:58:16] ideas have not been really supported by research. So, you have to realize that.

Dr. Weitz:          Now isn’t there a risk of increasing cancer with NR or NNN?

Dr. Chilkov:        So, theoretically there is. So, I’m conservative. I’m a very middle path clinician. Very middle path. So, the things I’ve told you that I give in high doses I think are super safe. But there are things that are questionable. So, I think you can use the senolytics, which curcumin’s in that category, resveratrol’s in that category. Those things are in that. I like Ficetan quite a lot. I think there’s a lot there. I like to stick with things that have human studies over time when we are thinking about cancer patients. As a clinician, I do not experiment on my patients. I’ll experiment on myself, but not on my patients. And so, I think we have to be careful.

                        And baby boomers like me are becoming hysterical about aging. So, I’ll be 71 this year. And so, we have to be careful to not go off the deep end and create Frankenhumans or whatever. We have to be careful because anytime you leverage only one pathway, you’re going to get into trouble. And so, I do think it’s not clear. I think as we age, we need to enhance our NAD pathways. And so, be conservative on that. An aging person needs more efficient mitochondria. But maybe we don’t go into these big therapeutic pharmacologic type doses of these other things I’ve mentioned that I know are safe in those doses. So, I think it’s too new. We don’t know the answer to that.

Speaker 7:         What about IV nutrients? Some practitioners even use IV [inaudible 01:00:19].

Dr. Chilkov:        So, you have to realize I also recommend them, but let’s have context. So, IV therapies are temporary, unlike when we prescribe something more that a patient takes every day. So, the day you get your IV, it has an impact for a few hours and then you pee it all out. So, you have to remember that. So, what are you trying to accomplish when you give an IV? So when you give high dose IV vitamin C, it becomes a pro-oxidant. In low doses it’s an antioxidant. But when you give it in high dose IV 50 to 75 grams per push, then it becomes a pro-oxidant and causes the production of hydrogen peroxide in the blood, which kills cancer cells and spares healthy cells. Not all patients tolerate that. Some people get hyperglycemic when you do that. So, you have to find out.

                        Also, you have to make sure high dose IV vitamin C is safe. You have to measure an enzyme G6 PD to make sure that they will not have red blood cell lysis when you give them high dose IV vitamin C. There are clinicians who are specialized in treating cancer patients with these IV therapies. And there are some good people here in LA and around the country that do that. But just because somebody does IVs in their office doesn’t mean they should be treating cancer patients with IVs.

                        You can give IV resveratrol, IV lipoic acid, IV curcumin. There’s a lot of to IV NAD, there’s IV phosphatidyls pulling. But you need a highly trained person to administer these therapies because… and also I insist that if we’re going to treat cancer patients with these aggressive IV therapies, there better be a nurse in a crash cart in that office. And the team there better be trained to deal with an emergency. And there’s all these clinics where that’s not so, and they’re not safe. And these are vulnerable, fragile patients. These are not healthy patients going for a little upper on their IV. And so, these are fragile, fragile patients and they have to be in a safe medical setting. Yes.

Speaker 8:         Have you heard of C15 or what is it?

Dr. Chilkov:        Those fatty acids? Yeah. I don’t think there’s enough information there to do anything. Yes.

Speaker 9:         Do you have any comments on beta-glucuronidase activity [inaudible 01:02:56]?

Dr. Chilkov:        I didn’t understand you.

Speaker 9:         Do you have any comment on beta-glucuronidase activity, the stool test at risk for the breast cancer?

Dr. Chilkov:        I’m not understanding.

Dr. Weitz:          Oh, some stool test report on beta-glucuronidase.

Dr. Chilkov:        Oh, [inaudible 01:03:11]. Yes. Yes, absolutely. So, if you have an estrogen-driven cancer, I have a whole lecture on the estrovalome, which is the way that the microbiome influences estrogen metabolism. And so, beta-glucuronidase is involved in conjugation and decontagation of estrogens in the gut. And so, if you have high levels of beta-glucuronidase, you have higher levels of decontagation of estrogen. What does that mean? So, estrogen in the bloodstream goes through the liver it gets conjugated, and excreted through the bile into the stool. If there’s too much beta-glucuronidase in the gut, that gets decontagated, which means that estrogen goes back into the general circulation and you get a double whammy hit of your own estrogen. So, patients who have that have a certain type of estrogen dominance essentially. So, you need to fix that. Yeah, you need to fix that. A whole lecture just on that subject.

Speaker 10:       What do you think about melatonin? Some practitioners now are using 200, 300 milligrams a day.

Dr. Chilkov:        So, melatonin can be used to alter tumor cell metabolism at multiple effects. And again, I’m a conservative clinician. So, all the original studies were done by a group in Italy that studied 20 milligrams of melatonin at bedtime as a dose in breast cancer patients. However, we think of melatonin in this very narrow way, but it has a lot of impacts on multiple pathways and metabolic pathways in the cell and in particular has an influence on cancer cells. And there is a rationale to give high doses of melatonin to patients. I’ve never gone myself over 180 milligrams. That’s plenty melatonin, I think.

                        And so, it’s interesting because I think melatonin is misunderstood. Melatonin is not a sedative. Melatonin is a dark signal to the brain. And so, it tells you it’s nighttime. It tells you to get ready for sleep. So, when you get into these pharmacologic doses, it’s not about that. It’s about changing metabolic pathways and cells, and some of which drive proliferation. And it’s pretty safe. I’ve never really seen anybody get into trouble with it. Patients, I think of this placebo effect where they think they’re sleepy because they’re taking melatonin until they explain to them it’s not a sedative. And they can wake up refreshed after they take a high dose of melatonin.

                        But I always start slow. I never go way up there. I’ll start somebody on 20 or 40 milligrams, and then up to 80. And I’ll go upstairs, get people up to see how they do. There are some people who just don’t rate it very well. The primary adverse effect is wild dreams. And so, that’s as bad as it gets. But for some people, that’s not normal. So, you can modulate it down then. But it is quite effective. But I tend not to go straight to those therapies. There are patients who do quite well, do anything extreme. But there are subsets of patients who become treatment resistant in the standard of care oncology setting, in which case we need to really think about what can we do that’s a big lever for them to really change their course of progression.

                        But realize most of the naturopathic therapies don’t kill cancer cells. Most of our therapies are metabolic therapies. You have to really realize that there are times when you need something that’s really toxic, that’s going to kill cancer cells because in some patients, you really need to reduce tumor burden quickly. And there’s nothing in natural medicine that does that. So, that’s why I call my approach integrative because I always ask the question, what’s the right tool for the job? Or what are the right combinations of tools for the job? And some people really, really, really need toxic chemotherapy to reduce their tumor burden for a period of time. And so, the enemy is not chemotherapy. The enemy is cancer. So, you have to have a way of thinking about how you’re going to give this person a good long life and quality of life. And sometimes chemotherapy is part of that solution for a finite period of time. And where people get into trouble is over-treated with chemotherapy. But it has a place.

Speaker 11:       I know you said you don’t experiment on your patients. Do you have any thoughts on peptides minus and alpha that have been showing in research that we do?

Dr. Chilkov:        I think we could say, what about off-label use of drugs? We could say that, too. So, I do think that there are some things that are quite safe to do. And if we’re in the realm of safety, why not? Why not if there’s a good rationale? But I still think you have to look at your patient. What are the metabolic pathways in their tumor cell line? What are their comorbidities? What will they tolerate? What can they afford? So, I look at all of that. I think there’s a lot of things we can do with off-label use of drugs like statins interrupt metabolic pathways significantly in numerous cancers. They’re cheap, they’re safe, and things like that. There’s metformins widely used in the cancer setting. So, I think that that’s a whole other lecture also.

                        But I think if it’s something safe, I think it’s safe to try. Metformin tries statin, try something like a well thought-through peptide. I don’t think there’s any reason not to. Everything I do is individualized. You have to just look at the patient. And I’m very mindful of how much I ask them to do and ask them to spend. And so, if someone really has limited financial resources, then I really want to make sure that what I’m giving them are the big levers that I do know are going to make a difference. It’s quite different when you have a stage four patient that’s become treatment resistant and then you have to think about all other kinds of things.

Speaker 11:       Any thoughts on giving it to younger patients and possibly proliferating cancer?

Dr. Chilkov:        Giving one to [inaudible 01:09:59].

Speaker 11:       Different peptides, because I think there’s a lot of [inaudible 01:10:01].

Dr. Chilkov:        I think we don’t know enough about peptides. I think, look what’s happening with [inaudible 01:10:06]. I mean, it’s the Wild West as far as I’m concerned. It’s dangerous. What we’re doing is dangerous. And so, here we’re in LA welcome to the Hollywood. So, everybody wants to be thin and rich. And so, we always at least be thin. Maybe not rich if you buy your [inaudible 01:10:27]. But I think I am just careful. These are really fragile, vulnerable patients. But it’s tricky because you also have the family to deal with. And so, you might have a patient that wants to engage in the kind of therapies that we include and their family’s freaked out about it or as a willing to spend the money on it.

                        And it’s tricky because I do feel that patients values and wishes for themselves should be respected. And sometimes the family just can’t deal with it. Or the family’s so terrified that the patient’s going to die, that they want to do everything the oncologist says, even though the oncologist stuff isn’t working anymore. It’s complicated. It’s very kind that people have different feelings about death, and mortality, and suffering. And I always say, if you want to work with cancer patients, you have to have a level of complexity. I think it keeps it interesting. Yes.

Speaker 12:       I just want to make sure I didn’t… I know I misheard something earlier about when you were talking about the diet, about the animal protein. You were like some decreased animal protein. But then [inaudible 01:11:38].

Dr. Chilkov:        So, I restrict red meat because there’s a lot of studies showing that red meat is very carcinogenic. And so, I restrict that. And it’s largely because of the iron in red meat. Cancer cells sequester iron and use it for their own metabolism. And so, there’s a whole line of cancer cell physiology, which is involved with ferroptosis and leverages iron as a way to-

Speaker 12:       I heard the protein and then you immediately-

Dr. Chilkov:        Yeah. Yeah. So, cancer patients need protein to maintain muscle mass or restore muscle mass that they’ve lost. So, if they have a high IGF-1, then you have to try and figure out what protein is going to build their muscle and not increase their idea of blood.

Speaker 12:       What was the name of the BCAA powder?

Dr. Chilkov:        There are many companies that make branch chain amino acid powders. Many, many companies. I just pick high quality companies where it doesn’t taste terrible. Basically, I taste everything before… different companies make better tasting things. So, it’s eight o’clock. Are we supposed to stop any-

Dr. Weitz:          Yeah, I guess theoretically [inaudible 01:12:57].

Dr. Chilkov:        Until we get kicked out. Should we get kicked out?

Dr. Weitz:          Thank you everybody.

Dr. Chilkov:        Thank you everyone. Oh, I have something for you. Wait a minute.

 

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Dr. Weitz:          Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, 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. Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we’ll set you up for a new consultation for functional medicine. And I look forward to speaking to everybody next week.

 

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Dr. Lani Simpson discusses How to Test for and Manage 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

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Dr. Lani Simpson is a Doctor of Chiropractic who has established herself as an expert at bone health and women’s health over the last 35 years. She is a Certified Clinical Densitometrist, which means she is an expert at reading bone density tests, and she was the first alternative doctor to be awarded this certification.  She produced Down to the Bone, a CEU course for practitioners and she has been presenting the Heat is on, Menopause and PMS seminars for chiropractors, acupuncturists, and other practitioners for the last 35 years as well. She is the cofounder of the East Bay Menopause and PMS center and of the East Bay Osteoporosis Diagnostic Center. Her website is LaniSimpson.com.  Dr. Simpson will be teaching an advanced course on Osteoporosis starting on April 20, 2024: Ultimate Osteoporosis Course.

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

 

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Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates. 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 osteoporosis; how to diagnose it and how to manage it with Dr. Lani Simpson. Osteoporosis literally means porous bones and it refers to a condition in which the bones become fragile and the risk of fractures increased. According to the National Osteoporosis Foundation, one out of two women and one out of four men over the age of 50 will break a bone due to osteoporosis.  What’s actually worse, and that’s actually, I think, an older statistic, so it’s probably worse now. The most common sites of fracture are the hip, the spine, and the wrist. If you have osteoporosis and you break your hip, there’s up to a 40% chance that you’ll die within the next year. When you look at a bone density scan, if there’s a T score of minus 2.5 or worse, this is generally defined as osteoporosis, and a T score of one to minus 2.4 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 osteoblasts to dominate over the osteoclasts and when we get older, there’s a tendency for the osteoclasts to dominate over the osteoblasts.

                                                Dr. Lani Simpson is a doctor of chiropractic who has established herself as an expert in bone health and women’s health over the last 35 years. She’s a certified clinical densitometrist, which means she’s an expert at reading bone density tests and she was the first alternative doctor, meaning non-MD to be awarded this certification. She produced the Down to the BONE course for practitioners and she’s been presenting The Heat is On: Menopause & PMS seminars for chiropractors, acupuncturists, and other practitioners for the last 35 years. She’s the co-founder of the East Bay Menopause and PMS Center and of the East Bay Osteoporosis Diagnostic Center. Most importantly for us, Dr. Simpson is the most knowledgeable doctor I know about bone health and osteoporosis.  Dr. Simpson, thank you so much for joining us.

Dr. Simpson:                      Thank you for having me. I always enjoy talking about bones with you.

Dr. Weitz:                           Let’s pick some bones. Let’s start right in with, how do we test and diagnose our bone health and when should such testing occur?

Dr. Simpson:                      A lot of times what happens in the alternative world is, someone will come into a doctor’s office with a bone density test. What they have is the report. In the 90s, the first bone density machine came on board. In fact, I had one in 1990, I don’t know, 1994, 1995. You didn’t hear as much about osteoporosis until then.  Prior to that, there was a way to test bone density, but it wasn’t good. But at that time also, there wasn’t any way to treat it. The nursing homes were full of people who had broken hips, mostly women. But one fourth of all hip fractures also occur in men. Men, by the way, don’t come back from that as well as women do. But when we hear that statistic that you said about 40% don’t make it after they get a hip fracture. That’s probably much older people. If we really looked at what the age range is, if somebody’s 60 or 70, in pretty good health fractures their hip, they’ll probably do okay. But those that aren’t, they’re doing the horrible diets. They’re not eating well. You and I know about that. We talk about it.

Dr. Weitz:                           That’s the typical American.

Dr. Simpson:                      Yeah. So we are seeing more osteoporosis and I really, really am concerned for the 30-somethings. My kid is 32, no, 33. I’m concerned about that generation. They’ve been the kids that were on computers, not exercising, not getting impact. My kid rides a bike, but that’s not impact. The food, a lot of young people don’t cook anymore. This is true across the board, but with each generation, we see certain things that are just plain bone depleting habits and they’re not good.  So obviously, preventing osteoporosis is one thing, but it’s quite another once you’ve been diagnosed. Can you reverse it? Frankly, I just have to say to everybody, if somebody says, “You can reverse osteoporosis. Just take my supplements,” run the other way. Who are we talking about? Some people have very advanced osteoporosis, but when people hear osteoporosis, they think, “Oh, it’s osteoporosis. They’ll treat it however.” An alternative doctor might go, “Here. Here’s the supplement.” Or, the knee jerk for medical doctors, “Here’s Fosamax.” Is it even the right medication? Is it the right sequence to give somebody Fosamax before, say, an anabolic that actually builds bone.  So we really have to understand, who are we talking about. My bones aren’t your bones. To lump everybody together makes no sense. Then I’ll have a couple other pet peeves. You asked when should somebody get a bone density. You look at someone like me. I’m thin. That’s just who I am. I weigh 115 pounds wet. I’m five foot five. So thin people are at more risk. Now mind you, I’ve been an athlete all my life, so that’s been helpful to me. But you want to get a bone density on women who are at risk before menopause.  Who’s at risk? Women. People who have a background of smoking, alcohol, doing that now. There’s so many things that impact the health of our bones. It’s mind spinning. People who are too flexible can have EDS, Ehlers-Danlos syndrome. A lot of the people that we watch, go to Cirque du Soleil or whatever, they’re doing great things, but there’s a condition there that they have.

Dr. Weitz:                           Wait a minute. Being more flexible means you’re at higher risk for fractures?

Dr. Simpson:                      No, no. Thank you for asking that.

Dr. Weitz:                           They’re less at risk?

Dr. Simpson:                      No, no. If they have a condition where they’re hypermobile, they can take their thumb and put it on their, can you do that? Can you take your thumb and put it on your-

Dr. Weitz:                          Oh, of course not. No.

Dr. Simpson:                      Exactly. They can do that.

Dr. Weitz:                          No, I know that.

Dr. Simpson:                      You put their arm up and it’s like, you know.

Dr. Weitz:                          Absolutely, yeah. People with that condition, it also leads to a lot of gut problems.

Dr. Simpson:                      Yes. That’s exactly right. Makes you wonder how much is which. I’ve had Marfans folks, patients over the years. It’s interesting. There’s a lot of ways to think about how I assess bone. But in Marfans, these are really tall people and they have a long femur neck. They’re more at risk because they have a longer femur neck, because it’s more of a lever. I always look at how long, because in Caucasians, sometimes we have a longer femur neck. Whereas you look at Asians, though they get it, too, but it’s more compact. Also, shorter people have less distance to fall.  It’s lots of ways I think about things that make sense about what’s the fracture risk? Honestly, Ben, that’s what we should be talking about. What is a person’s fracture risk? The bone density’s not everything. You and I were talking before we went on about a test called the trabecular bone score. That gives us a sense, you’ve got bone density. You want to have dense bones, like a piece of oak wood versus pine. Oak is really strong wood. It’s dense. Pine, not so much.  But also, you want whatever you have in terms of bone to also be resilient. I’ve had people who have osteoporosis, I have osteoporosis. But my trabecular bone score is good, which is why I haven’t fractured yet. I’m going to be 75 next month. I haven’t fractured and I’d like to say to you, “It’s because I’ve done everything perfectly.” No. I think I lucked out genetically because I did a lot of bad things. So genetically, I think I came into this world with pretty good bone quality genetics. We can test that kind of stuff now.

                                                But also, I get a sense about that. When someone says to me, “I’ve been an athlete all my life. I have never broken a bone, but I just got this diagnosis of osteoporosis.” If they’ve broken a major bone, that for me, is time to do serious workup. If they’ve broken their humorous or their femur or their wrist. Then also, I want to know what happened. Okay, you fell over. I had this one woman who was on a tennis court and she fell backward on both hands, so she equaled that weight. 52 years olds, shattered both wrists. That’s not normal.    Well, it turned out that yes, she had osteoporosis, but she was also going through menopause, so that probably tipped things over a bit because number one cause of osteoporosis is estrogen loss. That is primary osteoporosis, which is why it drives me nuts that women, especially who are at risk, are not given a bone density prior to menopause. Because by the time they’re 60, they come to me and now they have full-blown osteoporosis with fractures.  I know I kind of went off in a couple of directions there. Maybe you can bring me back.

Dr. Weitz:                            Okay. Let’s get back. Let’s put a little detail on the picture. Let’s go into a little bit about the DEXA scan and then also maybe explain a little more exactly what a trabecular bone score is. A DEXA scan reports on the hip and the spine, and sometimes the forearm as well. It’s giving a rating of the density of the bone in the T scores compared to a younger person with the Z score as compared to somebody equivalent age.

Dr. Simpson:                      Yeah. We’re measured up against, the database is average 30 year old. We actually want to do that. Some people say, “I don’t want to be measured up against them. I want to be measured up to my own age.” No, you don’t. You want to be close to a 30-year-old, average 30-year-old. The further you move away from that age group. By the time we’re 30, peak bone mass, the bulk of it is done by the time we’re 18. So 80% of our peak bone mass that we were destined to potentially lay down, and hopefully we did nutrition well and exercised during those years, is laid down at that time. By the time we’re 30, we don’t have all that help of the extra hormones. We just don’t.  So that would be the time, if people understood that, to increase their weight training. We know weight training works, in terms of stabilizing bone and in terms of sarcopenia, resisting that as we’re aging because the people who have the worst osteoporosis as they age are people who have muscle wasting and osteoporosis. But the one thing I want to say is that one bone density test, and this is really critical, does not mean active loss is occurring.  You can have osteoporosis diagnosis, but maybe that happened, and I like to use this word so people think about it, historically. We know eating disorders, for instance, a lot of things like that. But also, maybe there was a period of time you decided to be a vegan. When people do an extreme diet, and vegan is one of them, some of them have the worst bones I have seen. I’m not saying they can’t be vegan and have good bones. But I am saying when I hear the word vegan, it’s a risk factor. Big one for me.  So any kind of big change that’s going to eliminate food, those are, and frankly, a lot of people had eating disorders going to these diets. The intermittent diet. Okay, you can do some of it.

Dr. Weitz:                            It’s interesting. Vegans tend to perk up when they hear about somebody with a fracture and right away say, “That’s because you eat meat. That’s why you have a fracture.”

Dr. Simpson:                      And it’s nonsense, absolute, utter nonsense. I don’t eat meat. I don’t eat anything with four legs. I do eat chicken. I eat turkey. I eat fish. I wish I could do dairy, but I can’t for other reasons.  The protein thing is so critical. You could take all the calcium and vitamin D and vitamin K and all that kind of stuff. If you don’t have enough protein, and I see that over, and over, and over again in my patients. Most of them are women. I got men, too. But protein is critical. You can’t build bone if you don’t have good protein.

Dr. Weitz:                            But of course, the vegan argument is all that animal protein is acidic and it’ll leech calcium out of your bones to balance out your pH.

Dr. Simpson:                      But here’s the interesting thing about that. There’s always a kernel of truth. Yes, if somebody is on a strict paleo diet and they’re just slugging down a lot of meat, yes, it’s acidic. I’m talking about a little more of a balanced approach and not missing the forest for the trees. I talk about this a lot. We also saw, for many years, and it’s still going on, doctors recommending 10,000 a day of vitamin D. Have they tested the vitamin D? Have they tested the serum calcium? Have they tested the parathyroid? You can’t do that. That’s a hormone and for some people, especially those who have primary hyperparathyroidism. That is not a good thing. Also, some people are sensitive to high levels of vitamin D.  My second book is on, a lot of it is around vitamin D. Some people, even if they’re 40 nanograms per milliliter or 50. I’d say 50 nanograms per milliliter. My sweet spot’s about 45. I don’t care how much vitamin D you take. I want to see the blood level. You have to respect it this way. You have to test.

Dr. Weitz:                          We test all the time.

Dr. Simpson:                      Yeah.

Dr. Weitz:                           We’re in Southern California and I’m amazed at how many patients in Southern California who regularly go out in the sun still have low vitamin D.

Dr. Simpson:                      Yeah. Australia’s the same thing. We were talking about that the other day. People are told to stay out of the sun from 10:00 to 4:00. You can’t make vitamin D unless the sun’s pretty much directly overhead. If the sun is at an angle from time of day or season, you don’t make vitamin D. Then you’ve got people slathering on sunscreen. Here’s the thing. I support that to some degree.  The reason I wrote my second book is because I’ve had 25 rounds of skin cancer. Three months after that book came out, the vitamin D book, sun book, rather, with a lot about vitamin D, I found my first melanoma. It was literally, it was like freckle that had darkened. I’d had so many skin cancers because why. Because I abused the sun. I had so many sunburns as a kid, horrific sunburns. You’ve got some doctors out there say, “Oh, no. You don’t get it from,” of course, you do. If you abuse anything, that’s not good.  However, I don’t always put, my face. I don’t need any more sun on my face, but I will expose my skin for five minutes here, five minutes there, but I take vitamin D. Vitamin D is very important, as you know. It increases absorption of calcium, magnesium, phosphorus, and it does so many other things in the body. But the problem was, is that absurd study that came out, and I’m sure you’re probably aware of it, a couple of years ago, that was not about vitamin D, but they went in and looked at some vitamin D stuff. They said, “Oh, vitamin D doesn’t do anything for osteoporosis, doesn’t reduce fractures.” Then they said, “By the way, don’t test.”

                                                I was so upset about that because it’s wrong. I don’t care. Sometimes studies come out, they can be large. This was an epidemiological large retrospective study. What does that mean? People don’t know how to read studies. It meant nothing because all you have to do is understand basic physiology that, what does vitamin D do? It increases calcium, magnesium, phosphorus, all of which we need for our bone. So of course, it helps bone be strong. Studies, I can tell by hearing about it if it makes any sense to me physiologically.  Since we’re on calcium, let me just say this. I’d like to get rid of these stupid ideas that are out there. When you hear a generalized statement that is supposed to be for everybody like, “Get all your calcium from food,” I could scream. Who do they get this on? Who are those people? They’re average Americans who are eating pizza, who are obese. They’re not me, for God sakes. I’m not going to eat as much, I don’t eat as much food as a lot of people. It is harder for me to get the calories I need in, and certainly calcium, and I don’t eat dairy.  And then plus, let me just throw in the vegan thing again. Vegans, who eat a lot of greens, a lot of oxalates. We see more kidney stones now because you’ve got to have calcium, actually, to make sure the oxalates are going to go out in the stool rather than go into the kidneys.  I got off track there. Okay. Here’s the-

Dr. Weitz:                            Let’s point out a couple of important things about getting-

Dr. Simpson:                      Wait, wait, wait. Let me just finish that one thought, Ben.

Dr. Weitz:                            Okay.

Dr. Simpson:                      So the main thing is, really be careful about generalized statements because it doesn’t apply to everyone. When I’m dealing with osteoporosis, most of those people are taking maybe 600 a day of calcium citrate malate in divided doses and some are taking as much as 4,000. Why? Because they had part of their colon removed or whatever, I mean or their intestines removed. Now we have more and more people who are getting gastric bypass. Their bones are in bad shape. I just get my soapbox going here.

Dr. Weitz:                            Yeah. No. Any sort of gastrointestinal condition, the majority of them are going to decrease the ability to absorb nutrients. Even a simple condition like small intestinal bacterial overgrowth means you’ve got too many bacteria lining your small intestine where the bulk of absorption of nutrients takes place.

Dr. Simpson:                      Yup. Exactly. Digestion’s key.

Dr. Weitz:                            Let’s go over some of the important things about a DEXA scan and why some places, some DEXA scan centers get it wrong in terms of the things that need to be done. For example, the positioning of the patient.

Dr. Simpson:                      Well, another pet peeve that I had hoped, over the years, I’d have some influence on, but I haven’t. I’m still going to work on that as I’m moving into retirement because it’s just outrageous. It’s not required that anyone be trained who writes the report or signs their name to the report of the bone density and the technicians don’t have to be trained, so we see errors. People send me their bone densities. I find errors almost on every one of them, one way or another, but I’m really picky. Those errors, say for instance, let’s say you had a perfect bone density test. They did it right. Then the following year, the person was sloppy and they didn’t rotate your hip properly. That can be a 7% gain or loss. If it’s a loss, that’s going to trigger a medical doctor to give you a medication.

Dr. Weitz:                            So let’s describe the positioning. A patient’s on their back. Do they have something under their knees?

Dr. Simpson:                      That’s the best way, but are they doing that? No. In my book, by the way-

Dr. Weitz:                            That would flatten the spine.

Dr. Simpson:                      It would be better to have the knees up so that it’s down. But now, let’s say the first time you had a bone density, your legs were straight. Then you’re getting smarter and you decide you’re going to go in and say, “You know what? Make my back flat.” You don’t want to do that.

Dr. Weitz:                            Because it’s got to compare to another scan.

Dr. Simpson:                      Right. Now in my clinic-

Dr. Weitz:                            You’re supposed to be rotated in 15 degrees, right?

Dr. Simpson:                      That’s right. They put you in a little thing. So the GE Lunar equipment typically, they have both legs out at the same time and pretty much all logic’s doing the same thing. It’s faster. Is it the best way? No. When you have the back flat, as you know, you’re not going to have any overlapping. It’s just going to be better to analyze.

Dr. Weitz:                            And if the patient’s had scoliosis, that’s going to affect the results.

Dr. Simpson:                      If the patient has scoliosis, I had a case in the other day. Woman had 45 degree scoliosis. This center, and it was, it was Mayo or one of the big places, did the bone density of her spine every year and she had a lot of rotation. When you have rotation, let’s say … I can’t really say this part. Okay. When they’re doing a bone density, it’s straight through, P to A. When there’s scoliosis with rotation, now what do you get? You get some of the transfer processes and so forth, you’re going to get a false reading. It’s going to show a better bone density than it is.  Now, if you have two vertebrae that don’t have rotation, or very, very little, you can’t use one vertebrae in the spine for diagnosis. You can use two. You can use three and better four so that we can look at all four. The spine is typically going to be lower than the femur. That’s the discordance. People have arthritis, it’s going to falsely elevate the density. So I always, by the way, and this is me, I always order the four because it gives me additional data to look at. There’s only one diagnostic place in the mid-forearm. It’s the mid-forearm. That’s compact bone.  So the spine is mostly trabecular bone. What’s good about what we call the ultra distal radius is that it’s mostly trabecular bone, so it gives me another area to get a sense about trabecular bone and I like that. The more, like I say, I have these data points, the better.

Dr. Weitz:                            If the patients have osteoarthritis-

Dr. Simpson:                      That’s going to falsely elevate. I had a case where the person had spondylolisthesis, a forward slippage of L4 onto L5. Well, L4 was all messed up. See, if they were trained, they were delete L4 and then only include L1 through three.  So in the bone course that you and I have talked about that I’m starting on April 20, I’m going into detail about how to look at bone density because all doctors who are entertaining helping people with their bones should get the full bone density, not just the report. You want the images. So you either want to get the CD or ask the center to print out the images from the computer. You don’t want them to go into a file and make a copy of it because it’s going to look like blobs. If you get my book, y’all, it’s still good, look in the back. They look like sharp little X-rays. I can glean a lot from that information.

Dr. Weitz:                            If the patient gets a conventional X-ray, not a bone densitometer, and that shows bone loss, what does that mean?

Dr. Simpson:                      First of all, it doesn’t show bone loss. What it does, it shows density. Remembering for everybody, a single bone density doesn’t mean there’s active loss. We’re after that question to answer, but on an X-ray, if an X-ray says osteopenia, it’s actually osteoporosis. Because the word osteopenia means low bone density. That’s all that it means.  But in order to see that on an X-ray, you have to have about 40%, note how I’m saying this, less bone density in that spine for that to be real. That would mean that it would be, from a T score perspective, about a negative 3.5 or negative four. Each standard deviation’s 12%. If I have a negative four, it’s 48%. A lot of times, yes, that is visible on an X-ray. They can see it and they can see it in an MRI.  But what the report will say, it won’t say osteoporosis. It’ll say osteopenia because that’s how they do it in radiology. But don’t expect a radiologist actually to still write a good report. I’m just saying.

Dr. Weitz:                            I’ve seen where they write “slight bone demineralization.”

Dr. Simpson:                      That’s a good term, too. When they’re seeing that, that person has osteoporosis. It’s low bone density. We have to think about it. Mostly what we’re looking at, especially in the spine, you’re losing that nice lattice infrastructure. So you can imagine if you lose that, how are you going to build that back up. You going to take some supplement to start growing these? You have to think this through and understand bone.  But I also say that we can build bone quality at any time and I have seen people like you, Ben, who can increase bone density with the right program. It happens. It’s just not as common. Let’s say I did bone turnover markers on you or someone. Not you, because you really work out and all that. But I do bone turnover markers and I can see that bone turnover is high. That should not be happening. That means bone loss is occurring.  Here’s the interesting thing. My top two bone turnover markers are the C-telopeptide. That’s CTX, the P1NP, which is the pro-collagen type one. So the CTX is a peptide. It gives us information about osteoclastic activity.

Dr. Weitz:                            So these are [inaudible 00:31:34] that can tell us about whether or not the person is losing-

Dr. Simpson:                      Actively. Actively losing. It could be stable. Let’s say that CTX comes in at 700. Okay, now that’s giving me a hint, notice the words I’m using, everyone, a hint that bone loss is occurring. But I ordered two bone turnover markers at least, and now the P1NP, which is a marker of osteoblastic activity, is high. You would think that would be good. It’s not.  So in this case, let’s say the CTX was 750, P1NP was 120. They are turning over bone and losing. I want to see the P1NP around 30. I want to see the CTX around 200 or 250. Then I think they’re pretty stable. But if those are high, they are losing. The P1NP should only be high in one case and that’s if somebody’s on an anabolic medication.  Now, the other thing I’m doing because, again, I’m doing this course that’s coming up is, I’m reviewing all the data on people like you who work out a lot and bone turnover markers because you may be the exception. But that said, even people who work out and do all the right things, because people say this to me, they come in to me, they have a bone density, they’ve got osteoporosis. They just fractured something. They were walking across their lawn and fell on their hip and fractured it. “I can’t have osteoporosis. I’ve been doing blah, blah, blah, blah.” No, you can.  So a lot of different things, a lot of prongs in this wheel of bone that have to be illuminated, but it’s very individual, which is why I don’t think this is ever really going to be handled that way. But you and I both know, when you evaluate somebody, it’s an individual.

Dr. Weitz:                            So let’s go over some of the other tests. Osteocalcin and then Genova offers an uncarboxylated osteocalcin.

Dr. Simpson:                      Now, the under carboxylated is kind of a no. Where this all comes from is, Kate, I think her last name starts with an R, a vitamin K book. I’ve interviewed her myself many times. She’s super smart. I don’t think it’s really holding up, but here’s what we do know from physiological perspective.  Vitamin K2 does stimulate osteocalcin. Osteocalcin stimulates osteoblasts. To what degree? Is it going to help? I’ve never seen any evidence that, that alone as a treatment that, that would work. I wish I could.

Dr. Weitz:                            Now, could that be because very few people are taking the proper form and the proper amount of vitamin K?

Dr. Simpson:                      Okay. We’ve got K2, we’ve got MK4 and MK7. The proper would be the MK4.

Dr. Weitz:                            Correct.

Dr. Simpson:                      If we were really looking at it.

Dr. Weitz:                            And the proper dosage-

Dr. Simpson:                      Well, wait a minute.

Dr. Weitz:                            … 45 milligrams, which-

Dr. Simpson:                      And that’s a hell of a lot, so you better hope that, that’s right. That was first on the scene, Japanese studies. It was actually used as a treatment for osteoporosis.

Dr. Weitz:                            Correct.

Dr. Simpson:                      I’m just saying, it’s weak as a treatment program. It didn’t pan out. So what about MK7? MK7 comes along in lower doses, milligrams. You only take maybe 120 micrograms versus the 45 milligrams because as Dr. R, again, do you know her name? I can’t remember her name.

Dr. Weitz:                            Who are you thinking about?

Dr. Simpson:                      The woman who wrote the vitamin K book. Kate. Anyway. That’s where it really got launched, the MK7. That we find, of course, in foods. We find MK4 in foods, but it’s going to be more animal sources. MK4 is in animal sources like dairy, and meats, and so forth. By the way, our large intestines, if they’re healthy, actually make some MK4. So MK7 comes from fermented foods. The reason that took off and that book was written, and why she thought vitamin MK7 was better, it has a longer tail so it lasts longer in the blood. MK4, you would have to take throughout the day so that it would be available throughout the day.

                                                I’m looking into this again, Ben, because I want it to be true, but I’m pretty critical now. It was interesting because a couple of weeks ago, my doctor’s group, there was a woman who, I can’t think of her name right now, she’s a researcher on nutrition. I thought, “Oh, great. Here we go again.” Because the typical people, the doctors in my group are phenomenal. I see them save lives every day. They bring the most complex cases I get to learn from. Nutrition? It’s ridiculous. In fact, one person came a few months ago to give a little nutrition thing. You can eat peanut butter and white bread and you’ll still get enough protein. I’m screaming. But I learned a long time ago, they don’t know nutrition and I don’t bother with that part because I get to learn all the other stuff from them in terms of diagnosis and so forth. But the foundation of every treatment program should include obvious digestion, nutrition, all that stuff.  But anyway, this woman came on and I was kind of blown away. She was a real critical thinking researcher on nutrition. I asked her about the vitamin K. I said, “I’m just not seeing that much in terms of real, solid evidence.” But here’s the thing. Do I think people should get vitamin K? Yes. I don’t even do MK4. I think it’s fine if you do it. I don’t think necessarily it’s hurting. I don’t know how much good it’s really doing.

Dr. Weitz:                            Weren’t there more studies on MK4 than there were on MK7?

Dr. Simpson:                      Early on, yeah. Yeah. That’s true. I’m in the process of looking at all that again with a little more critical eye, once again.

Dr. Weitz:                            If you look at the different organs in the body, for the most part, vitamin K is stored as MK4 in most of the organs. The liver is the exception, where it tends to store it as MK7. But you ingest K1 and the body converts it and stores it as MK4.

Dr. Simpson:                      Well, not all of it. It’s a smaller percentage than you would think, but yes, it does do that. Like I said, I’m in the process of going through those studies again. I’ve been at this for 35 years or so and my ability to look at things changes as I learn more and I develop a wider lens with how I’m looking at things. So I don’t know. I just have to look at it again because I’m not so sure.

Dr. Weitz:                            Okay.

Dr. Simpson:                      I do have one little tip.

Dr. Weitz:                            Yeah.

Dr. Simpson:                      She also did a study on blueberries, which was really fascinating, where they did the equivalent maybe to 3/4 of a cup of blueberries. I can’t remember how they used it, was it powder, blah, blah, blah. Then a larger amount of blueberries, and then really high blueberry content. These are with animal studies. They found in the study, which was really surprising to her, that the middle amount actually was supporting the bone turnover markers in a better way than the high or the low. Whether or not that turns out to be really true with further studies, we know the polyphenols and all that kind of stuff and how powerful they are.  People get really wound up and then they’ll do five cups of blueberries and miss the point. Or they’ll do prunes. I never bought into the whole prune thing, but to this level, I do. Which is, if people want to eat four or five prunes a day for bone health, fine. I don’t recommend 10 or 12 prunes, which was in those studies. But I do believe that the polyphenols and the boron that is in prunes is helpful.

Dr. Weitz:                            Trabecular bone score. What is that exactly looking at? Is that measuring the trabecular bone versus the cancellous bone?

Dr. Simpson:                      It’s measuring, yeah. That’s the same thing, trabecular and cancellous is the same.

Dr. Weitz:                            Oh, okay.

Dr. Simpson:                      You’ve got trabecular and compact.

Dr. Weitz:                            Compact, okay.

Dr. Simpson:                      The trabecular bone score, first of all, the bone density’s volumetric, centimeters squared in terms of how they view that. Then the trabecular bone score is looking at structure. Structure is the resilience. That’s what we’re looking at is that resilience. I have a video that’s on YouTube, that I interviewed Dr. Didier Hans. You can just look me up, bone quality. He really explains it. It’s an hour when we’re talking about it, but understanding how important that bone quality is to our bone health.  That’s why we can have some people with a negative five, meaning 65% of their bone density’s gone and they’re not fracturing. Is that true for most people? No. We always have these extremes people like to point to, but I’m telling you, I’ve seen it and it blows my mind. It just tells you that bone quality’s really important.

                                                When you get a trabecular bone score, it is separate software that the company or the imaging center has to have purchased for about $10,000. So because no doctors know about it, or don’t know what to think about it, no one’s asking for it, so they’re not putting it in because they’re not going to be able to recoup their money. You have to have a bone density test of the spine and then they apply the trabecular bone score. They push a button to run the trabecular bone score test. Then you get a nice little printout and the higher, the better. One point four something is really, really good. Let’s say I have somebody with normal bone density, but that trabecular bone score comes in as a 1.080. That’s not good and that person often will come to me because they’ve already had a fracture that didn’t make sense.  So it’s really important, this bone quality. Of course, again, there’s genetics involved there. But also, what else would affect bone quality? All the things you and I know and do with patients; nutrition, gastrointestinal health.

Dr. Weitz:                            Sleep, exercise, on and on.

Dr. Simpson:                      I have people-

Dr. Weitz:                            Smoking, drinking.

Dr. Simpson:                      Over exercising. We’ve had people with what we call now, and there’s an article on my website called Anorexia Athletica. There are people out there that exercise, I know this one woman, she runs a marathon a month. Very, very thin. I’m trying to get to her a little bit because I’m around her some. I’ve given her my book and so forth. I’m sure she’s going to be in deep doo-doo when she gets to menopause. She’s right there now and if she doesn’t do something, she’s going to start fracturing. She already has had stress fractures. Are stress fractures a clue? They certainly can be. A wrist fracture can be the first heads up, there may be something wrong with these bones.

Dr. Weitz:                            In general, running marathons, triathlons is increasing your risk of having risk of osteoporosis or fracture.

Dr. Simpson:                      Keith McCormick is a good example of that. He’s a chiropractor. He’s written a book on osteoporosis. Super smart guy. When I met him, I wrote about him in my first book. He had, had 14 fractures.

Dr. Weitz:                            Wow.

Dr. Simpson:                      He’s the 100 marathon guy.

Dr. Weitz:                            Oh, wow.

Dr. Simpson:                      He ended up doing Forteo, which is an anabolic and saving his life, I believe. He still was out there doing that kind of stuff. That’s my opinion. Again, the hundred marathon thing, it’s got to be so tough on the body. So one day I said to him after he got better and stopped fracturing thanks to Forteo, I said, “So Keith, what are you doing now for exercise?” He said, “I just did the Tough Mudder.” I said, “You did what?” You know what the Tough Mudder is?

Dr. Weitz:                            Yeah, I think so.

Dr. Simpson:                      It’s that really intense, it’s a really intense athletic event. Throwing yourself over here and over there. You’re wafting through the mud. I said, “What did you do that for?” He said, “I wanted to see if I broke a bone.” We all think differently about things. That’s his thing.

Dr. Weitz:                            That’s better than, I ran into some patients who have osteoporosis, who’ve had fracture, and now they won’t do anything where they could ever fall or have to balance or anything. That’s not the right approach, either, because you need to work on your balance. You need to put yourself in situation where you can be safe, where you work on improving your ability to balance, and load, and things like that.

Dr. Simpson:                      I always say, it’s so true, walk in the world with awareness. But what’s happening in the example you just gave, they’re so fearful. I have a background of mindfulness practice, sitting for three months in silence in India and so forth. I’m out there doing pickle ball and doing my sports and stuff like that. I fell a few weeks ago, but I think the fear is worse than the fracture. The other thing I say to people, fractures are part of life. They just are. They can happen. We want to avoid them. Obviously, most fractures occur because people fall, pure and simple.

Dr. Weitz:                            So exercise for bone health. It looks like, from the studies I’ve been reading about, that the most effective exercises are involving heavy weight training exercises, things where you load the bones, like doing squats, dead lifts. It looks like there’s some special benefit to doing, if you can do it in a safe way, some high impact ballistic exercises. I’m sure you’re familiar with the LIFTMOR trial from Australia.

Dr. Simpson:                      Yeah, Belinda Beck. Belinda Beck, yeah.

Dr. Weitz:                            They have people jump onto a pull up bar and then drop down.

Dr. Simpson:                      Here’s the thing. When they first came out, I went up against them because they were showing people with rounded backs doing, just this really bad, I’m a former yoga teacher, so I’m very big on the mechanics of the body. But even something like OsteoStrong, which I did a whole video on that, I’m very against that program and it’s ridiculous and dangerous for a lot of people. You say, “Oh, you can’t fracture.” Of course, you can. If you sit there and strain and you have severe osteoporosis, and you know this, if you increase your intrathecal pressure, you can then, you think different about Schmorl’s nodes as we get older, you can end up with a Schmorl’s node, which is what? A fracture, partial.

Dr. Weitz:                            Right, but I think the reason why they feel that it’s safe is, you don’t sit there and suddenly get a big load on you. It’s based on how much you’re pushing or pulling.

Dr. Simpson:                      You’re straining.

Dr. Weitz:                            So you don’t start out with the heaviest load.

Dr. Simpson:                      No, but it’s B.S., period. Their claims are wrong. He got his PhD in Cayman Islands. I could go on about this guy. You don’t want to support him in any way. I did an hour long, he’s with, you know Anthony Robbins. I did an hour long video on him. It’s over on YouTube. I have 65,000 views on that, making no money on it, but I just got so tired of these people. They make these claims, “Oh, you just have to do it 10 minutes, 20 minutes, once or twice a week.” It doesn’t happen. They claim 14% increase in six months. It does not happen.

Dr. Weitz:                            Well, they’re claiming that you have to load your body weight, you have to put a load of more than your body weight. I forgot if it’s two or four times your body weight to really cause new bone formation.

Dr. Simpson:                      They have 150 studies. Have you watched that video I did of them?

Dr. Weitz:                            No, I haven’t.

Dr. Simpson:                      I was warned. The Canadian group-

Dr. Weitz:                            I have interviewed John [inaudible 00:51:11] before, though.

Dr. Simpson:                      Yeah. John? Yeah, I know John. I said to John, I said, “Bring me over five cases,” early on because of course, he would like me to support him. He shows them to me. He doesn’t even know how to look at bone densities. I said, “First of all, John, this one you’re showing me, you’re comparing the right femur to the left. Then this one,” I said, “Oh, this person’s 80 years old. They have osteoarthritis, John.” None of them were correct.

Dr. Weitz:                            Okay.

Dr. Simpson:                      I was warned not to put that up because they would come after me. No one, none of their attorneys, do you think they would if I was wrong? Yeah. And then there’s another one that Laura, I can’t think of her last name, out of Canada, who’s one of the top exercise experts in the world. She put up one about them, as well, because we’re all tired of hearing about them.

Dr. Weitz:                            What about vibration platforms?

Dr. Simpson:                      The original big hoo-ha came from Clinton Rubin. Back in the day when I was involved, people gave me stuff. I’ve got the Jufit. I’ve got the Marodyne. Because they wanted me to sell things. I sell nothing. I never have, but I would support something if I thought it worked. So what do I think?  When you stand on a Jufit or you stand on the Marodyne, and all this stuff about NASA, this is where people have to start putting their thinking caps on. NASA did the studies. On what machine? And did they continue to use it? The answer to that’s no, it didn’t work. It was done on the one and only machine was the Jufit. The Jufit, I have to say, which goes for around $6,000 or $7,000 is a very solid piece of machinery. It feels like a hum when you stand on it.  Who would I maybe recommend this to? I would recommend it to people who can’t exercise because it has a .05 vertical displacement. The idea is that by doing that hundreds of times in a short period of time, your body’s going to think you’re jogging. I would do it with people who have had lower limb fractures, people who just can’t exercise. That’s who I’d go for. Forearms, they can lean on it. They have to be able to afford it.  But I would not recommend it for you. I would not recommend it for me. I can exercise. Now, what about the more intense-

Dr. Weitz:                            I’ve been using one for the last several months.

Dr. Simpson:                      Yeah. You may have another reason to do that and that could make sense. But the Power Plate, which is more intense, and I’ve used one of those, and I have to say absolutely, my balance is crazy good after that. But it’s so violent and I’m concerned with retinal detachment, which definitely has been, that’s a big concern. Also, a lot of these vibration machines don’t have vertical displacement. They have horizontal. Horizontal, in the world, we don’t have horizontal vibration. So I’m concerned about the health of the joints with that kind of thing. So you have to be really careful if you’re getting into that stuff. Do we really all need now to buy vibration equipment?

Dr. Weitz:                            Best diet for preventing fracture, increasing bone density.

Dr. Simpson:                      A balanced one. In my book, I talk about it, although I’d up the protein now. But yeah, it’s about having that balance. Really, when I say to people, “Here’s the diet you should do. Dump the junk. Do you not know what the junk is?” If they’re at that level and they’re still drinking a six-pack of Coke a day, I don’t know how far you’re going to get with them. But people know what junk food is. We had a vegan restaurant, not a restaurant, but a store around the corner from us and it was just a bunch of junk food.  You want to eat three good meals a day. I always eat a really, really good breakfast every day. I have protein. I’ve got eggs. I might have a piece of turkey bacon with that or two. I might add some hemp seed. Actually, I like to do a tablespoon of hemp hearts and a tablespoon of pumpkin seeds in the morning. Right there, I’ve added about eight grams of protein. And I do avocado because I want to have the fat. I do all that. I just can’t eat as much as you, Ben.

Dr. Weitz:                            I do have a big breakfast. I think this morning I had a container of egg whites with chopped up kale, onions, mushrooms. I had avocado and I think chicken sausage in there.

Dr. Simpson:                      Oh, that’s my favorite. I like to put together mushrooms, kale, and onion. It’s kind of my go-to.

Dr. Weitz:                            What about including soy? There’s isoflavones in soy. Some studies have shown some benefit with those.

Dr. Simpson:                      You mean like genistein?

Dr. Weitz:                            Dietine and then there’s one called ipriflavone that some people are selling.

Dr. Simpson:                      Ipriflavone is, it’s not from soy. It’s actually just chemically made.

Dr. Weitz:                            Okay.

Dr. Simpson:                      The question is, and I talked about all this in my book. Would I take it? No, I don’t think there’s enough evidence. I think there’s evidence for eating a really good, solid diet. You have to get enough calcium, got to get enough vitamin D, magnesium, B12.

Dr. Weitz:                            Is [inaudible 00:57:49] a good idea?

Dr. Simpson:                      What’s that?

Dr. Weitz:                            Dairy?

Dr. Simpson:                      If I could, dairy, it is true that dairy’s inflammatory, but then you hear people say if you eat dairy, you’re going to lose bone. That is just so asinine. I’m sorry. It just is. I cringe when I hear this kind of ridiculous global statement. Then you’ve got people, every few months you hear the same kind of thing go out there, or get all your calcium from food, like that’s going to work for everybody. You’ve got to be really careful about buying into these things.

Dr. Weitz:                            Let’s go into nutritional supplements now. You talked a little bit about calcium and you said maybe on the average 500 to 800 milligrams a day.

Dr. Simpson:                      Depending. Again, it’s very individual. I always want to look at their metabolic panel, get a sense, especially if they had three or four of those, because then you can really look at the total protein and the calcium over time. But I like to see, again, it’s about blood level for me. I like to see it around 9.3. 9.5 would be really nice.  But when you’re on the low end of normal, it’s not good. When you’re on the high end of normal, it’s not good. I talk about, when I’m teaching lab techs, to note when you’re looking at high end and low end normals. B12’s another one. We used to think-

Dr. Weitz:                            Let me stop you on the calcium. Serum calcium is probably not a great measure of the body’s need for calcium, though. Isn’t that right?

Dr. Simpson:                      Say that again.

Dr. Weitz:                            Serum calcium, in my estimation, I don’t think is a particularly good marker for the amount of calcium the body really needs. I don’t think it indicates tissue levels.

Dr. Simpson:                      It’s the best we’ve got. It gives us an idea. That goes along with, by the way, if I’m evaluating somebody, I’m going to be doing a 24-hour urine. The interesting thing about a 24-hour urine, high end of normal, low end of normal matters also. When you do a 24-hour urine for calcium, let’s say it’s low or on the low end of normal, they’re not getting enough calcium, at least on that day. I’m going to do another. I always redo tests. I’m going to do another one, but there’s also a whole way. I can’t explain it in this thing, but you’ve got to do it right and I’ll test it again.  This is a really important point. When somebody comes to me and, I’m not taking new patients now, but when my older patients come back and I’ll still work with them, I never change anything. You want to do lab work first. I think a lot of doctors of any persuasion immediately want to start messing with stuff, when they don’t even know what they’re dealing with. Are they actively losing? What do the CTX say?  Because then, if you have that groundwork done, then you’ll be able to see if whatever you do is helping. If it’s a woman, her CTX is 600, 700. She’s year two of menopause. You might help her a little bit with nutrition, but boy, put low dose estrogen in there and get it up to 50 in the blood, it’s going to bring that down to about 250. I’m not a big fan, by the way, of gels and all that kind of stuff. That’s a whole other topic. But all these things matter.

Dr. Weitz:                            What do you think about AlgaeCal?

Dr. Simpson:                      Oh, God. That’s another company. Don’t support them. They make claims, “You’re going to gain blah, blah, blah in six months.” Of course, you’re going to gain because you’re going to be doing strontium and strontium does what?

Dr. Weitz:                            Improves absorption of calcium.

Dr. Simpson:                      No, it replaces calcium in the bone. Now, because of where it is in the periodic table, is going to show a higher bone density that’s not real.

Dr. Weitz:                            You don’t think there’s any benefit to strontium citrate?

Dr. Simpson:                      No studies on that one. Strontium ranelate’s where the studies are.  Now, is it worth doing if somebody cannot do anabolic medications, they have very serious osteoporosis? I would consider it. I just know the anabolics do a much better job. But to have these people out there willy-nilly just taking strontium, again, when a doctor has not actually evaluated this person fully, is just not right.  I don’t really like the AlgaeCal company. I’m careful with companies that I recommend or I’ll work with. The other thing, too, is what is AlgaeCal? They call it plant calcium. It’s calcium carbonate.

Dr. Weitz:                            I heard-

Dr. Simpson:                      Oral calcium is calcium carbonate.

Dr. Weitz:                            You sure of that?

Dr. Simpson:                      Yeah.

Dr. Weitz:                            Okay.

Dr. Simpson:                      But e-mail me if I’m wrong.

Dr. Weitz:                            I tried to check that and I couldn’t find any data from the company’s website.

Dr. Simpson:                      Where does the plant get it from? It absorbs the nutrient. It absorbs it from what? The soil. Because a lot of times people say, “Calcium carbonate, it’s rocks.” Of course, it’s rocks, but that doesn’t mean it’s also bad, by the way. There are some people now that I would give calcium carbonate. If they really do have an acid problem, calcium carbonate may be the way to go until I get other things going, but overall, citrate’s the way to go. Kidneys love citrate. I mean kidneys … Yeah, go ahead.

Dr. Weitz:                            Magnesium?

Dr. Simpson:                      Glycinate.

Dr. Weitz:                            Should we be two to one calcium magnesium?

Dr. Simpson:                      No. It depends. Some people can do that much. Others can’t. It depends on their digestion. It depends on their sensitivity to magnesium. It’s a bit of a balancing act and understanding their stools and all that kind of stuff.

Dr. Weitz:                            We do an RBC magnesium and try to make sure it’s above 5.5.

Dr. Simpson:                      I stopped doing that because I didn’t see that much difference with it, but I know. A lot of docs still order that.

Dr. Weitz:                            Okay. And your target level for optimal vitamin D?

Dr. Simpson:                      45 nanograms per milliliter. That can change if somebody’s on medications and so forth, with especially the PTH analogs. Yeah, that’s a good number.

Dr. Weitz:                            It seems a little low to me. I’ve seen data showing that 60 is a good target to decrease breast cancer risk.

Dr. Simpson:                      I thought so, but no. There’s too many risks when you do it. When you have too much vitamin D, what is it going to do? What’s going to happen to parathyroid? I’m asking you.

Dr. Weitz:                            Oh. It’s going to grab the vitamin D and bring it into the bone. If you have enough vitamin K, it’ll make sure-

Dr. Simpson:                      No.

Dr. Weitz:                            … soft tissues.

Dr. Simpson:                      No. It’s going to decrease your PTH, parathyroid hormone. The kidneys and the parathyroid glands and vitamin D all work together. That’s in my second book because we need the parathyroid gland to, if it’s too suppressed, you’re not going to get what we need from it, which is that the osteoclasts clean up old bone, right? In the body, the parathyroid hormone, that’s what it does.  Interestingly, the parathyroid analogs, the Forteo, teriparatide and abaloparatide, the Tymlos work differently. They build bone, but they also increase osteoclastic activity, especially Forteo. It’s interesting. There’s a lot of complexity with all of this. But the point is, if you look at people in Hawaii who are out all day not wearing sunscreen, their level’s about 30. So what you’re doing is a big, fat experiment right now, bringing people up to 60. Nobody did that. Nobody had 60. Who has 60 in just normal, normal life? I think that’s too high.

Dr. Weitz:                           People who are out in the sun all day.

Dr. Simpson:                      And you run the risk of losing bone when you get too high, for certain individuals.

Dr. Weitz:                           Yeah, I’m not sure if that level’s 60, though.

Dr. Simpson:                      I wrote the book. You can think what you want, but I’m saying I think it’s better to be a little more cautious. It is a hormone.

Dr. Weitz:                           45. What about boron?

Dr. Simpson:                      And then I need to stop.

Dr. Weitz:                           Okay.

Dr. Simpson:                      This is another good one. I’m glad you brought this up because boron, I don’t even know the name of the guy. He was recommending high doses of boron that was going to do this. This is what I’m talking about. We see this kind of stuff. Do you know who I’m talking about?

Dr. Weitz:                            I interviewed Laura Pizzorno and she has an article-

Dr. Simpson:                      Right, the AlgaeCal. And she has an article and who cares. Is boron, no, really. Is boron helpful to bone? Is protein helpful to bone? Yeah, but to do high levels, there is no evidence over time that’s safe or a good idea. When you start doing that, it’s really interesting because alternative doctors love to do high doses. Let’s do 10,000 vitamin D. Now let’s do 20 milligrams of this or that. But that’s kind of extreme.

Dr. Weitz:                           So what do you consider high? What do you consider a safe level?

Dr. Simpson:                      I think if somebody’s eating a good diet, eating apples, things like that, and maybe prunes, and they’re getting enough, I’ve reeled it in. I have to tell you, Ben, I’ve reeled it in over the years because I don’t know. I’ve just seen too many things now and I would rather be in a real safe zone because we really don’t know long term. Or the blueberry example I gave you. Somebody ate two cups of blueberries a day. Is that going to be beneficial or is it really just one cup?

Dr. Weitz:                           Let me ask you just one more quick question. Fluoride. Is that good or bad for bone?

Dr. Simpson:                      Well, fluoride is bad, but is it bad in small amounts because it’s in soil. It’s in everything, and especially now. They use the waste product fluoride. They’re watering everything with that water. I don’t think they’re filtering the water.

Dr. Weitz:                           Of course not.

Dr. Simpson:                      The question is, is there a way to really test? It’s interesting. I look at bone density, bone quality. I don’t know that I would associate high fluoride drinking water with that. My bones are good. I drink a lot of water. I don’t know. But back in the ’80s, that was one of the main treatments they were going after because when they gave people fluoride and they looked at X-rays, the X-rays were really dense, so they were really excited because it did increase density. But what happened over time was that these people on the fluoride started fracturing. These nice dense looking bones started fracturing because the quality was terrible.  The thing is, I guess as I’ve gotten older, I worry less with the more I know. I just try to keep myself on a good, even keel and do the best I can and get through this life. I’m careful about articles I read and things that people say because people just say stuff. They do. They just say shit. I’m sorry. They just do, Ben. They say stuff all the time. I used to be one of those people, but now I’m a little more, I don’t know. Maybe a little older and wiser, I’m not sure.

Dr. Weitz:                            Okay. You are definitely wiser. So tell everybody about where they can find out about your books and tell us about this upcoming course that you have.

Dr. Simpson:                      On April 20, I’m starting a course, may be the only time I do it live. It’s 20 hours plus. I take people through the basics of what you need to know in terms of reading bone density tests. Honestly, this is also for people who may want a different career or add to their, they may want to get into really helping people. So how I frame my work, and I have for years is, I’m an educator. I don’t take insurance and I charge good money to see me. Right now, the only thing people can really get online is the bone density second opinions.   But it’s needed and I really feel, I’ve always felt, actually, that chiropractors should have their hands in this. But what I keep learning is that they just don’t want to. I’ve been teaching for years. People, they didn’t really want a mentor. That’s what I’m creating with this. I’ve even got some doctors from Peru that have joined the course, which is great.  It starts on April 20 and it’ll start on a Saturday for four hours. I’ve got it in four hour blocks.

Dr. Weitz:                           And how do they find out about it?

Dr. Simpson:                      Go to my website. It says bone course right at the top.

Dr. Weitz:                           And website address is what?

Dr. Simpson:                      Lani, L-A-N-I, Simpson, S-I-M-P-S-O-N .com.

Dr. Weitz:                           Great.

Dr. Simpson:                      And they can find out about my books there and they’re sold other places. They’re in libraries.

Dr. Weitz:                           Excellent. Thank you so much, Lani.

Dr. Simpson:                      You’re welcome, Ben. Very nice working with you and I’m really glad that you’re learning about it and helping people the way you do because it’s so important.

Dr. Weitz:                           Thank you.

 

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Thank you for making it all the way through this episode of the Rational Wellness podcast. For those of you who enjoy listening to the Rational Wellness podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, 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. Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we’ll set you up for a new consultation for functional medicine. I look forward to speaking to everybody next week.

 

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Allison Samon discusses A Functional Medicine Approach to Autoimmune Disease with Dr. Ben Weitz.

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

 

Podcast Highlights

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Allison Samon is a Functional Nutrition and Lifestyle Practitioner who works virtually with people to get out of chronic illness, escape from mystery symptoms, and help re-design their lifestyle so they can be fit, energized, and pain free in ways that are easy, fun, and sustainable. Allison struggled with unexplained chronic pain for over 10 years. Her remarkable healing journey became the basis for her programs: Reboot from Chronic Illness and the Chronic Illness Recovery Blueprint. She’s also written an ebook “Detoxing Endocrine Disruptors: Essential Checklist” and is a featured author in the Amazon International Best Seller: Teach Your Expertise. Her website is AllisonSamonFunctionalNutritionist.com.

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

 

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Podcast Transcript

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

                                Hello, Rational Wellness podcasters. Today we’ll be having a discussion with functional nutritionist, Allison Saman, about autoimmune diseases and a functional medicine approach. Allison is a functional nutritionist and lifestyle practitioner. She works virtually with people to get them out of chronic illness, help them escape from mystery symptoms and help redesign their lifestyle so they can be fit, energized, and pain-free.  Allison struggled with unexplained chronic pain for over 10 years. Her remarkable healing journey became the basis for her program, Reboot from Chronic Illness, and A Chronic Illness Recovery Blueprint. But her proudest accomplishment is becoming a first time mom over 40 and inspiring other women to successfully have healthy pregnancies despite being considered geriatric. Allison, thank you so much for joining us.

Allison:                 I’m thrilled to be here, Ben. Thank you.

Dr. Weitz:            Can you start by telling us about your personal health journey?

Allison:                 Yeah. What’s funny about that is I considered myself to be healthy and active. I was active, but I was anything but healthy. As you know, the more active you are, the more you are prone to get injured, and that was the conventional wisdom is that I started limping.  I was having chronic pain in my knees, my lower back, my butt, I had numbness in one foot where I was constantly having to stomp my foot on the ground because I didn’t feel it. If I was sitting down, it felt like I didn’t have a foot, and it kept progressing. I had migraines, I had chronic fatigue, and I had an injury that was, I think the initial injury was a skiing accident where I got plowed down, my ski went one way, my knee went the other. That, I think maybe created an initial tear, but being young and active, you heal, or you think that you heal.

                                Several months later, I ran a race and took a nap after the race. I was in college and I was waitressing at night, and got up after my nap and I was limping. I knew that that was a different kind of ouchie, that I must have twisted something while I was running, but you know the difference between like ooh, and that’s not right, something is wrong here.  When I went to orthopedist at the time, he said, “You’re young, you’re athletic, you’re fine.” That was what I was hearing, but I just knew something was different this time and it eventually healed, but not in the same way, and again, over time it just kept progressing and then to other parts of my body.

                                I did everything from seeing neurologists, chiropractors, physical therapists, I basically went to every single person who had a lotion or a potion or some kind of thing to help, and none of it really worked. Acupuncture helped a little bit, but not everything. Didn’t help my knees. It helped my back, it helped my butt, it didn’t help my knees. Sitting was excruciating. I had a long commute, I was in New York City at the time in a completely different career, I worked in television, and sitting… Just having to sit in a chair was just miserable.  The irony is the one thing that all of these practitioners, I went to top people in New York City, Wayne Gretzky’s guy, and nobody ever once asked about what I was eating, not one person. I never made the connection because I thought I was healthy, but I was also thinking if I’m not fat, therefore I’m healthy. That was the mentality, and so I was like I can eat that because I’m just going to work out and it’s going to be fine.  Over time, that’s not true anymore and eventually your body starts to crap out when you’re feeding it such crap. That was a 10-year struggle for me that basically culminated with this top guy saying, “Let’s do exploratory surgery because your scans are not consistent with your pain.” I was like, “That doesn’t sound like a good idea. You’re just going to cut me open to look around and you don’t know?” I didn’t know any better at the time, I just knew that something felt wrong.

                                I was finally introduced to somebody who asked me, he was an alternative practitioner, and he introduced me to the energetics of food. Without even putting anything in my body, what food did just on my body. I was like that’s crazy. He asked me, “What did you have for breakfast?” I was like, “I had Special K and a glass of orange juice and a multivitamin.” Duh, a healthy breakfast. That’s what I thought was the way to go. I had no idea that that actually was just feeding a blood sugar dysregulated cycle that I was subsisting on, and it was fueling all of these symptoms that I had, but I had no idea because it fit the model of the time.

Dr. Weitz:            We’ve all seen that model of the healthy breakfast.

Allison:                 Right, and it couldn’t be more wrong. The funny thing is I don’t even like orange juice, I hated it always. I was drinking it because of the vitamin C. I thought I was being a good girl.

Dr. Weitz:            You regained your health once you started changing your eating? How did you change your eating?

Allison:                 The first thing I did was when he told me I didn’t have to drink orange juice and I was like that is insane, but okay. Thrilled, I’m thrilled not to. He’s like, “Why don’t you eat an orange or have broccoli or strawberries?” I’m like, “I can do that?” That was the first thing I did was I just stopped drinking orange juice, and my knee didn’t hurt the next day. I was like that’s crazy. What more can I try?  I wanted to see what other foods could I take out and I think that’s how it started. What can I take out and still eat because at the time, I was eating pretty much like a bachelor. Pasta out of a pot, cereal for dinner. I worked television, I didn’t have time to think about any of that stuff, but this is what opened my eyes to oh, maybe there’s something I’m missing. There was a lot that I was missing and I didn’t realize it.  The Lean Cuisines that I was having, all those microwave meals that I thought were healthy weren’t serving me in the way that I had hoped. When I started, it just opened my eyes to oh, yeah. That’s a lot of preservatives and that’s a lot of sodium. Maybe I’m not eating very many actual foods, like whole foods. What if my body likes that? Oh my gosh, it really did.  The inflammation started going down, I started not having pain in my knees. It didn’t happen overnight, let’s be clear, but it started this obsession of this new religion that I was taking on, which is nutrition. Why don’t people know about this? Nobody talked to me about it. I wasn’t having migraines anymore. I was on medication for migraines and I didn’t have them anymore, and I think it was because I was dehydrated, I was constipated, I was malnourished, and all of these things and exhausted, not sleeping. All of these things, it was ripple effect of like oh, you take one thing out and things start to get better, things start to improve. It sounds so simple, and yet it is.

Dr. Weitz:            You regained your health and now one of the types of conditions that you often see patients for, we discussed earlier, are autoimmune diseases. Perhaps you can explain what is an autoimmune disease, what is some of the most common ones, and what can we do about them?

Allison:                 Yeah. Autoimmune, it’s funny because when I was going through all… Nobody could figure out what was wrong with me. And they were looking at lupus, and I did have Raynaud’s, my fingers would turn white, I’d go and get a gallon of milk out of the refrigerated section in the supermarket because I was drinking copious amounts of milk as well, and my fingers were turned white. They were talking to me about a bunch of autoimmune.  Autoimmune, what I always tell people is you have to win the trifecta for autoimmune to occur. One, there’s a genetic predisposition, and two, there has to be some kind of dysbiosis in the gut. There’s something in the terrain that is there, whether it’s an infection, a microbial imbalance, there’s something. Three would be some kind of insult, some kind of trauma, some kind of event.

                                Autoimmune is when your body starts to turn on itself, it starts to think that its tissues are actually a pathogen or an invader. I haven’t seen anybody in my clinical practice who hasn’t had trauma as part of their story, even if they don’t realize it, that it was a triggering event, because sometimes pregnancy can be the triggering event because they had that predisposition and then it’s a physical and emotional trauma. There’s major changes going on, and the trauma could even be blood sugar swings. I mentioned that briefly before.  I was having severe blood sugar swings, and I didn’t realize it was an issue because that was how I kept my energy up was sugar. Some people use coffee, soda, cigarettes. I didn’t do any of that because I was a healthy person, but I used fat-free candy. That was my way. You have those high highs and high lows, and that is actually stress on the body, which if you have an underlying autoimmune condition, that could be a trigger.

Dr. Weitz:            What are some of the most common triggers for autoimmune diseases? You mentioned blood sugar imbalances. What are some of the other ones?

Allison:                Depending, inflammatory foods, so things like gluten and dairy, those were things that were absolutely staples in my diet and they’re inflammatory in the gut. Again, if you-

Dr. Weitz:            Are they inflammatory to everybody or just to some patients?

Allison:                I would say that they’re inflammatory to everybody. I don’t think that they manifest the same in everybody. I always say if you don’t have hormonal issues, if you don’t have digestive issues, then it can be okay for you.  There’s a lot of pushback about that, but if you have an autoimmune gluten absolutely must come out of the diet because of what it does, how it can contribute to a leaky gut situation, which also feeds this autoimmune pattern that we can have.  You asked what are common autoimmune diseases? I mentioned Raynaud’s. That’s one that I think is common, but it’s not something that people really pay a lot of attention to because it’s usually one of many. The saying goes if you have one, you get three because often, people are just living with it and don’t realize that there’s things they can do about it. They just think-

Dr. Weitz:            Yeah, no, it’s definitely the case that if you have one autoimmune disease, you’re more predisposed to a second or a third.

Allison:                Yeah, and especially because it usually goes untreated. It’s like well, you have it and there’s nothing else you can do. That’s what they said to me with my hormone imbalance. Your body’s always going to do what your body’s always going to do. Now I know that that’s not true. We can actually change the course the way that our body is working-

Dr. Weitz:            Or you can take injectable drugs that block your immune system.

Allison:                You could do that too. You could do that too, yeah. For sure. I, personally, we take a more diet and lifestyle approach. That’s the functional nutritional way, following functional medicine where it’s a bio individual approach, but knowing that the field of epigenetics tells us that we can influence the way our genes are working and using our environment, using our food, using our movement, using our mindset, all of these things can contribute to a stress response and different triggers and just how our bodies respond.

Dr. Weitz:            When you’re consulting with a new client and you’re talking to them, what are some of the clues that make you suspect what their triggers might be? How do you try to whittle it down?

Allison:                 I always do a really thorough intake. I build a timeline and a matrix. This is the functional medicine way-

Dr. Weitz:            This is the IFM, Institute of Functional Medicine, matrix.

Allison:                 Yes, absolutely. I have an adapted version of that, but that’s exactly where it comes from. Really extensive timeline and there’s often things in there that people don’t realize matter, because it all matters. They’re like I had my gallbladder removed, but that was 15 years ago, so that doesn’t really matter, right? It’s like, yes. I was on the pill for 25 years. That doesn’t matter, does it? Yes.  All of these things matter, and people don’t realize how all of these things add up to what brought you here today, and thankfully that you’re thinking forward enough to say, I want to change. I’m not on the right path, and there’s something else I can do, and I would like to do that. I’m looking at that. I’m looking for the traumas.

                                Again, it could be a lost job, a death in the family, a divorce. There’s always something, or it could be something like oral surgery or a lot of surgeries or a lot of infections. I’ve seen that a lot too where somebody’s like I had this mystery infection, I had this, I had COVID. It’s like okay, these are incidents where things can take a turn after. When I look at what their diet is and I see they’re having digestive problems, or they don’t think that they have digestive problems, but they have things like rashes or they have brain fog or they have joint pain, I’m seeing all this as what’s that connected to? It’s all coming from the gut. There’s always some kind of gut issue that needs work with autoimmune. I don’t know that conventionally, that’s ever looked at.

Dr. Weitz:            When it comes to after your consultation, I’m assuming in a lot of your patients, you’re doing some testing?

Allison:                 Not in the beginning. I always want to see if they have recent labs that were within the last six months. Definitely want to see because there’s information that we can learn from basic functional labs. I would like to see them, but I don’t order testing. I do, as a functional nutritionist, I don’t order testing right away because usually there’s a foundation that’s missing. That’s where I start them with, like getting them off of the inflammatory foods. The gluten, the dairy, the sugar, alcohol, if that’s an issue for them, taking those things out of the diet, making those shifts, making sure…

                                Really, it’s these three non-negotiables is are they sleeping? Are they pooping? Is their blood sugar regulated? Are they having mastery really over blood sugar? That’s where I’ll start. When I find that there’s no movement or enough movement… I always say, and I actually learned this from one of the speakers in one of the functional meetups, and I don’t know if it was Tom O’Brien who said I took it and I run with it, and it is great. If I don’t move the needle with you within the first two weeks of us working together, I know that we’re not on the right track, but I always do. Poop, sleep, blood sugar, there’s always something there.

Dr. Weitz:            How do you know they’re having blood sugar problems?

Allison:                 Because they will say that either they’re not sleeping or I look at a food journal. We do a lot of that, a lot of tracking in my world. I’ll look at that and go huh. Sometimes to myself, huh, because they’re not eating, there’s a lot of people who come in on intermittent fasting, and not that there’s not a place for it, but not for somebody who is chronically ill. We don’t fast a sick person.  I’m often trying to undo that and say, we can go back to that when we get you into a place where you’re not having these crashes, when you’re sleeping well, when you’re not having this digestive distress, when you’re not having anxiety, that’s another sign.  They’re so anxious. It’s this dysregulated blood sugar. You could just tell in how somebody presents or when you start talking to them about diet, how they get triggered by it and they get really defensive. You’re not going to take that away from me. I can’t do that, or I can’t live without that. There’s certain tells. And then after a few weeks, we will do hormone testing where I’ll take a look at where is their cortisol. They’re completely flat lining or look at their having a W.

Dr. Weitz:            You’re talking about salivary cortisol testing?

Allison:                 Mm-hmm. Depending, I might do salivary, sometimes I do Dutch, but it’s really easy to show them on a ZRT saliva to see those graphs where Dutch can sometimes be like what am I looking at? That can be overwhelming, and so it really depends on the person, what they’re able to handle because some people, you have the know it all clients and you have the I am so freaked out about this whole process and making these changes and we have to go really baby steps.

Dr. Weitz:            Okay. Do you do stool testing? You talked about the gut.

Allison:                 I will do stool testing, but again, not right away. I have to do all of the non-negotiables first and building that foundation but yes, I have done the GI 360, Biome Effects. Those are the two tests that I’ve done.

Dr. Weitz:            The GI 360 from Doctor’s Data and the Biome Effects from Microbiome Labs?

Allison:                 Correct. It’s only when I’m suspecting that there’s infection and oftentimes we might think that there’s infection right away, but there’s no foundation, there’s no solid foundation. To jump into, let’s say a kill, they’re not ready for that yet. We have to build so they feel like okay, yeah, I’m going to the bathroom, I’m sleeping through the night, I’m eating throughout the day, I have more energy, my brain can focus, I can work, I’m nicer to my friends and family, I’m happier, and then it’s like okay, now we can move to this stage. It’s really just a systematic way of peeling back those layers and then rebuilding them.

Dr. Weitz:            You mentioned your non-negotiables that you start with. Why don’t we go through what exactly are you non-negotiables?

Allison:                 They have to be sleeping, they have to be pooping regularly, at least once a day. Nice poops, we talk about that.

Dr. Weitz:            Now, what if they’re not sleeping? They say I haven’t slept for years. I try, I wake up, I can’t fall back to sleep.

Allison:                 We’re going to work on their blood sugar balancing. It all goes back to that. If they’re not sleeping, it’s likely because they had low blood sugar. What I might do is start off with… There’s a couple of things. Start off with let’s have a snack before bed. Snack, not a meal. I always have to say a snack is a snack. It’s not a meal. Something that’s protein and fat, small before bed so that they can sleep. That usually helps, but also bringing in mindset.  We do a lot of calming, a lot of parasympathetic, just calming the body because if you can’t calm the mind, you can’t calm the body and it’s just this vicious cycle. I give them some tools where they can hopefully fall asleep faster or stay asleep. And then of course, if they’re still having trouble, if there’s other hormonal imbalances like let’s say estrogen dominance, and it’s waking them up in the middle of the night, I’ll bring in some adaptogenic herbs to try to help them sleep.  There’s lots of tools. I guess that’s the beauty of the functional way is that there isn’t one way. There’s so many different ways, and it depends on the person and what they’re willing to do and what their body is capable of handling or what they-

Dr. Weitz:            Your non-negotiables are they have to be sleeping, so you work on their sleep, you balance their blood sugar. What are the other non-negotiables?

Allison:                 Poop. They got to poop. Have to poop.

Dr. Weitz:            What if they’re not pooping?

Allison:                 We’re going to get them pooping. That’s usually the first thing I think that that happens is we get them pooping pretty much right away.

Dr. Weitz:            How do you get them pooping?

Allison:                 We take a look at what they’re eating. It’s often maybe they’re devoid of real food. Maybe they’re devoid of fiber, maybe they’re devoid of food that they can actually break down, so we might be working on stomach acid. It’s not exactly the way they’re thinking, I need to take a laxative or I need to take fiber pills. It’s like what if you don’t have the stomach acid to break down that food so that you can absorb that food so that you can poop out that food?

Dr. Weitz:            How do you decide if they have proper stomach acid?

Allison:                 That’s a good question. Based on what their symptoms are, if they’re presenting with a lot of bloating or they’re not pooping, or they say that they have trouble eating certain foods like meat, let’s say, can’t digest meat and they want to digest meat, their stomach acid may be low. They might have acid reflux, which as you know can be an indication of low stomach acid rather than high. There’s lots of different symptoms there and honestly, anybody in the autoimmune population, I know that there’s some kind of dysfunction in their digestion.

                                Having low stomach acid is often… It’s just very common and so I’m going to make that assumption there, that they need to either bring in some stomach acid and/or digestive enzymes to help with that digestive process. That often, right away, they’re like wow, I didn’t realize that I wasn’t eating my food properly. I’m like isn’t it amazing when you actually absorb the nutrients in your food, what happens right away? You don’t need a substance, you have food. It’s wild.

Dr. Weitz:            Okay. You get them pooping by using stomach acid or digestive enzymes, and that works most of the time for your patients?

Allison:                 Yes. Sometimes it’s the kinds of food that they’re eating, or maybe they’re not eating enough. I’ve seen that too, where they’re so afraid of overeating or gaining weight because now I want them eating regularly throughout the day and they are not really eating and they’re concerned that they’re pooping. It’s like you have to eat food in order to poop.   Making sure that they’re having nice balanced meals, and for some, it might have to be smoothies and pureed vegetables or just steamed vegetables, things that are soft, things that are easier to break down. It depends. It just depends on the person.

Dr. Weitz:            Okay. Let’s say you do some of these basic things, you add some hydrochloric acid, you get their blood sugar balance, but now they still have this hypothyroidism. What do you do next?

Allison:                 We’re making sure that their blood sugar is balanced, so we’re making sure that they have… When I say say balanced meals to support blood sugar balancing, that’s protein, fat, and fiber. There’s a lot of education around fiber and carbs. Everybody’s still so crazy over carbs.  I like to explain it that, think of it in terms of fiber, because all plants are carbohydrate. It depends on what plant you’re having and which ones have more fiber. Just think in terms of fiber, how can I get more fiber? Don’t be so afraid of carbs. It’s the refined carbs that we’re wanting to avoid, but not carbohydrate. Bringing in fiber, protein, fat, and fiber, and-

Dr. Weitz:            Give me an example. What’s a fiber?

Allison:                 What’s a source of fiber? We have cruciferous vegetables are really good-

Dr. Weitz:            Vegetables, okay.

Allison:                 Yeah, vegetables. Also, there’s so many different ways you can get fiber. Your leafy greens, but also things like nuts and seeds also have fiber that they’re forgotten. I love nuts and seeds and I like to, as I say [inaudible 00:28:48] up your meals and your snacks. You can always add some nuts and seeds as long as they can tolerate them. That is another test that I actually will run is-

Dr. Weitz:            Do you like legumes and whole grains?

Allison:                 Love, love, love, love, love. More things like green like seeds, so amaranth and quinoa and buckwheat, those kinds of grains. Yeah, love them. So many different ways that you can get fiber. Fruit, forgot about fruit, don’t forget fruit. So many ways.

Dr. Weitz:            Great. Let’s say your patient is still struggling with this autoimmune disease. Where do you go next? Let’s say they have rheumatoid arthritis and you’ve done some of these basic things.

Allison:                I am betting that they’re already starting to see some improvement, but I love, love, love for things like rheumatoid arthritis, anything with pain, and that’s something that is near and dear to my heart is SPMs. Making sure that not only do they have good quality fish oils that are just part of their diet, I think that that’s really helpful for digestive health, it’s really helpful for joints, brain, eyes, skin, hormones, but also I love SPMs. I wish that I knew about them when I was struggling so because they’re fantastic for helping to resolve that pain. Bringing them on board regularly, and then as time goes on, they can just have it in the emergency kit.

Dr. Weitz:            These SPMs are derivatives from fish oil that help to resolve inflammation.

Allison:                Yes. That’s the thing is that there’s so many naturally anti-inflammatory foods like turmeric, love, but the resolution of the inflammation to actually bring it to that other stage, the difference is noticeable. I love it all.

Dr. Weitz:            You see a noticeable difference. What kinds of dosages are you typically using for SPMs?

Allison:                Again, it depends on the person.

Dr. Weitz:            Of course.

Allison:                I will say two in the morning and two in the afternoon, so four. I’ve had people go up as high as eight when they had a lot of pain. The good thing is they don’t have to do that for more than a day or two, and then it usually comes down and that’s so wonderful about it. I definitely love SPMs as part of a chronic pain protocol, if you will. And then I love-

Dr. Weitz:            Yeah, go ahead. Go ahead.

Allison:                No, I was going to say, so I love bringing in… Using food as medicine and when I want people having snacks, having an anti-inflammatory tea that they can put protein powder in, they can put MCT in, they can put collagen in, whatever it is that they want to make it something more robust, but it feels really good on the hands, it feels tastes good in the body, and it just has all of these… Turmeric, and clove, and nutmeg, and cinnamon. It’s yummy and also just helps people. I’ve had people who hands were like this. It opens them up, which is amazing to see.

Dr. Weitz:            You’re saying if they make tea? What kind of tea is this? What are they putting in the tea?

Allison:                I have them make a turmeric tea latte.

Dr. Weitz:            Turmeric tea latte. Okay.

Allison:                Yeah. It’s absolutely delicious. What I also love about it is people sometimes have sensitivities to certain herbs or foods, and so because you’re making it yourself rather than a package, not that there’s anything wrong… There’s a lot of really great products out there, and not that there’s anything wrong with that, but if you have to… I can’t do this one spice. Okay, fine. Omit it from the recipe, but you can still have these anti-inflammatory herbs. You’re having it with a high protein, you can add fat to it or not, you can have it just as a tea or you can make it a more robust snack and it’s more bang for your buck, I think.

Dr. Weitz:            Okay. I’m not sure where to go next. What else do you want to say about autoimmune diseases?

Allison:                I think that they can all be… I don’t think that they’re a life sentence. I feel like when you have the tools, every single autoimmune can be, I don’t know what the word is. You can mitigate the symptoms. You have the tools where the flare-ups are going to be fewer and farther between, and if something comes up, you know why. Because I didn’t sleep, because I ate that crap I wasn’t supposed to be eating, because I forgot to eat, because I had that really stressful event happening with my family, and that was my trigger, but I know what to do.  I have different supplements, I might use foods, I might do mindset things I might, do all of the above. It’s not one thing. It’s not one thing that got you here. It’s not one thing that’s going to get you out of it. I feel like once upon a time, I maybe was afraid of a lot of these conditions that I didn’t experience, I didn’t know what they were, but now I know because I understand how the body works. I know that get them pooping, get them sleeping, get their blood sugar balance, and I know that everything else, once they’re functioning optimally…

                                Because look, if you’re not pooping, you’re not sleeping, and your blood sugar is imbalanced, then your liver is not working properly, then you are not detoxifying toxins and hormones, that backs up… It backs up, backs up, backs up, backs up into all of these other issues, neurological, and hormonal, and mood, and structural. If everything is backing up and then you’re creating leaky gut or if you’re having structural issues, it’s creating leaky gut, which then creates inflammatory and immune issues. It is just this vicious cycle.  If we get everything working properly, metabolizing properly, then it’s more of a ripple effect of positive benefits instead of going down this everything’s falling apart, which is I think where most people go. That’s definitely what was happening with me until I had this… It can happen really quickly for people, even if they’ve been struggling for 20 years with these things, we can get them into a place of relief and getting their livelihood back, 100%.

Dr. Weitz:            That’s great. Any final thoughts for our listeners and viewers, and then give your contact information?

Allison:                I would say do the work yourself in knowing what your non-negotiables are. Meaning when you go to a practitioner, know that you are taking care of yourself and advocate for yourself. Are you doing the sleep, poop, and blood sugar balancing? If you are working on that and you’re stuck, then work with somebody on how to get around that. Just know that your body wants to heal and there’s probably things that you didn’t know that haven’t yet been uncovered or nobody asked those questions, and that’s what we do in the functional approaches is we ask those questions, we ask all of these other questions.  It helps for you to know yourself and just know that anything is possible as long as you advocate for it, and also are willing to think outside the box and take some steps that might not be so comfortable to get to the other side of this complex thing by doing these simple things and your body and life will feel much better.

Dr. Weitz:            That’s great. How can listeners, viewers find out about working with you or signing up for some of your… You have some courses available?

Allison:                Yeah. I have a gift for your listeners. If they go to allisonsaman.com, and we’ll put that below, I have my roadmap to roadmap to chronic illness recovery. Essentially, it’s the five steps that I took. It took me 10 years to figure it out. It won’t take you 10 years to figure it out, but the five steps that will help you with these non-negotiables that you can do today or to tomorrow to move that needle within the next week or two where you’re starting to see change and it covers all the things that we were talking about. I feel like that would be the first great step.  I’m Health Allie on social media, Instagram, YouTube, Facebook. I would love to just hear how it works for you, what’s going on for you, and what you found to be most valuable.

Dr. Weitz:            That’s great. Thank you, Allison.

Allison:                Yeah, thanks so much for having me.

Dr. Weitz:            You’re welcome.

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                                Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review.  If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, 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.  Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395-3111, and we’ll set you up for a new consultation for functional medicine. I look forward to speaking to everybody next week.