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Dr. Jose Colon talks about how to improve your sleep with Dr. Ben Weitz. 

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Podcast Highlights

1:49  Sleep is very important.  We spend a third of our lives sleeping and there’s a lot of regenerative processes, and encoding of memories, and healing the body that occur with sleep. A 12 mth old should be getting about 11 hours plus a nap in the daytime. A 10 year old should be getting about 10 hours of sleep. A ninth grader should be getting about 9 hours of sleep. Adults should be shooting for 8 hours and the elderly should get at least 7 hours of sleep per night.

5:06  The consequences of poor sleep can include cognitive problems in thinking and thought processing. ADHD when the diagnosis is made as an adult and pseudodementia can both be related to sleep problems.

7:17  Sleep quality is as important as the amount of sleep. You need to have uninterrupted cycles of REM, when your brain is actually very active and we are encoding our memories with emotions and we have our testosterone secretion, etc. and non-REM sleep cycles, which is our deepest sleep where our brain wave is really slow and we have growth hormone and gastric acid secretion and myoprotein synthesis. 

9:03  One of the biggest disturbances of REM sleep is untreated sleep apnea. Antidepressants tend to decrease REM sleep, as does light exposure during sleep.

10:49  Some of the most important effects of sleep deprivation is poor memory, poor performance such as driving, increased inflammation (CRP, IL6, TNF), decreased testosterone production in men, alterations in the menstrual cycle in women, increased cardiovascular risk, and increased insulin resistance.

14:19  The most important factors that affect sleep include electronics and perhaps most important is stress and stressing out over the fact that you are not sleeping. Dr. Colon recommends instructing your patients that if they can’t fall asleep, to do some relaxation training like awareness of breath meditation, which will tend to slow down your respiratory rate, which will put you into that parasympathetic mode.

19:14  I asked Dr. Colon if everyone who gets a sleep study has sleep apnea and is prescribed a C-Pap machine? Dr. Colon explained that sleep apnea is when you stop breathing in your sleep and he answered that not everyone who goes through a sleep study comes out with a diagnosis of sleep apnea and for those who do have sleep apnea, not every treatment is with a CPAP machine.

22:59  Vitamin D deficiency can affect sleep and even induce sleep apnea.

25:15  Restless legs syndrome can affect sleep and this is often related to inadequate ferritin levels, which Dr. Colon recommends to get the ferritin levels above 50 by treating with iron.

26:58  Cognitive Behavioral Therapy is the gold standard for treating insomnia. Another emerging treatment for insomnia is mindfulness based treatment for insomnia, which was created by Jason Ong.

29:15  Circadian rhythm entrainment 

33:11  Some of the more effective supplements for sleep are zinc, magnesium, lavender, melatonin, but it is more effective to run a Micronutrient test or an adrenal profile or a melatonin test or a urine neurotransmitter profile and find out what your individual patient needs and treat that. 

 

               

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Dr. Jose Colon is an MD who’s board-certified in Sleep Medicine and Neurology. He teaches for the Institute of Functional Medicine and he’s the author of books for women’s sleep (The Sleep Diet – A Novel Approach to Insomnia), sleep and mindfullness in children, and sleep for infants. He’s the founder of Paradise Sleep, on organization dedicated to the education of sleep and wellness. www.paradisesleep.com  

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcripts

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast. Bringing you the cutting edge information on health and nutrition, from the latest scientific research and by interviewing the top experts in the field. Re-subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.

Hello Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and leave us a ratings or review so more people can find out about the Rational Wellness Podcast. Today our topic is sleep. How important sleep is, how much sleep do we really need, what factors affect our sleep, and what we can do to improve our sleep. We’ll be interviewing Dr. Jose Colon, who’s an expert at sleep. He’s an MD who’s board certified in sleep medicine and neurology. He teaches for the Institute of Functional Medicine, and he’s the author of books for women’s sleep, sleep and mindfulness in children, and sleep for infants. He’s also the founder of Paradise Sleep, an organization dedicated to the education of sleep and wellness. Dr. Colon, thank you so much for joining us today.

Dr. Colon:            Hey, thank you. It’s wonderful to be here, and I appreciate your podcasting.

Dr. Weitz:            Great. So how much sleep do we really need? And I know it differs for kids versus adults.

Dr. Colon:            Yeah, so of course sleep is important. It’s a third of our lives and even more of that in kids. There’s a lot of regenerative processes, and encoding of memories, and healing the body that we’re having with sleep, so it is important. And when we ask how much sleep someone needs, I have to say it really is variable. There are things that we like to tell people. We want to tell everyone to get eight hours of sleep, to get seven to eight hours of sleep. And that’s true. That’s a good recommendation, but it really is variable. It’s also variable across the different ages. I like things that are easy to remember, so I’m gonna give you a couple of numbers that are easy to remember, but then we’re gonna talk a little bit more specifically about bright, okay? So easy to remember is that a 12 month old should get 11 plus one. 11 hours of sleep plus one nap in the daytime. A 10 year old should be getting about 10 hours of sleep. A ninth grader through high school, okay, your teenager, should be getting about nine hours of sleep. That’s a perfect storm of a lot of different problems because they’re asking them to wake up during non, you know, unphysiological times. When you have your eight to four job, okay, eight hour days into adulthood, you should be getting about eight hours of sleep. In your elderly, in your 70s, we try to shoot for about seven hours of sleep. And it’s not so much that the elderly need less sleep, it’s just that there are factors, medical factors, that occur that we get more sleep intrusions … sleep arousals, fragmented sleep, but seven hours is a number that’s easy to remember, plus it’s normal to reintroduce naps into the elderly period.

Now, all of these numbers that I gave you, you can plus or minus one of them. And many times it’s minus one of them. And even then, having said that, different people say different things. You know, Dr. Mark Hyman mentions that everyone should get about eight hours of sleep, and American Academy of Sleep Medicine and National Sleep Foundation reiterate that. Dr. Andrew Weil talks about how there are some people that can get less than six hours of sleep and have no ill effect, and he’s right, because international classification for sleep disorders also does have short sleep syndrome as a normal variant. There are some people that get less than six hours of sleep and have no adverse effects. Now, to classify for that diagnosis you need to have no adverse effects, of course.

Dr. Weitz:            I talk to people all the time who say, “I get five six hours that’s all I need”, but how do they really know if that’s really true? What are some of the things that they might not even be noticing that could be affecting them?

Dr. Colon:            Yeah, so let’s talk about consequences of poor sleep. And we all know consequences can be cognitive, they can be problems in thinking and problems in thought process. There’s a lot of diagnosis of adult ADHD that is made as an adult, where they haven’t had the symptoms before. And that’s someone that you really want to get a sleep study on and see how much sleep they’ve been having. Same thing with pseudodementia, I was taught that, in medical school, that if someone complains that they’re having dementia, the fact that they’re complaining means that they know it, so they may be depressed. Well, not so fast, you may want to make sure that they don’t have an untreated sleep apnea that’s causing that. Other factors-

Dr. Weitz:            What was that term you used, pseudodementia?

Dr. Colon:            Yes, pseudodementia. Pseudodementia. Yeah. And-

Dr. Weitz:            So these are people who don’t truly have dementia, they just have dementia because they’re not sleeping enough?

Dr. Colon:            Well, they complain of memory concerns, but then they do a … you know they do the cognitive testing and it turns out to be normal, so they diagnose them with pseudodementia, and they say that is from depression. And to put them on an antidepressant. But you know, I mean, it really could be an untreated sleep apnea. The other thing it could be, it could be mild cognitive impairment. Or subject cognitive impairment, as Dr. Bredison talks about in his book The End of Alzheimer’s.

Dr. Weitz:            And those are the beginning stages, before you get to full blown dementia, right?

Dr. Colon:            Yeah, correct, correct. Other consequences of disruptive sleep are insulin resistance. So if you’re seeing … any evidence of insulin resistance, unfortunately many times people will just check the hemoglobin A1C, but fasting insulin levels are higher before that. So these are all factors that you would look into, if they’re not sleeping well, take a look at their cognitive status, metabolic status, and that can tell you if it’s affected or not.

Dr. Weitz:            Interesting. So not only the amount of sleep, but there’s also the quality of sleep, and I know there’s the importance of getting the REM sleep, and can you explain what are some of the most important factors in the quality of sleep?

Dr. Colon:            Yeah, so that’s something that people commonly ask me. They’ll be like, “Dr. Colon, tell me about REM sleep”, and all the cycles are important. People many times think that REM is your deep sleep, but it’s actually a very active brain time. Very active brain time. And we’re taking today’s information and we’re encoding memories, in particular memories with emotions. In our REM sleep we also have increased blood flow that’s going through our organs. In that first REM cycle you have testosterone that is secreted. But this is all in balance with your non-REM sleep as well. The non-REM sleep, just like a washing machine has a deep soak, our deepest sleep is at the beginning where our brain wave is really slow and we have growth hormone secretion, we have gastric acid secretion, so all of this is important. And you have this really rhythmic setting to where you have this gastric acid secretion in the beginning of the of the myoprotein synthesis, and then with our REM sleep we have increased blood flow, delivering it to our body for healing our body. So it’s all very important.

Dr. Weitz:            What are some of the, how does your REM sleep get disturbed? Like can you get a normal amount of sleep but it’s just not the quality of sleep? What happens there?

Dr. Colon:            One of the biggest disturbances of REM sleep is actually a untreated sleep apnea. And the reason for this is because in REM, our body has less muscle tone, so you don’t act out your dreams, it’s a protective mechanism. But when we decrease our muscle tone, our muscle tone in our airway also decreases as well. So some of the problems that can occur with REM sleep can be an untreated sleep apnea. Other things that can affect our REM sleep are antidepressants decrease REM sleep, and that’s one of the major factors there. Another thing that can affect your sleep in general, whether it’s your REM sleep or your non-REM sleep, is light exposure. If you’re sleeping with light exposure, some new studies have shown that that increases insulin resistance as well.

Dr. Weitz:            Yes, so your room should be very dark, maybe even wear a sleep mask or something like that if it’s not.

Dr. Colon:            Absolutely. A quiet, dark room is helpful. Sleep masks can be helpful if they’re tolerated, I was actually in Iceland where they had 24 hours of sunlight, and I could not keep that on my face.  And I’m like, I’m a sleep specialist, I need to get to sleep, you know, but I couldn’t keep it on my face.  But other people can, other people sleep very well with it.

Dr. Weitz:            Yeah, I’ve got one from Tempurpedic, and it sort of pushes gently on your eyelid, and if you push gently on your eyelid it actually stimulates that oculocardiac reflex that causes you to relax.

Dr. Colon:            That’s a good tip, that’s a great tip, I’m gonna use that in my clinic.

Dr. Weitz:            So let’s go through some of the negative effects of what happens when you don’t get enough sleep. I know I was, I listened to your lecture and I was looking at your Powerpoint and you talked about decrease in performance, you talked about memory problems, maybe we could go through some of the more important ones.

Dr. Colon:            Yeah, one of the things that you see really early on is memory. And it’s been shown that sleep deprivation, when people do different functional memory tests and cognitive tests, that they work as if they’re impaired, sometimes worse than someone who is intoxicated. And they’ve actually done these studies where they give one group of people alcohol and they sleep deprive another group, and they put them on driving simulators, and consistently the sleep deprived group does worse. So if you combine sleep deprivation with alcohol, then that’s even worse. Other things that can affect, that can be affected if you have poor sleep is-

Dr. Weitz:            By the way, when it comes to memory, is it more long-term, short- term, or both?

Dr. Colon:            Definitely clearly short-term, you see some problems, like okay, I went to the kitchen to get something, what did I go to get? You don’t forget your own name, but I guess … both can be affected. But immediately you see short-term memory issues.

Dr. Weitz:            Okay. And then go ahead, you were gonna say something else?

Dr. Colon:            Well, other things that poor sleep affects and decreased sleep is your inflammation status. Inflammation and sleep are really bi-directional, where inflammatory disorders are associated with more sleep concerns, but likewise if you have short sleep, you have higher markers of c-reactive protein, Interleukins, and measures of inflammation such as Tumor Necrosis Factor alpha. That affects cardiovascular status as well, so they’re … doing findings that when you treat your sleep apnea with CPAP, that that also improves your cardiac status, but beyond that, when you treat insomnia with cognitive behavior therapy for insomnia in cardiac patients, they have better cardiac outcomes as well.  I also can’t emphasize enough the insulin resistance. Poor sleep really affects insulin resistance as well.

Dr. Weitz:            So you can be working with somebody who is a type 2 diabetic or a pre-diabetic, and maybe controlling their, let’s say you’re a Functional Medicine practitioner and you’ve got them on a low carb diet and still they’re waking up with high fasting blood sugar, it could be their sleep that’s actually affecting that?

Dr. Colon:            Yeah, and same thing with Polycystic Ovarian Disease. You know, likewise, all of those things, you’re very correct.

Dr. Weitz:            So it, can it directly affect your hormone levels?

Dr. Colon:            Yeah, absolutely. You know, for men you have that first REM cycle where you’re secreting the testosterone, and untreated sleep apnea has been associated with testosterone that’s low. And then also with women, I mean women have what, a 28 day cycle, that’s the lunar calendar. So I mean, yes, sleep does affect it, yeah.

Dr. Weitz:            So in men, is it more likely to affect total or free testosterone, or both, or?

Dr. Colon:            Both.

Dr. Weitz:            Interesting. So what are some of the most important factors that affect sleep? You talked about light, what about electronics, EMFs, what are some of the other factors?

Dr. Colon:            So all of those are really important. The light, the electronics, EMF, every single study that I read about electronics and sleep, there’s nothing positive, I mean nothing is, everything comes back that electronics really disturb sleep. But you asked me another question, you asked me what are some of the most important factors that affect sleep? And I gotta tell you, in my experience, the most important factor that a stress … that causes problems with sleep, is stressing out about sleep pattern, is people, some people can’t sleep because something’s bothering them and what’s bothering them is that they’re not asleep. And sometimes we overemphasize, you can’t overemphasize sleep, yet sometimes we overemphasize it to the point that it causes sleeplessness. So it’s important for patients to know this, it’s important for them to know that yes, we’re gonna try, we’re shooting for our seven to eight hours of sleep per night. But if you have a night that you haven’t slept, you’re not gonna drop dead the next day. You’re gonna be okay.  You know, if you’ve gotten those first four hours, the core sleep is within your first four to five hours. If you’ve gotten that, this is gonna help you, at least for the next day. Do we want to do that chronically? No. But some people literally lose sleep over not sleeping.

Dr. Weitz:            Right. So maybe you should say to yourself, if you had a poor night of sleep, don’t worry about it, and even if you just … I usually like to tell the patients, look, even if you just lay there and rest, that’s beneficial to your body. And don’t worry about the fact that you didn’t sleep.

Dr. Colon:            You know, so let me add something to what you just said. Alright, this is gonna help your patients, okay? You’re correct. Even if you’re not asleep, if you’re resting, that’s helpful. Everyone has a heart rate, everyone has a brain, okay, and these are interconnected with our breathing.  So you can instruct them, if you’re not asleep, this is the time to do some relaxation training.  This is the time to do an awareness of breath meditation.  And when you do this, you’re naturally gonna start to notice your breathing.  When you notice your breathing, your respiratory rate slows down.  As your respiratory rate slows down, you’re hitting that parasympathetic response. And this is so clutch, because if you’re not asleep, you’re at this parallel where one of two things are gonna happen. You’re either gonna stress about it, and you’re gonna go up at the sympathetic stress, or you can elicit that relaxation response and then at least you’re getting the decrease in cortisol, you’re getting the decrease in heart rate, and you’re starting to relax.  So you’re right, if they’re not asleep, you can have them do some type of relaxation response and they’re still getting some R and R, some rest and restoration.

Dr. Weitz:            So I have heard about the importance of breathing through your nose as opposed to mouth breathing and some people even tape their mouth, what do you think about those techniques?

Dr. Colon:            That … you know, so sometimes we use chinstraps so your mouth doesn’t open if they have an untreated sleep apnea, because-

Dr. Weitz:            People actually put tape over their mouth.

Dr. Colon:            Yeah, I don’t recommend that.  I haven’t heard of tape over their mouth. You know, we prefer to breathe through our nose, it’s more natural to breathe through our nose. Some people have some congestion to where they need to breathe through their mouth. Recently when I was in Lima, I told you that I had some congestion from some of the pollution that was over there, well one of the nights I woke up in the middle of the night and I had a lot of congestion.  I had to breathe through my mouth.  Now chronically you don’t want to do that, you’re right.  Chronically you don’t want to do that. And if you have that congestion, ideally you want to figure out what’s causing that congestion.  Do we have too much gluten or dairy in our diet?  Do we have environmental exposures?  What can we do to reduce that?

Dr. Weitz:            Yeah, I’ve always been a mouth breather for a number of years, and I took some training on breathing with a Butyeko breathing coach, and it really helped.

Dr. Colon:            That’s great.  At the same time, I also have some people that are retired boxers that they’re not going to breathe through their nose.  So you have to work with the clients where they’re at.

Dr. Weitz:            Right. So can you talk about sleep apnea and what exactly happens when you get a sleep study, and does everybody who goes through a sleep study end up with a CPAP machine, and what are some of the other concerns people have with that?

Dr. Colon:            So not everyone who has a, who goes through a sleep study comes out with a diagnosis of sleep apnea.  And even people who have sleep apnea, not every treatment is with CPAP. But sleep apnea is where you stop breathing in your sleep.  Your airway collapses while you’re in your sleep, and it’s restrictive, and you have less oxygen. That can induce cortical arousal so it affects your brain.  And then the known method, the single best known method for treating it is the CPAP machine, which cushions your airway open.  But there’s other people that can wear a dental device, a dental device that advances your jaw forward and just to kind of give a demonstration, okay, if I’m asleep, my jaw comes back.  Okay you hear a snoring sound? Now if I move my jaw forward, now I’m not making that snoring sound there.  So these are very effective, and … yes, they’re very effective for mild to moderate sleep apnea.  So you need a sleep study to see where you’re at. But the compliance of those have been shown to be better than that of CPAP, actually.

There are some patients that the sleep apnea may be positional only. So I do have some patients that I’ve treated successfully with a positional sleeping to avoid sleeping on their back, now they sleep on their side, and there’s positional devices that have been studied and have some robust literature. I typically tell people to get a full body pillow. When you have a full body pillow, that’s gonna align your shoulders to your knees, so you know what that does for your back, preserves your back and make it so you can stay in that position throughout the night. So those are the main treatments. There are of course some sleep apnea surgeries that are not really highly recommended. There are-

Dr. Weitz:            I’v had some patients get those surgeries recently where they carved out part of the back of their throat, and you know, tried to make some more room there.

Dr. Colon:            They’re serious surgeries … that I have referred some patients for it, and I’ve yet to have a surgeon in my area want to do it. They’re like, “No, why don’t you go back to Dr. Colon and work on that CPAP a little bit more.” They don’t have very good track records.

Dr. Weitz:            I just had a patient see a sleep expert who gave them some sort of device that stretches out the upper palate.

Dr. Colon:            So rapid palatal expansion is something that is very well established in the pediatric age group that decreases the incidence of obstructive sleep apnea and the severity, and I do advocate for that. In the adults, that is, I feel is an emerging topic. It is not being talked about by sleep experts. It’s being talked about more within functional dentistry, and I think that it has a bright future, but the sleep experts don’t have the data on that at this time.

Dr. Weitz:            I also interviewed a functional dentist who told me that he thinks that a fairly decent percentage of patients with sleep apnea really just have vitamin D deficiency.

Dr. Colon:            I have … the answer is yes, vitamin D deficiency affects sleep. In particular, sleep apnea. It also causes inflammation to where you can get tonsillar hypertrophy, which further affects sleep apnea. I had a patient that I saw for multiple, well I saw him for sleep. The patient has multiple sclerosis. Now when I diagnosed him with sleep apnea, and it was a marginal sleep apnea, but it was definitely present. It was present. And knowing that he has multiple sclerosis, knowing the functional medicine background that I have, I know that vitamin D can affect multiple sclerosis. So I got a vitamin D level on him, I started treating him with vitamin D, and his multiple sclerosis doctor endorsed it. “Yes, yes, let’s go ahead and treat.” Now, interesting. Something happened with his insurance company that they stopped paying for the CPAP machine. What happened, I don’t know, you can’t make sense out of nonsense, so don’t try. Regardless, it got denied. So I had to repeat a sleep study on him, and when I repeated it, sleep apnea was no longer there. This was after several months treatment on that vitamin D.

Dr. Weitz:            How much vitamin D were you giving him?

Dr. Colon:            We were doing … it was, I think, conservative. I think we were doing like 5000 units.

Dr. Weitz:            Okay.

Dr. Colon:            And some people will say, “Oh, 2000’s conservative.” No, I think 5000 was conservative. But even then, you know, it was only that much, and it was after several months of treatment, we repeated it, and it was negative. So what was wrong? I mean, was my sleep study wrong? No, I mean I looked at it, I read it. Both of them were quality, and I went back and looked at both of them. And the measurements were there. But he just didn’t have the sleep apnea. And he didn’t lose weight either.

Dr. Weitz:            So one of the things that can interfere with sleep is restless leg syndrome. And I know there’s some controversy over exactly what the causes are, and I saw one article that found a correlation between IBS/SIBO and restless leg syndrome, which I thought was really interesting, because I end up treating a lot of cases of IBS and SIBO. Can you talk about restless leg syndrome for a minute?

Dr. Colon:            Restless legs are uncomfortable sensations in your legs that are worse at night, worse when you rest, and they’re relieved by movement or by mental activity. There are many causes, and even then there’s two kinds, familial or non-familial. And there’s many causes, one of the main causes that everyone with restless legs needs to be evaluated is ferritin is  deficient. And notice I didn’t say iron deficiencies, because you can not have anemia but still have less ferritin. And if you don’t have the … enough ferritin you can have-

Dr. Weitz:            What’s the distinction there?

Dr. Colon:            So what are the main treatments that, medical treatments that people give, is the dopaminergic medications, right? Well you know, the dopamine receptor has ferritin in there, and further, so low CNS ferritin has been shown to cause restless legs and treating that. So the ranges, when you look at ferritin, you know it says that the range may be to 10 to 20, or if you’re at 20 that’s normal, but if you have restless legs, 50 and below, you know below 50, that’s symptomatic, and you want to be treating with iron in those patients.

Dr. Weitz:            Interesting. So how, besides restless legs syndrome, let’s go over some of the … I know you mentioned a few of these, but let’s go over some of the therapies to restore better sleep. You mentioned cognitive behavioral therapy, what exactly is that, and how does that work?

Dr. Colon:            Yeah, so CBTI is the gold standard for treating insomnia. And CBTI is working with a psychologist that really kind of helps retool sleep. That’s what I explain to patients. But one of the things that these therapists is doing is that they’re addressing our attitudes, our concerns, about sleep. You know how I said that some people don’t sleep because they’re stressed about sleep? Well, yeah, that’s what the psychologist works with. They’re like, “Okay so what’s gonna happen if you don’t sleep?” They’re like, “Well, if I don’t sleep I’m not gonna function the next day.” “Okay, and then what’s gonna happen?” “Well, I’m gonna go to work and I won’t be able to function. And if I can’t function, I’m gonna be fired, and if I’m fired, I’m gonna be homeless.” And literally people with insomnia can have some degree of catastrophic thinking that occurs. And the CBTI helps out with that.

And another emerging treatment in insomnia is gonna be MBTI, or mindfulness based treatment for insomnia. This was created by Jason Ong. And there is a perception, yet misperception that we can meditate ourselves to sleep. I mean, yeah, you can induce a relaxation response or sleep, and relaxation therapy and relaxation training is good for sleep, and I teach my patients how to do that. But MBTI is different, because you’re actually doing a practice of mindfulness, an eight week practice of mindfulness. What are some of the core concepts of mindfulness? Non-judgment. So if you stop judging yourself, you know that you’re not asleep, you stop … you worry about the present moment, don’t think so much about the future, the MBTI has been shown to be very helpful for insomnia as well.

Dr. Weitz:            Great, great. What is circadian rhythm training?

Dr. Colon:            Circadian rhythm entrainment is that we all have a 24 hour cycle. Everyone lives in a 24 hour society. Believe it or not, actually, our internal clock has a tendency to go 25 hours. So if you put people in a cave and you take them away from light cues, you disrupt their light cues, they stay up later, and later, and later, an hour later the next day. And what resets our cycle is that morning light, and then the darkness at night. So I’ll use, and even then, you really do have some people who are night people, and some people who are morning. You know, people have different circadian clock genes that predispose their circadian cycles. So circadian entrainment is trying to work on a particular wake up time with light exposure and you can even add melatonin, based on where their melatonin secretion should be coming out. When should they secrete melatonin? There’s a very, very helpful tool called a morningness-eveningness questionnaire. It has a German name to it that I can’t pronounce, so I just call it the morningness-eveningness questionnaire. And you can go online and get it, it’s called the AutoMEQ, M-E-Q, Auto M-E-Q.

Dr. Weitz:            Cool. And you talk about sleep restriction, restricting your time in bed, I guess this is for somebody whose sleep cycle’s all messed up, and if they’re having trouble sleeping at night and then they end up sleeping during the day, how does that work?

Dr. Colon:            So let’s, before we talk about how it works, let’s talk about what does not work, okay? So there are some people that spend extra time in bed, because they want to sleep more. And that sounds logical, okay if I’m not getting to sleep til … I’m throwing numbers out. If I’m not getting to sleep til midnight, let me go to bed earlier, so I can eventually get to sleep. The problem with that is that you’re spending more time in that bed learning not to sleep. And training your brain to not be asleep. So the key is to … the time. Restrict the time that you’re in bed until the times that we are going to be asleep. So that’s what we mean by sleep restriction, as well as also having a very strict wake up time, because that helps with the circadian entrainment as well.

So another thing that people say is, well if I didn’t sleep until this time, I need to sleep in longer. That sounds logical, but it’s causing a cascade of problems that’s disrupting your circadian system, which we have a natural tendency to run at 25 hour cycles, so if you didn’t get to sleep til whatever time, it doesn’t matter, wake up at the same time. And if you do that on a regular basis, that’s going to help your sleep drive, get to sleep a little bit earlier. So sleep restriction isn’t so much sleep depriving people, although you do go through a period of time where they might get a little bit less sleep, but you do that in a way that they end up getting to sleep on a regular time, a little bit early on a regular basis.

Now that is something that I would do either with a board certified physician in sleep medicine, or that would be a great period to find someone who, through the Society for Behavioral Sleep Medicine, a sleep psychologist.

Dr. Weitz:            Cool. What are some of your most effective herbal or nutritional supplements for sleep?

Dr. Colon:            You know, so whenever someone asks me what is the best supplement for sleep, I always say what are you deficient in? So I will commonly run some micronutrient analysis to see. I can show you evidence that zinc has been helpful for sleep, that magnesium has been helpful for sleep, lavender is helpful for sleep, melatonin is helpful. Everything that’s out there I can show you evidence. But what is it in your patient? So you run a micronutrient analysis and you look for a specific deficiency. Or you may run an adrenal profile, and you can find that they’re epinephrine or norepinephrines are high, or their cortisols are high, you know, some ashwaganda is gonna be good for them, or some rhodiola. If their cortisol is high, lavender has been shown to decrease the cortisol. Run a melatonin profile, and if their melatonin is normal, then giving them more melatonin is not gonna help out. If you see that their melatonin is low, okay then that’s someone that we may want to supplement with melatonin, or have them eat more foods that have both tryptophan to make your own melatonin, as well as also natural melatonin such as tomatoes, cherry juice, walnuts.

Dr. Weitz:            You do do urine neurotransmitter testing to see if their serotonin or GABA is low?

Dr. Colon:            I have, and the context that I do that is I’m saying, “Look, I’ve been seeing you, you’ve done the sleep hygiene, we’ve done the sleep studies, we’ve done the standard of care, and you’re still having some issues, do you want to do a little bit more?” And some people say, “Yeah, yeah, okay let’s do more.” And I’ve had a patient that their glycine was low. Alright, well let’s supplement glycine. Other patients that their serotonin could be off. I had one patient with excessive sleepiness that had high, really high GABA levels, well GABA is inhibitory. So they were complaining of insomnia, but in essence they were sleeping during the evening, it’s just that they were tired during the daytime. And we ran it, the GABA was high, well DHA can attenuate that response. So we targeted individualized treatment.

Dr. Weitz:            Interesting. GABA can also help with sleep, and some people use it in sleep formulas.

Dr. Colon:            Correct. GABA can help with sleep, but also if you have chronically high GABA levels, which many patients with idiopathic hypersomnia can have defective, overactive kind of GABA receptors.

Dr. Weitz:            So just like many things, not too much, not too little, gotta get it in that sweet range.

Dr. Colon:            Yeah, that and what are we treating?  So I get the question a lot, “Dr. Colon, what’s the one big thing that we can do with sleep?”  And number one is not worry about it, but number two is what are we treating?  Are we treating … do we have an unknown sleep apnea, if we have restless legs, do we have SIBO as you mentioned, do we have magnesium deficiencies, keratin deficiencies, and even sometimes throwing in micronutrient analysis and also the neurotransmitter profiles.

Dr. Weitz:            Right.  So basically try to get at the root cause, do a careful history-

Dr. Colon:            Yes, sir.

Dr. Weitz:            Do a certain amount of, you know, a reasonable amount of testing, and then let’s try to have some real target for what … you know, that we can really try to intervene and get to those root causes, which is really what functional medicine’s all about.

Dr. Colon:            You hit the nail on the head, doc.

Dr. Weitz:            Okay, Jose. So for those listening or watching this podcast, how can they get a hold of you? And how can they get a hold of your books and your training programs?

Dr. Colon:            Yeah, so all of my books are on Amazon. They’re also from my publisher, Halo Publishing, and yeah, I wrote a book for women for insomnia called The Sleep Diet a Novel Approach to Insomnia, which I wrote it at a time when I had no idea about nutrition, so it’s not so much about diet but about different lifestyle aspects. And I have, as you mentioned, children’s sleep book and a book for infant sleep. And I also put information on my website on sleep tips for free on paradisesleep.com.

Dr. Weitz:            And are you available for consultations in person and over the phone, or via Skype, or?

Dr. Colon:            I do work for a health system, so all of my consultations are within my clinic, actually.

Dr. Weitz:            Oh, okay. Great, excellent. And what’s your website?

Dr. Colon:            Www.paradisesleep.com

Dr. Weitz:            Excellent, thank you Dr. Colon, thanks for spending the time with us.

Dr. Colon:            My pleasure, you have a great one.

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Improving depression and anxiety with Dr. Jess Armine using a Functional Medicine approach.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast] 

 

Podcast Highlights

4:30  Dr. Armine explained that he loves chiropractic, but he always felt this draw to what we call Functional Medicine and what drew him in more was his son who developed schizophrenia at age 14. He has a high IQ and was very talkative but when he got treated by conventional psychiatrists with medications, he would just sit there on the couch rocking and became a non-entity. He had to find a better way, so he dug into the research and consulted an integrative psychiatrist and he developed a methodology of treatment that looks at both ends of the disease process down to the core molecular level, which he applied to his son.  And his son was able to graduate college and now he is an incredibly functional person who runs his own business and leads a normal life.

6:58  Dr. Armine found that in his son’s case, chronic, neurological Lyme was an important factor that he had to deal with. They also had to deal with strep and biotoxins.  His son also had gained a lot of weight because of the medications and all the fat created increased inflammation, so losing the weight also helped. 

8:57  Common mood disorders like depression and anxiety are caused, at least in part, by neurotransmitter imbalances, with serotonin being an issue for depression and too much adrenaline or too much dopamine being an important factor in anxiety.  Dr. Armine has developed a model of practice that looks both at neurotransmitters and at the the causes of altered neurotransmitters like exposure to chemicals, heavy metals, benzene, mold, fungi, bacteria, parasites. Also various psychological factors like being brought up in a non-nurturing environment or being exposed to yelling, abuse, social isolation, and PTSD can be important factors. All these stressors can affect the cell and neurotransmitter imbalance. (Neurotransmitters are substances that transmit neurological impulses from one nerve to another.)  Dr. Armine believes in addressing both the causes of neurotransmitter imbalance just mentioned and also supplement with nutraceuticals to boost neurotransmitter levels.

17:32  Dr. Armine uses urinary neurotransmitter testing, which has been criticized as not reflecting the level of neurotransmitters in the central nervous system.  But taking a brain biopsy or getting a spinal tap is not practical for use in clinical practice and urinary neurotransmitter levels should be correlated with symptoms and treated as biomarkers that tell you about trends, rather than as absolute levels.

21:12  Organic acid testing is helpful to let you understand metabolism. You can see what’s being absorbed, what’s not being absorbed. You can see the reasons why. You can see the mitochondrial pathways.

23:38  Genetic testing also helps him by giving him a heads up into what areas might have problems.  MTHFR does one thing and one thing only. It takes 5,10-methylenetetrahydrofolate and turns it into 5-methyltetrahydrofolate. That’s it. 

35:30  Treatment should always involve improving leaky gut.  You can use digestive enzymes, a demulcent herb, colostrum, and a probiotic.  Fix Lyme if it’s there. You need to treat the foundation of the body first, which means decreasing various stressors to the body, by cleaning up your environment.  Drinking good water with as good a water filter as you can afford. Check your house for mold. You have to heal the cells with vitamins and minerals that can get into the cells and phospholipids to rebuild the cell walls. You want to consider mitchondrial function.  Autoimmune Paleo diet works well to reduce inflammation, but it doesn’t work for everyone. If they have neurotransmitter imbalances, you should treat the inhibitory neurotransmitters before the excitatory, which means you want to increase GABA. You want to either use the liposomal form from Quicksilver Scientific or the 4-amino-3-phenylbutyric acid form of GABA that came out of Eastern Europe, such as PheniTropic from Biotics or Kavinace from Neuroscience.  For serotonin it’s better to use 5-HTP than tryptophan, since the tryptophan pathway can lead to quinolinic acid, which is a nasty excitotoxin. You can take SSRIs all day long, but if you are not producing enough serotonin, it won’t work.

 

 

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Dr. Jess Armine is a Doctor of Chiropractic and a Registered Nurse and has been in healthcare for over 37 years. His focus is using a Functional Medicine approach to treating various neurological and immunological conditions in patients with a focus on taking a careful history, lab work, and also looking at genetics. You can contact Dr. Armine at his website DrJessArmine.com Dr. Armine offers new clients a free 15 minute consultation to see if he can help them and he does consultations via phone or Skype.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcripts

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube and sign up for my free eBook on my website by going to DrWeitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness Podcasters. Thank you so much for joining me again today. Dr. Ben Weitz here, and for those of you who enjoy our Rational Wellness Podcast, please go to iTunes and leave us a ratings and review and go to YouTube and sign up to become a subscriber to our YouTube page, which is Weitz Chiro, or you can search for Rational Wellness in YouTube.

Today, our topic is how to deal with mood disorders like depression and anxiety by trying to balance our neurotransmitters. Depression is characterized by persistently depressed mood or a loss of interest in activities, and it affects more than three million Americans per year. In fact, it’s been in the news a lot. There have been a series of celebrity suicides, so depression is really in the news. Anxiety is characterized by feelings of worry, nervousness, or fear that are strong enough to interfere with one’s daily activities.  Depression and anxiety are typically treated by mainstream medicine with medications like selective serotonin reuptake inhibitors, also known as SSRIs, like Prozac, Zoloft, and Lexapro, which are among the most commonly prescribed medications in the United States.  According to a new analysis of federal data by the New York Times, long-term use of antidepressants is surging in the United States. Some 15.5 million Americans have been taken the medications for at least five years, and the rate has almost doubled since 2010.  Most of these antidepressants were originally approved by the FDA for short-term usage, and there was only a few studies lasting longer than a few years, but yet many patients are put on these drugs indefinitely. It’s very difficult to get off these drugs. A large percentage of patients who take them report severe withdrawal symptoms when trying to ween themselves off or are unable to ween themselves off.  Other than talk therapy, what other approaches can help such patients?

This is why I’ve asked Dr. Jess Armine to join us today for a functional medicine approach to dealing with mood disorders. Dr. Jess Armine is a doctor of chiropractic and a registered nurse, and he’s been a healthcare professional for over 37 years. He’s trained in chiropractic, anhelation, genetic research, neuroendo immunology, functional medicine, applied kinesiology, and cranial manipulation.  Dr. Armine is one of the few specialists in the United States specializing in correlating genetic SNPs, which are single nucleotide polymorphisms like MTHFR with neuroendo immunology. He also correlates this with acquired mitochondrial dysfunction and cell wall integrity to help identify hidden imbalances–that’s a mouthful–hidden stressors in the body. He develops individual treatment plans specific to the health history and physiology of each patient. Dr. Armine, thank you so much for joining me today.

Dr. Armine:         Thank you for the opportunity for being here and talking to your listeners, and that was a great introduction. Thank you so much.

Dr. Weitz:            Thank you. I’d like to give a quick shout out to the chiropractic profession because this just occurred to me this morning. For some reason, some of the smartest doctors in the functional medicine world, like yourself, are chiropractors.

Dr. Armine:         Yes.

Dr. Weitz:            I just recently interviewed Dr. Tom O’Bryan, Dr. Michael Ruscio. We were talking a little bit about Dr. Kharazzian, so anyway, for whatever that’s worth. Dr. Armine, what got you so interested in researching and treating mood disorders?

Dr. Armine:         Well, when I became a chiropractor, chiropractic is wonderful. I always had a really good time with it. Always felt this draw to what we now call functional medicine. It’s something that interested me because I could put the puzzle pieces together, but essentially, what threw me into high gear was my son, who is now 31, developing schizophrenia at about age 14.  I did exactly what every good father should do. I took him to the doctors and this child with 160 IQ who was glib and had frankly exceeded me intellectually when he was 10 became a nonentity with the medicines. He would sit there on the couch just rocking. I’m a fairly spiritual guy and I looked up at the spirit of God and said, “This disease is squaring with the wrong daddy.” I apologize for the bad word.  I launched into studies and as it would happen, I had a lot of good people put in front of me and I learned an incredible amount of stuff that as you mentioned, the neuroendocrinology concepts, neurotransmitter analyses, and so forth and so on, that helped me develop a methodology of treatment that looked at both ends of a disease process right down to the core molecular level.  I applied this with my son. Of course, I worked with an integrated psychiatrist also, and between us, he graduated college. He became an Eagle Scout when he was younger. He was a director of a nature program in the Boy Scout camp. He now runs a business on his own and he is himself. He still has some issues, but you know something? He’s a functional, incredibly functional person. He is my hero, actually.

Dr. Weitz:            That’s a great story.

Dr. Armine:         He really is. That’s why I’m here. That’s where my passion in the circles that I run in. If anybody comes to them and they have severe neuropsychiatric challenges, they tend to refer them to me because that’s my passion, figuring out why, the base reasons, and the downstream effects is my passion. I like to think I’m pretty good at it.

Dr. Weitz:            If you don’t mind my asking, were there one or two keys that you thought were really helpful in your son’s case?

Dr. Armine:         Yes. Number one, like I said, he was an Eagle Scout, so to think that he didn’t get bitten by a tick is kind of foolish. Lyme disease, neural Lyme, was one of the issues. The medicines made him gain weight like crazy, and just the adipose tissue increased inflammation to a degree, and to think inflammation like a forest fire. Once it gets going, once it gets really going, and you’re out in California so you have a feeling for this. I’m in Pennsylvania. We don’t see forest fires, but they will just get so hot that they’ll burn everything, even things that aren’t supposed to burn. It feeds on itself. We know why now.

That’s in the whole cell danger response thing. We can interrupt that, but the keys were chronic cerebral inflammation, what’s now called chronic inflammatory response syndrome, that can be done by biotoxins, by Lyme, by strep, by so many things. Those were the keys to putting the fire down and then replenishing. Yes, it was done with medicines and nutraceuticals because of the severity of the pathology, and as I’m explaining neurotransmitters, you’ll see why. Those were the keys. The keys were cleaning up his physiology, because let’s face it, the bugs don’t like a normal environment. They like their own environment.  If you can do that and take care of what the bugs have done to you, the damage they’ve done, reversed or in other words, work in both ends, even the most severe pathology … He was suicidal. He was seeing demons. This is a boy that I would committed suicide myself. That’s why he’s my hero. I meet very few people who can go through that and survive.

Dr. Weitz:            That’s awesome. What causes the common mood disorders like anxiety and depression?

Dr. Armine:         Well, even though there may be arguments on both sides of the issue, there is no question that neurotransmitter imbalances cause mood disorders.  Remember that the neurotransmitter imbalances don’t happen by themselves in a vacuum. They happen for reasons.  Typically, we think of depression as being a serotonin issue. We think of anxiety as being too much adrenaline or too much dopamine. It’s not always like that. It’s really a matter of balance. The neurotransmitter balance is what you’re looking for, and also the imbalances will cause mood disorders.  The resulting mood disorder is based on genetic predisposition with something causing that genetic predisposition to express, which is usually the neurotransmitter imbalance and the resulting mood disorder. If we look at it in a line like that-

Dr. Weitz:            By the way, doc, what are neurotransmitters?

Dr. Armine:         Okay. Neurotransmitters are substances that transmit neurological impulses from one nerve to another, okay?  Very simply, nerves are not connected. They have a synapse. We’re not going to use big terms. They have a synapse.  The neurotransmitters, the chemicals are sitting in warehouses called vesicles.

Dr. Armine:         When a nerve impulse comes down, it comes down, somebody at the synapse, I always call them the warehouse guy, the guy with the hardhat, says, “Hey, send me some,” I’m from Brooklyn, okay, “Hey, send me a bit of serotonin here. I’ve got to get this over there,” right? The serotonin vesicles will release some serotonin into the synapse, take that information, go to the other nerve, and the nerve impulse continues.  When that neurotransmitter, that substance goes off the receptor, it’ll sit around in the synapse and does one of a few things. It either hangs out with its buddies for a while or it gets broken down by COMT, Catechol-O-methyl transferase, or MAO, monoamine oxidase, or it gets reabsorbed. That’s the reuptake, so it can be reused again.  That’s the normal process. Your food intake, your amino acid intake goes into the axons of the nerve and produces neurotransmitters, and so people have a good understanding of it, I’m going to share my screen for a real, real short visual. Let me hit slideshow.

Dr. Weitz:            Okay.

Dr. Armine:         We’ll handle this from the current slide. Okay. This is the stressors that can affect the cell. This is what causes all the problems. This is from the metabolic features of cell danger response by Dr. Naviaux, who’s at the Metabolic Disease Center at the University of California San Diego. He discovered all the things that can damage a cell, as you might expect, for chemical, physical, heavy metals, benzene, microbial, mold, fungi, bacteria, parasites, parasites is a biggie, by the way.  What most people fob off as being non-essential or not significant are the whole psychological constructs of yelling, abuse, isolation, PTSD.  People who have been brought up in a non-nurturing environment, people who were exposed to various forms of abuse, either on a single or ongoing basis, will damage the cells just as much as microbial or chemical influences.

This is a little animation. We’re going to talk about dopamine here. Dopamine is created in the axon, as you can see. It’s degraded by monoamine oxidase, but you see the little vesicles where it is stored. When dopamine is necessary, those vesicles will release dopamine into the synapse so that the dopamine in this case will go into the receptors, do their thing, and then either get degraded or get reuptake, like I told you before.  Now, this is optimal activity, and on a scale, this is what it looks like. Your neurotransmitter stores are good. The activity is just fine. When you encounter stressors, the stress increases the neurotransmitter activity. In other words, more neurotransmitters are needed at the synapse, and the stores become depleted. This is a process that takes some time. You have high activity. You’re able to respond to the stress, and it’s a good thing.  If you’ll notice the scale, the activity goes quite high, and the neurotransmitter stores start dropping. When you have chronic stress, the fact is that the stressors use up the neurotransmitters rather quickly and we can only produce neurotransmitters at a particular rate, even if there’s no problems, even if the system’s perfect. We can only produce it at a particular rate.   What you have here is optimal looking activity because the stores are decreasing, and they’re decreasing rather chronically. Look at the scale again. The scale is the neurotransmitter activity starts dropping, the stores are dropping, but you don’t even have symptoms yet. This is the thing. You don’t have symptoms yet. This is happening way before you have symptoms.

Now, when the stores are depleted, you have inadequate neurotransmitter levels because the stores have nothing in there. The warehouses have nothing in there, so it doesn’t matter how hard you try, there’s simply low activity. Now, this is where you get symptoms where the neurotransmitter stores have bottomed out, the activity has bottomed out, and now you become depressed, now you become anxious, now you have whatever.  Reuptake inhibitors, if you go back one slide, go back two slides, sorry, prevent some of the reuptake and give you optimal looking activity because what they’re doing is preventing the reuptake by inhibiting some of the receptors that would tell you to reuptake the serotonin or dopamine or norepinephrine, whatever it happens to be.

Really what’s going on, what we really must understand is that by the time you have symptoms, you have incredibly low neurotransmitter stores and the reuptake inhibitor will work, give you optimal looking activity, but if you’re lucky, between five and 10 years before you simply have absolutely nothing, as these medicines do nothing to talk about why you’re like this, why you’re not getting the neurotransmitters that you’re looking for.  When people argue about, “Well, neurotransmitters have nothing to do with mood disorders,” what they’re really saying, and they’re saying it inartfully in my estimation, what they’re saying is you should be concentrating more on the rationale or the reason for the neurotransmitter imbalances, neurotransmitter storage, however you want to put it. Instead of treating from the bottom end, by treating the neurotransmitter imbalance or the supposed symptoms, you should be looking at the rationale or the reasons or the root causes, if you will.

My theory, my method of practice, which has been really successful, is to identify and treat the root causes and treat why you’re not producing your neurotransmitters, and then as you can see, since you need to fill up these warehouses or vesicles, you need supplementation for a period of time, serotonin, let’s say.  You cannot put enough tryptophan into your body to fill up those stores in anything like realtime. Unless you want to eat a turkey a day or three turkeys a day, it’s not going to happen, assuming that your GI tract will handle it. That’s how this actually works, so you have to look at things from both ends, both points of view.

Dr. Weitz:            Interesting. How do you measure neurotransmitters in your patients and which lab do you like to use?

Dr. Armine:         I can see that you like to open up Pandora’s Box of controversies, so let me address the unanswered question. I use urinary neurotransmitter testing. Urinary neurotransmitter testing, urine comes from the circulating serum of the body. Whether you do serum neurotransmitter, platelet neurotransmitter, or urinary transmitter, you’re taking it from the same pool.  The ubiquitous argument is, and it’s usually against urinary neurotransmitters, is that they don’t represent central nervous system neurotransmitters. You know something? That’s absolutely correct. If you want to measure central nervous system neurotransmitters, you have to get cerebral spinal fluid or take a biopsy of the brain, which is usually a bad thing to do with people, especially in your office.  Listen, I’ve been in ER, an emergency department nurse, critical care nurse. I was head nurse of coronary intensive care unit. I’ve been in critical care, so I know how to do a lumbar puncture. I’ve never done one. I’ve seen it happen, but to do a lumbar puncture to get cerebral spinal fluid is usually done with meningitis and stuff, is not a benign procedure. Frankly, you’re not going to do that on an office-based basis.

Urinary neurotransmitters give you a balance of what’s in the periphery and what’s in the central nervous system in order to be used as biomarkers. Biomarkers means that you don’t take the number as an absolute. You look at the pattern, what’s high, what’s low, what’s going on. You can tell the pattern, and then if you have somebody who has a particular symptom, you can correlate your nutraceutical or pharmaceutical intervention based on the pattern.  The reason I use urinary neurotransmitter testing is because there’s been a ton of studies, a ton of research, and they have good databases. When I do a serum neurotransmitter test, and I’ll make my typical joke, dopamine is normal between zero and 140, which begs the question, if I have no dopamine, is that normal? I’m serious. That’s what it says.

If I see something that’s, I’m just making up numbers now, 15 to 140, does that mean 16 is normal? No. That’s low. By the way, our rule of thumb when you’re looking at your lab tests, use Armine’s rule of thirds. I have to put my name on something. Really, let’s face it, all right? Take that reference range. Just a rule of thumb. Not always, but it works pretty well. Take the reference range, divide it into thirds in your head. If your number fits in the middle third, it’s probably okay. If it’s in the lower third, especially the low part of the lower third, it’s suboptimal. If it’s in the upper third, it requires interpretation.  I look at people and I look at their blood tests and say, “You know something? 12 to 16 hemoglobin, you’re 12.1. You’re 250 pounds. I don’t think that’s good for you.  You don’t have enough blood cells.  You’re not bringing in oxygen around.”  They’re like, “But it’s normal.” I say, “It’s not normal.”  That’s an average.  That’s an average.

Dr. Weitz:            No, that’s great. I love this.  Armine’s rule of thirds.

Dr. Armine:         I know it’s silly, but I just think Hashimoto has got his thyroiditis. Everybody’s got it, right? I said, “I’m going to put my name on something that’s pretty benign, but I’ll be remembered for it, so it’s okay.”

Dr. Weitz:            What do you think about organic acid testing as a way to get a sense of what’s going on?

Dr. Armine:         Organic acid testing, by the way, happens to be one of the better ways of discovering what is going on with your body physiologically.  I’m also an expert in epigenetics. That’s where I’m known in the MTHFR community, and I’ve been with Dr. Ben Lynch for many years and did research, and his strategy and application was my invention. I gave it to him because he’s got money, I don’t, and he developed it.  There’s a new one coming up that’s going to be better than anything that’s been previously here.

When you look at genetics, you’re looking at probabilities. You can look at a pathway and say, “Gee, that pathway might not do well under oxidative stress,” but you don’t know. Organic acid testing tells you because that’s the result of the pathways. So when it comes to the neurotransmitter part, you always have to remember that you’re looking at metabolites. Dopamine will metabolize either down the cascade of dopamine, norepinephrine, norepinephrine, epinephrine, metanephrine, all the way down to something called VMA, or we’ll go down the pathway where it becomes homovanillic acid, HVA, which is what’s measured.  Always remember that pathway requires co-factors and co-enzymes, so that pathway requires SAMe, B1, B2, B3. If you don’t have enough of that, you might get a false reading, but you can read an organic acid test. You can see what’s being absorbed, what’s not being absorbed. You can see the reasons why. You can see the mitochondrial pathways.

Yes, if you correlate, remember, a test is only a test. You don’t treat tests; you treat people. Remember, doctors say that a lot, but then they treat the tests. If you walk out of somebody’s office with a shopping bag of vitamins, that doctor’s treating each line of a test. Before you spend 300 or $400, walk out. Do me a favor, because that healthcare provider is supposed to correlate your symptoms with the testing and then figure out what your body needs, and it’s usually not done by reading one line after another after another and then trying to supplement each line. Organic acid testing is one of the better ways of determining what’s going on with you globally to include neurotransmitters.

Dr. Weitz:            How does genetic testing help in analyzing and treating mood disorders?

Dr. Armine:         Genetic testing will give you a heads up into what areas might have problems, again, under an oxidative stress load. I say that a lot. Remember, oxidative stress is microbial stress. It is stress of biotoxins, of regular toxins, of the psychology. All of those things cause an increase in inflammation/oxidation compounds/oxidative stress.

Dr. Weitz:            By the way, oxidative stress is also often known as free radicals, right?

Dr. Armine:         Exactly. Free radicals, reactive oxygen species, reactive nitrogen species. There’s a bunch of names. It all comes from Durk Pearson and Sandy Shaw back in the ’70s, who wrote that big thick book called Life Extension.

Dr. Weitz:            I remember that.

Dr. Armine:         Yes. I actually read it. Oh my god.

Dr. Weitz:            I did, too.

Dr. Armine:         Even when I move around, books, I do everything online anymore, but I keep that book because it’s a badge of courage that I read it. I was like, “Aha.”

Dr. Weitz:            I love that book, but one thing is I still have in my memory those horrible images of them showing what they look like.

Dr. Armine:         No, no, please. It’s burned in my brain. It’s burned in my brain. Please, please. “Hi, I’m strong.” “No, you’re not. No, you’re not. Don’t show pictures like that. No, no, no. Oh god.” You want to get a mood disorder, look at those pictures. Of course, America came in, the American business came in and I won’t say a bad word, but took pieces of it and said, “Oh, you can take this and lose weight,” and that-

Dr. Weitz:            Right. By the way, for those who aren’t familiar with this book, this was really the first book that came in and expressed clearly the relationship between free radicals and antioxidants and disease and this was the new key to solving a chronic disease epidemic.

Dr. Armine:         Exactly. It was mainly about aging and how cells were injured, and they went and discovered the ROSs, reactive oxidative species free radicals, but guess what? This is why Dr. Naviaux, the panel I just showed you, he took that concept, brought it way out, not only described what created the oxidative stress, but what that oxidative stress did to the homeostatic mechanisms, what you got you ill, and what interfered with them and how you can go about interrupting the forest fire, which takes it way out into orbit.  Genetic studies, well, you can look at different pathways. Those people who are stuck in the MTHFR paradigm, MTHFR does one thing and one thing only. It takes 5,10-methylenetetrahydrofolate and turns it into 5-methyltetrahydrofolate. That’s it. It’s not a deity. It’s not a devil. It’s not waiting in the tall grass to get you.

The reason that people misinterpret it is because when they first studied epigenetics, they looked at homocysteine, and they said, “Gee, high homocysteine is a cardiac marker. MTHFR is connected to that.” They only checked two variants, by the way, the C677T and A1298C, which are where they are in the particular person’s genome. They made a correlation that if we treat this, which you can’t treat it, that would be able to control the homocysteine, but that didn’t work out so well.  Anybody who had any kind of chronic illness who was testing for this said they developed databases because the erroneous conclusion was if you have MTHFR polymorphisms or SNPs, that’s going to cause clotting, that’s going to cause different disorders, it’s going to cause foot fungus, which the last one’s a joke. That’s not true. It’s a combination of things because that’s one gene, one enzyme in a pathway, that folate pathway, going to methylation, going to methionine and doing methylcobalamin and so forth.

When you look at genetic studies, if you’re looking at a list of genes, it’s hard, but if you’re looking at it into the pathways, you can say, “You know, that pathway has a lot of polymorphisms, and if there’s a lot of oxidative stress, we’re not going to get the products we’re looking for, so maybe I should look in that direction.” Believe it or not, it’s predictive in that if you look at it properly, you can say to yourself, “Gee, this person’s mitochondria is kind of on the weak side, so let me look at the glutathione pathway. That recycling mechanism doesn’t look like it may be working.  Let me see if that’s the reason,” because that person recycles glutathione, which is going to give you a lot of oxidative glutathione, and that’s going to block the mitochondria.

You can have a big old heads up of where to look and then how to intervene. It shortens the diagnostic process. Once you find out why, it’s difficult, but the how becomes easier. It’s that whole finding out why, and a lot of my medical colleagues tend to stop at a certain area. We all know that, since you’re a chiropractor, you’ll understand this, the medical physicians are taught not to say three words, “I don’t know.” They would rather look and say, “Gee, I can’t figure it out. It must be you.” Don’t ask me where that legal logic came from. “It’s in your head.” Yes, it’s in your head. They’re neurotransmitters. You’re blaming the patient because you can’t figure it out. Makes no sense to me whatsoever, yet if we look at the genetic pathways and don’t take them as godlike or absolute, you’re going to get a pretty good idea of how that patient will fail.

 A little hint for you and your listeners. You can know the genetic pathways. If you want to know how they express, as they express differently in different people, you would see the pathways. Ask the person who they look like. If your daughter looks like Grandma Gale, for instance, ask about Grandma Gale and what kind of problems she had because they’re going to express that way. That’s the direction they’re going to go. Not absolute, but that’s the direction they’re going to go.  If Grandma Gale was a schizophrenic who committed suicide, god forbid, and your daughter has chronic Lyme and has the same genetic disposition, you’ve got a problem that you might want to deal with a little bit more strenuously than if they just had a little bit of depression. That’s a little diagnostic clue that tells you why things happen the way they happen. It also gives you a big jump onto the how.

Dr. Weitz:            I know every case is different and we have to take it case by case, but can you give us a little more detail in maybe some of your treatment protocols, say, treating a patient with depression?

Dr. Armine:         Absolutely. Not even a problem.

Dr. Weitz:            Let’s say we have a patient with mild to moderate depression. How would you work them up? Give us an idea of some of the types of protocols that you might use in treatment.

Dr. Armine:         Absolutely. The first thing is in real estate, it’s always location, location, location. In medicine, it’s history, history, history. Sir William Osler in 1895 said, “Listen to your patient. He’s telling you the diagnosis.” He was one of the founding fathers of Johns Hopkins. One of the things they teach and they teach the practitioners is how to use historical information.  That’s a lost art, by the way, because when you fill out a history form, nobody really looks at it and they go right to the chief complaint. You take a really good history. You look for temporal relationships. This happened and then that happened. This happened and that happened. That tells you where to look. It often tells you what’s wrong.

Dr. Weitz:            By the way, for those of you who are not familiar, if you take the practitioner training program through the Institute of Functional Medicine, they really do preach taking a very detailed careful history starting with birth and childhood and everything else.

Dr. Armine:         They do, and they also teach putting things on a timeline.

Dr. Weitz:            Timeline, yeah.

Dr. Armine:         When I took some of their courses, I’m sitting there and they put it all on the time line. I’ve been practicing like that for at least a decade before I did that, and as I looked at the little arrow, I said, “Not a bad idea. Good idea.” You’re forcing people to use it and then take the information.  Now, if you take that information and if you have testing or if you do testing, it should be targeted to what your suspicions are. You have somebody who’s got depression, you know that you have a neurotransmitter imbalance, so if you have an organic acid test, the neurotransmitter test, and by the way, I used to use Pharmasan Labs, but they’re not in existence any longer. I tend to use Labrix right now. They do a pretty good job.

Dr. Weitz:            Which is now owned by Doctor’s Data.

Dr. Armine:         Yes, exactly, and Doctor’s Data does a good job. It’s a blood test, though, and they’re neurobiological amines. The Labrex is a urine test, which is a whole lot easier to get. You’re going to get the same information. You’re going to get the same patterns. You can also get from the urine the cortisol levels and the four point cortisol you can get from urine with the Dutch test, but you can also get the saliva test that will tell you what the adrenal cortex is doing, as well as the adrenal medulla because you’re going to get insight into that.  What I’ll do is normally I’ll do an organic acid test if it isn’t already there because it gives me so much information. If they have the genetics, I’ll look at the genetics and see where the probabilities are, but that’s only telling me the why, why they’re like that. I also listen for what the probabilities are for their root causes. That’s really wide.  People, once you develop a relationship with them, they will tell you everything and anything. You can almost tell somebody has had severe psychological trauma if there’s portions if their childhood they cannot remember. They blocked it out. I see this with women who’ve been abused sexually in their childhood usually by family members. It’s a terrible thing. I don’t have them talk about it or anything. I just recognize it as being a form of PTSD.   I’ll listen for if they’re a camper or if they went out of the country and they had diarrhea and their stomach was never really the same. If they went to Cambodia, I know they got parasites. Let’s call a spade a spade. Lyme disease is rampant, but Lyme disease, you always have to consider. Don’t look at the maps because those are the CDC positives. Lyme disease is everywhere. They have found Lyme disease in the emperor penguins in Antarctica.

Dr. Weitz:            Wow.

Dr. Armine:         The ticks were brought over by the sea birds. Let’s face it. It’s everywhere, so you must consider it and you have to know how to test for it. You have to know how to read the test. You have to know which test to do at what stages, and that becomes a bit of a quagmire because Lyme disease diagnosis is a clinical diagnosis, not a testing diagnosis. There’s a whole mess of things that can cause it, thyroid problems, not just polymorphisms, strep, anemia. It’s endless. When you have that-

Dr. Weitz:            Gut disorders.

Dr. Armine:         Especially. Thank you very much. I appreciate it. Gastrointestinal leaky gut syndrome is the major reason. It can be primary or secondary. It can happen and then you have the problems, or you can have the problems and then the leaky gut can happen, but all the antigens getting through the gut into the base of the membrane cause immunological dysregulation that causes chronic inflammation, chronic neurotransmitter imbalances, a whole mess of things. When you’re treating somebody, regardless of what the testing says, it’s a good bet to treat leaky gut syndrome.

We talked about treatments. Well, treatments are based on treating the foundation of the body first, which is decreasing stressors, which is environmental stressors, drinking good water, getting good air, asking about their house, because a lot of people are sick in their houses and they’ve never tested for mold. It’s a very easy test to do. You don’t have to spend a lot of money.  Generally, cleaning up their environment as best as they can within their means. We can have people buy horrendously expensive house water filters, but if they’re a family with three children with a single provider who’s bringing in the money, maybe just a Brita filter would be okay. At least you can get most of it, okay? Decreasing other kinds of stress, giving them advice in certain areas.

Some people need certain types of therapies, EMDR, EFT, things like that, then you want to heal the cells themselves because leaky cells, dysfunctional cells are a common ubiquitous issue. That’s supplying vitamins and minerals that will get into the cell and phospholipids that will help rebuild the cell walls. When you’re having gut problems, that becomes a real issue, so you start thinking about transdermal or liposomal products.  Once you start attending to that, a lot of times, people start getting better just by virtue of the fact that everything begins to work, then simultaneously with that, I’m going to fix the gut almost in everybody because I haven’t met a person that doesn’t have leaky gut, regardless of what the leaky gut tests say.

By the way, that’s the worst test in the world. If you have a test that says you don’t have leaky gut and you have a chronic illness, throw it out. If you don’t believe me, here’s a way of thinking about it. Think of the risk benefit for that. What is the risk of giving somebody digestive enzymes, let’s say a demulcent herb, maybe colostrum or something else to heal themselves, a probiotic, versus what happens with leaky gut syndrome, which is chronic inflammatory response. No risk, and the probability of benefit if you seal up that gut is incredibly high. When you have that kind of safety profile, you treat the blessed thing. If you do that, you prevent antigenic entry, which lowers inflammation, which is what most of the body’s energy is just trying to do everyday is drop inflammation, and then it becomes more specific and individualized.

I’m always considering mitochondrial function. That is comparatively easy these days to support. You can use coenzyme Q10, PPQ, you can use a transdermal patch that has everything in it depending on the individual and their lifestyle, and you have to consider that and how well they’re going to take the nutraceuticals. You have to consider the nutrients that are going in. If they can’t absorb it, then give them things that are more easily absorbed, either on a protein powder basis or at least talk with them about being on an antiinflammatory diet. AIP paleo is kind of a typical thing that works with a lot of people, but doesn’t work with everybody. You have to be individualized about it, but you want to pull back from grains and sugar and go more on the antiinflammatory range. That’s easily looked up, and there’s a couple of books out there that are not expensive.

Then, I get real specific as to what I’m treating. It depends on what I’ve tested for. If we have Lyme disease, if we start getting to the root causes, and if we have neurotransmitter imbalances, the guidance for that is very simple. You treat the inhibitory neurotransmitters before the excitatory, which means you want to increase GABA. GABA, gamma-aminobutyric acid is the particular molecule that calms the human brain. That is available in a liposomal form from Quicksilver Scientific. It’s also available in phenolated form.  Now, I know everybody argues with me about Phenocol or Phenoblast. The reason for that is that the common one is beta phenyl gamma amino butyric. That’s a big word. That’s the one you usually buy. It has all kinds of problems, but there’s another molecule, the form of 4-amino-3-phenylbutyric acid that comes out of eastern Europe. All the studies for those were done in eastern Europe and they were done in Russian. I happen to speak Russian and read Russian, so I read the studies, and they don’t have it. I’ve been using this stuff for decades. No problems whatsoever. It gets through the blood brain barrier. The reason things like Pharmagaba and the regular GABA is that they’re water soluble. They don’t get through the blood brain barrier. If you get better with those common GABAs, that’s proof positive you have a leaky blood brain barrier.

Dr. Weitz:            What form of GABA are you talking about that’s used in Russia?

Dr. Armine:         Well, let me bring it down to what you can get here. From Biotics, it’s called PheniTropic, from Neuroscience its called Kavinace. I’m sure a couple of other people have them, but those are the two products I use. It’s the 4-amino-3-phenylbutyric acid. People argue with me that it’s just a nomenclature thing, but I’m going to tell you that those molecules, the ones I’ve used have never had any problems, and I’ve been using them for decades.

Dr. Weitz:            Either that one or the liposomal one?

Dr. Armine:         Right. Liposomal works really well. I’ve had people like this in front of me. I’m like, “Open your mouth. Open your mouth.” Four sprays and I wait there for five minutes and then they’re sitting back going, “All right.” Remember, the difference between a benzodiazepine and giving somebody GABA is a benzo stimulates the GABA and intercepted to release GABA, and the constant use of benzos damages the GABA receptor. That’s why you have so many problems. Giving somebody GABA gives them what they need without stimulating the receptor and yes, you burn through it after a while.

Serotonin, you can give someone L-tryptophan or better yet, 5-hydroxytryptophan. What’s the difference? Early on, we were giving people just L-tryptophan, and some people were getting excitatory with it. In the late ’90s, Kelly Olson, PhD, who was the R&D director of Neuroscience found the pathway that tryptophan can actually connect to an enzyme called IDO. That enzyme, when it’s stimulated by inflammation, yeast, microbes, stress, will start looking for substrate, pulls the tryptophan out of the pathway, and creates kynurenic acid, which is neuroprotective, and then quinolinic acid, which is a nasty excitotoxin. Then, it produces NAD, which is B3, which I think is a hell of a way to get B3 for your body, to have to go down that pathway.  The quinolinic acid is what creates the excitation, so under inflammatory conditions, tryptophan is pulled out of the pathway that should create serotonin, but it doesn’t. Part of it’s pulled out, at least, so you’re creating excitation on top of excitation from the microbes. That’s the reason people don’t use tryptophan, so when you went to 5-hydroxytryptophan, this tryptophan is metabolized with BH4 and iron and B6 to 5-hydroxytryptophan. It’s a one way pathway.  If we use that, we can create serotonin, and then the serotonin will either get degraded or become melatonin. You need serotonin for practically everything. 80% of it is produced in your gut, which is one of the reasons we have so much serotonin problems, because we have so many gut problems, so you’re not producing enough serotonin.  You can take SSRIs as much as you like, and yes, it will work for a while by increasing the serotonin, the synapse. You won’t correct your problem. That will fail. In typical medical thinking from big pharma, it’s not working, let’s give you Abilify. An atypical antipsychotic? Are you crazy? We’re not crazy. We’re just greedy. I know that, but you’re also crazy. Okay, if you say so, but you’re nobody. You’re a chiropractor. I’m like, “Whoever I can influence, I will.”

When it hits you, it’ll be like tsunami. Let’s do more. Let’s not fix you because we’re in a chronic disease management society. There’s no money in curing cancer. There’s money in treating cancer. There’s no money in curing diabetes. There’s money in treating diabetes. You ever wonder why there’s such a thing against Lyme disease? There’s no Lyme disease in Australia. You know why? They don’t allow the diagnosis. How can you have it if there’s no diagnosis? They have people believing there’s no Lyme disease there. Duh.  In England, at least it’s turned around because of certain things, but for the longest time, somebody would get a positive Lyme test. They’d do their own test. It was always negative, and so they treated people for chronic fatigue and depression. The downstream effects. There’s more money in treating the downstream effects than there is in curing the disease. Yes, the consciousness is raised towards Lyme, but how many other things are doing that? We have to be our own advocates.  The unfortunate thing is we’ve lost our general practitioners. We’ve lost our generalists who used to be the kings that coordinated everything. Now we have specialists, specialists, specialists, who are very, very good at what they do, but that’s all they do. They don’t coordinate with one another. The coordination of correlational, putting the dots together or the puzzle pieces together is left to the person who is least trained to do it, and that’s the patient themselves.

Dr. Weitz:            That’s because of the insurance model that limits the amount of time that doctors can afford to spend with patients because of the reimbursement rates, which we didn’t talk about, but unfortunately that’s the reality of it.

Dr. Armine:         They’re forced into eight minutes a patient to include the documentation time. You’re absolutely correct. Most of the doctors I know are frustrated as heck because if they can even tap at the chief complaint, that’s all they can do. They don’t have the time and they’re not allowed the time. That’s the whole thing. They’re not allowed the time.

Dr. Weitz:            This is why I think patients would be best served, and by the way, I think I have to end it here, but I think most patients would be best served having both a conventional primary care doctor and a functional medicine doctor like yourself or myself and working as a team together because we can have some of the time that the primary care doctor doesn’t have because we’re not going to be limited by [inaudible 00:47:02].

Dr. Armine:         Exactly. That’s coming to fruition. I see it in England now. I travel around the world training people, but I see it a lot in England now. I see it a lot here where there’s true cooperation happening. That’s what you look for in a functional medicine or a healthcare provider, somebody who is willing to advocate for you, do the correlation, and coordinate with your other healthcare providers.

Dr. Weitz:            Dr. Armine, this has been a wonderful discussion.

Dr. Armine:         Thank you.

Dr. Weitz:            I’d love to continue it. Unfortunately, I’m up against a hard break.

Dr. Armine:         I know.

Dr. Weitz:            Can you tell us how practitioners and patients can get a hold of you and contact you?

Dr. Armine:         Well, certainly. They can go to my website at DrJessArmine.com. What I offer that a lot of people don’t is I offer a 15 minute get acquainted session. You can schedule that. We can discuss your problem, and then I can tell you if I can help you or not, which makes me comfortable, makes you comfortable. That’s the way that people can access me. They certainly can go to my website and make an appointment. Most people speak with me on a little 15 minute get acquainted session and we can really determine in that short a period of time if this is an appropriate case for me. That’s the best way to get in touch.

Dr. Weitz:            That’s great. Excellent, Dr. Armine. Keep doing the good work. I’ll talk to you soon. You take care now.

Dr. Armine:         Thanks so much.

 

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Dr. Tom O’Bryan explains how to fix your brain and prevent and reverse neurological diseases like Alzheimer’s and Parkinson’s Disease with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast] 

 

Podcast Highlights

4:48  Dr. O’Bryan pointed out that autoimmune diseases are recognized to be the third leading cause of getting sick and dying in the world. And now since we now know that the mechanism of atherosclerosis is autoimmune, autoimmune becomes the number one cause of morbidity and mortality.

6:00  Dr. O’Bryan explained that the main mechanism for autoimmunity is molecular mimicry. He cited the work of Dr. Alan Ebringer from the 1970s where he wrote about the link between the HLA-B27 gene, an infection with Klebsiella pneumoniae, and ankylosing spondylitis.  If you have the HLA-B27 gene and you get an overgrowth of Klebsiella pneumonia, which is an environmental trigger, you are now very much at risk of developing the autoimmune disease, ankylosing spondylitis,  since the immune system that attacks the Klebsiella then attacks your spine. Here is the reference for the paper: https://academic.oup.com/rheumatology/article-abstract/16/3/190/1778858 

8:34  Dr. O’Bryan went on to give another example of molecular mimicry where the immune response to the measles vaccine leads to a cross reactive attack on the thyroid. Or your immune system may go after your myelin sheath on your nerves, which is what MS is, etc.

12:45  Dentists may give you antibiotics, esp. if you have a history of heart problems, because when they probe around in your mouth, you may get leaky gums and since you have lots of bacteria in your mouth and if any of that bacteria, esp. if you have streptococcus bacteria that gets through the leaky gums into the blood stream, through molecular mimicry, your immune system may go after your heart valves and you get rheumatic heart disease. Dr. O’Bryan said that he saw Dr. Ebringer in Portugal presenting at the Autoimmune Conference and he found that when they swabbed the noses of MS patients and found that every one has high concentrations of Actinobacter. When your immune system makes antibodies to that actinobacter, then it goes after the myelin sheath of your nerves and your brain, creating MS. Once you understand this mechanism, then you have to do what you can to reduce the environmental triggers, such as exposure to toxins, such as breathing in the benzene when you pump gas in your car.  Or the BPA in the plastic coffee lids at the coffee shop.

19:05  The World Wildlife Foundation did a meta-analysis and they found that there has been a 59% reduction in the sperm count in fertile, healthy men. Scientists worry about extinction of a species at 72% and we’re at 59% in 37 years. What do you think is gonna happen in the next 20 years? We have to wake up. And where’s this coming from? It’s all the toxic chemicals that get into our body. We should stop storing food using plastic wrap and stop cooking using aluminum foil. Over time, it’s the accumulation of all these toxins that store in our bodies for years and years. You eat fish, which is healthy but fish often have pesticides, PCBs that were leaked into the ocean from the farms and they tend to accumulate in our bodies, esp. in the tissues with estrogen receptors like the breasts, uterus, ovaries and the testicles, which is one of the reasons for the lowered sperm count.  And then these pesticides are passed from the mother through the breast milk into the babies and these chemicals like PCBs are neurotoxins. Dr. O’Bryan recommends that women should detox their bodies for six months before getting pregnant so their baby has the best shot to develop the best brain.  And if our kids are going to be the ones to save the planet, they need to have good brains.

26:00  We now know that pathogens like bacteria and viruses can get into the brain due to a leaky blood-brain barrier and when the immune system in the brain, the glial cells attack, they produce amyloid plaques which can create an inflammatory cascade in the brain that leads to neurodegenerative diseases, like Alzheimer’s and Parkinson’s diseases, over time.

32:32  Dr. O’Bryan advocates spending one hour per week learning about how this autoimmune mechanism gets activated by our environment and what we can do about it.

 

                                          

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Dr. Tom O’Bryan is a Doctor of Chiropractic, a best-selling author, and an internationally recognized speaker focusing on food sensitivities, environmental toxins, and the development of autoimmune diseases. His 2016 book, The Autoimmune Fix won the National Book Award and the docuseries he released the same year, Betrayal: The Autoimmune Disease Solution They’re Not Telling You  has been seen by over 500,000 people worldwide. He also organized The Gluten Summit – A Grain of Truth. His website is www.theDr.com  He will be releasing his second book You Can Fix Your Brain: One Hour a Week to the Best Memory, Productivity, and Sleep You’ve Ever Had on September 18, 2018.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcripts

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to Rational Wellness podcast on iTunes and YouTube and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.

Hello Rational Wellness podcasters, thank you so much for joining me again today. And for those of you who enjoy the Rational Wellness podcast, please go to iTunes and give us some ratings and reviews so more people can find out about the Rational Wellness podcast. And if you want to see the video version, go to YouTube and search for Rational Wellness or Weitz Chiro. Our topic for today is autoimmune diseases. Autoimmune diseases are becoming increasingly common causes of sickness and death in the United States. Autoimmune diseases have been on the rise for at least the last four decades.

Now, our immune system is designed to protect us from bacteria and viruses and parasites, and to repair our tissues when they’re damaged. Autoimmune diseases are when they are diseases where the immune system, instead of attacking outsiders, starts attacking our own cells and organs. This means that our immune system is out of balance. There are approximately between 80 and 100 different autoimmune diseases and at least 40 other diseases are suspected to have an autoimmune basis. According to Dr. Tomas O’Bryan, if we include diseases that have an autoimmune basis, autoimmune diseases are the third leading cause of death in the United States, since most of these diseases are chronic and often life threatening.

Some of the more common autoimmune diseases include Alzheimer’s disease, Parkinson’s disease, rheumatoid arthritis, psoriasis, Crohn’s disease, Hashimoto’s hypothyroid, multiple sclerosis, and diabetes. Conventional medical doctors typically treat autoimmune diseases by trying to control the symptoms, such as providing thyroid hormone in the case of Hashimoto’s thyroiditis, or by using medications that suppress the immune system. Such as corticosteroids, chemotherapy agents, or the now very common but very expensive injectable TNF alpha blocking agents like Humira and Remicade. These drugs, often referred to as biologics simply block your immune system, or part of it, which is a problem ’cause you need your immune system to fight off infections and cancer.

But Functional Medicine treats autoimmune diseases by looking at some of the underlying triggers and factors that have led to the immune system becoming dysregulated, such as leaky gut, food sensitives, toxins, infections, nutritional deficiencies. And this is very important, if I have a patient with hypothyroid of autoimmune origin and most women in the US with hypothyroid, have Hashimoto’s autoimmune disease, and all this patient is treated with is with thyroid medication. Sure, they’ll feel better for a period of time, but it doesn’t do anything for the underlying, smoldering fire of the autoimmune disease that has been attacking her thyroid gland and chances are, this will continue. The patient likely will need a higher dosage of thyroid medication over time, or they may end up with another autoimmune disease.

So, not just regulating the thyroid but doing something about the autoimmune disease is crucial for this patient’s long term health. I’m so happy that we’re joined today by Dr. Tomas O’Bryan, internationally recognized speaker, educator, and Functional Medicine doctor. He’s a member of the prestigious Institute of Functional Medicine Faculty. Dr. O’Bryan is a best selling author, and in fact, his last book, The Autoimmune Fix, won the National Book Award. And he’s most known for his work on the dangers of gluten and on autoimmune diseases, and he has an upcoming book on autoimmunity in the brain that we are going to pick his brain about today. Thank you for joining me, Dr. Tom.

Dr. O’Bryan:                        Oh, thank you Dr. Ben, it’s really great to be with you and that was a wonderful introduction and summary, and I would just tweak one thing that you said. And that is that immunologists have known for at least 15 years that autoimmune diseases are the third leading cause of morbidity/mortality, getting sick and dying in the world, just across the board. When you include what we now know is true, that atherosclerosis, the plugging up of your pipes that causes cardiovascular disease, atherosclerosis is autoimmune. Now autoimmunity becomes the number one mechanism in getting sick and dying in the world, ’cause we’ve always thought that heart disease is the number one cause of dying, but now we know that heart disease is autoimmune in it’s initiating phases so that means the mechanism. Whether it manifests in your heart, or your blood vessels, or your brain, or your kidneys, or your lungs, or your liver, the mechanism of getting sick and dying is your immune system trying to protect you, attacking your own cells.

Dr. Weitz:                            Right. And that’s something that’s really interesting is how we always want to ask, “How is it that our body’s creating disease?” But in autoimmunity, the body’s actually trying to protect us.

Dr. O’Bryan:                        That’s right, that’s right. So that we don’t just geek out here between the two of us and lose people, let me give you this analogy.  And this puts it in perspective because what most researchers say the number one mechanism behind all of this happening is something called molecular mimicry.

Dr. Weitz:                            Yes.

Dr. O’Bryan:                        I’m gonna give you an example of what molecular mimicry is. It was 1978, in my first genetics class and I still remember the day when the instructor came in. The professor came in and he had this research paper in his hand and he was so excited, so excited, because here was a paper that he said was a paradigm shift in medicine and in genetics. And the paper was by Dr. Alan Ebringer from King’s College in London, who I was with just two weeks ago in Lisbon at the Autoimmunity Congress, now 40 years later. This is when Dr. Ebringer was a graduate student working on his PhD, and he had published this paper that if you carry the gene HLAB27, and that’s just one of the genes.

Dr. Weitz:                            Right.

Dr. O’Bryan:                        And if you get an infection to a bacteria called Klebsiella pneumoniae, which is the most common cause of pneumonia for old people in hospitals, it’s this bacteria. If you get a Klebsiella infection and if you have this gene, you’re very vulnerable to developing the autoimmune disease ankylosing spondylitis and it’ll kill you. That’s not an easy diagnosis, you don’t want that diagnosis. But this was the first paper that said, “Genetics?” Now what are genetics? Genetics are the deck of cards you’ve been dealt in life, you can’t do anything about your genetics. You got the gene, you got the gene, but it’s genetics. And then there was an environmental trigger, that’s the category we’re gonna talk about, environmental triggers.  In this example, it was the bacterial infection Klebsiella, ’cause we all have a little Klebsiella in us, but when it grows and it starts to take over, now it’s an infection. So the genetics and the environmental trigger, you’re at risk of developing the autoimmune disease ankylosing spondylitis, and this was 1978. Here is the reference for the paper: https://academic.oup.com/rheumatology/article-abstract/16/3/190/1778858   

Dr. Weitz:                            Wow.

Dr. O’Bryan:                        And I’d forgot about it after that, I didn’t pay any attention to it until now, this whole world of what we’re talking about is molecular mimicry. Let me give you an example of molecular mimicry. When you get a vaccination for measles, they give you a shot of the bug measles. It’s an injection and your brain says, “Whoa, what’s that in the bloodstream? That’s not good for me. General! You and your immune system, you have army, air force, marine corp generals, sitting around with nothing to do. General, you now are General Measles, take care of this.” General Measles builds an assembly line, that assembly line starts producing soldiers, or actually special forces, and they’re trained to just go after measles. They’ve got high powered rifles and they go out into the bloodstream, looking for measles, they’re called antibodies.  These antibodies are going through the bloodstream, they’re going everywhere looking for the … and it’s a protein signature of the bug measles. So General Measles has programmed these special forces, said, “Look for this protein signature.” And I’m gonna say it’s AABCD, I’m just gonna make up the numbers of the signature of that particular protein. These soldiers are going through the bloodstream everywhere looking for AABCD, wherever they find it, they’d fire a chemical bullet. AABCD, boom, and they fire the chemical bullet. Now you have to remember, the bloodstream is a highway, it’s just a highway. Everything’s going in the same direction, but it’s a highway, there’s no lanes of traffic. It’s like bumper cars in there all the time. Like, remember the circus when you were a kid? Driving bumper cars, crashing into each other. That’s what’s going on in your bloodstream all the time.

You’ve got these special forces going through there, bumping into everybody looking for AABCD and wherever they find AABCD, they fire their chemical bullet. Now, the blood’s going past … I’ll use the example of the thyroid. The surface of the thyroid facing the bloodstream is made up of proteins and fats, the proteins are made up of amino acids, and the amino acids are hundreds of amino acids long, but in that sequence of the surface of the thyroid facing the bloodstream, the amino acid sequence includes AABCD. So now you’ve got special forces looking for measles bugs AABCD, over to AABCD, all of a sudden they go, “Hey look, over there! AABCD.” Boom. And they fire their chemical bullet at the wall of the thyroid facing the bloodstream. Now you’ve damaged that thyroid cell.

You have an entire new body every seven years, every cell in your body regenerates. Some cells are really quick like the inside lining of your guts, every three to five days, some cells are very slow, like bone cells are very slow. But you have a whole new body every seven years. And how do we get these new cells? Well, your immune system makes antibodies to get rid of the old and damaged cells, like thyroid cells, to get rid of the old and damaged cells and make room for new thyroid cells to grow. And there’s antibodies to your muscles. and to your brain, and to your liver, and to your kidneys. That’s like if you do a blood test looking for antibodies, there’s a normal reference range for those antibodies. So you’ve got special forces looking for measles, they mistakenly see AABCD and they fire their chemical bullet at that, you destroy or damage that thyroid cell, so your body makes a few extra thyroid antibodies to get rid of the damaged cells.

It’s not a problem, except it keeps happening day after day, after day, and then eventually your immune system becomes … it’s a continuous loop making more thyroid antibodies and you develop an autoimmune disease of your thyroid, called Hashimoto’s thyroid disease. And it’s molecular mimicry that the AABCD of measles looks like the AABCD of your thyroid, and the same is true for the myelin, the saran wrap around your nerves and if you go after your nerves, if you go after myelin, that’s what MS is. The same is true for your muscles and your heart. Why do dentists give you antibiotics when you go to see the dentist? It’s because when they’re probing around in there and you rinse your mouth out, you’ve got pink water, right? There’s a little blood in the water. What does that mean? Well, it means you’ve got leaky gums now. If you’ve heard about leaky gut, you get leaky gums when they’re probing around in there and the blood comes out, you got leaky gums.

There’s thousands of bacteria, different types of bacteria in our mouth, if any of that bacteria gets through the leaky gums, especially streptococcus … everybody knows about strep throat, so you got strep in here. If strep gets through the leaky gums into the bloodstream, your immune system makes antibodies to strep, but it’s very, very common that because of molecular mimicry, AABCD to the strep, it goes after your heart valves and you develop heart disease. That’s why dentists give you antibiotics is to kill the strep that may have gotten into your bloodstream through the leaky gums, so that you don’t make a bunch of antibodies to strep, which because of molecular mimicry, may go after your heart, and you get rheumatic heart disease.

That’s the mechanism, that’s a very common mechanism and what causes MS. As I said, I was with Dr. Ebringer two weeks ago in Portugal, and he was presenting at the Autoimmunity Congress that every single MS patient that they check, every single one, they do nasal swabs and they check for the bacteria up in the sinuses. And every single MS patient has actinobacter in high concentrations in their nasal cavity, and actinobacter via molecular mimicry, goes after myelin, the saran wrap around your nerves, and if it does that, you get MS. And every single MS patient … and he published on this and he presented his papers to the Scientific Congress, there were 500 doctors in the room. Just our jaws dropped because when you see … the only other one we know as 100% is celiac disease, 100% of celiacs have a problem with wheat, no question about that, everyone knows that. But now we know with MS, they’ve got actinobacter infections up in their sinuses.

That goes right up into the … that bacteria gets up and it goes up into your brain and if you make antibodies to that bacteria because of molecular mimicry, AABCD, it may go after the myelin of your nerves and of your brain and you develop MS. That’s molecular mimicry, the number one mechanism in getting sick and dying in the world, your immune system attacking yourself. And now we’re learning, why does this happen? Where does it happen? And that’s what this book is about. That’s why it won the National Book Award is because you read this and you go, “Oh my god. Wow, that just makes sense.” ’cause there’s over 300 studies in the back references of this book.  It’s 35 years of my life, right? But I mean, that’s the mechanism.  So every parent, every person, but especially every parent needs to understand this, so you can protect your children and ’cause when you learn about this mechanism, you start doing the little things to reduce the environmental exposures that activate your immune system. Remember I talked about you’ve got the gene, you get the environmental exposure, then you get the disease? So you want to reduce the environmental exposure. For example, you ever pump gas and you can smell the gas?

Dr. Weitz:                            Sure.

Dr. O’Bryan:                        You’re smelling benzene. Benzene is a neurotoxin, it goes up into your brain and it fries your brain, it causes inflammation in the brain. We’re just so used to it ’cause we don’t feel sick when we smell it, we think it’s fine. It’s not fine. You’re standing downwind and you’re smelling benzine, so what do you do about that? You have to pump gas. Walk around to the other side of the hose. Now you’re upwind and you don’t smell it anymore.

Dr. Weitz:                            Yeah, I usually just get back in the car and close the door till it’s done.

Dr. O’Bryan:                        Exactly, exactly. Even better. But we have to start thinking differently about how to protect our bodies ’cause if you go, “Oh I’m smelling something. Oh, I’m downwind.” And then you get back in the car or walk around to the other side, but we don’t think that way, we just stand there and say, “Oh yeah, I can smell the gas. And fine, it’s not harming me. I’m fine.” No, you’re not fine. It’s killing off brain cells, but it’s not enough to make you feel sick at the moment so you think it’s okay. But if you make antibodies to benzene or benzene binds onto your own tissue, then the immune system goes after that tissue to kill that tissue. That’s the other mechanism, the primary one’s molecular mimicry, and the other one is called neoepitopes. That’s geeky stuff, we don’t have to get into that.

But the message is, we have to wait … listen, we don’t have time to mess around anymore, we don’t have time. I’m gonna tell you two studies. The first one, the World Wildlife Fund published this study almost two years ago, and between 1970 and 2011, that’s 41 years, there has been on average, a 58% reduction in populations of all vertebrae species on the planet. Anything with a spine, insects, birds, fish, mammals, 58% that are gone in 41 years. Now, for the birds, the average as a category was 35%, for mammals living near fresh water, it’s 78%. 78% of the beavers are gone in 41 years, 78% of the bobcats, of the porcupines, the woodchucks, they’re gone. 78% gone in 41 years, why? They’re drinking the water and if you were drinking the water coming out of the streams by your house, or out of the rivers by your house, you’d get cancer quicker, you’d be unable to reproduce, just like the animals.  That’s the first study. They say, “Oh well, that’s too bad. We don’t need bobcats anyway.” Some people think like that, that’s okay if you think like that-

Dr. Weitz:                            I’ve heard people say that.

Dr. O’Bryan:                        Yeah. That’s okay if you think like that, but here’s the one that you can’t ignore. They did a meta analysis, that means they looked at many studies on one subject. And the subject, it was 186 studies between 1974 and 2011, so 37 years. Same time period as the World Wildlife began wiping out the animals, same time period. Between 1974 and 2011, the topic for 186 studies? Sperm count in healthy men, not in fertile men, healthy men. And it’s a 59% reduction in sperm count across the world, 59% reduction. So what? Scientists worry about extinction of a species at 72%, we’re at 59% in 37 years. What do you think is gonna happen in the next 20 years? We have to wake up. And where’s this coming from? It’s all the toxic chemicals that get into our body, it’s the plastic lids on the coffee cups at Starbucks and every other coffee shop, it’s the saran wrap you put on your food, and the plasticizers in the saran wrap leak into the food. You can’t have food touch plastic wrap.

Dr. Weitz:                            I know, you go to the store and you try to buy organic chicken and it’s sitting on styrofoam covered with plastic wrap.

Dr. O’Bryan:                        Exactly right. Exactly right. We have to wake up, we have to wake up. Aluminum foil breaks down, you bake with aluminum foil, 185 degree centigrade, which is 365 Fahrenheit for an hour and a half, you can bake a turkey in there or a chicken, hour and a half. And then you take the aluminum foil and you put a magnifying glass to it, it’s all broken up into thousands and thousands of little pieces of aluminum. You can’t see it with the naked eye but use a magnifying glass and go, “Holy cow, look at that.” That stuff is in the food. It’s in your food, you get aluminum in your food, you say, “Oh so what? I can’t taste it, it tastes good.” Just Google “aluminum and Alzheimer’s” and look at hundreds of studies, I’m not exaggerating. “Well, where’s it come from? Where do we get aluminum?” It’s from your aluminum foil, it’s from the vaccinations that they use aluminum, there’s a whole list of places, it’s in the chem trails. There’s so many places that we’re getting minor amounts of aluminum exposure.  And the industry-

Dr. Weitz:                            In the antiperspirants that people put under their arms.

Dr. O’Bryan:                        Exactly, exactly. Aluminum chlorohydrate, and the industry, the way they get away with this, there’s no study ever that’s shown, when you use aluminum chlorohydrate in your antiperspirant, it causes a problem in humans. There is no study, none. However, the aluminum has a half life in your body at 7 to 11 years and it’s the accumulation of all of the little exposures that build up over time. The plasticizers, they’re called phthalates that’s in all plastic, the heavy metals like aluminum, and arsenic, and lead, and mercury, the PCBs. They did a study in Norway, two and a half years before they closed the study, this was a government commission. Should we tell women not to breastfeed in their first pregnancy? Two and a half years, it’s like, “What? I thought breastfeeding was good for you, that’s the best thing you can do for a baby, the very best thing.” Well, what are they talking about?

People in Norway eat lots of fish. The fish come from the fjords, the fjords run along the country going up and down the country, they’re narrow and they’re deep. But the farmers have been using insecticides and pesticides for generations, the rain carries the insecticides and pesticides down into the fjords. The fish have pesticides, insecticides, PCBs in their meat. There’s no evidence that the amount of PCBs in any fish is dangerous, there’s no evidence. But it stays in your body for decades and when you grow up eating a lot of fish, which is healthy for you, these PCBs accumulate. Where do they accumulate? In the estrogen loving cells. In women, that’s the breasts, the uterus, the ovaries. In men it’s the testicles. Yeah, there’s estrogen receptors in your testicles. It’s one of the reasons why loss of sperm count.

The women are accumulating these PCBs in minor doses for 20 years, for 30 years. Then they get pregnant, hopefully they have a wonderful pregnancy and a wonderful delivery. Now, as they’re in the delivery phase, the brain’s sending message down to the breasts saying, “Okay, it’s time to start lactating, start making some new milk, make milk.” And the milk is made by the fat cells in the breasts. Well, the fat cells in the breasts is where all the PCBs have been hanging out for 20 years and accumulating, so mother’s breast milk is highly toxic to this poor, immature immune system, vulnerable baby. And these PCBs are neuro toxins, they fry your brain. Just think of a hot pan and you put an egg in there, that’s what these PCBs do in your brain. And it inhibits the child’s brain from developing properly and you read the studies and you see kids that have PCBs exposures, their IQs are down when they’re seven, eight years old. Not a lot, but they’re down, they’re not as functional, they’re musculo-skeletal coordination is less, it’s cause the brain didn’t develop properly.

So, what do you do? The commission said, and there’s so much politics in this, and finally, “No, no. Breastfeeding is more important than the other, pros and cons of both.” And I agree, breastfeeding is more important. There are too many benefits to breastfeeding, but what do you do? Every woman of childbearing age, should detox their breasts before they get pregnant. For six months beforehand, you learn how to detox your body and get the stuff out of you so that your baby has the best shot to develop the best brain they can, because it’s the future generation that’s gonna have to save the planet. We’ve messed it up so bad and it’s those kids who will think outside of the box. They’re the ones that’ll save the planet, so we need their brains working as good as possible.

Dr. Weitz:                            That’s great. You were talking about infections and we’ve learned recently that we used to think that the brain was a completely sterile situation because of the blood-brain barrier. But now we’ve learned that there are pathogens, bacteria, and viruses that actually get into the brain, isn’t that right?

Dr. O’Bryan:                        In my new book, which comes out in September, it’s called, You Can Fix Your Brain: One Hour a Week to the Best Memory, Productivity, and Sleep You’ve Ever Had. We have an entire chapter in here on the blood-brain barrier and I’ve coined a term that I hope becomes common language in the next year, capital B, the number 4, B4. “What’s your B4? Do you have B4?” What does that mean? A breech of the blood-brain barrier. You’ve heard of leaky gut, well you also get leaky brain, and when you get a leaky brain, these big molecules get in there and you have four different immune systems in your body. And the most potent one, the no mess around immune system is in your brain, called the glial cells. These guys have bazookas. They don’t have high powered rifles, they have bazookas.  Anything gets in the brain, they just blast it, which is great except if you’ve got B4, things are constantly coming into the brain, so you’re blasting, blasting, blasting. There’s lots of collateral damage and that starts the entire inflammatory cascade in the brain. Every brain dysfunction, depression, anxieties, schizophrenia, bipolar, Alzheimer’s, Parkinson’s, seizures, attention deficit, autism, they all have a breech of the blood-brain barrier because that’s how the molecules get in that your immune system gets activated to protect you from, that causes the inflammation that damages your brain tissue. When you do the right tests, and we talk about the tests in the book, for B4 and you say, “Oh my god, I’ve got B4.” That’s just like saying, “Oh my god, I’ve got a leaky gut.”  Okay, “How do I fix a leaky gut?” Okay, “How do I fix a breech of the blood-brain barrier?” And then you start applying the principles to fix the breech of the blood-brain barrier and then you go back and you recheck in three to six months to make sure you’ve dialed this thing down and it’s fixed now.

Dr. Weitz:                            Now, some people out there would be hearing all this talk about bacteria, and viruses and they might think, “Yeah, we just need to take more antibiotics and just kill these things.”

Dr. O’Bryan:                        Well, that’s probably the main reason we have the problem we do now today, is because that was a … it’s called reductionistic thinking. “Let’s just wipe out all the bacteria.”, the antibacterial soaps and all that kind of thing that generations have been focusing on. And what we now know, is that humans are designed to live in balance with Mother Nature, we’re all on the same planet. I don’t want to get airy fairy here ’cause some people say, “Oh, he’s too airy fairy.” But we’re designed to be in balance with the planet earth, when you’re in balance with the planet earth it means that you walk on planet earth, not concrete. I mean, even when you live in a city like LA, or New York, or Kansas City, wherever you are, on Sundays get out in a park and take your shoes off. Do the Pretty Woman thing that you know, he takes his shoes off and he’s like, “Oh, this feels different.”, and just get grounded.

Dr. Weitz:                            Earthing.

Dr. O’Bryan:                        Earthing, yeah. Right. I mean, there’s a lot of validity to that concept. Your brain works much better when you’ve done some earthing exercises, get grounded on the planet. Antibiotics are absolutely the last resort, not the first option. And we are exposed to so many of them because they spray most of the vegetables in this country with antibiotics. Some of the spray when the planes are going by over the fields, it’s full of antibiotics and they’re killing off the bugs and bacteria to let the plants grow, but then you get weak plants. You don’t have plants that are as strong as the others, but then the antibiotic residue’s in the food. But the industry says, “There’s no studies that show the level of antibiotic in broccoli is ever a problem for humans.”  They get away with that crap, but it’s the accumulation, it’s the accumulative damage that occurs that has caused problems for us today.

Dr. Weitz:                            Yeah, ’cause this stuff doesn’t leave our bodies. Yeah, I was going into the supermarket the other day and this woman’s taking those wipes and I said, “No, no. You should lick the handle of the supermarket cart, that’s the best thing for you.” She thought I was crazy and she just kept going.

Dr. O’Bryan:                        You are a nut case. Sorry.

Dr. Weitz:                            How do we protect ourselves and prevent these autoimmune diseases? What can we do? Besides trying to avoid some of these toxins, but avoiding toxins is not an easy thing, but assuming that we do get some of these toxins and what do we do?

Dr. O’Bryan:                        The first thing is, read the book. Read this book and I’m not saying it because I wrote it, I’m saying it because it’s a paradigm shift, that when you understand what you’re up against, it’s an OMG, it’s like, “Oh my god.” But then the way you approach it, and this is how you are successful, the way you approach it, there’s two concepts. The first one is … and in many of my talks, I start with this line in the very beginning. In the Museum of Science in Florence, Italy, there’s a display and it’s a round marble stand with a glass dome above it and inside the glass dome is Galileo’s finger, one finger, like this. Now, it happened to be his middle finger and it was his last message to the church.  There’s a couple of books on Amazon that you can read about Galileo’s life and how-

Dr. Weitz:                            Are we gonna put Trump’s middle finger in a glass?

Dr. O’Bryan:                        That’s a really interesting idea. But the one finger concept is one hour a week. You allocate one hour a week, Tuesday nights after dinner, Sunday mornings before church, whenever it is, but one hour a week every week. “To this topic, I’m going to learn more about how the autoimmune mechanism gets activated by my environment and by my children’s environment. I’m gonna learn more about this.” ‘Cause it’s overwhelming, and it’s so overwhelming, it’s immobilizing. You don’t know what to do, but if you allocate one hour a week, just one hour and you set the alarm on your watch for one hour, you can bite size chunks of those. ‘Cause my term is, “Base hits win the ball game.” So you just go for a base hit this week, “Okay, I’m gonna learn a little more about these PCB things and how that stuff accumulates. And then how can I reduce my exposures?”

You only need one hour, that’s it. And next week, “I’m gonna learn about mercury and how I can prevent so much mercury from my kids. Oh my god, all the tuna’s got mercury? I didn’t know, oh my god.” Well, there’s one that doesn’t, it’s called Ventresca, with a V, Ventresca from Vital Choice Seafoods, you can find them online, and that can of tuna fish, there is no measurable mercury in it at all, and there’s a reason why there is none. And it’s seven grams of tuna fish, so you give your kid a can of tuna fish once a week that’s Ventresca, doesn’t have the mercury poisoning that all the other ones do, once a week and your kid’s got brain food, the most important brain food, the DHAs for a week, from one can of tuna fish.

Dr. Weitz:                            How did they get the mercury out of the tuna?

Dr. O’Bryan:                        Randy Hartnell owns the company and Randy was a salmon fisherman in Alaska for over 20 years. All salmon fishermen, they get tuna in their nets. And if they catch a tuna, they put them in a different bin and then they sell them to the tuna guy when they come back to shore, but the baby tuna, nobody wants. So all the salmon fishermen throw them away, they throw them back into the water and it’s unfortunate, but that’s fishing, that happens. So Randy goes, “Well, wait a minute here.” ’cause he had learned how mercury accumulates in tuna because mercury comes from the rain coming down on the ocean and the mercury is in the air from cold burning power plants, the rain brings it down into the water, the plankton absorbs the mercury. The little fish eat the plankton, so they get some mercury. The medium size fish eat the little fish, they get higher concentrations of mercury. The big fish, like tuna, eat the middle sized fish, they get the highest concentrations of mercury, right?

Baby tuna haven’t had the time yet to eat a bunch of medium sized fish, they don’t get the mercury. So Randy found that the belly of the baby tuna, there was enough meat there to make it worthwhile, to lug it back and do whatever they have to do for the manufacturing stuff. So they’re canned tuna fish is the belly of baby tuna, it’s called Ventresca, it means fish belly in Italian. So that fish has no measurable … you can’t say none because you could find electro microscopic traces in there, but no measurable amounts of mercury compared to all other tuna fish.

Dr. Weitz:                            Right.

Dr. O’Bryan:                        And it’s much more expensive because it’s more manpower and more of these fish have to be … for each can, that kind of thing. But one can a week for your kid, they’ve got all the brain food, that DHA they need for a week.

Dr. Weitz:                            Cool.

Dr. O’Bryan:                        It’s very cool. Very, very cool.

Dr. Weitz:                            They can also eat sardines too, it may not be quite as good but also because it’s a smaller fish.

Dr. O’Bryan:                        That’s right, that’s exactly right. And they’ve got good levels, really good levels, I think it’s about three grams to three and a half grams EPA DHA in a can of sardines, which is a good amount, a really good amount. But seven grams in that can of tuna fish, dropped my jaw when I saw that. That’s a tremendously high-

Dr. Weitz:                            Yeah, that’s amazing. Yeah.

Dr. O’Bryan:                        That’s really great. ‘Cause most of the capsules are 760 milligrams.

Dr. Weitz:                            No, most of them are like 500 and some as low as 200, so you probably need like 15 capsules.

Dr. O’Bryan:                        That’s right. To get the same amount of brain food as you get in one can of Ventresca.

Dr. Weitz:                            Wow.

Dr. O’Bryan:                        That’s exactly right.

Dr. Weitz:                            That’s cool.

Dr. O’Bryan:                        I know, it’s just so cool. And that’s in my book, so it’s like one hour a week to learn that one little thing. You say, “Oh cool, I’m gonna order that.” Then you order it, okay, you’re done for the week. That’s it. Next week, you learn a little bit more, next week, you learn a little bit more. And that way it’s in bite size chunks that you can apply for you and your family and in six months, you’ve got it down. You’ve got it down. But we don’t live our lives that way, we want it all now. So we read this whole book all at once and go, “Oh my god, this is a really great book.” And what are you gonna do, “I don’t know where to start.”, right?  So, one hour a week with this stuff and you can implement it. And who cares if it takes you six months or a year, who cares, it’s the rest of your life, and you will have made these changes, these lifestyle changes, reducing the amount of exposures that you and your family are getting everyday.

Dr. Weitz:                            Great. How can we get rid of these toxins after they’re in us?

Dr. O’Bryan:                        There’s protocols for detoxification, you have to detox. One of the things you can do is aerobic exercise, you have to sweat ’cause sweat will just flush some of this stuff out. And aerobic exercise means you wear a pulse monitor. You wear a pulse monitor and you stay in your pulse range, and you set the alarm on your pulse monitor on the watch, and the formula is 180, minus your age, plus or minus five, that’s your range. And if you’ve been diagnosed with a disease, you do 175, minus your age, plus or minus five. And you stay in that range, and you set the alarm on your watch for that range. Let’s say it’s 130 to 140, so you’re walking on a treadmill and your pulse is going up and it gets up into that range, “Oh good, I’m in the range.” And then it goes, “Beep, beep, beep, beep, beep, beep, beep, beep. Oh, I’m at 149, wow. Okay, I better slow down a little bit.”

And you slow down a little bit and the beeping stops and you’re in your range again, and then it goes, “Beep, beep, beep, beep, beep, beep. Oh wow, I’m up at 152, what happened? Oh my gosh I was thinking about my uncle and what a jerk he is.” Whatever your brain does will effect your pulse, so you slow down again, you get in your range. And then it’s going, “Beep. Beep. Beep. Oh, I’m too slow. Oh, I better pick it up a little bit.” And then you’re training yourself to stay in the range where the alarm is silent. And you stay in that range 30 minutes … it’s 150 minutes a week, so it’s 30 minutes, 5 days a week. You go for walks around the block, that’s all you have to do, just get in your range. And if you’re walking and you’re not quite in your range, most people will be in your range by just walking, and if you’re not quite in your range, carry a couple of soup cans with you and then that will bring your pulse up a little bit.

Dr. O’Bryan:                        That’s the old Jack LaLanne thing, the soup cans, “Okay ladies, go in the kitchen and get your cans of soup.” Right? When they come back with their soup cans and they’re exercising and doing their thing, it doesn’t have to be difficult. So the first thing you do-

Dr. Weitz:                            By the way, you know Jack was a chiropractor?

Dr. O’Bryan:                        That’s right, that’s right. He was a great man and he was just a giant of a man.

Dr. Weitz:                            Yeah, I love Jack LaLanne, very inspirational.

Dr. O’Bryan:                        Yeah. Next, everybody when they wake up in the morning, they go to the bathroom, almost everybody, first thing they do is you go to the bathroom. The very next thing you do before anything else, drink two big glasses of water before anything else, two big glasses of water to start your day. And within a few days to a week, you’re looking forward to the water ’cause you notice you had a great bowel movement an hour later, or just feel a little bit better. You have to hydrate, you have to have the highway able to carry the traffic to get rid of the crud that’s in your body. So you start with two glasses of water, and then throughout the day, the amount is a half ounce per pound body weight. That’s how much water you have to drink in a day, a half ounce per pound body weight, and just figure out what you weigh, and then divide that by two, that’s the amount of ounces of water you have to drink.

It’s a lot of water. If you weight 150 pounds, that’s 75 ounces of water a day, that’s a lot of water. “Oh my god, I’m gonna pee a lot.” Yes, you are. And that pee’s gonna be full of toxic crud that you have to get out of your body, deal with it. “Oh no, I don’t want to go to the bathroom so much.” Then we’ll put that on your tombstone, “You didn’t want to pee it out.” I’m sorry, right? There’s just some basic things that we have to do to clean our bodies out. And when you do that, you notice in a week, a month, a couple of months, you’re just feeling better than you’ve felt in a long time, right? And people are saying, “Wow, you look good, you look good.” And say, “Oh, I’ve been drinking more water and I’m walking five days a week and yeah, it just feels really good.”

Dr. Weitz:                            That’s great, Tom. You’ve got tons of great information and thank you so much for sharing with us. We could talk for hours.

Dr. O’Bryan:                        Yes, we could. Yes, we could. My recommendation for everyone is read the book, if you go to my website, thedr.com, but just don’t spell the word doctor out. Thedr.com/book, and then it’ll take you to Amazon, but there are some handouts that you can download there that are extras, after I wrote the book. When you read the book, you’ll say, “My gosh, this just makes sense. This just makes sense. My son’s attention deficit, maybe we can help.” Or, “My husband’s rheumatoid arthritis, maybe we can help.” Yeah. Yeah.

Dr. Weitz:                            And when is your new book gonna be out, On The Brain?

Dr. O’Bryan:                        September 18th.

Dr. Weitz:                            Okay, good. We’ll be looking forward to that.

Dr. O’Bryan:                        Thank you so much.

Dr. Weitz:                            Okay. Anything else for people who want to contact you? I guess you gave us your website and we know about your book, so that sounds great. Thank you so much for joining me, Tom.

Dr. O’Bryan:                        Oh, it’s a pleasure. Thank you for having me.

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Dr. Elroy Vojdani speaks about Small Intestinal Bacterial Overgrowth (SIBO) and Irritable Bowel Syndrome (IBS) and a new serum antibody test for SIBO with Dr. Ben Weitz.

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Podcast Highlights

6:07  A 2017 review paper demonstrated that there is a very wide range of patients with IBS who test positive for SIBO on breath test, from 4-78%. I asked Dr. Vojdani why he thought there was such a wide variation in test results?  Dr. Vojdani explained that there is no standard definition of what IBS is and the breath test is complicated to perform and requires important pretest procedures in terms of diet and avoidance of certain medications. Also the breath test is a complicated set of procedures to perform and it requires being focused for three hours. And you can use glucose or lactulose as a substrate for the breath test, each of which will give you different results. And there is also controversy as to how to interpret the breath test results among the experts and there are several different consensus reports on how to interpret it. Dr. Vojdani estimated based on the research and his clinical experience that approximately 60% of patients with IBS have SIBO.

10:39  I asked Dr. Vojdani what role stress plays in IBS? Dr. Vojdani does feel that stress plays a big role in many patients with IBS. I pointed out that the small intestine has a lot of serotonin receptors and if you prescribe an SSRI for a patient with IBS to help with stress, that SSRI, by increasing serotonin, may be increasing the motility of the small intestine, thus helping with SIBO.  On the other hand, Dr. Pimentel does not think that stress has much to do with IBS and he argues that our flight or fight stress response does not involve suddenly having to go to the bathroom. If you are out on the Savannah trying to run away from a lion, the last thing you’d want to do is to have a bowel movement right then. 

14:48  Under normal circumstances the following mechanisms prevent bacteria from migrating back up into the small intestine from the large intestine: 1. Acid production in stomach, 2. Bile secretion into the small intestine from the liver and gall bladder, 3. Pancreatic enzymes, 4. The immune system is centered within the mucosa of the small intestine, 5. Ileocecal valve, 6 Migrating motor complex cleansing waves of peristaltic contractions. 

17:55  Dr. Pimentel developed a way to diagnose SIBO with a blood test–a serum that that measures anti-Cytolethal Distending Toxin and anti-Vinculin antibodies. Dr. Pimentel’s concept is that SIBO often starts with a bout of food poisoning that results in a release of Cytolethal Distending Toxin (CDT) from the bacteria that causes food poisoning (often Campylobacter Jejuni).  The immune system mounts an attack on the CDT and then via molecular mimicry, the immune system damages structural proteins in the intestinal wall (Vinculin), which affects the nervous system of the small intestine that produce the cleansing waves (the Migrating Motor Complex, aka, MMC). This results in SIBO.  What this means is that IBS is essentially an autoimmune disease. 

21:50  Elroy and his dad, Dr. Aristo Vojdani, looked at Dr. Pimentel’s research and noted that his test could not help in diagnosing the constipation subtype and even in the diarrhea and mixed subtypes, the sensitivity is only about 60%, which is good but not great. The Vojdani’s also noted that Pimentel’s test only looked at IgG antibodies, while the primary immune complex in the gut is IgA.  So they developed their test looking at IgA, IgG, and IgM antibodies to Cytolethal Distending Toxin the sensitivity of the test that the Vojdanis developed for Cyrex Array 22 has a sensitivity of about 88%, based on their validation data. 

25:47  Dr. Vojdani explained that if you are positive with their SIBO/IBS antibody test that this indicates an autoimmune subtype of this disease and this indicates that these patients have broken their oral tolerance, which is a major breakdown in the way that their immune system functions.  And if you don’t do significant work to restore the oral tolerance in that patient, the patient will never get better or they will get better but they will relapse.  In order to restore oral tolerance, Dr. Vojdani suggested that some research shows that high dosages of vitamin A, vitamin D, vitamin K, and probiotics may all help with this.  And there’s a lot of really fascinating research being done into the use of helminths as a mechanism to restore oral tolerance.  Helminths are the therapeutic use of parasitic worms.  Low Dose Immunotherapy also holds some promise as a therapeutic option in restoring oral tolerance.

 

                                              

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Dr. Elroy Vojdani is a practicing Functional Medicine doctor in the Brentwood section of West Los Angeles Regenera Medical and can be reached at 424-256-0272. His website is https://www.regeneramedical.com/ The new SIBO antibody test that he developed with his dad, Dr. Aristo Vojdani, is available at Cyrex Labs https://www.joincyrex.com/the-cyrex-system/array-22-irritable-bowel-sibo-screen

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcripts

Dr. Weitz:    This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition. From the latest scientific research and by interviewing the top experts in the field.  Please subscribe to the Rational Wellness Podcast on iTunes and YouTube and sign up for my free ebook on my website by going to drweitz.com.  Let’s get started on your road to better health.  Hello, Rational Wellness podcasters. Thank you so much for joining me again today. I’m very excited to be talking to Dr. Elroy Vojdani. And we’re going to talk about irritable bowel syndrome and small intestinal bacterial overgrowth. For those of you who enjoy the Rational Wellness Podcast, please go to iTunes and give us a rating and review so more people can find out about the Rational Wellness Podcast.

                                                So our topic today is about irritable syndrome, irritable bowel disorder, or irritable bowel syndrome. And otherwise known as IBS. And this is the most common gastrointestinal disorder. It occurs in up to 15-20% of the US population. And irritable bowel syndrome is a condition marked by gas, bloating, abdominal discomfort, constipation, diarrhea, alternating one and the other, as well as a range of other symptoms.  Traditional medical treatment has been composed of medications for controlling symptoms. IBS is generally being considered to be a stress related condition with no known cause. However, a number of years ago, Dr. Mark Pimentel … This was about 10 or 15 years ago … from Cedars-Sinai became the first one to discover that small intestinal bacterial overgrowth or SIBO is actually the cause of IBS in up to 78% of cases. SIBO consists of bacteria that normally grow in the colon or the large intestine. And then those bacteria start to grow into the small intestine which normally is mostly free of bacteria. The gold standard for diagnosing SIBO is finding more than a small amount of bacteria upon jejunal aspirate.  I know that’s a complicated sounding name but what that means is if you were a gastroenterologist and you were doing an endoscopic exam where you stuck a tube down someone’s throat, when you get to the part of the small intestine known as the jejunum, you scoop out some of the liquid and then you analyze it via a culture. And if you find bacteria, more than a small amount, this is a positive indication of bacterial overgrowth.  However, this test is very invasive and is not regularly done in clinical practice. It’s basically done in research and by a very small number of clinical gastroenterologists. So Dr. Pimentel developed a breath test using either lactulose or glucose or other substrates for diagnosing small intestinal bacterial overgrowth in which the patient ingests the substrate, the lactulose, which is a fermentable fiber. And then, they blow into these tubes and then the tubes are measured for hydrogen or methane gas. And this is now a very common way for functional medicine practitioners to diagnose small intestinal bacterial overgrowth which often is the cause of IBS.

                                                Dr. Pimentel also developed a serum antibody test. He called it the IBS check test. And now it’s offered by Quest as IBS Detect Test. And it’s done specifically for IBS with diarrhea or IBS mixed. But it’s not indicted for IBS with constipation. Recently, Dr. Elroy Vojdani and his dad, Dr. Aristo Vojdani, developed a new serum antibody test available from Cyrex Labs that’s a number of steps more sophisticated than the IBS Check Test. And this is why I’ve asked Dr. Elroy Vojdani to talk with us today about IBS, SIBO, and the state of testing for this condition.

                                                Let me introduce Dr. Vojdani. He’s the founder of Regenera Medical, a boutique functional medical practice in Los Angeles, California. Dr. Vojdani is the son of Dr. Aristo Vojdani, the father of functional immunology. And he is one of the most important doctors in a functional medicine world and he developed all the testing offered by Cyrex Labs. Elroy began his medical career as an interventional radiologist diagnosing and treating complex late stage cancers and other extremely debilitating diseases. But he really wanted to prevent these chronic conditions so he embraced functional medicine and now he’s in private practice utilizing that paradigm. Dr. Vojdani has also co-authored over 15 articles in scientific literature and continues to be involved in research in autoimmune and other medical conditions.  Dr. Vojdani, Elroy, thank you for joining me today.

Dr. Vojdani:                        Ben, it’s my pleasure. You and I have known each other for a little while now and I’ve always enjoyed our conversations. So it’s great to be here with you.

Dr. Weitz:                            Good, good, thank you. So irritable bowel syndrome, as you know, is a very common condition. There was a review paper in 2017 that demonstrated that there was a pretty wide range of number of people with IBS who test positive for SIBO. That paper indicated, based on a review of literature, that there was anywhere from 4-78%. In fact, Dr. Pimentel’s paper actually found 84% of patients with IBS testing positive for SIBO.  Why do you think there’s such a wide variation in results from these studies?  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347643/

Dr. Vojdani:                        It’s a really fascinating topic because on one hand, you have IBS which is this collection of clinical symptoms. Very common clinical symptoms. Urgency, constipation, diarrhea, alternating between the two. It’s something that many human beings experience. So IBS is this collection of symptoms. And then, when we talk about SIBO, we’re talking about this specific quantitative and qualitative dysbiosis that you mention where you have an overgrowth of bacteria in the small intestine.

Dr. Weitz:                            And by the way, can you explain what dysbiosis is?

Dr. Vojdani:                        Yeah. So dysbiosis is an alteration in some way of the gut microflora, the bacteria, viruses, and parasites that live in a symbiotic relationship with us in our gut. So when we talk about dysbiosis, it’s an alteration either in the number of those bacteria or in the type of those bacteria. And SIBO is actually both, right?

Dr. Weitz:                            Correct.

Dr. Vojdani:                        So essentially what was going on in the research world in the last 20 years was that we were discovering that this very common set of symptoms that we call IBS was starting to correlate very often with this type of dysbiosis that we call SIBO. So as you mentioned, the numbers as to the overlap between the clinical condition IBS and the dysbiotic condition, SIBO, were all over the place from as you mentioned 4% all the way to 84%.  Some of the reasons for that is that how we classify IBS, there’s a very wide range. There are Rome I-IV criteria. There are other criteria. Outside of Rome criteria. So it depends how you …

Dr. Weitz:                            The North American consensus.

Dr. Vojdani:                        Exactly. So we don’t have a firm idea as to what we call IBS. We also have various different ways of detecting SIBO so you can do jejunal aspiration, as you mentioned. You can do breath testing. And in breath testing, there are several different ways you can do that either with glucose or lactulose as you mentioned. And then, there’s different diagnostic criteria for what those results are on the breath test.  So basically, we have no standard definition of IBS and we have no standard way to diagnose SIBO. Put that in the mix with a bunch of geographic variations and you get a number that’s all over the map as to where the overlap exists between those two.

Dr. Weitz:                            I think another factor probably has to do with when you have a test that has to be performed by a patient. They have to follow a very specific dietary regiment for a day. And you know, it’s not easy to follow the specific protocols. The patient has to properly breathe into these tubes. They have to do it every 20 minutes. And this requires being really focused for three hours. And I’m sure that there’s a lot of variation in the way that the test is actually performed.

Dr. Vojdani:                        Yeah, absolutely. And each individual practitioner has their own unique instructions for their patients as to how to prepare for a breath test. And many have their own unique way of interpreting a breath test. So again, there really is no standard there that exists in how we diagnose SIBO via breath testing. So we get massive variation.

Dr. Weitz:                            So if you had to guess just from what you know, what would you say percentage of patients who have IBS who actually have SIBO?

Dr. Vojdani:                        I think it’s closer to the 60% mark personally. That number seems to make sense. IBS, we like to think of it as this one condition and I’m sure as we’re going to continue to talk about, it’s likely a collection of different disease processes that all have very similar manifestations.

Dr. Weitz:                            Right. What role do you think stress plays in IBS?

Dr. Vojdani:                        I think stress … Let’s go back in time 25 or 30 years ago when we would talk about IBS and IBS was this condition that we talked about as being entirely genetic and stress as being the only two factors that played a role, right?

Dr. Weitz:                            Right.

Dr. Vojdani:                        So we would treat people with some lifestyle intervention. Tell people to avoid spicy food and coffee. And if we were really inclined, maybe we’d prescribe an SSRI or maybe some benzodiazepines to remove the stress component from this disease. It certainly plays a big role. There’s no doubt about it.

Dr. Weitz:                            And by the way, it’s kind of interesting that if you look at SSRIs, which increase serotonin production, the small intestine actually has a large percentage of serotonin receptors and so if you prescribe an SSRI and you increase serotonin production, you may be increasing the motility of the small intestine. So it may be that those antidepressants were actually having a beneficial effect.

Dr. Vojdani:                        So interesting, right?

Dr. Weitz:                            And not just psychological. Yeah.

Dr. Vojdani:                        We didn’t even know really that there was an enteric nervous system that existed in the gut when we were prescribing SSRIs. And many people do actually respond well to SSRI prescription when you’re trying to treat IBS. So we didn’t know why it worked. We thought we were treating the brain but it turns out there was some treatment to the gut that was going on.

Dr. Weitz:                            Right, right, right. Now Dr. Pimentel has another take on that whole stress issue. He feels very strongly that stress is not a reasonable explanation for IBS in a lot of cases.

Dr. Vojdani:                        Yeah. So I think it’s really important to understand that as we’re really learning more about the mechanism in which IBS occurs in individuals that we’re discovering that there’s an autoimmune or auto inflammatory component to this for many people. And when you just zoom out a little bit and maybe talk about IBS and the autoimmune and auto-inflammatory world, it’s really impossible to deny that stress plays some role in the initiation of autoimmune auto-inflammatory disease for people who have the genetic predisposition for it. It’s not a 100% factor the way we talked about it 25 years ago but I think it’s undeniable that it plays a role.

Dr. Weitz:                            Right. But I remember when we talked to Dr. Pimentel when he attended our meeting. I thought he made a really profound point which is when you look at it evolutionarily, if you’re out in the Savannah trying to run away from a lion and that’s the typical example of somebody who’s under high stress, last thing you’d want to do is having to have a bowel movement right then when you’re trying to run away. It doesn’t seem to make sense that that would be a normal stress response.

Dr. Vojdani:                        Yeah. I respect Dr. Pimentel a tremendous amount. His research is incredible and he gave a great talk but I think using an analogy in our paleolithic times is very difficult because we’re really seeing this massive epidemic in modern times of autoimmune and auto-inflammatory disease. I think because our lifestyle has migrated so much from where we were a couple thousand years ago and our body, our genetics, our composition, haven’t had a chance to catch up with those very rapid changes. So sure, maybe our stress would have been running away from some type of predator and we wouldn’t want to have a bowel movement while we were doing that back then, but our immune system was also vastly different. Our diet was vastly different. Our responses to these type of things were vastly different. I think when we talk about autoimmune, auto-inflammatory diseases, it’s really important to understand that these are unique things that are popping up in human beings today because of the new world that we’re living in in comparison to what we were in the past.

Dr. Weitz:                            Sure. So what normally, under normal conditions, keeps the bacteria from the large intestine from growing into the small intestine?

Dr. Vojdani:                        Yeah, you know, the human body in so many ways is really resilient in preventing these things from happening. And we have tons of mechanisms built into us, physiologic mechanisms, that prevent SIBO from occurring. It begins with gastric acid production in the stomach which helps to sterilize the small intestine as it moves through the small intestine. As it moves through the small intestine, you have bile acid production which through saponification efforts can also destroy bacteria.

Dr. Weitz:                            So you’re talking about bile that’s secreted by the liver into gallbladder and then released by the gallbladder into the intestine to help us digest fats, right?

Dr. Vojdani:                        The liver and the gallbladder both secrete directly into the duodenum which is the beginning of the small intestine, right? So if you have bile mixing around in your small intestine, that technically adds to the antimicrobial effect of all these juices that are being produced.  You also have enzymes which are being produced by the pancreas and the small intestine which can also break up the surface of these bacteria. We have a very powerful defense mechanism, our army, our immune system, is really centered within the mucosa of our small intestine. So we have this very powerful mucosal immune system that is … We have all these different mechanisms between all the surveying immune cells that are centered within the gut ileum. We have secretory IGA that’s being produced and floating around in the ileum. That’s all designed to prevent us against dysbiotic things like SIBO occurring.  And then of course when you talk about the junction between the small intestine and the large intestine, that area between the ileum and the cecum, there’s a valve there. An actual valve that when functioning appropriately acts as a one way valve and prevents things physically from moving back into the small intestine.  There’s a lot of things that we’re born with that prevent SIBO from happening which begs the question, why is it happening so much?

Dr. Weitz:                            Right. You know, Dr. Pimentel’s theory is that it starts with a bout of food poisoning that leads to damage to the migrating motor complex which is nervous system of the small intestine and under normal conditions, another mechanism are these cleansing waves that occur which is when you haven’t eaten for a while and you hear your stomach gurgling, it’s essentially there’s peristaltic wave of contractions that go through your digestive tract that also helps to keep your small intestine clear.

Dr. Vojdani:                        To the migrating motor complex.

Dr. Weitz:                            Yes.

Dr. Vojdani:                        Right, so these forward peristaltic waves that occur in between times of eating predominantly at night also ensure that things move forward.

Dr. Weitz:                            Right. So I mentioned the antibody test that Dr. Pimentel developed. How effective do you think that test is? Because my experience was I used it not a large number of times but it didn’t seem to be that helpful. It seemed not to be positive in most of the cases of patients that really did seem to have SIBO.

Dr. Vojdani:                        You mind if I take a step back and kind of explain where Dr. Pimentel came up with the idea to start checking antibodies.

Dr. Weitz:                            Yeah, let’s do that.

Dr. Vojdani:                        So there was a ton of research that was being done as to what enteropathogenic bacteria do to survive within animals. And there was research that was being done into E-coli which is a very common pathogen. Clostridium difficile, campylobacter jejuni, and shigella were really the focus of this research the last 20 years or so. And we learned that they have something called bacterial cytolethal distending toxin. Their weapon for, I guess, survival in combating our defenses against them.

Dr. Weitz:                            Right. And by the way, this is part of a category known as bacterial endotoxins. And bacteria often secrete this and then it creates damage. The endotoxin creates a bunch of damage.

Dr. Vojdani:                        Exactly. The other example of an endotoxin is lipooligosaccharide or LPS.

Dr. Weitz:                            Exactly.

Dr. Vojdani:                        We talk quite a bit in many disease. Right? And we’ve known about LPS for a really long time. I think learning about bacterial cytolethal distending toxin was something relatively new.  So several labs including Dr. Pimentel’s lab started doing animal models where they would infect the animals with campylobacter jejuni, one of the enteropathic bacteria, and would observe that after infection, they would develop IBS-D symptoms in that animal model. So they came up with this idea that maybe IBS, at least the D or mixed subtype has a post infectious process.  So, they continued to study that and learned that this toxin is way more powerful than we thought it was. It didn’t have just the ability to kill cells. If you think about the name cytolethal distending toxin it’s all about its ability to inject a toxin into a cell and destroy it. But we also learned that our immune response to the toxin begins or initiates an autoimmune cascade that progresses the inflammatory attack even without progressive insertion of the toxin in different cells.

So what does that mean? This bacteria is way smarter than we thought. And infecting an intestine with this bacteria results in symptoms for much longer than a typical disease you should have symptoms, you end up with symptoms for maybe the rest of your life. So that was really, really fascinating research, right? We started to understand that at least a subtype of IBS had this autoimmune mechanism. And that’s because when we … once that cytolethal distending toxin is injected into the epithelial cell, it starts attacking something called the adherence junctions which are basically the cytoskeletal network of our small bowel epithelium. In attacking that, you start releasing new antigens into the bloodstream including the toxin itself and by attacking either the proteins at the adherence junction or attacking the toxins through molecular mimicry, you start attacking adjacent cells that might not be infected with the toxin. And then, you get disruption of the adherence junction and essentially your small bowel epithelium can’t function that way it’s supposed to.  So you end up with a lot of these symptoms. And also the migrating motor complex or the enteric nervous system is disrupted in this model as well.

                                                Basically, Dr. Pimentel’s initial research was done in a really large trial. He looked at over 2,000 patients that had IBS subtype D based on Rome III criteria and found that the clinical utility of this test was very useful in separating people who might have diarrhea predominant IBS from IBD, from celiac disease, and from normal controls which is a very typical, difficult, clinical scenario when these people come in the door for the first time, right?

Dr. Weitz:                            Yes.

Dr. Vojdani:                        So his research validated the use of an antibody to essentially an IgG only antibody to the cytolethal distending toxin of campylobacter jejuni and then he also looked for IgG antibodies on the vinculin. Found them to have a sensitivity of close to 60% in patients with the D subtype. Somewhere lower than 50%, maybe 45% for the mixed type. And then, the constipation subtype is much lower, maybe 25%. So that was his initial data through his labs, research, and work on this antibody model.

Dr. Weitz:                            Yeah, it’s kind of ironic because you would think that decreased motility of the intestine would be more associated with constipation but I guess there’s not a strict correlation there.

Dr. Vojdani:                        Yeah. That’s the really interesting thing about his research. It really only looked like it was going to be valid. And in my opinion, the sensitivity of 60% is good but it’s not great and when you’re trying to develop a clinical marker for a disease, you really hope for much better than a 60% catch rate because you’re a little bit better than flipping a coin which is not fantastic.

Dr. Weitz:                            Right.

Dr. Vojdani:                        I think when my dad and I looked at that research and looked at that autoimmune model of this disease, one of the first things that caught our eye was that they’re testing IgG antibodies only in that test. And when you think about the way the immune system works, IgA is no doubt the dominant antibody of the mucosal immune system. So it makes sense that if there were going to be an antibody that were to be formed, IgA would likely to be the most common. IgM can happen in early autoimmune diseases as well. IGG tends to be more chronic and more systemic so it made sense to us that if you were going to detect this, you should look at least at IgA on top of IgG and why not look at IgM as well to try to increase your net of capture because depending on the number of years that that patient has been post infection or post exposure to cytolethal distending toxin, they might have any one of those three antibodies.

                                                So, that’s essentially what we did at Cyrex in developing Array 22 which is what we call generation two of that antibody testing. And in our validation data, essentially we looked at 24 patients, all different types of IBS, basically to serum of 24 patients who show up to a clinician’s office for the first time with IBS. It didn’t matter which subtype. We had a sensitivity of 21 out of 24 were positive. So that’s about 88% or 89%. So much, much higher than what Dr. Pimentel’s data suggests. And our controls in our control group, we only had a positive result in one out of the 24.  So our data looks a lot more promising. And I think when you think about the mechanism of this disease, the test makes a lot more sense.  https://www.joincyrex.com/the-cyrex-system/array-22-irritable-bowel-sibo-screen

Dr. Weitz:                            And so your test, as you just mentioned, would also be helpful in diagnosing patients who have IBS/SIBO, with methane, the constipation type.

Dr. Vojdani:                        Yeah, so the constipation subtype, I will say is likely … Let’s say those three patients out of the 24. I don’t have a breakdown as to their subtype but I would say it’s more likely that the constipation subtype is going to be negative on this test. That comes from my personal clinical experience using it in patients with constipation dominant. That being said, I still find that test to be positive in may 50-60% of those patients. And to me, it’s really, really valuable information because you’re not just learning what does the patient have and giving them a diagnosis and then taking you down treatment road.

                                                You’re also learning that if they have this subtype of this disease, an autoimmune subtype of this disease, that they’ve broken their oral tolerance. That their immune system has a major breakdown in the way that it’s supposed to function. And if you don’t do significant work to restore the oral tolerance in that patient, the patient will never get better. You can eliminate them with whatever protocol you want to. You can put them on any diet you want to for any period of time. One day down the road, they’re going to get the symptoms again because there’s nothing that is resetting where the error in physiology occurs for those patients.

Dr. Weitz:                            So how is it that you do that?

Dr. Vojdani:                        Restoring oral tolerance is really challenging. And I just came back … We were just talking before we started the podcast about the annual conference for IFM in Hollywood, Florida which was last week. I just came back. And a very big push at this conference was research designed to do whatever we can to restore oral tolerance. And you have to understand that oral tolerance is something that begins and develops very early in life. This is where our thymus sends out lymphocytes to survey what’s in our body and deciding which of those lymphocytes to eliminate as they might be autoreactive. So that’s essentially what oral tolerance is so that you don’t … you also don’t attack the foods that you eat. You don’t attack your own tissue. And that you don’t have the set of autoimmunity.

                                                Restoring that process, takes a very significant period of time because it takes a very long time to break oral tolerance. But we’re finding that there are a lot of things that we commonly use that really help restore oral tolerance and restore to regulatory cell function which is what we’re trying to do. So high doses of vitamin A. High doses of vitamin D. Vitamin K. Probiotics do this. And then, there’s a lot of really fascinating research being done into the use of helminths as a mechanism to restore oral tolerance or at least to accelerate that.

Dr. Weitz:                            And by the way, helminths are worms which are being used therapeutically though not yet approved by the FDA here.

Dr. Vojdani:                        Yeah. Most of the research has been done on whipworms but Dr. Sidney Baker has been using a different type of helminth which is taken from the rat/beetle model which is much, much smaller than whipworms and their lifecycle is much less dependent on an animal that’s similar to us. So it seems like people are having less side effects from it.

                                                And then, of course, there’s a lot of work being done into how do we restore secretory IGA function. Maybe disrupt bio films. Doing whatever we can to reduce the inflammatory attack that’s going on within the immune system so that you give the immune system a breather and a chance to take a break from all the inflammatory insults and reset its oral tolerance essentially.

Dr. Weitz:                            Now in terms of treating SIBO, you didn’t mention anything about antimicrobials or antibiotics to get rid of the bacteria. Is that part of what you do as well?

Dr. Vojdani:                        Yeah, so I think antimicrobials whether they’re pharmaceutical or herbal certainly play a tremendous role in eradicating SIBO patients. I’ll tell you my clinical experience. I get patients who have been eradicated once, twice, three times, four times, are getting the issues with the recurrence and then they come into my office which might just be because I’m my dad’s son and there’s a reputation for seeing some complex cases but those are my typical SIBO patients. So really what we try and do in those patients is understand what is continuing to propagate the inflammatory insults. In most cases, the organism that is secreting the bacterial cytolethal distending toxin is long gone. If someone has C-Diff of campylobacter or shigella or e-coli. They tend to know about it.

                                                But it’s really more about understanding do they have leaky gut associated with their SIBO/IBS? Are there significant food immune reactions that are contributing to their inflammatory insults centered in their small intestine preventing the healing? Do they might have other GI organisms that are chronic stealth in nature. Things like giardia, other pathogens that are there that are contributing to this.  I tend to look at what other factors … thinking about this as an auto-immunologist, what other factors are contributing to this inflammatory insult against the gut? Why does the patient keep having recurrences? What can we do to restore the immune function and the physiologic function centered within the gut so that these recurrences don’t keep happening. That being said, medications are certainly very helpful for these patients at least to give them some symptomatic relief while they’re doing that work.

Dr. Weitz:                            Have you looked into low dose immunotherapy?

Dr. Vojdani:                        Yeah. Low dose immunotherapy, I think, is very, very promising. Particularly there are a lot of practitioners that are doing this. I don’t know for sure that every person is going to respond to it but I think it’s going to be very immune dependent. If you are really in the depths of the fires of a TH1 driven inflammatory autoimmune response, low dose immunotherapy has the potential to make your symptoms worse just because the immune system is so revved up that you can’t reset oral tolerance there. But I think it’s a very promising therapy.

Dr. Weitz:                            And I think using your test could actually enhance that particular therapy because once you determine which particular bacterial organism it is, you could design the low dose immunotherapy for the campylobacter or the particular bacteria and potentially get their body, their immune system, to be tolerant of it.

Dr. Vojdani:                        Absolutely. And leaky gut, because of the nature of the relationship between the adherence junctions and the tight junctions, if the adherence junctions are broken, the tight junctions are almost bound to break as well. So the symptoms that we see happening in IBS/SIBO where we have multiple immune reactions likely come from that breakdown of the tight junction.  So if you have the breakdown of the tight junctions, you end up with food immune reactions to numerous foods and maybe foods that are on the low FOD map diet or whatever diet you want to put them on. And you end up in this conundrum where you put someone on this diet because you want to help them with the symptomatic relief related to SIBO and it will do that but you’re still propagating an immune reaction to the gut because they’re being continuously supplied with an antigen in high levels that their immune system is reacting to.  So that’s where those two things become complimentary and that information is extremely useful, I think, in that situation.

Dr. Weitz:                            Now are you … do you feel that your antibody test should take the place of the breath test or should be used in conjunction with it?

Dr. Vojdani:                        I don’t have a very strong opinion one way or the other about the use of breath testing. I think the focus of our work and research was in Functional Medicine we really try to understand root causes. From a cellular level, where are the physiologic breakdowns occurring? So I think what really appealed to us about this initial research and even more so when we did our own research and our own validation in expanding the antibody testing and looking at this autoimmune mechanism more was that you’re really understanding at a cellular level where the disease is propagating. Right? And to me, that’s much more powerful in trying to help this person not have a recurrence five years from when they walk in your door which seems to be a really ongoing problem.

Dr. Weitz:                            Sure. I totally understand that. But from the small intestinal bacterial overgrowth world, there are sets of paradigms that I know I and other practitioners have been working with so there’s a set of paradigms that seems to work better methane SIBO versus hydrogen SIBO and Pimentel’s about to come out with a new hydrogen sulfite SIBO which and if people already have a whole different set of protocols. So that’s the only issue I have with doing your test is which … It would be nice to also know if it’s methane or hydrogen to utilize some of these protocols that we’ve found a certain amount of efficacy with.

Dr. Vojdani:                        Yeah, listen every practitioner when it comes into the SIBO world has their own unique way of doing things and I think that’s totally appropriate because every individual that walks in our door is going to be a different version of the disease from the next one that walks in the door. It’s just the way human beings work. And whatever tools you have at your disposal that are getting you results, I’m all for it. I have no issue with that.

Dr. Weitz:                            Yeah. No, I’m just thinking that I would still probably be inclined to want to do both testing.

Dr. Vojdani:                        I can see the rationale for that, sure.

Dr. Weitz:                            Yeah, yeah, yeah. So do you currently treat a lot of patients with IBS and SIBO?

Dr. Vojdani:                        I do. I do. Yeah. And as I mentioned, I tend to get the patients that …

Dr. Weitz:                            Are tough cases. Yeah. All different therapies.

Dr. Vojdani:                        There are some good cases going on in the SIBO world in that more of my western colleagues are becoming fluent in some fashion to the idea that SIBO exists. And they’re ordering breath testing and maybe doing Rifaximin therapy with patients. So a lot of that initial work is being done out there and I’m sure many patients get very significant symptomatic relief from that initial eradication and don’t need further eradication. But I tend to see the patients that have been eradicated a couple of times and are looking for some more complex answers.

Dr. Weitz:                            Right. Typically, we think of things like well, you’ve killed the bacteria but you haven’t reset the migrating motor complex. So now you need to give them some agents that could reset the migrating motor complex whether that be nutritional or there’s medications and then, sometimes we think well, you haven’t broken up the biofilm. So in addition to doing the antimicrobials, you’ve got to give biofilm agents or you have to do a phase two and rebuild the intestinal wall. And use probiotics and prebiotics and glutamine and things like that.

Dr. Vojdani:                        Yeah. I think our protocols for SIBO are getting much more complicated these days for a very good reason because it’s a very complicated disease process. Again, I really think of myself as an auto-immunologist so I tend to focus on where the disruption in the immune system is because people who have damaged their enterovenous system and migrating motor complex, if that happens because of exposure to cytolethal distending toxin, and maybe you form antibodies to vinculin, which is part of the adherence junction, those antibodies cross react with your enteric nerve.

                                                So you can give them all the 5HTP, ginger, B6, you want and that might help them get through the current symptoms but if you’re not working on stopping B cells from producing antibodies, they’re going to attack the enteric nervous system, what’s the point?

Dr. Weitz:                            Yeah, good point. It’s interesting. I could just imagine some pharmaceutical researcher out there right now where there is some very expensive drugs that are typically used for inflammatory bowel disorders. Drugs that cost thousands and thousands of dollars a year and basically are just prescribed for the rest of your life. And I could just see them salivating right now because if IBS is now an autoimmune disease and they could start selling those immune blocking drugs now to not just patients with Crohn’s and ulcerative colitis, but to everybody with IBS. Wow.

Dr. Vojdani:                        No doubt about it. I think they’re salivating for sure because we know that the epidemic of autoimmune disease in general is blowing up, right?  But we’re also starting to discover that so many more diseases at least have an autoimmune component like we were just talking about ankylosed and spondylitis at the conference now understanding that there are target auto-antibodies for ankylosing spondylitis.

                                                So we always knew that was an inflammatory disorder but we never understood that that was an autoimmune disorder. That’s one. We just published one, my dad and I, alone with [inaudible 00:39:40] and published the first of three articles in relationship to Alzheimer’s Disease. It’s in just the recently published June volume of the Journal of Alzheimer’s Disease. It really looks like we’re going to start thinking of Alzheimer’s Disease as an autoimmune disease in the near future too. The implications of that to the pharmaceutical world, I think, are probably huge. But thankfully, you and I are functional medicine doctors and we treat things in very effective and more natural means because when you start modulating entire branches of the immune system, you end up with very significant issues down the road.

Dr. Weitz:                            Right. Essentially what you’re saying is that we’re trying to reset the immune system. We’re trying to balance it. we’re trying to help re-regulate it. Whereas, the pharmaceutical approach basically is bringing down a hammer on your immune system. Just block a big chunk of your immune system. And of course it doesn’t work.

Dr. Vojdani:                        Because you might get some symptomatic relief, but your immune system is also responsible for surveying which cells in your body are starting to make genetic changes that are going to predispose them to becoming cancer in the future. So you take a whole arm of your immune system out and you reduce its ability to stop you from having cancer in the future.

Dr. Weitz:                            Right. Which is why the Functional Medicine approach in the long run is going to end up winning out.

Dr. Vojdani:                        No doubt about it. So you and I are on the right team.

Dr. Weitz:                            I’m happy about that, Elroy. Well, thank you so much for joining me today for patients and/or practitioners who would like to get hold of you, what’s the best way for them to contact you?

Dr. Vojdani:                        So our website is regeneramedical.com. R-E-G-E-N-E-R-A Medical, one word. You can reach our clinic at 424-256-0272.

Dr. Weitz:                            And you’re available to treat patients in person and also by …

Dr. Vojdani:                        Yes, we are accepting patients currently. Our office is in Brentwood right on Wilshire and West Gate. Just get in touch with us. Happy to answer any questions.

Dr. Weitz:                            Sounds good. Excellent, Elroy. Talk to you soon.

Dr. Vojdani:                        Thanks, Ben. Have a good one.