Tocotrienols with Dr. Barrie Tan: Rational Wellness Podcast 127

Dr. Barrie Tan discusses Tocotrienols with Dr. Ben Weitz.

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Podcast Highlights

2:52  Dr. Tan was interested in studying carotenoids and in 1982 he got a grant from the Malaysian government to study palm oil and he was trying to figure out what kept palm oil so stable and he discovered tocotrienol.

4:00  Vitamin E is a family of molecules that includes alpha, beta, gamma, and delta tocopherol and alpha, beta, gamma, and delta tocotrienols. Alpha tocopherol was first discovered and was first called vitamin E in 1922. It was called tocopherol from Greek words meaning birth and to bear or carry because it was found to be essential for fertilized eggs to result in live births in rats.  Even today, alpha tocopherol is considered to be vitamin E and most of the research has been done with alpha tocopherol and it is most well known as an antioxidant. If you go the Linus Pauling Institute Micronutrient Information Center at Oregan State University in a long article on Vitamin E only a few sentences are devoted to tocotrienols.  Both tocopherols and tocotrienols look similar but the tail of a tocopherol is long and it is saturated, while the the tail of a tocotrienol is shorter and is unsaturated.  This tail allows tocotrienols to function differently than tocopherols.  Dr. Tan believes that the data that has shown the benefits of vitamin E was really attributable to tocotrienols rather than to tocopherol, which are both found in some of the same foods, which is why so many of the studies of vitamin E done with alpha tocopherol failed to prevent heart disease or cancer or cognitive decline or to decrease mortality.  Researchers Asaf Qureshi and Charles Elson at the University of Wisconsin first discovered in the 1980s that tocotrienol rather than tocopherol caused the reduction of cholesterol, esp. LDL, through the post-transcriptional suppression of HMGR (3-hydroxy-3-methyl-glutaryl-CoA reductase), which is the enzyme responsible for cholesterol synthesis.  Unlike statins, which also block CoQ10 synthesis, tocotrienols do not block CoQ10 synthesis, and tocotrienols can also be added to Red Yeast Rice or to statins and it enhances the effects.  When tocopherol was added to tocotrienols, it blunted the effect to lower cholesterol.  So to achieve the therapeutic benefits of tocotrienols, they must be taken apart from tocopherols.

7:22  Alpha tocopherol may actually have a negative effect on lipids. In studies where tocotrienols are shown to lower cholesterol, when tocopherols were combined, the ability of tocotrienols to lower cholesterol were blocked.  This likely explains why some of the studies on vitamin E showed little or no benefit.  Dr. Tan mentioned that tocotrienols also lower triglycerides and that they can also work synergistically with EPA/DHA fish oil for this purpose.  Here is a study showing that tocotrienols can protect against the lipid oxidation of fish oil more effectively than tocopherols:  Antioxidant activities of annatto and palm tocotrienol-rich fractions in fish oil and structured lipid-based infant formula emulsion.

14:40  Tocotrienols have been shown to have an anti-cancer effect in cellular and animal studies against bladder, brain, breast, cervical, colon, gastric, leukemia, lung, ovarian, pancreatic, prostate and skin cancer.  There are currently a number of clinical trials using tocotrienols in humans with cancer, including a phase 2 trial that was recently published on ovarian cancer. They looked at patients with metastatic ovarian cancer and gave one group Avastin and the other group Avastin plus tocotrienols–300 mg three times per day and their survival doubled at 12 months and was 25% increased at 24 months.  Dr. Tan did not think that taking tocotrienols is a problem for patients taking traditional chemo or radiation because the effect of both is not simply as a pro-oxidant but have a number of mechanisms by which they fight cancer and taking tocotrienols has not been shown to reduce their effects. In fact, so far, the opposite has been shown to be true.

21:00  Tocotrienols have been shown to improve bone health in post-menopausal women.



Dr. Barrie Tan is a PhD in chemistry, who is dedicating to researching Vitamin E.  Dr. Tan discovered tocotrienols in palm, rice, and annatto, with annatto being the most efficient source, since palm and rice also contain substantial amounts of tocopherols and alpha tocopherol inhibits tocotrienols.  He produces an Annatto Tocotrienol product through his American River Nutrition Company.

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 or go to www.drweitz.com.


Podcast Transcript

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. Please, if you like the Rational Wellness podcast, go to Apple podcasts and write us a review. That’ll help us come up in the searches for alternative health in Apple podcasts. Also, if you want to see the video version, go to my YouTube page, and if you go to my website, drweitz.com, there will be detailed show notes and a complete transcript.

Our topic for today is tocotrienols with Dr. Barrie Tan.  Some of us may not know what tocotrienols are. They are part of the vitamin E family, which consists of eight fat soluble iso forms. Alpha, beta, gamma and Delta tocopherol, and alpha, beta, gamma and Delta tocotrienols.  Most multivitamins only contain alpha tocopherol, which is generally what is considered to be vitamin E. One of the better sources for research on vitamins, The Linus Pauling institutes micronutrient information center in its detailed article on vitamin E is almost exclusively about alpha tocopherol, and there’s only one small paragraph about Tocotrienols.

                                Dr. Barrie Tan is a PhD in chemistry, who’s dedicated to researching vitamin E, and is an assistant professor at the university of Massachusetts. He’s credited with discovering tocotrienols in Palm rice and annatto, with annatto being the most efficient source. And there’s an annatto plant right in the background behind Dr. Tan. And since palm and rice also contain substantial amounts of tocopherols, an alpha tocopherol inhibits tocotrienols. He produces annatto Tocotrienols product through his American river nutrition company. Dr. Tan, thank you so much for joining me today.

Dr. Tan:               Thank you for the nice welcome. I look forward to the program and to your listeners who’s participating with us.

Dr. Weitz:            Absolutely. So Dr. Tan, what got you so interested in vitamin E, and particularly in Tocotrienols

Dr. Tan:               The year was 1982, ’83. I started as an assistant professor at the university of Massachusetts. I was there for about 12 years. And during that time I got a grant from the Malaysian government trying to study what kept the Palm oil so stable. So when I extracted all… at the time I was really interested in carotenoids because Palm oil is very bright orangy color. So when I remove all the fat, remove all the carotene, which is what I was interested in, there’s a few drops of something at the bottom.  And then I found out what it was; it was largely Tocotrienol.  When I reported back to the Malaysian government they say, “Oh, that’s just vitamin E. Is it?” “No, this is a little different than normal vitamin E alpha tocopherol. It does contain some, but it contain other peaks. And then I later found out to be Tocotrienols. So that was my simple start, probably 1984 or 1985 when I did it. This was long time ago.

Dr. Weitz:            Okay. And so vitamin E, as I mentioned, is not a single molecule. Can you give us a little more detail into what vitamin E is and how it was first discovered?

Dr. Tan:                It almost looked like if it weren’t me and a few others pushing for Tocotrienol, Tocotrienol probably never would have existed today. As you mentioned, Oregon State University only gave a tiny little sentence or two about Tocotrienol.  Tocopherol was found almost 50 years before Tocotrienol. And when it was found, it was known famously as vitamin E alpha tocopherol from UC Berkeley research. And it was to help the fetus to bring into full term. Most people don’t even know that, but probably know that it’s an antioxidant. But that was the reason.

                                Now if you fast forward 40 years, Tocotrienol was found. So very simplistically, structurally, a tocopherol has a head and a tail, like that. And the tail is saturated. A Tocotrienol, same kind of head and a tail. The tail is shorter slightly. And then they have double bonds, so it is unsaturated. So chemically, a tail of a Tocotrienol is unsaturated, otherwise look pretty similar, both as antioxidant. And now if you fast forward almost 100 years later, just about every thing that show vitamin E to work belongs to Tocotrienol. Just about everything that had been shown for tocopherol study fail, with the exception that it is a fat antioxidant.

Dr. Weitz:            It’s interesting, for years I’d seen these studies where they’ve used vitamin E and you try to test it to see if it prevents heart disease or cancer, and every time I’ve looked at the studies, I always thought, “Wow, I wonder why it’s not working. Ah, I don’t think they’re giving enough vitamin E. They only gave 200 micrograms or international units or they only conducted to study for two years and that’s not long enough to prevent cancer.”

Dr. Tan:                Yeah. And actually that concern that you have, I have too. I have no intention here to demonize tocopherol. I struggle as you did. The large, large clinical study, some of them done over eight, 10 years, simply did not pan out, Alpha tocopherol did not work. At best, it didn’t work. At worse, it may even raise the possibility of cancer and cardiovascular disease. That brought a lot of concerns to me. And then they thought that maybe it’s a synthetic vitamin E, so then they moved to using natural vitamin E, till alpha tocopherol, and is still continue not to work at high doses, 400 IUs, 600 IU.  So then I knew that if vitamin E were to work, and if Tocotrienol were to have a shot, let me stay with Tocotrienol. And that all came because of the fundamental seminal work in the 1980s. Much later when they found out that Tocotrienol, without exception not tocopherol caused the reduction of lipid. That came off from University of Wisconsin.

Dr. Weitz:            Interesting. I’ve heard you say that alpha tocopherol can actually have a negative effect on lipids.

Dr. Tan:                Yes. That came about because after the Wisconsin group came up that Tocotrienol could lower cholesterol, they did several clinical trials. About 60% work and 40% not. So it’s almost 50, 50. So it bothered the researcher. So the way they did it was, wait a minute, before we do any more clinical trials, it’s too expensive and take too long, we got to stop. So they went back to the bench work to find out in animal study, and this is what they did.  They were suspicious there’s something with the Tocotrienol, maybe a matter. At first, they thought that the Tocotrienol presence will be innocuous, so they put this amount of Tocotrienol with no tocopherol, then the next study, same amount, they add in a little bit more tocopherol, and then the next one, same Tocotrienol, more tocopherol.  And then when they did this, remember, a same amount of Tocotrienol. As they increased the amount of tocopherol, then they found out that the ability to lower cholesterol simply stopped. Now that was in… They published that in 1997. Since then, 2007. And 2007, 20 years after that, people have done it for cancer, for cardiovascular disease, and for metabolic syndrome systematically.  Every time tocopherol is present with Tocotrienol, tocopherol put brakes on the function of Tocotrienol.

Dr. Weitz:            Right. So there’s quite a number of articles now looking at the benefits of tocotrienols for cardiovascular disease.  And it was interesting looking at the mechanism by which it lowers LDL cholesterol, which is different than the way statins work, right?

Dr. Tan:               That is correct. And that came about… that study was discovered probably at the very end of the 1980s.  Statins work directly. If this is the LDL receptor that the statin locks it up, and then the drop is very dramatic. But we’ve Tocotrienol, we see a lot of cholesterol coming. So the scientific lingo is post-transcriptional, after it makes it, they down regulate the HMG reductase so it lower.  So if you translate them into application, a statin would lower say 40, 50% cholesterol; very dramatic.  And a Tocotrienol will probably lower it to about 20%. But hey, for a nutritional supplement to lower 20%, I’m fine with that.

Dr. Weitz:            And by the way, we’re specifically talking about LDL, right?

Dr. Tan:               Yes. The LDL cholesterol. And we have also found, in addition, in the earliest study, the Tocotrienol also lower triglyceride.  Now triglyceride is also cardiovascular, but when you have people with high triglycerides, it’s of particular import with people who have metabolic syndrome, for example, many of your listeners would be interested to lower triglycerides, so they take fish oil.  So fish oil lowers triglycerides.  So Tocotrienol also lowers triglycerides particularly for the interests of metabolic syndrome.

Dr. Weitz:            Cool. And Tocotrienols can be used synergistically way with statins or red yeast rice. Is that correct?

Dr. Tan:                Yes. Some people even add Tocotrienol with red yeast rice to do the cholesterol lowering.  And others put Tocotrienol with fish oil to lower triglycerides. And I even tell people, a little bit of a new one.  It was just published in the American heart association that anybody who wants to lower their triglycerides to take about three grams, at least two grams, perhaps three grams of DHA and EPA.  Particularly EPA because they say that the combination of EPA and DHA will lower the triglyceride, but there’s a possibility that the LDL may increase, which is a no-no to people who are diabetic like that. So if people add fish oil to Tocotrienol, not only they lower their triglycerides, they will resist the LDL from increasing for one, but possibly even lower the LDL.  So it’s a great combo to have fish oil and Tocotrienol for lowering the triglyceride as well as the LDL.

Dr. Weitz:            Brilliant. Plus, isn’t there a synergistic benefit because when you take a lot of unsaturated fatty acids like Omega-3s, they can become oxidized and the tocotrienols taken at the same time can prevent that oxidation?

Dr. Tan:                Yes. I have been trying to support this.  I’m a member of GO-ED, the global organization, EPA and DHA. Trying to convince people, convince company to make fish oil.  Everybody knows that taking fish oil is a good thing. Everybody also knows that oxidized fish oil is a bad thing.  So they would consider the possibility of putting Tocotrienol to protect the oxidation of these very unsaturated fat that’s unstable. And we have that study. That study was done for us at University of Georgia in Athens.

Dr. Weitz:            Interesting. So let’s say I was going to take two grams of EPA, DHA, how much Tocotrienols do you think I would need to protect that?

Dr. Tan:                Okay. If it is just for the protection of the omega-3, probably anywhere from one to two milligram. In one capsule of one gram fish oil will be enough to protect the extended shelf life. But if it is to add in so that it will support your LDL to drop and not increase, then probably more like 100 milligram. So depending on the intention of this. So one or two milligram or 100 milligram.

Dr. Weitz:            Okay. So particularly it’s delta tocotrienol that’s the most potent

Dr. Tan:                Yes. If you do a PubMed search, say people out there, say, “Oh, Dr. Tan is biased.” Which is fine. I understand that because I made this compound. If you go online, if you type Tocotrienol, right up sticking up like a sore thumb would be things of Delta Tocotrienol and gamma Tocotrienol. And then a beta Tocotrienol just about doesn’t exist in any effect at all. And then Alpha Tocotrienol trail. It’s a distant third; if anytime. So therefore on Tocotrienol studies, more than 90% of it would be on the function of Delta and gamma Tocotrienol.

Dr. Weitz:            Cool. I read several papers about the anticancer effects of Tocotrienols, including this review paper written this year that, “Tocotrienols modulate a life or death decision in cancer.” Talking about Tocotrienols having anticancer effects against bladder, brain, breast, cervical, colon, gastric, leukemia, lung, ovarian, pancreatic, prostate and skin cancer.  It’s amazing.

Dr. Tan:                I know.  When people first read something like that, the first blush is it just sound like snake oil. Now, when you read all of those things there, there were actually studies done on it.  If you were to type Tocotrienol on animal and cell lines study on those, I’m going to guess they’re probably 300 to 400 papers; lots of them. So we were among the first to decide if it worked in cell line and animal study, we should be all in to do clinical trials.  Currently, we have six clinical trials on cancer study.  One of them is published on it.  And the cancers we study on human trials are ovarian, breast, lung, and colon cancer.  And my colleagues are doing it on pancreatic cancer.

                            And so if you like I can tell you the ovarian cancer that was published. So we have two groups. One group is stage four cancer, which means that the cancer have gone everywhere, and within six months or so, most of the patient did not survive, and they’re taking the very expensive drug called Avastin. What Avastin does is anti-angiogenic; it prevents the artery from the tumor, it chop off like that. But even so, most of it did not live much more than six months. And then the other group is on Avastin plus Tocotrienol. Then their survival doubled to 12 months. And even at 24 months, 25% of the patients were still living. We consider that remarkable for a simple nutritional supplement.

Dr. Weitz:            Yeah. No, it’s amazing. Now what about if patients are taking traditional chemo?  It’s generally thought that taking high dosages of antioxidants can prevent the effectiveness of chemo and radiation since… maybe not targeted drugs like Avastin, but the traditional chemo drugs work by using free radical reactions to kill cancer cells.

Dr. Tan:                Yeah. This is a particular fixation about cancer doctors in the US. I asked professor Jacobson in Denmark, where all our trials were done. He said that they don’t have that as a problem.  When a chemo drug works to stifle the ability of the cancer to cell signaling or killing the cell directly, it may or may work to end any antioxidant capability.  At the place where Tocotrienol will work to kill the cancer is largely not as an anticancer, is anti-angiogenic, not necessarily antioxidant. It actually turn the signal of the cancer to multiply itself, turn the cancer on to make it die itself. You see it work on other operative besides antioxidant. So to the best of my knowledge, when Tocotrienol has been used in adjunct with chemo drug or without, sometime they compare neck to neck but not in adjunct. And oftentimes, the Tocotrienol work same as the chemo or better. In the pancreatic cancer is one. In the Tamoxifen, it did not antagonize the Tamoxifen in breast cancer. But if you use alpha tocopherol, the tocopherol would antagonize a function of Tamoxifen.

Dr. Weitz:            Interesting. Interesting. Yeah. I know one prominent integrative oncologist talks about the fact that people are sometimes worried about taking 500 milligrams of vitamin C, which has a very modest antioxidant properties, and then encourage everybody to eat fruits and vegetables, and a cup of blueberries has like five, 10,000 times the antioxidant properties of a vitamin C tablet. So how can it be that eating fruits and vegetables enhances your ability to fight cancer potentially whereas a vitamin C tablet is going to prevent it?

Dr. Tan:                Yeah. I don’t know who started this idea that if you take antioxidant it will counter the effect of cancer. I actually have read the opposite. If you go to the study of professor Drisko, Jeanne Drisko from University of Missouri, Kansas City. She came up with a cocktail of antioxidant for women cancer survival, and then they’re able to have better quality of life. So I’ve seen that more than that it hurts.

                                If a cancer drug work as a pro-oxidant to kill the cancer just like that, I believe that that will be too simplistic. If it is like that. If you look at most cancer drugs, they are very toxic to the patient. So if it really worked, it worked to kill the cancer and probably also slowly kill the patient themselves. This antioxidant and oxidant thing is too simplistic. It works on other direct mechanism to go after the tumor. But with Tocotrienol in animal study and in humans study, we have done it now over two years, we systematically do not find negative effects of Tocotrienol on the patient, whether they are cancer study or non cancer study.

Dr. Weitz:            Interesting. I also saw several papers on tocotrienols improving bone health in postmenopausal women. Can you talk about that?

Dr. Tan:                Yes. Bone health. We started a trial after we had many animal studies in Texas Tech university at Lubbock. So at the Lubbock Texas study, we did the osteopenia trial. We gave the women one year, but not more than 10 years after menopause. So we don’t want them to be in the period where they’re osteoporotic.  Only in the osteopenic stage. So we noticed that after three months, the bone turn over, which means the building of the bone, increased by 100% or more. And the bone resorption, the indicators show drop by 15% or more. That resorption, the breakdown of the bone.

                                And then during this stage where oxidative stress is also increased, and the oxidative stress is reduced by 48%, almost 50%. So we considered the [inaudible 00:22:08] combo is fantastic. Now this is unique of Tocotrienol. Why? Because people who know about bone health usually think about calcium, they take above vitamin D and more recently they think about vitamin K2. But we’ve shown that in Tocotrienol, this unique vitamin E is able to do what I just told. And that was published last year. So that’s the bone study.

Dr. Weitz:            Interesting. Can you explain what the mechanism by which it improves bone health?

Dr. Tan:                Okay. I’ll do it based on this. Calcium is a constituent inside the bone. So that’s why we take calcium. Vitamin D is a chaperone that helps the calcium to get into the bone. And hence vitamin D. Vitamin K2 is to form the [osteoclasin 00:23:05], the protein inside the bone. It’s like a protein lettuce to trap the calcium in its place. So I told you all the other one. But with Tocotrienol, Tocotrienol actually increase the bone building, the osteoblast, and decrease the bone breakdown [osteoclad 00:23:28]. So it’s actually work on the bone cells itself. So in that way, the workings of Tocotrienol differentiate from the other three things that I mentioned to you.

Dr. Weitz:            Interesting. Do you have any idea of what [inaudible 00:23:43] what percentage change it would be in bone?

Dr. Tan:                The study that we currently had done is only for three months. It’s too early to tell [inaudible 00:23:55] a test to work. So we only see the biomarkers. The increase of the bone building and a decrease of the bone breakdown. So all together it would resist bone loss over time during the osteopenic stage before they get to osteoporosis.

Dr. Weitz:            Wait, but that’s amazing if it increases the osteoblastic activity because currently the drugs that are typically used for osteoporosis are drugs that block the osteoclastic activity. And so there’s a tendency to have some problems down the line because you get more bone but you tend to get more junky bone. We need those osteoclastic cells to clear out the old junky bone. And so the key is really to prevent that stronger bone to prevent fractures, not simply a more bone.

Dr. Tan:                Yeah. That comment you make is very interesting Dr. Weitz because when the people use this bisphosphonate drug to make this junkie bones like that on the bone-

Dr. Weitz:            These are drugs like Fosamax, for example and [crosstalk 00:25:01]

Dr. Tan:                Yeah. Now when they use this way, they have a very unusual side effect, the junkie bone, it cause the osteonecrosis of the jaw. It’s got B-R-O-N-J like that. We are actually working with a compound, another time you can interview me on this, it’s called [inaudible 00:25:21], designed for health cell. Just started the launches. I [acronyze 00:25:24] it to [GIGI 00:25:25]. And GIGI will stop the breakdown off the osteonecrosis of the jaw caused by bisphosphonate drugs. Isn’t that amazing?

Dr. Weitz:            Really?

Dr. Tan:                Yeah. And after the interview is over, I’ll be happy to send you some study and also if the audience are interested, I will be able to do that. But for this [osteop 00:25:49], for bone health, we have so far been able to study on a clinical trial on osteopenia like I described. And then we also did an animal study and I thought that your audience will be interested because you are a chiropractor by background. We also studied this osteoarthritis, and we found out that in animals study, in two study where we gave them Delta Tocotrienol, it improved the CV ionic fluid, and then the cartilage repair, which is a very specific part of the bone as opposed to the solid bone here, but is the bone at the joint. And also reduce the inflammation. So I know that you didn’t ask me, so while I add it, it’s only an animal study. It reduces CV ionic hyperplasia. It’s making junky bone. It reduce that. It reduce the inflammation of the cell at the joint, and finally it reduce the cartilage erosion, approximately 200% or so.

Dr. Weitz:            200%. Wow.

Dr. Tan:                Yes. We’ll be happy. One of them is published last month. The other one is published about 10 years ago.

Dr. Weitz:            Wow. Amazing. You just mentioned that tocotrienols have an antiinflammatory effect, and we think of them, we think of vitamin E or tocotrienols as an antioxidant, but it also has an anti-inflammatory effect.

Dr. Tan:                Yes. And the way we tested that was when this doctor from Wisconsin found out that we figured out how to extract this from annatto. Annatto is a unique plan because when you think of the plant kingdom, most of them have tocopherol.

Dr. Weitz:            And that’s the plant in the picture behind you?

Dr. Tan:                Yes. That’s the plant in the picture. And this is not a weird plan. We used the annatto here for coloring cheese. If you look at cheese, they say, Annatto color. So we remove the color from the cheese here and then you have the [Toco 00:27:49]. The Tocotrienol made by the plant to protect the color that is put in the cheese like that. So basically that is what the plant use it for. So when he found out-

Dr. Weitz:            So the plant is using the tocotrienols to protect the carotenoids that are in the plant.

Dr. Tan:                That is correct. And it was intuitively, I found out, because if you touch the plant, it stains your hand. So usually carotenoids are bound to something, like the beta-carotene in carrot, lycopene in tomato, otherwise they’re terribly unstable like the foliage color; two weeks of fantastic splendor and then it turns brown. It’s not stable at all. But this color here-

Dr. Weitz:            It turns brown because it gets oxidized.

Dr. Tan:                Yes, rapidly oxidized. So in this plant here, the color does not go away fast. So this is about 22 years ago when I stumbled on this plant. I surmised that it’s got to be a powerful antioxidant that protected. And fortunately, thank goodness, thank God that I discovered, they are 50 million chemicals on earth, how would I have guessed? And when I did this, I thought it was a polyphenol. I wasn’t thinking it was a Tocotrienol, vitamin E, much less Tocotrienol.  And then when I found out and analyzed it’s Tocotrienol, no tocopherol, remember most plan have tocopherol. Some plant like rice and Palm have a mixture of tocopherol and Tocotrienol. The annatto plant consisted purely of Tocotrienol. So therefore Dr. [Koresh 00:29:28], who did this study, he said, “Barrie, I’m going to test this and see if it reduces cholesterol.” He did. So I told him that the Harvard Medical school study found out that half the problem with arteriosclerosis is high cholesterol, the other half is inflammation. Can you please do inflammation study for us, which is the question you add. So when the study completed, a lower triglyceride, lower cholesterol, about 15 to 20% like I indicated to you.  And then he also measured the inflammation. So surprisingly, The C reactive protein drop approximately 30%. I say yes. So it addresses the lipid as well as the inflammation. So yes. To answer your question, Tocotrienol clearly quenched the fire in our body.

Dr. Weitz:            Wow. So we can measure oxidized LDL on advanced lipid profile, and so we can use Tocotrienols to lower that oxidized LDL.

Dr. Tan:                Yes, we can. And other people have shown that if you use Tocotrienol, it will reduce the oxidized LDL because people said that LDL is potentially atherogenic, oxidized LDL is definitely atherogenic. So if there’s any way that you can protect, if you happen to have high LDL, if you have a compound that can protect this oxidation, is a good thing.

Dr. Weitz:            Awesome. And I understand it can also be beneficial. There’s a liver condition that is much more prevalent than people realize. It’s generally ignored, but doctors and researchers who are experts on liver disease believe that this condition is going to result in as tsunami of people needing liver transplants in the next decade or two. And it’s nonalcoholic fatty liver disease.

Dr. Tan:                Yes.

Dr. Weitz:            This is very common now in our population, maybe as many as 100 million people in the United States may have this, and it’s part of the obesity epidemic. I understand tocotrienols can have some benefit with nonalcoholic fatty liver disease.

Dr. Tan:                Thank you Dr. Weitz for asking this question. Currently, the reason I got into this was other people who have been studying animal study, and even the clinical trials surmising that this would work. And we already know that Tocotrienol work on metabolic syndrome, diabetes and obesity, and this kind of thing overlap each other. And then the silent group is fatty liver because you don’t feel anything. The liver is the largest solid organ. It performs 600 different function. It’s got so many function.

                                So if the liver failed to function properly, is a bad news. 20 more years ago, this kind of liver condition is caused by excess amount of alcohol drinking. Mayo clinic discovered it. So they had a patient coming in the doctor surmised that the patient is probably drinking too much alcohol because the liver was fatty. The patient said no. So when they found out that… So because it was not alcohol-related, that’s why they called the disease non-alcohol fatty liver disease, and it’s a dietary thing because the fat back flush into the liver and can go out anywhere.

                                So we knew this. So we did a study and is this fantastic. The study, we gave people 600 milligram per day of annatto Tocotrienol. We found that the liver enzyme dropped about 15, 20%, the fatty liver index dropped, the C-reactive protein dropped, which is a very good… By the way, C-reactive protein is manufactured in the liver. So it’s a stress protein from the liver, usually is a marker for all inflammation, but for me, is a particular marker for the inflammation of the liver and also drop.

                                So we did a study, 600 milligram for three months. We now just completed a study still at 600 milligram for six months, and a dramatic effect on these people is that at the three months, they dropped 10 pounds. Normally I do not subscribe that Tocotrienol help people to lose weight. It’s not lose weight. But after three months, it dropped 10 pounds, and after six months, it dropped almost 20 pound, like 18 pounds. Dr. Weitz, this is very important because if their weight drop, that means that their liver is recalibrating their body. Their enzymes in the liver drop, the weight drop, the C-reactive protein drop, and the fatty liver index drop. I don’t know what’s there not to like. This is fantastic. Right now there’s no cure for this.

Dr. Weitz:            Do you know how amazing it is to have a product that would cause 18 pounds of weight loss? We have debates in the nutrition world about which diet to use for weight loss, and one diet ends up producing two and a half pounds of weight loss and that’s considered a success over a period of months. But 18 pounds of weight loss, that’s like unbelievable.

Dr. Tan:                Yeah. I think that probably in the next three months or so, the six months study will be published for the almost-

Dr. Weitz:            What is this? Kill their appetite or something?

Dr. Tan:                The control group and the normal group were asked to do exercise, eat a normal diet like that, but they’re not on a regiment diet, just have a healthy diet. So we know that it is compared correctly. I would say that this is really quite something. If the audience want to address fatty liver, this would be a good way to reduce the inflammation. Silence the enzyme that is highly inflamed. And in fact, we also check the glucose level, is it called [homer scale 00:35:34], it’s a homeostatic something of the glucose function. It’s an American Diabetes Association measurement. Even the Homer drop.

                                I am really thrilled about this, and looking much forward to the published study enable to recommend people who have fatty liver to do this, at least to control and contain for the damage to the liver, which is otherwise not good, and enable to help to reverse it possibly.

Dr. Weitz:            So let’s talk about dosages. You mentioned 600 milligrams for fatty liver. What about for reducing cholesterol and triglycerides? What kind of dosage should we use optimally?

Dr. Tan:                Probably about half that amount. Depending on a person’s weight, two to 300 milligram would suffice. And then fatty liver because a person is already gone that direction on fatty liver, 600 milligram. Many of our clinical study on cancer, they use 900 milligram. But now in the newest study it looked like if they are not end stage cancer, if they’re stage two or three, probably half the dosage will be enough. Four to 500 milligrams. So the extreme thing, 900 milligram, but the one, the [Frank 00:36:54] disease, then probably about midway about 500 or five, 600 milligram. And of people who just have normal lipidemia or have a family history of this but don’t have the disease themselves, probably half that again, from two to 300 milligrams.

                                And remember, when you take them, it’s a lipid soluble thing. You don’t need to make it any [inaudible 00:37:16] or other thing, just take it with a meal. There’s enough emulsification in the stomach, bowel sock in the gut, and that should be able to emulsify to absorb the Tocotrienol.

Dr. Weitz:            Okay. I was reading one of the papers on cancer and they did say that there’s an issue with bioavailability.

Dr. Tan:                Yeah, the bioavailability on-

Dr. Weitz:            That 2019 Tocotrienols modulate a life or death decision in cancer. That author talked about the bioavailability.

Dr. Tan:                Yes. They raised that as a question because in the cancer study, you may need highest dose, like it’s 900 milligram like that. Where it is not advisable, would be to take all the 900 milligram at one shot. So it should be taken 300 milligram with breakfast, lunch and dinner. So it’s T-I-D. So if you take a 600 milligram, take it 300 milligram, they call it B-I-D, which means take two doses with lunch and dinner or breakfast and lunch.  In other words, at one single dose, it should be up to 300 milligram but not more. So if you wanted to take 250 milligram, is fine. And precisely because of that, Designed for Health, for example, sells it 115 milligram and a 300 milligram. So you can go online, they have it. And you can also buy it from Amazon as well.

Dr. Weitz:            What about for cardiovascular disease?

Dr. Tan:                Cardiovascular disease. The study that we did was at 250 milligram, between 200 and 300. So at the time we make the soft gel 125 milligram. We gave to patient 125, they take two soft gel, 250, three for 375, and four for 500. So when we dose escalate, we find out that 250 hit the number. And if you want to reduce inflammation, maybe 500 milligram, otherwise if to just to reduce lipid, 250 milligram would be fine.

Dr. Weitz:            So if you’re going to take it for cardiovascular, you would do the 250, and you would do that once a day and preferably when you take your fish oil or if you’re using red yeast rice or a statin, take it with that?

Dr. Tan:                Yeah. You take it with that and take them with a meal. The statin drug, you can take it with or without a meal. The fish oil oftentimes is taken because fish oil is a lipid. So if you take it with fish oil, with a meal… When I say with a meal, and sometime people are religion, I just mean that one hour before a meal, up to two hours after a meal. Why do I say that? If you take it one hour before a meal, when you eat the meal an hour later, you masticate with the meal will be fine. And why you can take it two hours? Because as you eat food, the food is not going to get out of your stomach for at least two hours. So when I say with a meal, I mean one hour before, up to two hours after, not religiously must be, I eat the food, now I got to take it now. People ask me like that’s so [crosstalk 00:40:33]-

Dr. Weitz:            No, no. It’s good to clarify that because some patients are trying really hard to follow the directions exactly, and they’ll agonize if they’re told to take it with the meal and they take it right after the meal or… So what you’re saying is it takes a long time for the fruit to get digested, as long as it’s somewhere around the time of the meal. That’s fine.

Dr. Tan:                That’s fine. Yeah.

Dr. Weitz:            I know you have a small book for consumers, The Truth About vitamin E, and you also have a textbook, right? That’s available as well.

Dr. Tan:                Yeah.

Dr. Weitz:            Can you ask about those?

Dr. Tan:                I’m going to show you. This is a picture of the book here, like that. The Truth About Vitamin E. And it’s a short book. It’s only about 70, 80 pages long. So if you wanted to have a copy of this book here, you can go on barrietan.com, and my name is spelled B-A-R-R-I-E.com. And then if you put the code word, wellness, because we are on your program here, wellness, and then you can download an electronic copy.

                                So if you wish to have a hot copy, you can email me through that. Otherwise, if you want it faster, you get download and it’s free, and then you can see a lot more study and a lot more things that we discussed here; dosage, [inaudible 00:41:59] and then what is useful for what area. It should be in there. So I did that as a public service, as a love for this, that I spent almost my whole life studying this, to let people know today of that special vitamin E. That’s why I say the truth about vitamin E is actually Tocotrienol, not tocopherol. There are just too many problems with tocopherol to find that is any use. That even if you use it, you have to tiptoe around all the benefit because of the potential negative benefit. So I decided that I’m done with tocopherol.

Dr. Weitz:            And what about you have a textbook also?

Dr. Tan:                Oh yeah. A textbook. Yes.

Dr. Weitz:            And this is something more for clinicians who might be interested in delving deep into some of the detailed scientific information about Tocotrienols

Dr. Tan:                Yes. How about while Kim is getting me the textbook for me to show, I know that as a remark that I want to make just in case we didn’t cover it. Currently, we are continuing our study more overweight and obese people, they’re 60, 70 years old, because carrying a lot of heavy fat is not good. They’re healthy. So keep watch, in another year we’ll know that study like that. And another note that you may or may not ask, we also noticed that when you add Tocotrienol, it help… When you address cancer, 1% of cancer is called cancer STEM cell. These are rogue cancer cell that circulate in our body. We now have scientific proof that Tocotrienol actually even nail the cancer STEM cell. We have shown it on prostate cancer, breast cancer, pancreatic cancer, and skin cancer. Can you imagine that? Even if you nail the cancer, the rogue cell will go on. So we even nail after that. I am so surreal about that.

                                So for no other reason, for prevention reason, we should be taking… because in our body, even if we don’t have [Frank 00:44:18] cancer, we have cancer, rogue cancer cell floating around to do this. So to answer your question, for the scientists, this is a book that I added here and I’m the main editor here. So this is called Tocotrienol, Vitamin E beyond Tocopherol. And a picture of annatto here. This a summary of all the different professors and scientists on the research work.

                                So this clearly is not something I say. I’m just a mouth piece to tell other people, yes, we helped to conduct some studies ourselves, but there are other researchers, they have published the whatever they find is important, and if it didn’t work, they will say so, if it works, they will say so. So it’s not so much that I’m controlling, and there’s no such thing. The only thing that I have is I’ll say this, I have faith in knowing that this particular vitamin E is unique. Very few vitamin have such credential to actually intervene disease, but Tocotrienol does.

Dr. Weitz:            Yeah. I’m completely amazed and definitely immediately going to add it to my anti-aging regimen. And those are my patients who want to be on an anti-aging regimen as well.

Dr. Tan:                Well, thank you, Dr. Weitz. I’m thrilled about days that you asked me for this interview. Hopefully within a year, we… This by the way, this one here was the second symposium. It was a summary of the… When we have a conference like that, hopefully next year or the year after, we’re going to have the third international symposium, and then we’ll invite all the scientists and researchers and medical doctors of the world to come in. And then would disclose what new findings are on this.  So watch for new things to come. And then as I wrap up, I’m very passionate about this, related to Tocotrienol is a compound, which I mentioned in the program earlier called [inaudible 00:46:23]. Now I know it’s a mouthful of a word. And you simply can acronyze it to GIGI. GIGI is an endogenous nutrient in a human body, which means our human body makes it. To get your attention, you can Google [inaudible 00:46:40], GIGI is required for the synthesis of CoQ10. And everybody knows CoQ10. GIGI is required for the synthesis of vitamin K2.

                                You talk about vitamin K2 fermentation, is required for the synthesis of vitamin K2. And also required for the synthesis of heme in our body, because it’s endogenous. Can you imagine what it means if you don’t have GIGI. And the most important thing I consider, GIGI is required in the synthesis of protein. That is why the reason when we take statin drug to lower cholesterol, it inhibit GIGI. Most people don’t know that. Most people do know it inhibited CoQ10. And do you know why it inhibit CoQ10? Because it inhibit GIGI. And GIGI is required in the synthesis of CoQ10.  But if you take CoQ10, it cannot help you to solve that myopathy problem of statin. But if you take GIGI, GIGI will mitigate the problem of statin in myopathy. Get me to about GIGI another day. That is so exciting. And by the way [crosstalk 00:47:57]-

Dr. Weitz:            [crosstalk 00:47:58] available, you said.

Dr. Tan:                Yeah. GIG is. The only company is available now is for design for health, and they have a white page. Dr. Weitz, please go on the white page like that or you can even interview Dr. David Brady. He’s the chief medical officer there, or if not, if you bring me on again, I would love to do this, and be among the very first to do that. I will love to talk to you about that. It was so exciting. [inaudible 00:48:24] and then when you do this like… let me tell you this, the entire molecule of GIGI is on Tocotrienol.

                                Now the human mammal don’t know how to do that. The plant can do that. Next time when you get me a talk, I’ll show a picture about the picture of Tocotrienol. The entire molecule of GIGI is on the Tocotrienol. So this is my fate. I’m meant [inaudible 00:48:50]. I noticed this fun thing, but I wanted to tell you, the audience, I did not make this up. I’m just fortunate to stumble on this Amazonian plant. And if there’s sheer, pure joy to pass to the consumer is to let them know that this is good for their health.

                                So Tocotrienol is good for all the reasons for the past hour we talk about, and GIGI is an endogenous nutrient. Without GIGI, we cannot describe life as we know it, and GIGI, as we grow older, GIGI drop. Actually the lowering of CoQ10 as we age is actually a biomarker of lowering of GIGI because GIGI is required for the synthesis of Q. Forget the statin thing, the statin thing only make the CoQ10 drop even more. But even if you don’t take statin, the lower CoQ10 with age is a maker for lowering endogenous GIGI.

                                I know I got carried away, but that is the very exciting thing. So I hope it’s useful to you all. Thank you so much for inviting me to talk.

Dr. Weitz:            And thank you so much Dr. Tan. I’m going to definitely hold you to that, getting you back on to talk about GIGI.

Dr. Tan:                Thank you so much, and you have a wonderful day. And thanks for the audience who listen to this talk. Have a great day.

Dr. Weitz:            Thank you for all you’ve given to the world for your discoveries on Tocotrienols and now GIGI.

Dr. Tan:                Thank you. Much obliged.




Inflammatory Bowel Disease with Dr. Ilana Gurevich: Rational Wellness Podcast 126

Dr. Ilana Gurevich discusses Inflammatory Bowel 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. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

3:25  When Dr. Gurevich sees a patient with extensive GI pain and there is no frank blood, then she starts to consider the possibility of Inflammatory Bowel Ddisease.  Other symptoms include anemia, nutritional deficiencies, thin, cachexic frame, and having many bowel movements with diarrhea and often containing blood, would all indicate inflammatory bowel disease like Crohn’s disease.  Dr. Gurevich pointed out that patients with Crohn’s disease are at risk for obstructions, which is basically an acute abdomen that can present suddenly with a 14 out of 10 pain and often requiring hospitalization and surgery.  She explained that 80% of all Crohn’s disease patients have some kind of terminal ileum involvement.  With Crohn’s disease you can get a shrinking or narrowing of the lumen and eventually that narrowing can become so small that it becomes completely obstructed.  Some Crohn’s patients are living with a partial obstruction where if they eat too much they can get into an acute flare of abdominal pain.  Such patients can also develop strictures, which are little pieces of narrowing or thinning of the intestinal lumen and that can also lead to an obstruction.  Such patients often require surgery eventually.

6:10  When Dr. Gurevich has a patient she suspects of having inflammatory bowel disease she will get a stool fecal calprotectin, which is a measure of white blood cells or neutrophils that are localized within the intestine. It is very predictive for ulcerative colitis–almost 98% predictive for ulcerative colitis, and it is somewhere between 30 and 90% predictive for Crohn’s disease.  Dr. Gurevich said that with fecal calprotectin, under 50 is negative. Between 50 and 120 is borderline and over 120 is positive.  Lactoferrin is another inflammatory marker that can be run as part of a stool test.  For Crohn’s disease, you can look at inflammatory markers in serum, like SED rate and HsCRP

9:39  Dr. Gurevich said that her other favorite test for monitoring patients with Crohn’s Disease is the Prometheus Labs Monitr Crohn’s Disease test that measure 13 biomarkers for mucosal healing status.  It is considered 92% specific and 98% sensitive for Crohn’s Disease.  Prometheus also offers the IBD sgi Diagnostic which differentiates Crohn’s from Ulcerative Colitis.  Dr. Gurevich also likes to run a GI Map stool test to look for protozoans, pathogenic bacteria, fungus, and parasites.  It also looks at inflammatory markers. Sometimes she will also look at food intolerances.

11:29  From a Functional Medicine perspective, we want to review their history in detail to find some of the underlying triggers, such as hormones, dysbiosis, stress, etc. 

12:41  A scarred or open iliocecal valve can increase the risk of SIBO in patients with IBD.  Dr. Gurevich will sometimes see patients having a flare and she will do a  SIBO breath test and discover that they have IBS/SIBO and after she treats the SIBO, their IBD improves.  She finds that a lot of her IBD patients end up with SIBO as well.  80% of Crohn’s patients have a some involvement of the terminal ileum and tend to get scarring or sclerosis of the terminal ileum and this often affects the ileocecal valve. This will lead to regurgitation of bacteria from the large intestine up into the small intestine leading to bacterial overgrowth leading to more inflammation.

17:17  Dr. Gurevich will sometimes use naturopathic manual techniques to close the ileocecal valve, though it doesn’t work well if there is scarring. For patients with strictures she often uses N-acetyl glucosamine because there was on study showing that it benefited such patients. She tends to use ozone for her inflammatory bowel disease patients.  The goal is treat these patients aggressively so they never develop the strictures, but sometimes once they do, surgery is often the only option.

21:02  Besides SIBO, other common co-infections in patients with Inflammatory Bowel Disease are parasites and protozoa. Protozoa are often labelled on stool panels as commensals [meaning good], but Dr. Gurevich does not believe that protozoa are commensal.  Helminth therapy could be effective in IBD, but it usually takes 6 months for it to be effective, according to Dr. Gurevich, so they will not help if the patient is having an acute flare.

22:38  When Inflammatory Bowel Disease patients are having an acute flare of their pain, Dr. Gurevich usually starts with diet. She likes to use the Specific Carbohydrate Diet, which is the most studied for IBD and it really meat heavy and excludes all grains and legumes, similar to paleo.  There is also a semi-vegetarian Crohn’s diet, which has no meat and is heavy on grains.  She will usually start with one of these two diets.  Dr. Gurevich finds that her most effective treatment modality is rectal ozone, which can get some amazing results.  When they are having an acute flare, they have so much reactive oxygen species, or O1s, and ozone is O3, which combines with all the O1s and renders them all into stable O2.  Rectal ozone is very uncomfortable because you are shoving a bunch of gas up them and they will likely feel bloated and crampy for the rest of the day and they may have really intense bowel movements.  But Dr. Gurevich said that she is able to get 70% of her IBD patients out of an acute flare up.  She does find Elemental diet can also be very helpful, though by day 7, it gets tough to stomach it.  L-Glutamine can also be very effective, but an effective dosage for an average 130 woman is about 27 gms per day–9 gms 3 times per day.  Saccharomyces boulardii probiotics have also been shown to be helpful.  For ulcerative colitis and especially for ulcerative proctitis, Dr. Gureviuch will use high dose vitamin E rectally.

29:38  Biologics are immunosuppressant drugs like Humira, Remicade, and Cimzia that block part of the immune system to reduce the immunological attack on the intestinal lining in Inflammatory Bowel Disease, like Crohn’s and Ulcerative Colitis.  These drugs are TNF alpha blockers. There are two new drugs, Intyvio and Stelara, that also block part of the immune system, but work via different mechanisms. Stelara blocks Interleukin 12 and Interluekin 23.  Dr. Gurevich said that while biologic drugs are not perfect drugs and can have serious side effects, if a patient is well controlled with their IBD while taking a biologic and does not have significant side effects, you should most likely not take the patient off the medication. If they have been taking a biologic and then stop it, the immune is more likely to form a reaction to the medication and if they go into another flare, then then they will no longer be able to take that drug or other drugs in that category.  Considering how severe Inflammatory Bowel Disease is, we should be very cautious to remove a medication that is working well. 

36:25   Dr. Gurevich may look for food sensitivites with the Carol Food Intolerance Test, which is an energetic based diet created by Dr. Carol in the 1920s and taught in some west coast Naturopathic schools. Dr. Gurevich has found this method of determining food sensitivities very helpful, though she admits there is little scientific validation of it. She finds standard IgG food sensitivity panels futile since virtually all of her patients have increased intestinal permeability.


Dr. Ilana Gurevich  is a board-certified naturopathic physician and acupuncturist and is currently co-owner of two large integrative medical clinics, one in northwest Portland and one in northeast Portland.  She runs a very busy private practice specializing in treating inflammatory bowel disease as well as IBS/SIBO and functional GI disorders.   She lectures extensively and teaches about both conventional and natural treatments for inflammatory bowel disease as well as SIBO.  She is one of the foremost experts on the intersection of IBD and IBS and how treating one resolves the other. She can be contacted through her website, naturopathicgastro.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 or go to www.drweitz.com.


Podcast Transcript

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. Pre-subscribe to Rational Wellness Podcast on iTunes and YouTube and sign up for my free e-book 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 Apple Podcasts and give us a ratings and review. That way, more people can find out about The Rational Wellness Podcast. Also, you can go to the YouTube page and there’s a video version there, and if you go to my website, drweitz.com, you can get complete show notes and full transcript.

Our topic for today is inflammatory bowel disorders, of which Crohn’s Disease and ulcerative colitis are the most common conditions. There are also a few less common inflammatory bowel conditions, including microscopic colitis, which can only be identified upon biopsy of the intestinal wall. Inflammatory bowel disease is characterized by chronic inflammation of the gastrointestinal tract that leads to damage to the mucosal lining of this digestive tract. Crohn’s disease can affect any part of the GI tract, including the mouth, esophagus, stomach and the anus, but it most often affects the portion of the small intestine closest to the large intestine and there tends to be patchy areas of damage and the damage may reach through multiple layers of the intestinal wall. Ulcerative colitis occurs only in the large intestine and the rectum. Damaged areas tend to be continuous and usually start in the rectum and spread into the colon and is usually present only in the innermost lining of the colon.

Symptoms of inflammatory bowel disorders include persistent diarrhea, abdominal pain and cramping, bloody stools, weight loss, fatigue, among others. Anemia and other nutritional deficiencies are common. The main stays of conventional medical treatment include immuno suppressive drugs like prednisone and biologics like Humira and Remicade and surgical resection in severe cases. Dr. Ilana Gurevich is a board certified naturopathic physician and acupuncturist and is currently co-owner of two large integrative medical clinics, one in northwest Portland and one in northeast Portland.  She runs a very busy private practice, specializing in treating inflammatory bowel disease as well as IBS, SIBO and functional GI disorders.  She lectures extensively and teaches about both conventional and natural treatments for inflammatory bowel disease as well as SIBO.  Dr. Gurevich, thank you so much for joining me.

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

Dr. Weitz:                          Excellent. When you get a patient in your office, what makes you suspect them as having inflammatory bowel disorder?

Dr. Gurevich:                     At this point, my practice is really, really specialized so I’m only seeing GI based disorders and there’s a certain subset of symptoms and when you rule out if they’re having frank blood, if they’re having extensive pain, if they’re having nutritional deficiencies, anemia is one of the most common things I see, if they’re cachexic, well below a normal healthy weight, then you’re always thinking inflammatory bowel disease. It can sometimes present with constipation but that’s much more rare and then the other things you’re generally looking at, with ulcerative colitis, you’re looking for bleeding. Ulcerative colitis patients have, depending on their severity, some are between five and 30 bowel movements a day, a lot of those bowel movements are just blood or blood and mucus. Crohn’s disease presents significantly more with pain, really intense acute abdominal pain, and Crohn’s disease patients are at risk for obstructions, which is basically an acute abdomen that can present really out of nowhere and all of a sudden they have 14 out of 10 pain and they have to be hospitalized and then they have to go in for emergency surgery to resect.

Dr. Weitz:                          What happens when they get that obstruction?

Dr. Gurevich:                     Generally speaking, the only way to get through out of a complete obstruction is to surgically remove that part of the obstruction. If it’s a harsh-

Dr. Weitz:                          What exactly’s happening anatomically in that case?

Dr. Gurevich:                     80% of all Crohn’s disease patients have some kind of terminal ileum involvement. The terminal ileum is the bottom of the intestine and the ileocecal valve is right there. That part can … Crohn’s disease, what happens with it, is you get this shrinking or narrowing of the lumen and eventually that narrowing gets so small that it’s completely obstructed. That then is the surgical emergency. There are lots of Crohn’s patients that are living with a partial obstruction, where all of a sudden they eat just a little bit too much or they eat something they’re not supposed to and they get into this acute abdominal pain, they start vomiting because you can’t push it through the intestinal tract so it comes back up and then it kind of passes and they slow down their eating and then they can kind of live this not very full life, where food is really well controlled or has to be really specifically controlled not to flare.

They can also develop strictures. Strictures are these little pieces of narrowing or thinning of the intestinal lumen and that also leads to an obstruction and a stricture … Where partial obstructions can sometimes be inflammatory tissue, it can also sometimes be scar tissue, and strictures are much more commonly to be scar tissue so biologic agents or steroids don’t always work to respond to these strictures to decrease the narrowing and so, for a lot of these patients, surgery is really … They’re just on a surgery track.

Dr. Weitz:                          Wow. How do you work these patients up?

Dr. Gurevich:                     The thing about inflammatory bowel disease is the GI’s a really, really complicated organ and it controls … We know that the majority of your neuro transmitters in your brain are actually made in your intestinal lumen, so hormones play a part. We know that if you have food poisoning, that actually upregulates your likelihood of developing inflammatory bowel disease. We know that if you take antibiotics, within six months you have a significantly higher likelihood of developing Crohn’s disease. We know that parasites and protozoa can trigger these kind of inflammatory responses. They can also sometimes be treatment for these inflammatory responses but sometimes they can trigger these diseases. Anything that you put into your GI track so pesticides, food coloring, preservatives, processed food that your body doesn’t react to, can cause this subacute or acute inflammatory reaction, which then puts them on a track for inflammatory bowel disease.  And the likelihood of developing inflammatory bowel disease is actually on the up.  We see an increase in Western cultures, we see a huge increase in cultures that never had inflammatory bowel disease that are taking up a Western diet and lifestyle, and then we see increasing amounts in just heavily medicated populations.

Dr. Weitz:                          Another aspect of the benefits of spreading American culture around the world.

Dr. Gurevich:                     Lucky us. Yep.

Dr. Weitz:                          What kind of testing do you do for these patients? Colonoscopy and endoscopy, of course, right?

Dr. Gurevich:                     That’s the gold standard. When a patient comes in to see me and if they haven’t been diagnosed, one of the first things I’ll do is a stool fecal calprotectin.  This is a stool collection that’s looking for the amount of white blood cells or neutrophils that are localized within the intestine. It is very, very, very predictive for ulcerative colitis, almost 98% predictive for ulcerative colitis. It is somewhere between 30 and 90% predictive for Crohn’s disease. I think that is partially because a lot of Crohn’s patients don’t have any disease in their large intestine, they’re really just localized to their small bowel or upper GI. Those patients are not going to be great testing subjects for calprotectin.  Lactoferrin is another test that we can do. For Crohn’s disease, you can look at inflammatory markers like a SED rate or a HsCRP, High Specific CRP, or also a regular CRP. The literature is a little bit mixed about which one is a better test for IBD. And then once you have a diagnosis, then-

Dr. Weitz:                          By the way, on a fecal calprotectin, what’s the cut off value?

Dr. Gurevich:                     50 or under is negative. If you’re between 50 and 120, you’re considered borderline, and then you’re supposed to retest in six weeks. If you’re over that, then you’re considered positive and depending on how high over that you are, that’s how significant the inflammation is, with the exception of ulcerative proctitis. Ulcerative proctitis is an ulcerative colitis that is only at the bottom part of the intestinal tract and those patients just have really, really high calprotectins because all of the white blood cells are right there. We’re collecting the stool that’s right there so you’ll often see the calprotectins for these patients in the thousands and that doesn’t necessarily talk about severity of their disease. It just talks about location and the fact that we can find them really easily.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     And then my other favorite test right now, actually for monitoring, for Crohn’s disease patients, is Prometheus Labs has recently come out with something called a Crohn’s monitor score, which is a blood test, which anybody who treats IBD … Patients complain about the fact that they have to collect their poop, which is gross, and then carry their poop in their purse, which is gross, to drop it off at the lab. This is a blood test, they don’t need fasting, it takes 13 separate bio markers and it’s actually considered … I think it’s 92% specific, 98% sensitive, for Crohn’s disease, which is … That’s better than a calprotectin.

Dr. Weitz:                          Yeah, cool.

Dr. Gurevich:                     Yeah and so that’s what I’ve been using now for monitoring.

Dr. Weitz:                          Prometheus Labs.

Dr. Gurevich:                     Mm-hmm. And they’re the ones … All IBD patients know them because they’re the ones who have the Crohn’s blood test to differentiate Crohn’s and ulcerative colitis. They’re also the ones that have the blood test that looks at biologic levels to see if you’re within ranges, if the drug is working effectively, and so they’re a standard lab and so that is generally my standard workup. My Functional Medicine or naturopathic workup includes stool testing for Protozoa and parasites. I’m using DNA stool testing now.  It’s stool testing for inflammatory markers in the small bowel.  Zonulin is one that I use a lot, even though I think literature’s a little bit mixed on it.  I’m also sometimes looking at food allergies and food intolerances, not always, but sometimes, and then … What else is my workup?

Dr. Weitz:                          For the stool test, I think I heard you say that you’re using GI Map now?

Dr. Gurevich:                     Mm-hmm, that’s my favorite right now. I think that the DNA PCR is like a game changer, actually.

Dr. Weitz:                          Right. Cool. How do you apply a functional medicine approach to these patients?

Dr. Gurevich:                     I think it all comes down to the history. These people, they were not born with inflammatory bowel disease, something happened to have them develop it, and so you’re kind of figuring out when they started feeling bad, how long they felt bad, how many workups did they go through, and then based on that, you’re coming up with, ‘Okay, I think that this is a really hormonally mediated inflammatory bowel disease.  We’re going to really focus on the hormones.’ Or, ‘Oh, this is a clear cut, you were over medicated, you took too many antibiotics.  This is clearly a microbiome disorder and so we have to focus on that.’  Or, a lot of patients, stress is one of the things that could definitely trigger one of these acute attacks and so how are they mitigating their stress? I have patients time and again who are so well controlled.  I’m running calprotectins on them every three months, I’m running Crohn’s monitor on them every three months, they’re so well controlled, and then all of a sudden a stressful event occurs and we lose control. Those people, we’re all talking about the lifestyle, are they getting counseling? How are they dealing with their stress triggers? And so, every patient’s kind of their own individual and you have to figure out why this person has inflammatory bowel disease.

Dr. Weitz:                          Right. I heard you speak with Dr. Narala Jacobi on her podcast last year and you mentioned that you will often see a scarred and/or open ileocecal valve and that this can play a role in increasing their symptoms by increasing the risk of SIBO in these patients. And I spoke to Dr. Pimentel a few months ago and he did not feel like the ileocecal valve plays much of a role in IBS patients. He really focuses on motility as the key cause of SIBO and when I was talking to him, he said that even patients who have had their ileocecal valve resected, removed, do not necessarily have SIBO as long as they have good intestinal motility.

Dr. Gurevich:                     I’ve spoken to Dr. Pimentel. I really respect the work that he did. I feel like if his theory on bacterial overgrowth holds true, it’s like a game changer. However, I feel like a lot of his research is really structured in the fact that he is trying to differentiate IBS from IBD. If you look at all of his stats and all of his slides, he’s basically like, ‘We see this in IBD people, we don’t see this in IBS people, but we see this in IBS people and we don’t see this in IBD people.’ And I have to tell you, from what I’ve read in the literature, I just don’t think that holds up.  I think that what I’m seeing now, … There was this one study in 2009 that really, really old study, before I think even Pimentel started teaching, I think he was publishing a little bit then, talks about how IBS is often one of these misunderlying causes of IBD and I see this all of the time, where you see these people and you’re like, “Okay, you’re clearly in a flare, you’re in a lot of pain, you’re having diarrhea. Let’s double your biologic. Let’s triple. Okay, let’s switch your biologics. Okay, let’s add a steroid. Let’s add Budesonide.” And they’re not getting any relief and then you figure out exactly … You work them up for IBS, you find the IBS, you treat the IBS-

Dr. Weitz:                          You do a breath test.

Dr. Gurevich:                     Exactly, you do a breath test. And you treat it and they completely go into remission. I have this one patient who completely changed my … I lecture about her all the time. She changed my entire trajectory of understanding Crohn’s disease. She came in, she saw me, she was 42 years old and she had a BMI of 16, she was completely ammenorrheic for over seven years because she was so cachexic. She had such terrible inflammation in the leg, she would wear stockings, compression stockings, to keep it in, and I just happened to sit through one of Allison Siebecker, the first lecture Allison ever gave, I just attended a conference, and I was like, “Okay, let’s work you up for this.” She had been in a constant flare for, I think, 13 years. She refused any medication. She was like health guru so refused any medications but could not get rid of her flare. She was getting transfusions, she was so anemic. She was getting transfusions every three to four months because she was bleeding so heavily with the Crohn’s disease. We treated her SIBO. She has been in remission for over six years. She had no ileocecal valve. I continue to treat her SIBO, she’s on rotating herbs on a regular basis. That is the main reason why she’s in remission. There is no way that you can pretend that IBS and IBD have nothing in common.

Dr. Weitz:                          Well, if you think about it, Dr. Pimentel’s idea that IBS is really an autoimmune disease actually fits nicely with this and makes it even more likely that IBS is related to IBD.

Dr. Gurevich:                     Totally, a thousand percent. Crohn’s patients, 80% of them have some kind of involvement in their terminal ileum, right? Which basically means, if you have scarring or sclerosis of that part of your intestine, motility is going to be affected. There is no way … Functionally, that ileocecal valve is supposed to be a one way, everything dumps, and back pressure has a close up. These people who have a scarred or inflamed terminal ileum and ileocecal valve, you’re getting a ton of regurge. That is a large bowel. Pimentel himself cites 10 to the third, bacteria in the small bowel tend to the twelfth bacteria in the large bowel. It is regurging right up into the small intestine and then it’s like the wise world west. There’s all of this room, everybody’s bringing their family, everybody’s reproducing. Of course, you get bacterial overgrowth and then that bacterial overgrowth, of course, causes inflammation within the lumen. Of course.

Dr. Weitz:                            Right. And I also heard you say that sometimes you use naturopathic manual therapy techniques.

Dr. Gurevich:                     That sometimes can be really, really helpful. I’d say less for inflammatory bowel disease patients because of the scarring. In the studies, there’s only one study, I feel like, and it is was a teeny tiny type study, that said that it can turn over strictures, which is using N-acetyl glucosamine. I don’t know if that’s played out for me in my clinical practice but I have that one study so I try it on all my stricture patients. I use a lot of ozone for my inflammatory bowel disease patients, which I think it’s the best treatment that I have. It’s very uncomfortable but it’s a really effective treatment but even that sometimes [inaudible 00:18:07] the strictures. But you know, I think the goal is treat them aggressively so they never develop the strictures but sometimes once they do, surgery’s the only option.

Dr. Weitz:                            What about those techniques for using manual massage type techniques for breaking up scars in intestines?

Dr. Gurevich:                     The clear passage stuff, is that what you’re thinking about?

Dr. Weitz:                            Yeah.

Dr. Gurevich:                     They work on … And I center them a lot. They are incredible at adhesions. Scar tissue that forms from the outside. They do not have … I think, they themselves, will not say, and I personally have not seen them do great with strictures and I think it’s just different mechanism of action. A stricture, it’s inside the lumen, and so you have more localized … There’s more of an inflammatory cascade there and so, because of that, using manual therapy to break up adhesions is not going to work because that’s not the underlying cause.

Dr. Weitz:                            Right.

Dr. Gurevich:                     But I will say, one of the things that I do have my patients do all of the time, post surgery, is go to Clear Passage to get the adhesion worked on because the adhesions predisposed to a second surgery for a different underlying cause. And so, inflammatory bowel disease patients will constantly go … I think they have, on average, somewhere between two and five years before they’re expected to have a follow up surgery and so if you use the Clear Passage, Clear Passage does have the studies to show that their manual work decreases the likelihood of repeat surgeries because they’re cleaning up the adhesions.


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Dr. Weitz:                        Besides SIBO, what are the most common co-infections that you’ll see with your IBD patients?  I saw an article by Jill Carnahan, where she talked about parasites, Candida, and also Epstein Bar virus.

Dr. Gurevich:                   I definitely see parasites and protozoa but parasites are definitive as bad, protozoa is often labeled as commensal. I really can’t believe that. As a rule, I think that protozoa should not be within the system and there was a really interesting IBS study in 2014 that looked at protozoa being the underlying cause for a lot of IBS like symptoms.

Dr. Weitz:                         Well, there are some people claiming that parasites should be part of our system too and even using worm therapy.

Dr. Gurevich:                    I actually, and I mentioned that earlier, helminths are really interesting. The problem with helminths in IBD is it takes six months for them to become effective.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     And so, if they’re in the middle of a flare, you’ve got six months and the likelihood that you can make it through six months without a, obstructing, and b, ending up on some kind of immunosuppressive modality, you would have to have a willpower of like a bull to be able to make it through. But helminths are really, really interesting and protozoa, I don’t think I would use parasites as. I think there are good worms, I think there are bad worms. I think good worms don’t reproduce within us, we can help them shift the microbiome and the environment, bad worms reproduce very aggressively and invitably will cause obstructions.

Dr. Weitz:                            Right, okay. What are your favorite options for when patients have acute flares?

Dr. Gurevich:                     Diet is always key for what I do. If they’re willing to do a specific carbohydrate diet, I think that’s the best studied. There’s also this other diet called semi-vegetarian Crohn’s diet, which is basically exactly the opposite of SCD. SCD is really meat heavy, very paleo, no grains. The semi-vegetarian Crohn’s diet is like a macrobiotic, really grain heavy, no meat like diets. That one’s been studied, I think, mainly in Korea. If they are willing to give me a diet, I want them to give me a diet. At this point, in my practice, ozone is my go to. ozone, rectally, is amazing. It’s super uncomfortable. The theory of ozone, the reason why I find it so effective … Or what I do in my practice is I’ll start by either running a Crohn’s monitor or a calprotectin before we start any kind of treatment because I want a baseline and then as soon as we get that result, we’ll start treatment.

When I start with ozone, you take oxygen through an oxygen tank and you put it through an ozone generator and it uses electricity to break up those very stable bonds and so what happens with those bonds is, we know about 20% of them reform in the ozone or O3, which is super, super, super unstable. In fact, if you leave that ozone in a bag, at the end of 30 minutes, it’s going to be all oxygen because all of those third electrons are going to find each other. If you administer it rectally, what happens is because they’re in an acute flare, they’re having all this chronic inflammatory cascade and so what’s happening is they have all these reactive oxygen species, or O1s, that are just looking to unbreak their bonds and that’s causing the inflammation. If you insulffate rectally ozone, that O3 finds those reactive oxygen species and, just like that, immediately it’s an anti-inflammatory. It works really, really quickly, it is very, very safe. However, it is so uncomfortable. It’s really a borderline torture. Maybe that’s extreme.

The large intestine, it’s supposed to squeeze and push things out and I am having them put in 750 ccs of gas up and so what they get is bloating, obviously, cramping. Oftentimes, they’ll have intense bowel movements because the large intestine is getting the receptor, the information, to stretch, which is making it purge. It will, at 750 ccs, which is what I use for Crohn’s patients, they are burping up ozone. It is literally going up their entire GI system, which means for the rest of that day, they are feeling gassy, bloated, distended, crampy. It’s not comfortable. I don’t use this treatment for my IBS people but IBD, if I can give them this ozone, which we know, rectally, is 100% safe, and we know that because they recently did an animal study, not a human study, but an animal study. If I can give them that instead of a steroid or a biologic, for me it’s a no brainer. And it doesn’t work across the board but I’m going to say 70% of my population, I can get into a remission with it.

Dr. Weitz:                          What about elemental diet?

Dr. Gurevich:                     Elemental diet, it’s always a trick for me, what is more torturous? Putting a bunch of gas up your butt and getting bloated and distended or drinking … This drink tastes great, day one, minute one. Day seven, minute God knows what, it’s borderline torture. But if they’re not willing to do the gas, I’ll totally go elemental diet. Glutamine has the potential to be really, really effective. The dosage for glutamine is about 27 grams. That’s nine grams, three times a day, for somebody who’s my build. That’s a really high dose. Glutamine does not dissolve really well in water, it doesn’t taste bad, but some people consider that torture, some people get really good efficacy from it.  Saccharomyces boulardii has really good potential to get people into remission.  For ulcerative colitis, there’s lots of good studies on the mixed probiotics. They used to study VSL3.  Now that product is re marketed as vis biome, but that is another really … For UC, that’s something that I always try. Vitamin E. Vitamin E, rectally.

Dr. Weitz:                          Really? Interesting.

Dr. Gurevich:                     And they have studies on it actually. For ulcerative proctitis, vitamin E is generally … Also, for ulcerative proctitis patients, I’ll start there. Basically, you use Now brand has this 54,600 IU per dose of vitamin E. It’s got no fillers, no carrier oils, it’s a-

Dr. Weitz:                          Are you talking about D Alpha or mixed tocopherols?

Dr. Gurevich:                     I think it’s DL, I think.

Dr. Weitz:                          D Alpha? Okay.

Dr. Gurevich:                     Yeah. It’s definitely rectally at that time, like a retention enema, about csc.

Dr. Weitz:                          Oh, so it comes in an enema or it-

Dr. Gurevich:                     No, it comes in … It’s like $15 a bottle. It just comes as-

Dr. Weitz:                          So, liquid, okay.

Dr. Gurevich:                     Yeah, and you give patients syringes and if they want rectal catheters, I can give them that too. But that’s where I’ll usually start with ulcerative proctitis patients, if I work them up and it looks like they have a microbiome inflammatory based ulcerative proctitis.

Dr. Weitz:                          What about curcumin, which is the original TNF alpha blocker?

Dr. Gurevich:                     I’m using turmeric instead of curcumin, mainly because I … Did you read that study? It was actually done with the … It was this Indian PhD, who was the guy who originally did all the curcumin research. He turned around and he repeated his research like 20 years later, using curcumin-free turmeric because in India, the turmeric market got so large.  So India was sitting with all of this curcumin-free turmeric.

Dr. Weitz:                          What to do with it?

Dr. Gurevich:                     Totally and he was like, “Let me study it.” And it was as efficacious and it’s cheaper. Yes, I totally use turmeric. I use turmeric more. Ill use it sometimes acutely. I’d never seen it, alone, get somebody out of a flare but I’ll use it as my, “This is what you’re on indefinitely until you don’t flare again”, protocol.

Dr. Weitz:                          Right. I’m seeing mastic gum and then there’s this herb that I’ve seen mentioned called Thunder God Vine.

Dr. Gurevich:                     I’ve never heard of that. There is a really interesting study on wormwood, artemesia on about keeping IBD … I have a couple of bad track records with using artemisia and getting really high LFTs, which once you discontinue, the liver function has to resolve. I’m a little bit wary.

Dr. Weitz:                          Okay. Can you talk about the use of biologics and some of the risks associated with taking them and coming off them?

Dr. Gurevich:                     Yes. Actually, I feel like this is a little bit of my soap box. Biologics are really serious medications. They are immuno suppressants so they really dull the immune system, dulling the immune system then theoretically dulls the response of the neutrophils and lymphocytes that are attacking the lumen of the patients and actually, the way that helminths work, is by giving the immune system something else to attack so that it’s not attacking itself.

Dr. Weitz:                          Right.

Dr. Gurevich:                     Biologics, especially with peds, but even with adults, I’m very slow to start somebody on a biologic. I’m fortunate enough to live and work in Portland, Oregon, where I have a good gastro group that I refer to, that refers to me, and so they feel a little bit sometimes more comfortable holding off on the biologics. Some patients find because maybe they don’t want to be on biologics. They have a lot of serious side effects, about one in a thousand people will end up with some kind of lymphoma or cancer, higher likelihood of infections and sometimes they don’t work. However, and this is where my soapbox kicks in-

Dr. Weitz:                          And as we can see, biologics basically are blocking part of the immune system.

Dr. Gurevich:                     And in the past, with Crohn’s disease patients,-

Dr. Weitz:                          And we’re talking about drugs like Humira and Remicade and there was a whole series of-

Dr. Gurevich:                     Humira, Remicade and Cimzia are all TNF alpha inhibitors, so that’s where curcumin works on that. There’s two new ones that are out, which is Intyvio and Stelara. Intyvio is large bowel only and Stelara just came out, it’s a new one for Crohn’s. They are all monoleukocyte inhibitors, I think, which is exciting because in the past, we had one mechanism of action. If you didn’t respond, you’re done. They would try you on those three drugs in that order and then you’re done. Now, we have these two other drugs. I think Intivio, 40% efficacy of bringing you into remission so not great stats but if it works, it works. But the most important things is these drugs are biologic mimickers, right?  They mimic the biology of the system, which means that, one, your immune system might form a reaction to them, and two, if you take them out of the system and the person goes into a flare, there is a significantly higher likelihood that when you put it back into the system, they’re going to form a reaction to that drug and then this really, really great tool that was working to keep the people out of a flare and keep them in a remission is no longer an option and a lot of the other drugs in the same class that are slightly different might also not be an option.

Dr. Gurevich:                     If a patient comes in, and is well controlled and doesn’t have side effects on a biologic, it’s not going to be my advice to get off the biologic.

Dr. Weitz:                          Yeah, I’ve had patients come in and every time they take their biologic, they got such a severe skin breakout and had to take prednisolone just to take the biologic.

Dr. Gurevich:                     Yeah, absolutely. By no means is a biologic a perfect treatment for inflammatory bowel disease but if it is a perfect treatment and you’re in a total remission, I’m hard pressed to say, “You need to come off this biologic.” I am going to give you everything we can to decrease likelihood of developing a lot of these lymphomas, other ways to mitigate the immune system, get them on a clean diet, try to clean up their exposures and do everything else in my field of ability but I am going to be hard pressed to say, “God, you have been controlled, why would I stop that?” Because this disease is terrible.

Dr. Weitz:                          So, why is it that they’re more likely to react to the biologic if they stop it and bring it back?

Dr. Gurevich:                     Because now the immune system, which was suppressed, is unsuppressed and so revving and as the biologic is fading out of their system, the immune system can tack onto that protein and then up regulate the immune response so when they see it again, they’re much more likely to form a reaction.

Dr. Weitz:                          I see. Interesting.

Dr. Gurevich:                     One of the ways that we use biologics, or the standard medical community uses biologics, is they’ll match it with immuno suppressants. Back when I was diagnosed 25 years ago, we had three drugs that I could choose from. We had Prednisolone, we had Mesalamine, and then we had 6MP, which is also called Imuran or Azathioprine.  They’re all the same drug class. The studies have proven out of the last 20 years that those drugs are actually not very effective for treating inflammatory bowel disease but what they will do is they will use combination therapy. They’ll start somebody on a biologic and then also start them on immunosuppressants to decrease the immune system even more from forming a reaction against the biologics.  Biologics are not good. Immuno suppressants are awful. Liver inflammation, liver swelling, infections, cancers, they’re awful, and so these patients will get started on double treatments and then nobody takes them off. And so, when I was putting together my very long presentation for Nirala Jacobi’s masterclass on IBD and I was just looking through the literature on what studies have they looked at on how long somebody should be on these immune suppressants and how effective they are.

And, of course, nobody’s done big studies on them. They’re a little bit smaller studies but what the literature has panned out is it is only effective if you do Remicade. If you do Humira, because Remicade is 75% human mimicker, 25% mouse genes. Humira’s 100% human mimicker and so if you give Remicade, because of those mouse genes, you’re much more likely to form a reaction obviously because the body’s much more likely to react to a mouse protein. And after six months, it has no efficacy and the studies that they did outside of-

Dr. Weitz:                          You have to restrict cheese intake, in that case. I’m just kidding.

Dr. Gurevich:                     Sometimes you do for other reasons.

Dr. Weitz:                          The mouse, the cheese. Yeah, okay. Sorry.

Dr. Gurevich:                     The side effect profiles, the way they did the study is, is they did biologic followed by immuno suppressant, or biologic and immuno suppressant together, and they did it over two years and so the side effect profiles appeared almost identical because everybody got the immuno suppressants. And so, generally, if I’m going to counsel, I’m going to counsel. If they can, they’re okay with injections, Humira’s a better option and I don’t counsel to do immuno suppressants usually.

Dr. Weitz:                            Okay. Now, you mentioned, with respect to diet, food sensitivities. How do you sort through that and are there certain … You mentioned two completely different types of diets, paleo type of diet, which restricts grains and legumes and things like that, and then you also mentioned more of a vegetarian type of diet.

Dr. Gurevich:                     What I use in my practice is called the Carol Food Intolerance Test, which nobody has heard about unless they’re a naturopath who graduated from one of the west coast schools. It is this really, really kooky energetic based diet that Dr. Carol created it in the 1920’s. We do it in basically the same ways. For me, I think there’s no studies on it, there’s no science on it, but for me, clinically, it’s one of the ways that I’ve been able to keep my disease in remission and I feel like it’s kind of often the most accurate. I don’t use any of the IGG … I don’t use any of those tests. I find that those, in my clinical practice, are futile. My entire population has intestinal permeability. They have intestinal permeability because they’re seeking out my treatment and waiting to get in with me for appointments, right? So, that test is just going to do a good job really telling me what they’re eating. I don’t use that test at all. I think elimination is probably the gold standard and so what I’ll do is I’ll start them on SCD if they’re okay with meat and I think it’s better studied. If I can get them into remission, great. If I can’t or if they hate me, I’ll start them with the other one. I’ll flip.

Dr. Weitz:                          Have you used Low FODMAP?

Dr. Gurevich:                     Yes, definitely, and I feel like what I’ll do is I’ll put them on any diet. I’ll put them on a restricted diet, either SCD, whatever they want to start with, until they’re able to get into control and then once they’ve been in control for a little while, … It’s not sustainable to do that diet for the rest of your life. I call that diet a skeleton and then we want to build … We want to put the meat in the muscle and skeleton. Introduce, challenge, did you do okay? Great. Introduce, challenge, did you do okay? No? Okay, stop. Go back to where you just ended, let’s give it a couple of days. Okay, now you’re ready. Introduce, challenge. I want them to figure out what they can eat and what they can’t eat.

Dr. Weitz:                          If you do an elimination diet, how many foods do you eliminate?

Dr. Gurevich:                     All of the main intolerances. Dairy, gluten, eggs that are not organic, soy, corn, nightshades, sugar. The standard anti-inflammatory diet.

Dr. Weitz:                          How often do you find that gluten and dairy need to be kept out?

Dr. Gurevich:                     Not as much as I would have expected.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     I feel like people who react know right away. Not as much as I would expect.

Dr. Weitz:                          Okay. How often do you find heavy metals or mold as co-factors?

Dr. Gurevich:                     I think I am probably under treating and under testing because there is this entire theory about fungus being one of the big underlying causes of Crohn’s disease and I think that I’m not paying enough attention to it, if I’m honest.

Dr. Weitz:                          Right. Well, it’s a lot of stuff to pay attention to.

Dr. Gurevich:                     Yeah, that’s true.

Dr. Weitz:                          Okay. I think those are the main question I had. I thought that was a good interview.

Dr. Gurevich:                     Thank you. You are also extraordinarily researched. I’ve been listening to a lot of your podcasts.

Dr. Weitz:                          Oh, you have?

Dr. Gurevich:                     Yeah, you are extraordinarily researched. I don’t know how you find time to do it.

Dr. Weitz:                          I just don’t sleep.

Dr. Gurevich:                     Great, that’s healthy. Totally no side effects to that.

Dr. Weitz:                          Exactly. How can our viewers find and get hold of you and find out about your programs? I know you have this IBD course, right? That’s available through Nirala.

Dr. Gurevich:                     Yep it’s SIBO Doctor Master Course through Nirala Jacobi. I think you Google that. That is going to be … I do my final interview with her tomorrow. It’s going to be five and a half hours just on inflammatory bowel disease. I do a lot of teaching and a lot of lecturing around. You can find me at my website, is naturopathicgastro.com and I still see patients and I also have some residents who work under me where if people don’t want to wait, they can absolutely … The residents run all of their cases through me and so we work on the cases together but it’s a lot cheaper and it’s a lot easier to get in with them.

Dr. Weitz:                          Awesome.

Dr. Gurevich:                     Thank you.

Dr. Weitz:                          So much.

Dr. Gurevich:                     That was so fun. Thank you.



Sleep Apnea with Dr. Joel Gould: Rational Wellness Podcast 125

Dr. Joel Gould discusses Sleep Apnea 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. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

3:25  Dr. Gould pointed out that rather than referring to it as obstructive sleep apnea, the new teminology is Sleep Disordered Breathing (SDB). Obstructive sleep apnea came out of looking at older, obese people who would choke in their sleep and generally all require a C-Pap machine.  But now we are starting to see this in younger people, some with lesser versions of it, called Upper Air Resistance Syndrome (UARS).  And sleep apnea has such a negative connotation that if you try to speak to patients about sleep apnea, they tend to feel like you are calling them a bad person and accusing them of being unhealthy.  Sleep disordered breathing is a broad label that includes on one end, people with very severe apnea, and on the other end, people who are just having sleep issues for the first time, including children. 

Dr. Gould explained that dentists can fabricate a device called a mandibular advancement device, and that’s a mouthpiece that will eliminate snoring and can greatly reduce the symptoms of apnea. This helps to hold the airway open and is a great allopathic treatment for the disease. This is how he first got involved in treating this condition.

6:32  The most common symptoms for patients with Sleep Disordered Breathing are daytime tiredness, insomnia, gastric acid reflux, headaches, and snoring. The signs that can be seen in the dental chair are bruxism, crunching and grinding, and something called scalloped tongue. That’s when the tongue thrusts against the lower teeth all night long, and the tongue gets indentations. Those indentations are a sign that the part of the brain that controls the airway isn’t functioning right. To diagnose this, the first step is to wear a pulse oximeter while sleeping, which can show if your oxygen level drops while you are sleeping. If that shows evidence, then a home sleep study will be recommended.

12:30   Dr. Gould explained that sleep apnea is a lifestyle disease that is multi-factorial.  This disease came up in the ranks as a diagnosis for older men who stop breathing for 10 seconds or longer.  This creates a series of arousals from our sleep.  As we go down into deeper sleep, our body becomes more relaxed and we’re supposed to go into those deep stages of repair.  But our modern lifestyle, like exposure to blue light, which suppresses the melatonin that helps you to fall asleep.  And melatonin is also a very powerful antioxidant, so blue light exposure also increases your risk of cancer.  When your airway becomes too relaxed, your airway may collapse and this sends a signal that the person is choking and it will arouse them. There is a spike in cortisol from the sympathetic nervous system and the person awakes from deep sleep.

15:45  This cortisol spike may raise blood sugar levels and could explain why a diabetic has a morning spike in blood sugar that has nothing to do with what they ate. This cortisol spike would not get picked up by conventional salivary cortisol tests, since it happens in the middle of sleeping. Dr. Gould describes sleep apnea as the disease of modern living.  It is a disease of the autonomic nervous system, the part of the brain that regulates circulation, digestion, sleep, and all of the things that we don’t need to think about.  Sleep apnea will result in premature aging, since your sleep is broken and you don’t get to get into that deep sleep that allows the body to regenerate and refurbish itself.

22:38  Snoring is a vibration of the soft palate and it is results from a primary vitamin D deficiency, followed by secondary B vitamin deficiency, specifically B5, pantothenic acid, which is the precursor to acetylcholine.  Dr. Gould explained that in the brain stem you need to have a high enough vitamin D level to transcribe the enzyme choline acetyltransferase, which an enzyme that makes acetylcholine.  Vitamin D it allows you to up-regulate the transcription of your genes to make the enzymes to stay healthy.  If you lived in the wild, most people would have a vitamin D level of 50 or 60.  When the D level goes down low enough, you no longer have enough energy from the sun to transcribe the most basic and important enzymes, the ones like glutathione, or superoxide dismutase, the enzymes that will detoxify free radicals, and that’s why vitamin D deficiency and health are so linked. Doctors aren’t really necessarily understanding that this one thing, just on its own the vitamin D is a massive issue that humans are literally solar powered animals, and we use that energy from the sun to power our reactions. Vitamin regulates our immune system and if that is shut down and it cannot kill bacteria, viruses, and fungus, it will change our gut bacteria and the good bacteria that promote B vitamin production will disappear. B vitamins are crucial for the electronic transport chain in mitochondrial energy production and for neurotransmitter production, like serotonin, our feel good chemical. B5 is needed to make acetylcholine.

28:43  Whether you breathe through your nose or your mouth is also important.  Humans are designed to breathe through their nose and when you do, your nose filters and warms the air and provides nitric oxide, which causes a vasodilation.  But a lot of us become mouth breathers when we can’t breathe through our nose due to allergies or deviated septum or some other issue that affects our airways. Buteyko breathing and mouth taping can be two strategies to help promote nose breathing.  Dr. Gould said that he sees this mouth breathing a lot in kids–kids who suck their thumbs, kids who wet the bed, kids who have ADHD, these kids are all severely sleep deprived.  Their airways are growing and developing and if they breathe through their mouth, this tends to narrow the palate.  As kids are developing, if they don’t have enough vitamin D3 and K2, the airway won’t grow properly.  With low vitamin D3 you tend to get increased colds, flus, allergies, and with low vitamin K2 you tend to get early calcification of the nasal septum and not enough calcium going into the jaw for proper, normal growth, and the airway’s being compromised.  This was first discovered by Weston Price 80 years ago.  They develop long face syndrome, which is where the palate becomes narrow from mouth breathing and the jaw becomes narrow as well.

34:40  Sleep apnea and disordered breathing increases your risk of heart disease.  This is partially because sleep apnea is such a stressor for the body and you get an increase in the heart rate when you get woken up.  It is also because of the vitamins D3, K2, and B deficencies that are the root cause of sleep apnea.

37:30  When you suspect a patient of having sleep apnea, the first step is to give them a pulse oximeter to wear while sleeping for one or two nights. If you stop breathing while sleeping, you will see a drop in their oxygen saturation, which is measured by the pulse oximeter. You will see the oxygen level drop 3-4%.  After that, if they have severe health issues, then they should go to a medical sleep doctor and have a polysomnography done. If not, then Dr. Gould will have them do a home sleep study.

39:23  After the sleep study, Dr. Gould will often recommend an oral mandibular advancement device. This is a device in your mouth that brings the jaw forwards and increases the size of the airway and makes it harder for the tongue to fall back and block the airway.  By bringing the tongue closer to the top of the palate, it may stimulate the vagus nerve, which may reverse apnea.  Dr. Gould explained that most of the dental profession views it as a structural disease, but he sees it as more related to vagal nerve control of the musculature.  If you can breath while you are awake, then you should be able to breath while you are asleep. This shows that there is no physical obstruction.  But uncontrolled sleep apnea can lead to hypoxia and cause brain cell death, particularly in the cerebellum, which if it goes on long enough, can be permanent.  We need to put the physical barrier in and add in the vitamin D3 and K2 to allow deep, restorative sleep, so the brain can heal.  He may also supplement with a B complex and magnesium.



Dr. Joel Gould is a dentist with an interest in Functional Medicine. Dr. Gould graduated from the University of Western Ontario in Canada and practiced dentistry in rural Canada and in Vancouver for 10 years before relocating to Los Angeles. Dr. Gould’s practice is called Modern American Dentistry and he has practices in Manhattan Beach and in Woodland Hills. His website is https://www.modernamericandentistry.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 or go to www.drweitz.com.


Podcast Transcript

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 e-book 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, I would really appreciate it if you could to go Apple Podcast and give us a ratings and review. That will move us up on that list of alternative health podcasts, and more people will be able to find the Rational Wellness Podcast.  Also, if you’d like to see a video version, please go to my YouTube page, and if you go to my website DrWeitz.com you can see detailed show notes and a complete transcript.

Our topic for today is obstructive sleep apnea and how to treat it, both with a functional medicine approach, along with traditional care.  Sleep apnea is when a person has pauses in their breathing while sleeping, and each pause can last from a few seconds to a few minutes. Such pauses can happen many times per hour per night. It occurs in 1 to 6% of adults, and 2% of children, though I wonder if this number’s actually higher in adults who’ve never been diagnosed.  Sleep apnea may be obstructive in which the airflow is blocked, or central in which breathing simply stops, or a combination of the two. Obstructive sleep apnea is overwhelmingly the most common form. With central sleep apnea accounting for less than 1% of cases. So we’re going to focus on the obstructive sleep apnea today.  Patients with obstructive sleep apnea may not be aware that they have it. Common symptoms of sleep apnea include tiredness during the day, snoring, lack of energy, depression, ADHD and behavioral problems in children. Sleep apnea increases your risk of heart disease, stroke, diabetes, heart failure, arrhythmia, high blood pressure, non-alcoholic fatty liver disease, obesity, car accidents, cognitive impairment, and neurodegenerative diseases like Alzheimer’s.

                                Our guest for today is Dr. Joel Gould, who’s a dentist with an interest in functional medicine. Dr. Gould has a background in public health dentistry, and his practice is called Modern Health Dentistry. He has offices in both Manhattan Beach and in Woodland Hills. Dr. Gould is back for his second appearance on the Rational Wellness Podcast, first appearing on episode 17 over two years ago.  Dr. Gould, thank you so much for joining us today.

Dr. Gould:           Oh, great to be here. Thank you for having me again.

Dr. Weitz:            So, as a dentist, how did you come to be interested in treating patients for sleep apnea?

Dr. Gould:           Well, there’s definitely some background that I’d like to discuss with you. We’ve all heard about this syndrome obstructive sleep apnea. I know that your viewers are sort of a little ahead of the average person. I want to help everyone out by upgrading the terminology. We’ve sort of changed. We’ve gone away from OSA, obstructive sleep apnea to SDB, sleep-disordered breathingThe reason is that apnea was something that we looked at 20 years ago where older, obese people would choke in their sleep. That’s where you see them having a CPAP mask, but over time what we began to understand is that many people had a lesser version of this syndrome called UARS, upper-air resistance syndrome. This was basically, we’re starting to see this on younger, healthier people, and the obstructive sleep apnea name, first of all, it’s an accusation of poor health. Every time that I would question my patients, I’d say, “You know, have you heard of sleep apnea?” They’d say, “Oh, no, no. Not me. I don’t have that. I’m a good person. I eat healthy. I eat low fat. I exercise. I would never have that.” Or, “I sleep great.” And it’s really sad because so many people, their sleep has literally failed and they don’t really have any good options.

                                This sleep-disordered breathing is a much more broad label, and it can really bring into the tent everyone who has a sleep issue, because it’s a range. We have people at one end of the spectrum who have very severe apnea, and then we have people who at the other end of the spectrum are just for the first time having issues with their sleep, and this is happening a lot with children. This is something that we needed some more labels for, because apnea is literally Greek for, “Without breath.” This came from the past where we had this disease was initially discovered with basically Fat Joe, not the rapper, this was a character in Dickens’ writings hundreds of years ago where this character was falling asleep, and he was fat and he was eating all the time. This is our archetype for sleep apnea. It was called obesity hypoventilation syndrome.  Basically it looked at fat people and said, “Well you choke and you snore, so that fat and that fat neck is causing this disease,” and it’s exactly the same as what we did with cholesterol and fat and obesity.  We said, “Well, this greasy fat stuff must be making everyone fat.” It’s just basically non-scientific extrapolation.

                                So understanding that apnea is the term that we used to use, and it still fits, but this is a much more modern disease because this is happening to so many different people. Now, I got into this because dentists can help in the treatment of apnea by fabricating something called a mandibular advancement device, and that’s a mouthpiece that will eliminate snoring and can greatly reduce the symptoms of apnea. It’s a great allopathic medical treatment for this disease, is holding the airway open.

Dr. Weitz:            Okay, so what are some of the most common symptoms that you might see in a patient coming in your office that would alert you to the fact that they might have this disorder. Would you call it disorder?

Dr. Gould:           Sleep-disordered breathing, yeah.

Dr. Weitz:           Sleep-disordered breathing.

Dr. Gould:           Sleep-disordered breathing, right. Well, I think-

Dr. Weitz:           We need a new acronym–SDB.

Dr. Gould:           Well we have to update it. But you know, it’s a much better term because I think that what these guys… I got into this five years ago because dentistry was saying, “Hey, listen, your patients have this and you can see these signs much more easily than other doctors,” because we’re seeing patients lying flat. We’re seeing them with a bright light shining onto the airway. I can see the tonsils. I can see what the tongue looks like.  The classic symptoms, the ones that people will notice are daytime tiredness. The ones that we see in the dentist chair are bruxism, crunching and grinding, and something called scalloped tongue. That’s when the tongue thrusts against the lower teeth all night long, and the tongue gets indentations. Those indentations are a sign that the part of the brain that controls the airway isn’t functioning right, so a scalloped tongue, bruxism, but we’ll see insomnia.  Generally speaking, patients may complain of heartburn or gastric acid reflux, often headaches. And then there’s the snoring. Snoring is the most common complaint because you know, people will not sleep well, but they won’t really know what the issue is, but if their bed partner is making a lot of noise, that’s an immediate issue, so the snoring is often one of the first signs that we see.

                           Most people who don’t sleep well anymore, they know they don’t sleep right, but I don’t know if it’s an embarrassment, but we don’t have this great set of tools. If you have an issue with your sleep, what do you do? You and I talked about this, I’d asked you if you’d ever had a sleep study, and you kind of you know, you gave me the answer that I knew I was going to hear, and that is, “Well, I kind of don’t even want to know if I have it, because I probably have it, but I don’t want to be wearing the CPAP.”  So what I want to do, is I want to change people’s perspective and let you know that you want to know if you have this. A diagnostic test, either a pulse oximetry or a home sleep study, this is just something that you want to know about. It kind of blows my mind that so many Functional Medicine doctors, they know sleep’s important, and they want to do some stuff, and so much of this stuff that you guys do will help with sleep, but the cool part about a sleep study is it gives you objective data.

                                My whole point and what I want to share with your viewers or a lot of Functional Medicine doctors, is that this is not something that you push aside and say, “Oh, well go see your regular doctor. Go see a sleep doctor.” There are no solutions. There isn’t anyone that’s being referred out to this wonderful doctor who looks at the whole person and says, “Let’s talk about your insomnia, and let’s work through the different stages to get your sleep back.” That doesn’t exist.  What happens is then you know these patients will be sent to a sleep doctor. They’ll wait three months. They’ll go to a sleep facility, get all wired up for the polysomnography, which is the most intensive sleep study. They’ll come home with a diagnosis of apnea and a CPAP, and they’ll put it in their closet, and they’re like, “I’m good.” This is what’s happening around the country, and people aren’t really recognizing the dangers of apnea.

                                You mentioned to me today that you were reading about this, and this is linked to everything. Of course it is, because you spend one-third of your life sleeping. If your body isn’t doing it right, you can’t control that. You’re going to bed, and you’re hoping that you have… You know, the blinds are pulled, the room’s the right temperature. You’ve got a good pillow and you’ve got that great mattress, but now your brain has to go into a complex set of chemical reactions that is supposed to get you into sleep four to five cycles of deep sleep, REM sleep, and all that stuff, but you’re just putting your head down and hoping that it’s going to work.  So we’re at this point where doctor don’t have the tools to fix this, and that’s what I want to do. I want to raise awareness of what this disease really is. This is not something that you get as a punishment. This is not something you get when you don’t take care of yourself.

                                I was diagnosed at age 48 by accident by doing a home sleep study for myself, and I eat well, I exercise five days a week. I take care of myself. Why would I have this disease? I’m a good person. And so it’s really quite different. For you, when you have a patient who has a sleep issue, do you see it on the intake forms that’s something you question them about, and what do you do?

Dr. Weitz:           Oh, absolutely.

Dr. Gould:           All right.

Dr. Weitz:           Well, you know we use various sleep hygiene recommendations. I ask them about do they have a pre-sleep routine, what do they do in the evening? Are they looking at blue light? Are they looking at their computer screens? Are they watching TV? Are they talking about or reading emails related to work or finances?  We go through a bunch of factors that would play a role in affecting their sleep. We’re looking at cortisol. We might do a salivary adrenal cortisol test throughout the day. Some patients have this spike in their evening cortisol, so that’s something we can address. Then I’ll give them a series of recommendations, you know, blue light-blocking glasses if they are doing some computer work, not looking at emails or talking about work or finances, you know, a whole series of things.  Then we’ll consider what they’re eating. Are they eating in the evening? Then there’s nutritional supplements, you know, melatonin, 5-Htp, glycine, magnesium, et cetera, et cetera that may be of benefit as well. So that’s how I approach it.

Dr. Gould:           Okay. Well, it’s great. You have to understand that sleep apnea as a syndrome is a lifestyle disease and it’s multi-factorial like almost everything. I want to go through and just define some things for your listeners so they can understand what apnea really is, and that the way this disease came up in the ranks and that this was a diagnosis for older men through Medicare who have to stop breathing for 10 seconds or more.  How this all works, and why all those things you mentioned are a part of this, is that the sleep apnea syndrome itself is basically a series of arousals. Basically what I mean by that is what’s supposed to happen is that as we go down deeper into sleep, and our body becomes more relaxed, we’re supposed to be able to be paralyzed to go into those deep stages of repair, but still be able to breathe and swallow, okay? So our brains have this incredible system to coordinate this whole sleep and breathing thing. It all works great until we mess it up with all the things that we do in our modern life. Absolutely blue light is one of them.

                                The most simplest way to explain this is that melatonin starts to form in your brain after darkness, about two to three hours of darkness. Now if you keep on putting blue light in your eyes, then you’re basically destroying your melatonin. That’s doing two very bad things. Number one, you’re destroying the hormone that’s supposed to make you tired and put you into sleep mode, but melatonin is a powerful antioxidant, and by decreasing and destroying melatonin literally by the blue light going into your eyes, you’re decreasing your body’s ability to fight through radical damage, which will increase your chances for cancer. So too much blue light in your eyes, especially after the day’s over will increase inflammation and cancer.  So it’s a pretty profound correlation. This isn’t something that we think about. We know this happens. So you definitely want to manage that, but the question is now, you have all the conditions right, and now you’re gearing down for sleep, but what happens is that people’s airways are becoming too relaxed, and the actual sleep program itself, the brain cells themselves are not functioning at optimal level. There’s a couple different reasons why.

                                So once that airway becomes a little too relaxed, in very healthy people it’ll send a signal that the person’s actually choking, and will arouse them. In people who are more sick, the airway itself will actually completely collapse. The tunnel will fall back and block the airway, and the oxygen level will drop until the key motor receptors of the carotid artery and your brain tell you, “Hey, wake up. There’s not enough oxygen,” and that’s when you get the spike or release of cortisol. This is a fight or flight reaction. This is the sympathetic nervous system going into high gear saying, “Hey, this is a threat,” and this is exactly as if someone’s putting a pillow over your face and trying to choke you, except that it’s your own tongue that’s clogging your airway.  This spike in cortisol is called an arousal. It makes you come up out of that deeper sleep, and then you go back and relax and fall asleep again. This goes in cycles. This happens certain times per hour, and that’s how we grade the apnea. It’s normal to have some stoppage or slowing down of breathing in sleep, but we start to record them, then we get to the mild, moderate, or severe. So there’s a threshold of how many times-

Dr. Weitz:            Why don’t we just stop here for a second. On this cortisol, that’s kind of interesting because I mentioned measuring salivary cortisol throughout the day, and we would take those readings four times during the day, the last reading in the evening.  But with this scenario, the patient could have a low level of cortisol, but then because they awake in the middle of the night, that cortisol spikes, and we’re not actually able to record that.  I can now see how this can play a role in the increased risk of diabetes because it’s well known that cortisol causes your blood sugar to spike, and a lot of times when I’m working with diabetics and we’re trying to manage their blood sugar levels, and they’re getting a spike in the morning, I’m thinking well, they must have an evening spike in cortisol, and it could be that they are, but it’s not being measured by that salivary cortisol test.

Dr. Gould:           Yes, and that is correct. Again, so I like to sort of shrink these down to make them simple. This is basically an added stress on your body.  However it happens, basically you’re being attacked all night long. This is a stress to your body. That’s why people get so sick when their sleep falls apart. You can be assured that if there’s somebody in your practice, if they’re over 45 or 50 and they have diabetes, or if they’ve had cancer, they already have sleep apnea.  That’s a foregone conclusion, because these diseases are all related to the mitochondria and energy production. This has to do with the autonomic nervous system itself.  Those are patients, this illness is… I like to consider this all one disease.  This is the disease of modern living, because if we were hunter/gatherers, sleeping on the ground, living as the sun came up and down, eating these whole natural foods, our sleep wouldn’t get destroyed.  There’s multiple things that come together to destroy our sleep.

                            This is literally the disease of modern living, but you have to understand that if the autonomic nervous system, the part of the brain that is regulating circulation, digestion, sleep, all of our housekeeping duties, all of the things that we don’t need to think about, if that system and control system is broken, then whatever it controls is a malfunction. So if the brainstem itself, and we’re looking at two separate parts here. I’m looking at the part of the brain that controls the bulbar muscles, or the muscles of the airway, it’s generally cranial nerve 7 through 12, but the 5th cranial nerve is in there. The muscles of mastication, the trigeminal, that’s my nerve as a dentist. So the brain stem itself as a controller of all these different things, if the neurons or the brain stem themselves are unhealthy, whatever message, whatever they’re trying to control and regulate, it’s a short circuit, and that’s what I see.  So sleep apnea is only one expression of this syndrome, which is a disease of the autonomic nervous system. The reason that we focus on sleep is that your digestion is affected, your circulation is definitely affected, but the sleep becomes obvious right away because you can hear snoring. It’s loud. And you can feel tired. It’s obvious. Your circulation and digestion may not be ideal. You may have a little bit higher blood pressure, but this is what’s going wrong. It’s the controlling neurons of the autonomic nervous system that are supposed to be directing this very specific cascade of neurotransmitter release, and all this stuff that’s supposed to happen really elegantly starts to malfunction, and you can go right to one of the simplest things, and that is snoring. What is snoring, okay?

                            So let me ask you this, Ben: What causes snoring? What’s the root cause of snoring? Because that’s what we’re here for. We can put a piece of plastic in the mouth and eliminate snoring. That’s a great allopathic treatment, and we’ve basically hidden the signs of the diseases, but why is the snoring happening in the first place, and isn’t that the whole goal of Functional Medicine is to address the root cause and let the body restore itself?  This is one of the biggest root causes because every day we stress our bodies and we break it down, and we’re supposed to go to sleep and regenerate and refurbish all the chemicals and really heal. If we are not getting into those deep stages of sleep, we’re going to break down prematurely, and that’s what this syndrome is. It’s literally premature aging. Our bodies are aging faster than our ancestors because we’re not able to repair in sleep, because almost everyone’s sleep is broken. I’ve seen thousands of sleep studies.  You look like you have a question or thought on that. It’s a lot, but that’s what the syndrome is.

Dr. Weitz:           Yeah. What percentage of people do you think have at least a mild version of this?

Dr. Gould:           Well, so I have a little package I like to bring when I go to visit a Functional Medicine doctor, and show them a sleep study of a 23-year-old petite female whose Apnea–Hypopnea Index is high. It’s 27.  That’s almost at CPAP.  She’s a petite female.

Dr. Weitz:           What does that mean?

Dr. Gould:           So it means that there are people that you see on the street that look completely healthy that already have very bad apnea.

Dr. Weitz:           What does 27 mean? How does that-

Dr. Gould:           So the correlation we have, basically anything under a 5, and the score is how many times you stop breathing for 10 seconds or more. This is already well into apnea. This isn’t upper-air resistance syndrome where you have reduced breathing. This is somebody who’s stopping breathing. She has the same level of apnea that I had when I was diagnosed, and I was 48. She’s 23 years old and petite, eats healthy, goes to the gym, and she has terrible apnea.  Based on seeing this over and over, these young people who come to me who can’t sleep and they all have terrible apnea, I would say that probably, it just depends on where you’re at, and how people are living, but almost everyone has this to some degree, and especially in kids.

Dr. Weitz:            Ah, okay. That’s kind of what I was thinking.

Dr. Gould:           Yeah. Almost everyone.

Dr. Weitz:            Almost everyone has this to some degree.

Dr. Gould:           Yes. To some degree, yeah. And you know, there’s all kinds of weird stuff that’s happened that doctors aren’t getting. When babies are delivered, they have apnea. They don’t breathe. And what do they do? They put them under a UV light. Okay, and what’s that UV light doing? Well, you and I know the UV light is doing multiple different things, but we’ll go back to the question, “What is snoring?” What do you believe that snoring is caused by, because I’m curious to your thoughts. You’re a well-traveled, educated person. What is the root cause of snoring, and can it be reversed instantly? Aside from putting a mouth piece in. There’s no wrong answer here, so I’m putting you on the spot.

Dr. Weitz:           Yeah, you know, I never really thought about it too much.  My own experience with it, it seems to occur sometimes.  Sometimes it doesn’t.

Dr. Gould:           Some people snore when they have a drink.

Dr. Weitz:           I’m assuming the answer is because they’re not getting enough oxygen, right?

Dr. Gould:           No, that’s not the case, which is interesting because it’s all related. So you have to think about what is snoring itself? Snoring is a vibration of the soft palate. That’s it. Okay? And so it doesn’t really matter, you know, everyone has this specific thought. There’s those commercials when they put the bed up and they stop snoring, and yes, there’s a positional component to snoring. If you’re lying on your back, that’s when your palate’s in the best position to flap when you breathe. If you turn on your side, maybe you won’t snore, but some people report they only snore when they drink. Well what does alcohol do? It’s a central nervous system depressant.  So the answer to my question is: That snoring itself is a primary vitamin D deficiency, followed by a secondary B vitamin deficiency, specifically B5, which is the precursor to acetylcholine, which is one of the primary neurotransmitters of the autonomic nervous system.

Dr. Weitz:            And B5 is pantothenic acid.

Dr. Gould:           Pantothenic acid, correct. Okay. So there’s two parts to the reaction. One is that in the brain stem you need to have a high enough vitamin D level to transcribe the enzyme choline acetyltransferase. That’s just an enzyme that makes acetylcholine, okay? Now you know that vitamin D’s really important, and you know that it’s important in absorbing calcium, but no one asks the questions of, “Well how does vitamin D make you absorb calcium? Why is it related to all this other stuff?” It’s because it allows you to up-regulate transcription of your genes. So in a really simple way, when you add more vitamin D, you give your body the energy to allow for more copying of your own genes to allow you to make the enzymes to stay healthy.

                                Now, doctors are looking at vitamin D the wrong way, and you already know this, that most people should have a level of 50 or 60, that’s what we’d see if we lived out in the wild. So when we raise this level up, now we’re finally giving the body the fuel to be able to transcribe all the appropriate enzymes. When your vitamin D level’s low, I like to call it human power saving mode, or permanent winter, because throughout all of evolutionary history when your vitamin D level was low, it was winter. Your body’s smart. It has an adaption to winter, and when the D level comes down, your body no longer has enough energy to transcribe all the enzymes it wants to make, okay?  I’m going to assume that natural selection over thousands of generations has decided as your D level drops, which enzymes am I not going to transcribe? Which ones are not so important? If you’re making $200,000 a year and you’re getting massages and all this fancy clothes, then you start having your salary cut over and over, you start to give up the esoteric things first, but after a certain point, when you’re starting to not have enough money to pay the rents, that’s what vitamin D is like.  When the D level goes down low enough, you no longer have enough energy from the sun to transcribe the most basic and important enzymes, the ones like glutathione, or superoxide dismutase, the enzymes that will detoxify free radicals, and that’s why vitamin D deficiency and health are so linked. Doctors aren’t really necessarily understanding that this one thing, just on its own the vitamin D is a massive issue that humans are literally solar powered animals, and we use that energy from the sun to power our reactions.

                                You know that the vitamin D’s also tied to the immune system, so as soon as that level goes down, our immune cells, our macrophages, all of our blood cells, they no longer have enough energy in the form of vitamin D to transcribe the genes to make the antimicrobial proteins to be able to kill bacteria, fungus, and virus. Now, your immune system is shutting down because we don’t have enough energy to run that, and that changes the gut bacteria.  Vitamin D regulates the type of gut bacteria that you’re going to have, and as that level goes down, the healthy gut bacteria that we like, the ones that promote all the B vitamin production, the ones that keep our muscles healthy and give us serotonin, all the really good chemical products that bacteria make, they disappear, and that’s why we’re really in the depths of power saving mode.

                                As our deal comes back up in the spring and we have those antimicrobial proteins that are bacteria, our colonocytes can now start to filter it and decide what bacteria we want to keep. We’re going to go back to those ones that make the B vitamins, because you know how important B vitamins are. They’re interjected into every single reaction, especially the production of energy, the mitochondria, especially the repair of DNA.  These B vitamins are used by Mother Nature as neurotransmitters, or as the basis for neurotransmitters, as cofactors in enzymes, in electronic transport chain. These are Mother Nature’s helpers, those B vitamins. I think that… You know, you deal with a lot of people who are very sick who need that one-on-one help, but so many of the general public would benefit from just keeping that higher vitamin D level, because it would naturally provide more B vitamins. That’s kind of the equation.

                                So the second part is in the brain, having enough B5 to make acetylcholine is critical, and if you’re D level’s low, and your gut bacteria’s not making B5, you’re not going to have enough acetylcholine, and you’re going to lie in bed, and your brain is going to be racing, reaching thoughts, and you’re not going to be able to shut down for sleep because you don’t have one of the primary neurotransmitters for the sympathetic nervous system to go into the rest and repair phase, rest and digest, and that’s the equation. The vitamin D to make the enzymes, and the B vitamins to be the raw materials that are our transmitters.  You can think about how all these different reactions to B vitamins are so important to cellular production of energy, that if you don’t have enough, everyone’s going to break it down differently. And so the snoring itself, we’ll see this in children, they can stop snoring in two days, three days, four days with vitamin B supplementation. In adults it can happen that quickly, but it depends how long they’ve been snoring for. Is the part of their brain damaged yet or is it just suffering temporary breakdown?

Dr. Weitz:            Now isn’t the way you breathe also play a role in this? For example, whether you breathe primarily through your nose or through your mouth?

Dr. Gould:           Yes. So humans were designed to breathe through their nose. When you breathe through your nose it filters and warms the air. It basically provides nitric oxide, which causes a vasodilation. The lungs can expand fully and bring in more oxygen. We have a whole system, and that system breaks down when we can’t breathe through our nose. And we can’t breathe through our nose primarily because we have some inflammation. It could be allergies, colds, flus. It could also be a deviated septum. These are all issues that happen primarily in our youth when we’re growing and developing, and can affect our airways, so we definitely want to breathe through our-

Dr. Weitz:            And isn’t it very common that a lot of people end up being mouth breathers?

Dr. Gould:           Absolutely. You know, it’s one of those things… You’ve probably heard of mouth taping. People are taping their mouth to force themself, so yeah, and that could be cured for some people who are having sleep and breathing issues itself.  There’s also, you’ve heard of Buteyko breathing, and that’s where you basically-

Dr. Weitz:            I took a bunch of lessons in that to try and improve my nose breathing.

Dr. Gould:           Right, so the only issue is when you fall asleep. How’s that going for you? Can you control that? And so the answer is no, but if you tape your mouth, you’re going to wake up pretty fast if you can’t breathe through your nose. I think it’s kind of a cool technique, and I don’t think anyone’s really put the time and research in to figure out just how much that mouth breathing and nasal breathing effects us. Again, this is a multifactorial issue for some people that can’t breathe through their nose.  It’s very, very important. We see this in kids a lot. Pediatric patients, the kids who suck their thumbs, kids who wet the bed, kids who have ADHD, these kids are all severely sleep deprived. The issue they’re having is now they’re going through their growth and formation of their airway, and they’re breathing through their mouth, which narrows the palate, and it really amplifies the issues that we see. This is a really terrifying syndrome where as children, as they start to grow and develop, if they don’t have the proper vitamins, and that’s a vitamin D3 and vitamin K2 combination, the airway itself won’t grow properly.  With low D3, colds, flus, allergies, low K2 is you have early calcification of the nasal septum and not enough calcium going into the jaw for proper, normal growth, and the airway’s being compromised. That’s what I’m seeing in all the kids these days, is these tiny airways literally from a vitamin D3 and a vitamin K2 combination, this is something that Weston Price discovered 80 years ago and no one listened.

Dr. Weitz:           And this is literally looking at someone’s face that if their jaw’s/face structure is narrow, that’s what we’re talking about, right?

Dr. Gould:           Correct.

Dr. Weitz:           Isn’t it called like long face syndrome?

Dr. Gould:           Well yeah, so long face syndrome is basically when the palate is narrow, and it’s created from mouth breathing, so when you breathe all night long with your mouth open, it puts muscular pressure to narrow the palate, and the jaw itself, the lower jaw takes its growth cues from the upper jaw, and the development to the jaw itself is not pre-programed.  When we start to grow as children, the size of our brain is pre-programed, so our cranial size is going to be already laid out. But the jaw growth itself is reliant on the conditions that we’re in. We see this really profoundly as a concept called epigenetics. Weston Price over 80 years ago discovered that when two substances were removed from the food chain, he saw dental decay, gum disease, a collapsing of the arches, lack of room for all 32 teeth, and illness in general. Those two substances that he defined back in those days turned out to be vitamin D3 and vitamin K2.  It makes perfect sense because vitamin D is your calcium absorption hormone, and vitamin K2 is basically a cofactor that activates proteins that bind calcium in your blood, and take that calcium and put it into the matrix of bone and teeth. We’ll find those proteins in the mouth trying to bind to salivary calcium and put it into our teeth. This was a system, because we’re made so much of calcium, that in the summer when the sun is high in the sky, we’re getting a lot of vitamin D, and the grass is green, when we’re eating the meat and milk of animals that eat that green growing grass, that’s when we’re onboarding all this calcium. We’ll put it into our teeth and our bones.

                           In the winter when there’s no vitamin D, and there’s no green grass, our body’s going to say, “Hey, I don’t have enough calcium. I’m going to go into those bones and I’m going to pull that calcium out and utilize it,” so the D3/K2 was a system of managing our calcium to be able to allow us to be healthy throughout the year through winter. This was our winter… We basically have this whole other setting where we can… You know, in the northern hemisphere when we’re away from the zone of guaranteed sunlight and green vegetation, that we can live off of our storage of the meat of animals, and so the system is really effed up, because everyone as you know has descended into a vitamin D deficient state that I call permanent winter. Kids these days are all really suffering from the syndrome. It was something, again, defined 80 years ago by Weston Price.  I didn’t learn about Price’s work in dental school 30 years ago when I was in school, and today he’s still not taught. It’s quite interesting as to why… You know, we could tear him apart with all of our new science, but unfortunately for the big institutions, his work has been clarified and defined by the new science, so this is all really obvious stuff.  I’m trying to get the message out there that this is the root cause of pediatric sleep apnea, something that can be reversed in two, three, four days, and children having surgeries and wearing CPAPs.  I’ve got eight year olds who’ve been wearing these. You know, this is destroying these kids lives. It’s just a simple vitamin and mineral deficiency. This is a D3/K2 combination.

Dr. Weitz:           Interesting. Fascinating. Great information. Can you explain a little bit about the connection between this sleep apnea breathing problem and heart disease?

Dr. Gould:           Sure. So there’s two different ways that this affects you. The first one is the actual whole sleep apnea syndrome where you’re choking in your sleep. Again, the stress on your body, if you’re a hunter-gatherer out in the wild and there’s a lion or a tiger or something scares you, and you have to run, that was probably relatively common, but this whole syndrome where your body’s having that full-on reaction fight or flight, is happening over and over.  This is a terrible stressor on your body. For people who aren’t healthy to begin with, they don’t know that their basically running this marathon where they’re being chased by an animal all night long and being suffocated. They just wake up feeling terrible. The stress of the hypoxia, lack of oxygen, and the release of cortisol over and over again is very taxing on the body, number one.

                                Number two is these are people who already are not healthy. They already have completely inflamed vasculature, and the stoppage of breathing, and the increase of heart rate that happens after the arousal is signaled, you know after you’re woken up, many of your listeners may have had this where you wake up and you’re sweating and your heart is racing. That’s apnea, guys. If you’ve woken up several times in the night like that, you have some form of apnea. It’s reversible to a certain point. I think it’s reversible all the way, it just depends how much work you want to put into it.

                                The second part of the cardiovascular issue is that the root cause of sleep apnea is a primary vitamin D deficiency with a secondary B vitamin deficiency, and the cardiac cells, the endothelial cells themselves are suffering from an inflammatory process because those cells themselves cannot make enough of the anti-inflammatory enzymes. You can google any of your enzymes that eliminate free radicals, and you’ll see that supplementing vitamin D will increase their production and decrease the overall stress and inflammation of the cell in the body.  It’s complex because the endothelial cells are involved, the cardiac cells are involved, and then we go back to the brain stem. It’s the part of the brain that’s regulating everything cardiac, has issues transmitting the right message in the right way because it doesn’t have the right neurotransmitter mix. The actual signal, the cardiac signal and how you’re whole body’s running, run by the autonomic nervous system isn’t functioning right. It’s coming at us from all different directions.  It’s basically the overall poor health of a person, because it’s just so multifactoral, but when someone has apnea and it’s detectable like that, they’ve been sick for a long time and they have the other markers of inflammation as well.

Dr. Weitz:           So, when you have a patient with sleep apnea or-

Dr. Gould:           Disordered breathing.

Dr. Weitz:           Disordered breathing, right.

Dr. Gould:           Right, very good.

Dr. Weitz:           How do you decide what’s the first step?

Dr. Gould:           Okay. So I like objective data.  Anyone who comes to me, I want to use two different types of monitoring devices.  I like a pulse oximeter.  We send the patient home with that, and it gives us an idea of the severity of their apnea.  If the pulse oximeter shows them stopping breathing, I’m going to immediately recommend a home sleep study.  Now, if this is someone who has serious health issues, they should go to a hospital facility and have a polysomnography done by a medical sleep doctor, because these are the people that have to be on CPAPs, and those are the people that probably aren’t even coming to you.  They’re really sick, and they’re in that paradigm of allopathic medicine.

                                We can detect the apnea and do a sleep study that will show one night, two nights what’s going on, and will show whether this person’s getting REM sleep or they’re getting deep sleep, and are they choking?  What’s going on?  Are they having hypoxia?  Because we’ll see the oxygen level drop 3 or 4%. You cannot hold your breath and do that.  That’s in stoppage of breathing. All right, so this gives us an idea of who has this, and in my opinion, anyone who has had any health issues at all should have their sleep screened, especially if they complain.  Some people will come in saying, “I don’t sleep right.”  Some people, they’ll just be sick and they won’t know.  I didn’t not know that I had apnea, and mine was pretty bad.  It wasn’t on my radar just because I was thinking about an older, heavy person who didn’t take care of themself.  Not me.  Like why would I have it, right?  So, this is something that you can only tell literally, I have children, I have adults. I recently had a 52-year-old woman who was a bit overweight, but she had the best sleep I’d ever seen.  She’d been taking her vitamin D.  She was relatively healthy. So you can’t tell by looking at anyone. You have to really do an objective study.

Dr. Weitz:            So, you do this objective sleep study, this person comes out positive.  What’s the next step?  Do you test them for vitamin D?  Do you measure vitamin B levels?  Do you just try them on vitamins?  What do you do first?  Do you look at diet and other factors?

Dr. Gould:           Right, so as you already know this, different people will have a varying degree of interest. At the most simple level, I’m going to provide all my patients with an oral device if they have a diagnosis of apnea. If they’re health-oriented-

Dr. Weitz:           Is this oral device designed to move their upper jaw forwards to create more space, is that it?

Dr. Gould:           It does a couple of different things.  So the mandibular advancement device, lots of studies showing that it’s effective. Primarily it’s going to hold the lower jaw forward and open, and it increases the size of the airway and makes it harder for the tongue to actually fall back all the way. That’s one thing that it does.  The other thing is that by holding the jaw further forward, in a lot of people it will put pressure on the palate where the vagus nerve runs across, and sometimes that tongue on the palate will actually stimulate the vagus nerve and will decrease the apnea syndrome. I know that this is a very big topic is vagus massage, all different things that will help stimulate that nerve.

                            I believe that there is a component, because I will see some patients who have a profound effect with the oral device maybe more than they should have just by making extra space. I literally see like a change in how their brain is sending out that sleep signal. I don’t think anyone really knows to be honest with you. Most of my profession is still stuck on, “This is a structural disease, that there’s not enough room in the airway.” I want to dispel that myth right now because if you can breathe while you’re awake, then you can breathe while you’re asleep. There’s no obstruction. This is not a physical obstruction. This is a relaxation of the musculature.  I’m glad we got away from the obstructive sleep apnea because there’s no real obstruction. This is a problem with how your brain is regulating the musculature of the airway and the sleep program itself.

Dr. Weitz:            I’ve had patients who’ve had surgery to grind down some of the bones in the back of the throat and create a bigger space.

Dr. Gould:            Sure. Well, it’s sad because people are literally… Some people are going to need surgery, and there’s nothing wrong with that. Surgeons are great. They’re talented. So, this is my thought process: If someone’s willing to go along the ride with me, I will do a vitamin test on the spot. I’ll get their most recent level. I have a protocol that I want to get someone into the right zone, and then the issue really is that when someone comes to me, I don’t know how severe their apnea is, it depends on how long they’ve had it.  Keep in mind that the part of the brain that’s regulating this, day after day of hypoxia causes brain cell death. You know that the cerebellum, in particular is very susceptible to hypoxia because the Purkinje fibers are really big, and they’re the first ones to die. Once this is going on, the system where you’re stopping breathing, you have hypoxia and damage starts.  This goes on for many years until the brain itself, and the different parts of the brain, are damaged enough that no amount of vitamin supplementation is going to fix this. You need to put in a physical barrier to keep that airway open because the brain itself can’t heal. It’s not getting into good, deep restorative sleep.  If we can change the vitamin mixture to provide health, and we can splint the airway open, only night after night of deep restorative sleep….

Dr. Weitz:            Okay, so you’re measuring vitamin D.  Are you measuring vitamin K?  Are you measuring B vitamins?

Dr. Gould:            No, so the K always comes along with vitamin D because you can never get vitamin D without K2. They always came together, should never be. 

Dr. Weitz:            And then you’re using the MK7 or the MK4 and how much?

Dr. Gould:            So, MK7, everyone’s sticking to the 180 to 200 micrograms. No one’s really investigated this any further, but this was all from the Rotterdam Study.  This is a very famous study that’s happened over the years that most doctors who haven’t heard about K2 should look at.  I don’t know that we know the optimal level of K2. I just know that it’s currently known to be a cofactor on 17 different enzymes, and K2 is really… If it’s a cofactor on 17 enzymes and we got it from green growing grass, it’s really important. So there’s no upper limit on toxic dose, and I think that the more you can get the better, but I’d make everyone take 180 to 200 because I’d want to stay within the bounds of what’s accepted science at this stage.   I supplement magnesium. I get the vitamin D levels to 60 to 80 range. K2 daily, and then I go to a B vitamin, and I want to use my B vitamin very judiciously depending on the person.  And this is a personal…

Dr. Weitz:           Do you measure B vitamins?

Dr. Gould:           I don’t. This is the issue, is that if you measure B vitamin, what are you measuring? It’s a water-soluble vitamin. Are you measuring the current state where you’re getting your sample from? What does it look like one hour, two hour, 12 hours? How long do B vitamins last in our system?

Dr. Weitz:           Well, I mean, there’s various things you can measure. Say, B12. You can look at a serum B12, but you’re right, probably not that representative of tissue levels, but then you can measure a homocysteine.  You can measure a methylmalonic acid, so those are more functional measures of B12 status.

Dr. Gould:           Right. Well, B12 is the only one that I can recommend supplementing on its own, otherwise I’ll always want a B complex.

Dr. Weitz:           We also have genetic factors that affect whether or not you can metabolize B12 or folic acid, et cetera.

Dr. Gould:           Right. And that’s what makes this such a confusing syndrome is that there’s all this genetics and epigenetics mixed in here. Medicine has really focused on the genetic components of all these diseases. You know, this is kind of one of the things I joke about is if you go to your traditional doctor and you’re obese and you have high blood pressure, they say, “Well, listen, you have high blood pressure. Cut your fats. Do some exercises. Lose some weight, and then we can maybe get you off medication,” but if you’re fit looking anyway and you go to the doctor and you have high blood pressure, they tell you it’s genetic, and then they give you medication because you’re going to have to take this the rest of your life, because you have this genetic issue.  It’s all nonsense. Your genes are there, but it’s all the environment, so even the people who would have these genetic issues, a lot of them have the issue with B vitamins. They need more B vitamins, okay? But the B vitamins are fascinating because they are parallel to the bees, the insects in our environment. They’re literally under attack by modern living.  You know that bees are affected by glyphosate, pesticides, heavy metal toxicity, radiation, all the same things that are destroying our B vitamins as well, kind of cool that Bs…

Dr. Weitz:            How much B vitamins do you often recommend?

Dr. Gould:           So, it’s going to be on a case-by-case basis, and this is people need to decide. Really what I see, it depends on how long someone’s been sick for, and how sick they’ve been. Most of the are diseases, these autoimmune diseases, they’re have a D deficiency followed by a B deficiency. I have patients who are healthy their whole lives, and one of my favorite patients is a fitness trainer. This guy was fit his whole life, and then he started to put on weight, didn’t know what was wrong, basically got completely unhealthy within six months to a year, and when I came across him, he had complete uncontrolled, untreated sleep apnea. This guy had a rapid recovery and he didn’t need a lot of B vitamins, where someone like myself who I’ve been sick my whole life, I need more B vitamins because apparently most of my illness was related to this having a chronic lower level of vitamin D, being stuck in permanent winter and not having the right amount of B vitamins.  This really did a lot of damage in my life and my illness, so I tend to take more B vitamins, but you know that B vitamins are used up by being in the sun, drinking alcohol, and exercise and activity, so once this happens, once someone’s already become unhealthy, I really work with them on deciding how to take their B vitamins. Do they want to take them in the morning? Do they want to take them before bed? Too much can cause people to have insomnia as well, but for the most part, having a little more B vitamins later in the day can help you with your sleep. Simple as that.

Dr. Weitz:            And I’m assuming you’re using methylated or activated forms rather than straight folic acid and…

Dr. Gould:           Correct.

Dr. Weitz:            B12 versus the cyanocobalamin.

Dr. Gould:           Right. So I spent a lot of time researching B vitamins, and I don’t… I always try… My vitamin line, they’re methylated. There’s such a variety in the vitamins that we buy. There’s no one regulating this, and that’s why I always say, “Go to a reputable company that checks their own stuff.” You buy stuff off the internet and I don’t know what you’re getting. Some of it’s filler. Some of it’s real.  But the real issue is that no one’s really spending the type of money, time, and energy looking into these things, because this is really what our health comes down to. Who has the money to do this? You know that all the research is driven by big pharma, and they’re not interested in these vitamins. This is an organic way to get healthy, and they’re not looking at that. They have not sworn an oath to do no harm. They’ve sworn an oath to their shareholders to make money, and they’re going to make this any way they can.

                                If you’ve seen some of the commercials, they have these new ones where they’re showing this woman and she’s in a hospital bed with dark circles under her eyes, and she’s missing her son’s wedding or something. They’re really playing on our fears of poor health. It’s really terrifying, so no one’s going to be looking into this, and there’s so much research that needs to happen on what these vitamins are doing.  We’re coming to this in different ways. You know, people who are eating a ketogenic diet. We’re coming to all the right solutions, it’s just that this is the Wild West. You have your own system for how you treat people. How often do you test B vitamins? Do you ever supplement more than just, except for B12, do you ever give a single B?

Dr. Weitz:            Sure, or we’ll use specific formulas, like for example, if I have a patient who has an elevated homocysteine level, which we know is an independent cardiovascular risk factor and inflammatory marker, we’ll use a certain combination of B vitamins and certain other nutrients that are specifically targeted to modulate the homocysteine.

Dr. Gould:           Right. Do you worry about… Because those B vitamins are so inter-reliant on each other, do you worry about upsetting upstream or downstream results when you supplement one B vitamin like that?

Dr. Weitz:            Yeah, for sure. Usually we’re using mixtures, you know, but I may use different combinations of mixtures. So like, for homocysteine we’re specifically looking at like a B3, B6, B12, B9 combo with certain other nutrients like trimethylglycine and maybe a few other things, specifically to try and modulate that one factor.  We’re measuring it on a regular basis, so we’ve got targets. We intervene and then we retest to see if we’re accomplishing what we’re trying to do.

Dr. Gould:           Great, great. And again, it’s really complex stuff. Now I, looking at this from… As a dentist, I’m looking at macro world here, and the message I want to share with you and your listeners is that sleep is something that’s well within your wheelhouse that you should be monitoring. This is something that you can use as a marker for the improvement of your patient’s health, because I have no doubt that almost every single thing that you’re doing is improving their sleep.  I know your patients probably tell you, “Wow, I’m sleeping better,” when you’re doing all this other stuff. But I think that functional medicine doctors have this incredible opportunity to bring this into their practice. What I recommend is to find a local dentist. You’re going to have a hard time finding a local medical doctor to work with, but there are dentists in the community that want to work with you, that treat sleep apnea, that don’t feel comfortable with this vitamin D stuff.

                                This is recommending a partnership, a collaboration, because dentists have this unique ability to put things into the airway to help with sleep. We are doctors. We have a different perspective, but I think those relationships where you have a patient you suspect apnea, but what are you going to do with this person? If you send them back out into that cruel allopathic world, they will wait three months to go see that medical sleep doctor, and they’re all good people, but their solution is a CPAP for everyone.  I have had patients who’ve had very mild apnea, a AHI score of 7 or 12 or something that’s low, that they have this massive CPAP thing and they’re not going to wear it. There’s a really cool opportunity with these people that are coming to you, they care about their health, is to give them that tool and allow them to have a mouthpiece that can save their marriage with snoring, but it can definitely make everything that you’re doing work better.

                                When you start to see your patients having stable sleep, and not having these arousals, you’re going to see all of their markers change. Their inflammatory markers are going to change. You’re even going to see their vitamin D levels change. There’s a study where they put a CPAP on people, and their vitamin D level came up. It made sense to me because if you’re running from a lion or tiger all night long, vitamin D’s a metabolic hormone, and you’re going to wear it out. You’re doing all these things.  There was no time in evolutionary history where you should get more exercise running around and not be out in the sun. That never happened. So everything that you’re working on is affected by this, and you know, when it comes to your younger patients, you just don’t know why these people are so messed up. This is why a 23-year-old petite female and nothing you could test… The only thing that came up on her study was that she had a vitamin B level of 12. That’s why she had terrible apnea, because who knows how long she had that level for, and then choking in her sleep, it was just lowering it.

                                So there’s patients that you’re seeing that are suffering from this syndrome that you can greatly help by going to a dentist and having some sort of sleep screening. That’s what I’ve done in my neighborhood here. I have pulse oximeters. My local doctors will send a patient over. We’ll do a quick exam and they’ll log out a pulse oximeter, take it home for three nights, and we’ll see if they’re really a candidate, whether they should have a sleep study or not.  So these are things that should be going on in your community with your local healthcare providers.  I think that dentists are more open to this type of stuff than the average doctor.

Dr. Weitz:            No, that sounds great. Great. By the way, if you know of any studies that you have ready access to that you can send me about the connections between vitamin D and vitamin K2 and B vitamins, I’ll throw them in the show notes.

Dr. Gould:           Sure.

Dr. Weitz:           I’d appreciate that.

Dr. Gould:           You got it.

Dr. Weitz:           Good. So I think that about wraps it for today, being that it’s almost 9:00, and I have a 9:00 patient.

Dr. Gould:           All right.

Dr. Weitz:           So how can listeners and practitioners get a hold of you to patients can either see you as a patient, or practitioners who want to work with you on sending patients to you for sleep studies?

Dr. Gould:           Right, so you can reach us at ModernAmericanDentistry.com. We have a location in Woodland Hills. We have a location here in Manhattan Beach. If you have patients that you’re questioning whether they have sleep issues, basically you can email me, you can call, you can just refer people over. What we provide is copies of the pulse oximetry to give you an idea of what your patient’s doing in their sleep, a copy of the sleep study. Then we get a prescription from a medical sleep doctor to fabricate an oral device. We can work with you on the supplementations.  What I’m trying to do is create a protocol and system for dentists to be able to work locally in the neighborhood. That’s what my main focus is. It’s not so much treating the one-on-one patients. I’ve been doing that for a while, but I want to share this information from preventive perspective for children, and for people who are literally struggling today with their sleep. There are some real tools here, and that most poor sleep is literally early apnea.

Dr. Weitz:           Great. Awesome. Thank you, Dr. Gould.

Dr. Gould:           All right. My pleasure. Thank you.



Gut Brain Axis with Dr. Robert Silverman: Rational Wellness Podcast 124

Dr. Robert Silverman discusses the Gut Brain Axis 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. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

3:17  Dr. Silverman has made the Gut-Brain Axis the focus of his next book, Superhighway to Health, because the gut to brain connection is such an important part of our overall health.  One reason the gut is so important is that 80% of our immune system surrounds our gastrointestinal tract. Your gut is where your macro and micronutrients are absorbed.  The bulk of this absorption is in the small intestine, which is really 90% of the size of our intestinal tract, so it should not be called the “small” intestine. But the small intestine is only a single layer thick, so it is vulnerable to increased permeability if our gut becomes damaged. A damaged, leaky gut then can lead to a cascade of injuries and inflammation and eventually autoimmunity.

3:55  In the Functional Medicine world it’s commonly accepted that the gut is often the root cause of many other health problems, but this concept has not been embraced by the general medical community.  A lot of common medications are adverse to gut health, including antibiotics, opiates, non-steroidal anti-inflammatory medications (NSAIDs), like ibuprofen (Advil) and naproxen (Alleve). The NSAIDs damage the tight junctions, leading to leaky gut. If you have leaky gut, lipopolysaccharide, (LPS), is an endotoxin released by gut bacteria, gets into the blood stream and can lead to systemic inflammation.  If you cut your finger, you put a bandaid on it to protect your barrier.  Because we don’t see our gut lining, we don’t know if we have leaky gut, so we tend to ignore it. 

7:49  There are a myriad of non gut related symptoms, like skin rashes, brain and neurological problems, musculoskeletal pain that can all have their origin in the gut and if you clean up and fix their gut, you ameliorate them.  If you have a leaky gut, LPS and endolethal distending toxin get into systemic inflammation. You get too many toxins feeding through the liver and you damage your liver, you get a higher expression of diabetes, and you get an increase in obesity. You have three times the incidence of having a heart attack. You have more thyroid and other autoimmune problems. 50% of people who have spondyloarthropathies have leaky gut. Leaky gut, leaky brain. Gut on fire, brain on fire.

11:40  The vagus nerve goes from the brain stem, the medulla oblongata, down through the transverse colon. The vagus innervates most of the digestive and abdominal organs (liver, pancreas, intestines, etc.) and it even affects heart rate as well.  The vagus nerve is largely an efferent, meaning sensory, and when it senses dysbiosis, an imbalance of good and bad bacteria in the gut, it stimulates Toll-like receptor-4 and you get a release of LPS. The vagus nerve normally functions as a rest and digest nerve but when it dims, sympathetics go up and parasympathetics go down.  This also affects intestinal motility through the Migrating Motor Complex (MMC). We need nine to 11 peristaltic contractions in our small intestine per day to move our bolus from the small to the large intestine. When we have SIBO, we’re down to three because we have a backlog of the bacteria and it’s not moving through. Many attribute that SIBO to a decrease in vagal nerve stimulation.  Dimming of the vagal nerve may also close the ileocecal valve.  When you have a concussion, you down regulate the vagus nerve, which is why 60% of concussion sufferers get SIBO.  This is why with concussion patients, you need to treat their gut.

14:30  Our modern lifestyle and diet affects our gut-brain axis in a number of ways. Dr. Silverman recommends that we eliminate gluten, dairy, processed foods, sugar, nicotine, artificial sweeteners, and foods that we are allergic to.  We should also eliminate environmental toxins, like BPA, pthalates, food gums, emulsifiers, etc. We also need to manage our stress levels. 

18:45  Pesticides and toxins like glyphosate in Roundup should be avoided, which damage our microvilli and are considered carcinogenics by the Whole Health Organization.  We should eat organic as much as we can.

22:27  Dr. Jeffrey Bland, the founder of Functional Medicine, developed the 4 “R” program for gut healing, but Dr. Silverman has developed the 7 “R” program. 1. Is to Reset your diet and lifestyle.  The best diet should be individualized for each person. It could be it could be a keto, it could be a plant based, or it could be a Mediterranean.  You also need to do some form of exercise and this should include cardio such as walking, some form of resistance training and some form of flexibility work. 2. Remove. Remove toxins. Remove food allergies. Remove bad bacteria with emulsified oregano oil, berberine HCL, garlic, and other antimicrobials. Serum Bovine Immunoglobulins is also very helpful. This should also include some form of detox program.  Bacteriophages can also be helpful, since they can attach to only the bad bacteria and kill them.  3. Replace. Replace stomach acid, pancreatic enzymes, and probiotics, like Saccharomyces boulardi, which is a healthy yeast that functions like a probiotic. 4. Regenerate. Regenerate and repair the gut lining with a plethera of nutrients, including medical foods. Alpha lipoic acid, fish oil, and vitamin D are very helpful for reducing inflammation, promoting biodiversity, and promoting the mucosal lining of the gut. 5. Reinoculate. Use prebiotics and probiotics like Xylooligosaccharide and spore based probiotics like bacillus subtilis.  6. Retest and retain. Dr. Silverman mentioned that he really loves using the Cyrex Tests, including Cyrex Array 2, which tests leaky gut, measuring zonulin and occludin and also measuring LPS. He also likes the Array 22 to diagnose IBS.

33:40  Dr. Silverman treats vagus nerve dysfunction using violet laser light therapy using an Archonia laser for 30 seconds on each side of the vagus nerve from the brainstem down to the colon on both sides.  He also uses a percussor over the ileocecal valve and he will use some performance tape over where the ileocecal valve is.  He also recommends certain nutrients, including omega 3 fatty acids, green tea extract, and 6 or 8 additional nutrients that will be in his new book.

36:54  Dr. Silverman treats concussions with a five part protocol that includes addressing the upper cervical spine with manipulation, including the rectis capitis minor muscle.  He also uses proprioception and balance training. He uses a transcranial laser.  He also uses a nutrient protocol, including Magnesium Threonate, omega 3 fatty acids, turmeric, Specialized pro-resolving mediators (SPMs), and liposomal glutathione.  Dr. Silverman explained that the mechanism of a concussion is the shearing of the brain that leads to tearing of the axons that are involved in brain function.  Women are more susceptible to concussion than men, since they have weaker neck muscles and they don’t respond as well.  One way to test for concussion is to give a Vestibular/Ocular Motor Screen to the patient. Dr. Silverman often runs Cyrex Array 20 to monitor the blood brain barrier, but he also recommends testing for Interleukin 6, Interleukin 8, and C Reactive Protein, which are inflammatory markers. Neurofilament light polypeptide is a new biomarker that can be measured in plasma and is an early marker for Alzheimer’s and other neurological diseases.

42:25  Chronic traumatic encephalitis (CTE) results from brain trauma but there does not need to be a concussion. It can result from a series of sub-concussions that results in structural damage to the brain that doesn’t show up on CT scans. Dr. Silverman recommended Cyrex Array 20 for the Blood Brain barrier and having the patient do a tandem gait test and some cognitive tests are helpful, as well as the protocols that Dr. Silverman just mentioned for concussion.  Players suspected of having CTE should be given a functional MRI to see if there is a decrease in blood flow to part of the brain.


Dr. Robert Silverman is a chiropractic doctor, clinical nutritionist, international speaker and author of, “Inside-Out Health: A Revolutionary Approach to Your Body,” an Amazon No. 1 bestseller in 2016.  Dr. Silverman has a forthcoming book, Superhighway to Health, which is a complete guide to understanding the gut-brain axis and how it impacts overall health.  Dr. Silverman has a full-time private practice in White Plains, NY, where he specializes in the treatment of joint pain with innovative, science-based, nonsurgical approaches and functional medicine. His website is Dr.RobertSilverman.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 or go to www.drweitz.com.


Podcast Transcript

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. For those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple podcasts and give us a ratings and a review. That way more people will find out about the Rational Wellness Podcast. Also, you can go to YouTube and watch a video version, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

                                            Today we’re going to talk about the gut-brain axis with Dr. Robert Silverman. The gut brain-axis refers to the bi-directional, both ways, communication that occurs between the gastrointestinal track and the brain and the central nervous system. The gut microbiota communicate with the brain through the vagus nerve through the production of neuropeptides, through the production of neurotransmitters like serotonin and GABA through the immune system and through altered intestinal permeability.   The brain plays an important role in the modulation of gut functions such as motility, secretion of hydrochloric acid, bicarbonates and mucus and the gut immune response. The brain communicates with the gut through the sympathetic and parasympathetic branches of the autonomic nervous system. The brain also communicates with the gut through the hypothalamic pituitary adrenal axis using hormones which are essentially chemical messengers to control the digestive process. The vagus nerve is one of the main pathways for nervous system communication between the brain and the gut.

                                            Dr. Robert Silverman is a chiropractic doctor, clinical nutritionist, international speaker and author of Inside-Out Health: A Revolutionary Approach to Your Body, an Amazon number one bestseller in 2016.  Dr. Silverman has a forthcoming book, Super Highway To Health, which is a complete guide to understanding the gut-brain axis and how it impacts overall health. Dr Robert Silverman has a full time private practice in White Plains, New York, where he specializes in the treatment of joint pain with innovative, science-based, non-surgical approaches and functional medicine. And most important Dr. Robert Silverman is the chosen one.  Rob, thank you so much for joining me today.

Dr. Silverman:                    It’s great to be here today.  Thank you Ben, that was a great intro. Thank you so much. I’m excited about it.

Dr. Weitz:                           Okay, great. Why have you made the gut-brain axis your focus with your new book, Super Highway To Health, which is going to be released in February of next year?

Dr. Silverman:                    For me, I practiced 20 years and I found this may be the key access to our health. I think it was overlooked up to most recent memory and I believe that if we have a strong gut to brain connection that you will see a lot of health conditions quelch. Without question, the gut to brain axis is the topic of 2019 and beyond.

Dr. Weitz:                            In the Functional Medicine world, it’s commonly accepted that the gut is often the root cause of many other health problems, but this is not commonly accepted in the general medical community. Can you explain the impact that gut has on our health?  Can you also explain why the traditional medical community doesn’t seem to appreciate this connection?

Dr. Silverman:                    Let’s go through all the good stuff and then maybe we can get to why they’re not embracing it in the medical field. It’s interesting. Although there are a lot of medical DOs, MDs, DOs that are really coming in and looking at the medicine, functional nutrition model. The gut without question is everybody knows is 80% of our immune cells. I’ll say that again. It’s 80% of our immune cells. What have you done for your guts lately? Do you have the guts to be healthy? Your gut is where your macro and micro nutrients are absorbed. That’s foods, vitamins, and minerals. The bulk of the absorption occurs in a misnomer called the small intestine.  The small intestine is 90% of the size of our intestinal track yet we call it the small intestine. Food, nutrients and water are supposed to be absorbed in the small intestines. A new study just came out that lymph nodes are pointed exactly at that property in the small intestine. Whereas the large intestine, where a lot of bad things can occur, is a much thicker mucosal lining. It’s actually three layers, the mucosal lining in the large intestine. The small intestine is a single layer epithelial cell that if you unraveled it would be the length of a tennis court with the thickness of a paper towel.

                                            What’s most interesting to me is why people don’t look at it. I cut my finger, I put a band-aid on it because I know to protect the barrier. We don’t see the barrier in our gut so we don’t think to protect the barrier. So if our gut is damaged or it becomes leaky, if you will, too permeable, this can send a cascade of injuries, a cascade of inflammatory markers.  And that cascade stimulates and starts outside our gut in our bloodstream. It can be localized inflammation, systemic inflammation, and ultimately leading to, and we’ll go into more detail I’m sure, auto-immunity.

                                             The gut keeps what’s inside your body from actually going outside your body. Everybody right now, the doctors all know this, but every lay person, if you will, think about if your gut is too permeable or leaky, what’s inside your gut is floating around in your bloodstream. Most people when I say that, take a step back and go, “Oh, what do I need to do to keep this healthier?” Now why are the medical fields not taking this? It’s interesting. I went to chiropractic school in 1996 and leaky gut was already coined.  I think that a lot of the medical fields haven’t addressed this because a lot of the medications and a lot their treatments are very adverse to gut health. For instance, antibiotics, opiates. I mean opiates, the word opiate means opium. It has a slight amount of opium in it. Nonsteroid anti-inflammatories like Advil, Ibuprofen, Aleve, all damages the gut. They actually damage something called the tight junctions. Now you and I always use the word tight junctions and they open up and then we call that leaky gut.  Somebody just said … It was actually a patient who said to me, “So those tight junctions open up, I’m going to call them loose junctions.” I’m like, “That’s pretty good. I see you nodding your head.”  I just don’t think they’ve, taken this concept and it’s indisputable about the gut being 80% of the immune cells. For me I’m pausing because it’s so disconcerting, because it’s this constant battle every day. There are actually patients coming in that already say, “Hey, what can I do for my gut?”

Dr. Weitz:                            Right. One of the interesting things is all the myriad of non gut related symptoms that can actually have their origin back in the gut. You can have skin problems, you can have neurological brain problems, you can have a host of other problems that if you clean up and fix the gut, will often ameliorate.

Dr. Silverman:                     Absolutely, I have what they called my Dr. Rob’s gut matrix and it’s one slide and I’ve done a whole weekend on one slide. If your gut is leaky, if your gut is damaged, we can take it to the next step. If LPS, lipopolysaccharide, an endotoxin is expressed, lipopolysaccharide is on the inside of the body holding the outside of the membrane, holding gram negative bacteria there, endolethal distending toxins. If LPS is exposed, it leads to systemic inflammation.

                                            If your gut is too permeable, there’s too many toxins or an excess amount of toxins going into the liver. 75% of the toxins that get fed to your liver gets fed through your bloodstream from your gut. 25% gets fed through your portal vein. Leaky gut, damaged liver, leaky gut, higher incidence of prediabetes, diabetes, obesity because of the inflammation. In addition to that, we’ve also seen three times the incidence of heart attack now, with the expression of LPS. Leaky gut, leaky heart, increased auto-immunity.  Everybody comes in with a thyroid problem, so they think, or some autoimmune problem. Well, let’s trace it back possibly to the gut.  Leaky gut, higher incidence of musculoskeletal pain. 50% of people who have spondyloarthropathies have a leaky gut. You and I started it as chiropractors, we still do chiropractic. People are coming in with back pain, they think I’m nuts. I said, “Hey, I’m going to fix your area of your lower back, your L4-L5, but I got to fix your gut.  The literature is robust on that, in addition, and probably the biggest thing that we talk about is that gut to brain axis. Leaky gut, leaky brain, leaky brain, leaky gut. Gut on fire, brain on fire.  Your gut communicates with your brain within a millisecond.

Dr. Weitz:                            I also think it’s interesting that you were emphasizing the small intestine and in addition to there not being enough focus on the gut, what focus there is has been largely on the large intestine and doing stool samples and analyzing the bacteria there.  But not much has really been focused on the small intestine till all this focus on SIBO started coming in.  But Dr. Pimentel right now is doing a major project to map out the microbiota of the small intestine, which really hasn’t been done to this point.  I think that’s going to be… You will see a lot more focus on understanding the small intestine in the future, or I guess we should probably call it the long intestine instead of the small intestine.

Dr. Silverman:                    The long intestine with loose junctions. Yeah, I mean in a small intestine we know we can have leaky gut and when you think about it, I ask a lot of people, I say, “Where’s your gut leaky?” The question I really ask is, is it leaky in the small, large, or both?  Well, it’s probably both, but it’s probably more so in the small because the large intestine has all these really involved conditions like IBD, IBS, celiac, Crohn’s, ulcerative colitis.  Obviously Crohn’s is all the way through the track. The damage to the large intestine, can also backlog to the small intestine.  But interestingly enough, to get back to the gut to brain axis, if the large intestine is going back to the small intestine, it may be damaging the ileocecal valve, the flap or the doorway between the large and the small intestine. And what controls the ileocecal valve other than what you talked about earlier, the vagus nerve.

Dr. Weitz:                           Right?  What are some of the ways that our brain helps to direct the function of the gut?

Dr. Silverman:                    Well, let’s talk about the vagus nerve you mentioned-

Dr. Weitz:                           Okay.

Dr. Silverman:                    I’m sorry. Let’s do the vagus-

Dr. Weitz:                           Sounds good.

Dr. Silverman:                    There’s three. Now you really talked about the idea of neurotransmitters and everything. 93% of serotonin is your gut without question, those neurotransmitters are a player.  We forget our blood system.  We’re all interconnected, so it’s definitely going to communicate there. But the fastest way and the thing of most interest because everybody’s playing with it so much is without question, once again, that vagus nerve, that cranial nerve, that bi-directional communicator. The vagus nerve goes from the brain stem, the medulla oblongata, down through the transverse colon. It’s on the outside of the transverse colon, but it innervates the larynx, the pharynx, the liver, the pancreas. It does everything in that area down so it has an effect on heart rate. Now the stimulation of the vagus nerve, just as an aside, is really implicated in the increase in heart rate variability.

                                           You increase your heart rate variability. It shows health. Lot of good blood markers go with heart rate variability. The vagus nerve is 80 to 90% efferent. Now that means it’s a sensory nerve that communicates and the reason it’s a sensory nerve, it’s on the outside of the transverse colon and not on the inside. What is it senses: dysbiosis or the unleveling of good and bad bacteria and it does so and it stimulates something called toll-like receptor 4. Toll-like receptor 4, not to get too technical, is actually an innate immune stimulant on your intestinal, inside your intestinal track. And what stimulates toll-like receptor 4, lipopolysaccharide.  When it does that, the vagus nerve actually dims and sympathetics go up, parasympathetics go down, the properties of the vagus nerve no longer function like it is a rest and digest nerve or your wine and dine nerve. It also relates, you talked about motility, the migrating motor complex or the migrating motility complex. We need nine to 11 peristaltic contractions in our small intestine per day to move our bolus from the small to the large intestine. When we have SIBO, we’re down to three because we have a backlog of the bacteria and it’s not moving through. Many attribute that SIBO to a decrease in vagal nerve stimulation.

                                           Then you have the ileocecal valve that may be open so you get the backlog from the large to the small intestine or it may be closed. You can’t get the small intestine to go to the large intestine. One last parting shot on that before we go into more detail, when you have a concussion, it down regulates your vagus nerve. You’ve got to treat the gut.  60% of concussion patients get SIBO.

Dr. Weitz:                           Interesting. What are some of the ways that our modern lifestyle and the standard American diet affect the gut-brain axis?

Dr. Silverman:                    Well, I tell everybody, and this is in my upcoming book, I share it. I tell them this is my thousand dollar nutritional consult. Everybody got ready, GPS and you’re going to laugh, no gluten, no processed food, no sugar. Take care of your DNA, no dairy, no nicotine, no artificial sweeteners. If you want to add one more thing for your lucky seven, anything you’re allergic to, don’t eat.  We can cover the lectins in that seventh morning if you will. We started with all the bad foods, then we’re talking about the environment. Interestingly enough, the environment, BPA and pthalates, it’s very basic stuff. We get these environmental toxins that damage the integrity of our gut, which we want to keep in a pristine condition. And food, look at all the food chemicals, all the food gums, the emulsifiers. They all damage our gut lining. We just talked about drugs, the different kinds of drugs and everything and let’s not forget being a type a personality, how about stress?

Dr. Weitz:                            Absolutely. Increases stress hormones, adrenaline, cortisol.

Dr. Silverman:                    Yeah. That and now you’re getting from that gut to brain axis as you talked about in your intro to the HPA axis, which is that lateral periphery. That gut to brain is the center, it’s the highway. There’s an exit to get on another road, and that’s HPA.

Dr. Weitz:                           You brought up lectins. It’s a little bit of a side path, but should…

Dr. Silverman:                    Here we go.

Dr. Weitz:                           Should we be scared to death about lectins?  If I eat a lectin, am I going to die? If I eat a tomato, if I eat some other… Hey, if I have a legume that has lectins, is that going to harm me?

Dr. Silverman:                    Again, if we take wheat and dairy out, the amount of people that are showing to be allergic to lectins is much less. Do I think that everything’s lectin and just take every lectin out? I would probably say no to that. I would say that…

Dr. Weitz:                           If I get tested for sensitivities to lectins or to foods that have lectins and I don’t show sensitivities and I’m good.

Dr. Silverman:                    Yeah. Basically my position will be if you take wheat and dairy out and you’re not allergic to lectins, kumbaya. That’s going to be my answer. I think that clearly lectins are direct binders. If you’re allergic to them, they will directly bind to a tissue and damage you. However, if you’re not allergic and you took wheat and dairy out, I think you can eat them. They’ve got a lot of food values. At a certain point, if we’re going to be so restrictive, there’s nothing to eat. We’ll go back to what a famous chiropractor called Jack LaLanne. He said, “If man makes it, I won’t eat it.”

Dr. Weitz:                           Right. But tomatoes grow in the ground, man doesn’t make them.

Dr. Silverman:                    I mean, it’s an interesting thing. I’m a Tom Brady fan being an East coast guy, even though I’m from New York. So that it was nightshades and everything like that. But the reason they didn’t like nightshades was that they found out that insects died from chewing on a nightshade because there was a neurotoxin.  I think were a little bigger than the insects.  I’m not so sure that even nightshades are as deleterious as everybody thinks.

Dr. Weitz:                           Right. They’d been part of a healthy diet for a long period of time. I’ve had plenty of patients who eat nightshades regularly and we look for inflammatory factors. We look for… Try to screen them for potential, for chronic health problems. A lot of them don’t show any problems at all from eating lectins. That’s what I’ve seen.

Dr. Silverman:                    Yeah. You know what, I’ll take a tomato that isn’t sprayed versus a tomato sprayed any day.

Dr. Weitz:                           Oh absolutely. Yup.

Dr. Silverman:                    That’s a whole other podcast. But basically I’m a big proponent of organic food or quality farm food and everything. That’s one of our biggest problems. Our food nutrient deficiencies are huge and they are without question damaging and ruining us to our gut to brain axis.

Dr. Weitz:                            Absolutely. Pesticides and chemicals. Let that be the next question is what about toxins and what role does that play in our gut health and the gut-brain axis?

Dr. Silverman:                    The toxins may be one of the worst things. Now when we talk toxins, we already did the gluten and the dairy. Two of them are allergic foods. We ought to also cover the environmental toxins and the things. A great one to make sure everybody doesn’t take is Roundup. I mean they just paid a large amount of money because they’re so damning to everybody’s health. They’ve got glyphosate in it. The World Health Organization has called glyphosate a cancer causing property or cancer causing ingredient. It damages the microvilli, which are these little finger projections in our small intestine to grab all our nutrients and they damage them.

                                           Right then and there, obviously we want to avoid the bad soils. Also, and something that I’ve asked a lot of people in the farms is, is the farm or is there shade? If there’s shade, the water doesn’t hit as hard or if it is an organic farm but there’s no regular soil there? Meaning if it’s a full organic farm it’s fine. But if you have an organic section and a regular section when it rains and it rains without trees, so you get all flooding, there’s something called runoff. You run off all the ingredients from one to the other and even though it’s organic soil, you may be getting the pesticides. These are the type of questions that I like to ask, which farm, where’s it going, et cetera. 

Dr. Weitz:                           The water… Organic farming, in my opinion is better, but it’s certainly not perfect. There’s no way to make it perfect because they’re not using purified water. So even if the water didn’t run off from a regular farm to an organic farm, they’re still using water that they’re getting from the river or… And chances are it has some sort of toxins in it as well.

Dr. Silverman:                    No doubt. Understand that organic is only 95% organic which speaks to the idea of you always have to do the best we can. There are certain supplements that we have to take and there’s certain detox and gut helping programs that we should work on all the time. I just did a LinkedIn and we filmed a video and the video said, “Here’s one of the more commonly asked questions in my office. If I eat well, do I need supplements?” Well one, how many people eat well? Almost nobody. But yes, if you eat well you still may need some supplements and without question you want to make sure the gut to brain axis stays in a very strong integrity and making sure it communicates all the time at optimization.


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                                                Now back to our discussion.


Dr. Weitz:                              Now Dr. Jeffrey Bland, originally developed the Four R Program for healing the gut, but you have expanded it to the Seven R program in your new book. Can you explain what your Seven R program is and how it helps us heal our gut?

Dr. Silverman:                    Absolutely and everybody knows that Dr. Bland is the father of Functional Medicine and I’ve had some personal time with him. We all wouldn’t be here if it wasn’t for his vision. I believe that he’s a visionary, so kudos. I tip my hat to him. The Four R was awhile ago and every time I see him and he sees somebody do a rendition, an expansion of it, there’s a big smile in that man’s face saying, wow, look, here’s the seed and look where the plant’s growing. I’m up to seven right now. Let’s go through the seven. This is all pointed at the gut and the gut to brain axis.

                                           Number one R is to reset, reset your lifestyle. If we did anything, resetting the lifestyle would be without question of the ultimate, utmost importance. Within that resetting lifestyle like a diet like we talked about, it could be a keto, it could be a plant based, it could be a Mediterranean, and we could expand on that if you want a little bit. We have to individualize it for that person. New keto may work for you. Mediterranean may work for me. I’ve got a staff member here and plant-based may work for her. With that being said, we should all exercise, get our steps up, some form of body resistance or weight resistance. We don’t have to squat 900 pounds, but some body resistance, some form of flexibility and now really let’s chill with the blue light and all the technology even though you and I are on our laptops right now. Reset.

                                           Number two would be, remove. This is one of the biggest ones. Remove what? Remove toxins. Remove allergy foods. Now, the real question is, and I don’t know if we can cover it, is do food allergies give us leaky gut or did leaky gut cause the food allergies? Let’s take out the high allergy food as our test at that point. Testing and not guessing is a critical element because that starts our baseline. Now remove. We’re going to remove the bad bacteria very simply by using things like oregano oil and emulsified oregano oil, which removes all the bad bacteria from the upper body and berberine HCL and other things that’ll removed bacteria from the lower body. Garlic’s a great choice. SBI serum, bovine immunoglobulin is a great choice because it actually mops the gut and takes the antigen before it goes through the intestinal tract. My add there is, and it’s a question you and I have talked about multiple times, do we do the gut or do we do detox? Well, I do the detox in the gut. That’s when I do my 10, 15 and 30 day detox, within part two of the removal phase.

                                           Then it’s three, interesting three is to replace. What are we looking to replace? We’re looking to replace stomach acids, pancreatic acids. It’s really pointed at digestion. 60% of the gut is pointed at digestion. Now a lot of people say the next one is reinoculate and I say, “No, that’s not the time to reinoculate because the literature shows that if you have a faulty gut or a torn intestinal track, the good bacteria gets through and your body still attacks any kind of bacteria because your immune system’s on.” At this point from section one, or one through three, I recommend Saccharomyces boulardi. Saccharomyces boulardi is a yeast that functions like a probiotic that helps build the intestinal track. It also decreases your incidence of C. diff.

                                           At this point, our four is to regenerate. Regenerate, repair, or what I like to call heal and seal the gut lining. Use a plethora of nutrients. Some of these are called medical foods, nutrients that enable the gut lining to heal. They do so by promoting a microenvironment that’s anti-inflammatory and specific nutrients that adhere to the mucosal lining and allow it to proliferate and grow. Some other ones asides would be alpha lipoic acid, fish oils. Fish oils are great for the biodiversity in the gut. Fish oils dim the signal of toll-like receptor 4. If you want good gut health, better use fish oils. Vitamin D also helps with the biodiversity.

                                           Number five, obviously then reinoculate and we can go into detail. We can spend all day here talking about the different types of genus, species and strains. Some of the things that I’ve… It’s probiotics and prebiotics. Couple of takeaways that I like is the probiotics, we want diversity. We always want to switch. Some of the hotter ones right now that I like are the endospore bacillus subtilis, it’s an endospore and the prebiotic that I’m leaning towards is not FOS anymore, it’s XOS. XOS has a lot of literature, but the very basic takeaway is XOS feeds the good bacteria, FOS the bad bacteria and the good bacteria.

Dr. Weitz:                           Tell us what XOS is versus FOS.

Dr. Silverman:                    Xylooligosaccharide. It’s a different form of a carbohydrates where we call it fructooligosaccharides. If you guys can spell it, you may be able to beat those 12 year old kids on the spelling bee that got everything right. Good luck. XOS is really the choice right now. Something else that you may want to consider that in a remove phase is something we’re going to hear a lot about this. Bacteriophages, the phages are the choice. 110 years ago or whenever they decided to make antibiotics, antibiotics were made and they decided on it because they were carpet bombers. They killed all bacteria.

                                           The bacteriophages kills one family of bacteria. It’s structure is such that it attaches to the bacteria and it actually goes into the bacteria cell and getting into the bacteria cell, it populates and duplicates and explodes the cell. What it does is, it’s kind of like you have this city with bad guys and it doesn’t kill everybody, it kills all the bad guys and then lets the micro environment of the city, your gut, elevate. Bacteriophages are the thing they’re all going to talk about. There’s a lot of excitement there and they’re used to kill superbugs.

Dr. Weitz:                           I’ve kind of been hearing about that for the last five or 10 years and there’s a few products and then some people say, “Well, look, you can’t just have one product for killing all the different bacteria.” So far not much has really come out of this literature.

Dr. Silverman:                    The literature I’ve seen recently has been really strong, quite robust. It’s something I use. It’s one of my go-tos and like you said, there is no one product.

Dr. Weitz:                           Right. I’ve seen one product, but all it does is affect E. Coli, right?

Dr. Silverman:                    No, there’s a few more. Got a whole bunch now. I’d be happy to share them with you when you’re off the podcast.

Dr. Weitz:                           Okay.

Dr. Silverman:                    Love it. It’s great. I’ve been using them and getting really, really good results. The sixth R is to retain. It’s actually retest and retain. We have to do a baseline, testing is a critical element. We can talk a little about the testing that I recommend and it’s actually retest-

Dr. Weitz:                           What testing do you recommend?

Dr. Silverman:                    I like, you know what, if you’re going to… Without question, you don’t have to put a gun to my head. The tests that I really enjoy are the Cyrex tests. I found them to be quite effective in that they’re great at testing for barrier issues in autoimmunity. The barriers is a problem you want to detect, correct-

Dr. Weitz:                           Explain what you mean by testing the barrier?

Dr. Silverman:                    Okay. Well, there’s specific proteins that you can test for. For instance, let’s take the array 2. The array 2 deals with gut permeability or heightened gut permeability. They’re testing for LPS, which we talked about as an endotoxin. They’re also testing for occludin and zonulin, which are proteins that imply tight junction damage. Then they’re talking back to myosin, which is actually at the intestinal gut level. What they’ve also mixed it with in the real treat is they’re also testing for something called immunoglobulins, IgG, IgA, and IgM. IgG is our most common immunoglobin.  It’s 75% of our immunoglobulins in our body are IgG and it’s the only one that can pass the placenta. IgG implies chronic inflammation.  IgM implies acute inflammation.  IGA implies reactivation.  You’re seeing the damage and the area and the amount of autoimmunity going on. It’s not just showing you damage, it’s also showing you the damage that it can cause because auto immunity is an issue. One aside to the auto immunity is that as a chiro, people still come in for joint pain to me. We all know rheumatoid arthritis is our immunity, osteoarthritis is also, and you need to test the gut.

Dr. Weitz:                           This Cyrex test is a blood test and it’s designed to look for a leaky gut, right?

Dr. Silverman:                    Leaky gut, tight junction damage, that’s array 2 and also damage at the epithelial lining.  People don’t realize that you can have a… Here’s your gut, it’s semipermeable. You have LPS coming through causing a possible systemic inflammation. Interesting thing about LPS is, it doesn’t always have to cause symptomology, gas and bloating. There’s something called now silent leaky gut that Datis Karrhazian has coined brilliantly. He’s talked about, do you have fatigue? Do you have chronic inflammation in your body? Are you getting some forgetfulness? While you may not think it’s attributed to the gut, but it really is. These tests are great markers as a starting point just in the gut. They also have a SIBO versus IBS tests because we know if we have IBS, a lot of people transpose into SIBO and that would be Array 22.

Dr. Weitz:                           What about directly testing the gut by doing stool tests that look for pathogens, look for imbalances, look at, analyze the whole microbiota?

Dr. Silverman:                    I think those tests are great. I think that’s another great test. I know exactly the Genova test that you’re talking about and some other people have other stool tests. The real question is how much testing do we want to do? Do we want to test for food allergies? I’m a big proponent now of testing for genomic markers, trying to see where we are genetically. For instance, can you assimilate fat or do you assimilate carbohydrates? We all know that carbohydrates or improper carbohydrates are not a good choice, but we may assimilate them. We may have to change our macro nutrient content to the individuality of the patient in front of us. So testing, not guessing. That’s actually chapter four in my book.

Dr. Weitz:                           Of course, when you do a good stool test, it should include markers for whether or not you’re breaking down your fats as well because those will come out in a stool undigested.

Dr. Silverman:                    Absolutely. Testing is a critical element without question, even just testing a body fat seeing where somebody has visceral fat that’s indicative of things. I’ve seen visceral fat decrease when we’ve correct the proverbial leaky gut.

Dr. Weitz:                           Yeah. For the stool testing, I prefer the PCR based testing.

Dr. Silverman:                    Okay. I love it.

Dr. Weitz:                           Let’s talk about the vagus nerve.

Dr. Silverman:                    All right. Let’s go into-

Dr. Weitz:                           If there’s communication problems, what can we do about it? Is there a way to fix the vagus nerve and make sure this communication functions properly?

Dr. Silverman:                    Well before I started to really work with the vagus nerve, what I read and it’s still there is to gargle, to cough things like that. I’ve never found them to be speedy or extremely effective. There’s…

Dr. Weitz:                           No, what particular symptoms were you looking at that you expected these to have an effect on?

Dr. Silverman:                    I kind of backed down with no pun intended, I was treating so many concussions and not getting the resolution that I needed until I really started to implement and understand the gut to brain or if you will, the brain to gut axis. When I did that, I realized the vagus nerve was the player and then I started to work real hard, gather literature and try things empirically in my office. The thing I found the best to stimulate the vagus nerve, because the problem is it’s dim, we want to stimulate it, has been a 405 violet laser made by Archonia. I have found about 30 seconds on each side to really stimulate the vagus nerve and upgrade that communication with the brain to gut axis. That’s number one 

Dr. Weitz:                           You do it along the neck where…

Dr. Silverman:                    Yeah. I go from the medulla oblongata at the brainstem, down through the transverse colon, each side. Interestingly enough, vagus nerve left side is satiety, right side is mood and behavior. There are some differences. Yeah, there you go and it communicates really quick. Now-

Dr. Weitz:                           Other than this part of the neck afterwards, it’s deep inside the body cavity, right?

Dr. Silverman:                    It is. It’s exposed going through the jugular foramen. There are three nerves that actually go there other than some vessels, but those nerves are spinal accessory in glosspharyngeal nerve. But the vagus goes through there. I patch it up here and I came down and I go through the whole area. Now I’m at the point where I’m using like a percussor where the ileocecal valve is to create tone or increased tone by the transverse colon. I’m taping the space using a performance tape up here and a tape on the ileocecal valve. We’re getting the vagus nerve to go up and how do we know that?  Heart rate variability. We’re also coming out of my book with a vagus nerve nutritional protocol. There are some nutrients that help stimulate the vagus nerve and feed it. We’ve got about six to eight months of literature on that and I’m very excited to share that with everybody.

Dr. Weitz:                           Interesting. What are a couple of the nutrients that stimulate the vagus nerve?

Dr. Silverman:                    Omega-3 fatty acids, believe it or not, are one of the big ones. No real surprise there. Green tea extract is another one. You know what, I’ll give you those two and if you start with that, you’re really going to get going. But I’ve got like six or eight nutrients that are really going to get the vagus nerve to go. You guys are going to love that. Don’t worry, I’ll post it online when the book comes out. If you don’t buy the book you’ll get the post. I’ll write a blog on it.

Dr. Weitz:                           You mentioning how you treat a lot of concussions, can you talk about that? How do you… What’s your treatment protocol for concussions and what kinds of testing do you do and then what types of nutraceuticals are beneficial after a concussion?

Dr. Silverman:                    All right, so concussion is basically injured more from shearing of the brain. Remember the brain is made of a consistency of jello. That’s right, jello. It’s three pounds. It’s a very small organ. Yet it communicates with all the other organs in our body. The shearing from the moving, that’s where the tearing is, and there are some tearing to brain matter, but the biggest tear is the axons which allow you to communicate.

Dr. Weitz:                           And is one of the key factors that the person loses consciousness during the trauma for a period of time or is that not necessary?

Dr. Silverman:                    The loss of consciousness isn’t really a key determinant. About 9.3%, a little less than 10% of people actually lose consciousness. There are different grades, but they’ve kind of moved away from the grades, they’re are looking at the damage. It’s that shear back and forth. Women are more susceptible to concussion than men. They have weaker neck muscles, more impact, more whip, more shear. They don’t respond as well. We can go through that if you like, but some of the testing, very clear, everything’s in the eye so we use a visual ocular motor screen. You can download that. That’s two to four pages. The blood tests I used the Cyrex blood brain barrier. That is array 20. There’s also some standard blood tests now that you can look at. Some of the standard blood tests are interleukin six, interleukin eight and C reactive protein. They’ll show this tissue inflammation.

                                                In addition it’s something new called Neurofilament light. It’s a protein enzyme that the brain gives out. That’s actually an early marker for Alzheimer’s. It can depict Alzheimer’s, depending on what literature you read, from 16 to 23 years. 80% of people who get a concussion who have the APOE for a Leo in Alzheimer’s increases your incent. Something to look for. Those really cover the tests. The achievement are very interesting. It’s a five-part treatment for me.

                                                Number one, upper cervical. Upper cervical in the occipital ridge, the occipital triangle. You really want to go for those muscles, the muscle that’s most implicated is the rectus capatis posterior minor because it has the strongest myodural ridge. Because it has parallel collagen fibers so it gets whipped back and forth with the head. With that being said, any manual therapists, chiropractor would want to go in there and work on that area.

                                                In addition, we’ve got to start looking at the neck. Most people didn’t realize they all looked at you and didn’t realize the neck was holding the head up. I have torticollis so my neck is crooked but it makes my head look crooked so it’s intertwined. We have to look at the neck. Jim McMahon does a phenomenal 30-30. Remember that quarterback from your Chicago bears and your colored hair, crazy guy and he just stands there now looking with sunglasses in a dark room, having trouble articulating, doing puzzles. He went to a chiropractor in long Island, New York and he said that chiropractor was the first doctor who looked at his neck. So neck is a major thing manually, testing it, possibly adjusting it. Yes, medical doctors adjusting it. The literature is very strong on that. That’s the musculoskeletal chiropractic mode. The other modes are balanced and visual gaze. Balance, training, proprioception. Eight weeks of proprioception have shown to increase the size of the cerebellum where the bulk of posture and nerves are feeding.  That’s a great thing. Proprioception and balance and space between your nervous system and the muscular system. Gaze stabilization is a big deal. Your ability for eye-head movement. Dr. Ted Carrick, a chiropractor’s shown some great literature on that. I think it was in last year’s Frontier of Neurology, if you want to see that study. Laser, I use a lot of transcranial laser, 635 nanometers. The takeaway there is 635 and shown to stop cell apotosis, increase BDNF, brain derived neurotrophic factors which allow for brain neurogenesis. The takeaway here as in we’ve heard Dr. Perlmutter say this multiple times, the brain can now repair itself because we can’t have brain neurogenesis. Remember neuroplasticity, the ability of our plastic brain, plastic allow to grow nerves. I found the laser to be extremely effective for a great microenvironment. And then I use a nutritional protocol.

                                                I’ll give you the five nutrients. I have 15. Let’s give you the five. Magnesium Threonate. Magnesium L-Threonate has really shown to decrease any kind of injury, decreased brain aging, and up-regulate the ability of available magnesium both in the brain and the spinal cord. Omega-3 fatty acids, great for healing the brain, cell membrane. They actually enable you to avoid concussions. Everybody who’s treating teenagers or college kids or somebody who’s in a contact type sport, Omega-3 fatty acids.  Tumeric is always a great choice. We all know that. Pro-resolving mediators, specialized pro-resolving mediators allow for the resolution of inflammation. I’ll make it really easy. L-Glutathione decreases brain tissue damage by 70%. So Liposomal glutathione is my choice. There’s your big five.

Dr. Weitz:                            Cool. You’re talking about concussion, but we’ve learned in the last number of years a lot of football players and other athletes and even apparently people who don’t engage in athletics undergo some brain damage that is not really defined as a concussion. It’s called chronic traumatic encephalitis. It’s structural damage to the brain that can’t be seen on a normal scan. How do we diagnose that and can some of these protocols be beneficial for those patients as well?

Dr. Silverman:                    Yeah. CTE, they did a study of dead NFL players, 110 out of 111 had CTE, there’s damage to the brain. It’s sort of a sub-concussions can equal multiple concussions. Really the best tests are, for me, in here are tandem gait. What an easy thing, tandem gait. You remember you grew up at a similar time to I did, if you couldn’t walk a straight line you had too many back, back too much. I like the tandem gait. You should also test the blood brain barrier and that’s a hidden thing. I go into great detail in my book that the blood brain barrier is made up of the same protein structures as your gut. It’s a single layer organism of the same proteins. The only thing is I call it the bouncer of the brain.

Dr. Weitz:                            Are you saying that using gut-brain barrier tests from Cyrex array 2 is a way to help diagnose CTE?

Dr. Silverman:                    I won’t say CTE, but I test array 20 for the blood brain barrier and I found out if the blood brain barrier… array 20. The only thing that isn’t protect- The blood brain barrier obviously is what it says. It filters blood, 400 miles of blood to the brain. The only thing that really isn’t encased in the brain, in the blood brain barrier is the pituitary because it has to have direct contact with the blood. But once the blood brain barrier’s open, it’s direct access to neuro autoimmunity in the brain and that’s a lot of CTE and other things that we’re talking about. I’m big on that blood brain barrier. Some cognitive tests work really well and the treatments I mentioned before are treatments that you could use virtually mimicking the same treatments I just mentioned for CTE.

Dr. Weitz:                            Are there any other tasks that correlate with CTE?

Dr. Silverman:                    They’re in now some brain scans and MRIs that are being very revealing. So the brain scans are revealing the MRI, the key to the MRI is structure and function. If they have CTE, they have structural damage. But if somebody comes in your office, you want to ask for an MRI. That structure and function, structure is the structure of the brain and function is the blood flow. Obviously one of the biggest things that occur after concussion is lack of blood flow for the first seven to 10 days. You may want to get an MRI to see and reveal what’s going on inside the main organ in your body.

Dr. Weitz:                           But a standard MRI won’t show it.

Dr. Silverman:                    Standard MRI does not show it so you’ve got to ask for that structure and function. I can tell you so many times where I’ve had to ask and I’ve been corrected even if I’ve had to re-ask for it.

Dr. Weitz:                           What exactly is that called? It’s not called a structured function MRI, is it?

Dr. Silverman:                    No. Well, you know what, it’s a funny thing. My MRI place, if I were to walked there, it’s 10 feet away. I tell them that I want the MRI that reveals the vessels and they’re able to do it. That’s how I word it. Just say, I want to see the blood vessels, I want to see the functional movement of the blood. They’re like, “Okay, we know what to do.” Fill out this form.

Dr. Weitz:                           Okay.

Dr. Silverman:                    I can put in the comments section what they’re calling it and everything. It’s sort of like… It becomes rote to me at this point.

Dr. Weitz:                           Right. Good. I think this has been a good discussion. Do you want to give listeners three things that they could start on tomorrow for better gut-brain health?

Dr. Silverman:                    Absolutely. I’m going to make it really easy adhere to my GPS.  I said it before, no gluten, no processed food, no sugar. Take care of my DNA, no dairy, no nicotine or artificial sweetener. And guess what? Get a good night’s sleep.

Dr. Weitz:                           That’s great. How can our listeners get a hold of you and find out about your books and your programs?

Dr. Silverman:                    Well, great, thank you. My website is drrobertsilverman.com. Facebook, LinkedIn, Instagram, Dr. Robert Silverman. I’m very active socially. I’m always posting. I post two to three times a day. It’s a great way to get in touch with me and anybody wants to email me info@drrobertsilverman.com.

Dr. Weitz:                            Awesome. Thank you, Rob.



SIBO Advanced Concepts with Dr. Allison Siebecker: Rational Wellness Podcast 123

Dr. Allison Siebecker discusses SIBO advanced concepts 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. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

3:24  There is some confusion about what IBS/SIBO patients mean when they report some of their symptoms, such as constipation and gas and bloating. Different patients who complain about constipation can mean a number of things. Dr. Seibecker has a whole section in her new course about this.

Dr. Weitz’s observation: For some people, constipation means that they haven’t gone to the bathroom in three or four days.  Other people, they’re going to the bathroom multiple times but nothing is coming out. Then some people go to the bathroom and they just sit there for an hour straining. 

Dr. Siebecker:  Constipation is defined by both the texture and the frequency of the stool.  Texture has to do has to do with whether it’s loose, that will be more like diarrhea, or whether it’s formed that’s normal, or whether it’s in these little balls or pellet, which is a form of constipation.  So a person could be having high frequency, so they’re going and sitting down on the toilet and having a bowel movement say 10 times a day, but every time it’s one little pellet. So that’s mixed, that’s a mixture of diarrhea and constipation because then they have the texture of constipation but the frequency of diarrhea.  With respect to diarrhea, the texture there would be loose or watery and the frequency would be more than 3 times a day. So the normal range is 1-3 bowel movements per day. The other way to categorize it has to do with the sensation, whether they have urgency or are straining. If they are straining, this is a form of constipation. A person might have loose texture, but not go very frequently. They sit on the toilet and strain and strain and then out comes water, which another form of mixed, though they might call this constipation.  The other consideration is to look at the Bristol Stool Chart, which Dr. Siebecker has on her pencil holder. 



Type 1 is the small balls characteristic of constipation.  3 and 4 are normal. 5-7 is the diarrhea side of things.  When you have patients with mixed pictures, what matters is not what you call it, but that both you and the patients are on the same page with what they are talking about.

When it comes to bloating, there are two terms–distention and bloating.  Distention is when the abdomen swells out with gas. Bloating is technically the sensation or feeling of bloating, basically of the abdomen swelling out like you get a feeling that your abdomen is swelling, but it may or may not be.  Some patients have the sensation or feeling of bloating, of their abdomen swelling, but it never does.  This relates to visceral hypersensitivity. The sensation of bloating can be very aggravating and some patients need to put on looser pants due to the discomfort.  We must differentiate this from edema, which can occur from water retention, which in women could be related to the menstrual cycle.  If you do a percussion on the abdomen as part of your physical exam, you can hear a hollow tympanic sound when it’s gas and not when it’s fluid or fat.

13:25  When a new patient comes to see Dr. Siebecker, usually they have been to see several other doctors, so her examination and approach is a bit different than a doctor seeing a patient for IBS who has not seen anyone else yet.  Before doing any testing, she usually likes to use first line therapy, including diet and lifestyle. She makes sure they are eating healthily, chewing their food, using stress reduction, fresh air, and exercise.  The next steps are basic supplements and low risk modalities, like digestive enzymes, hydrochloric acid, and probiotics. 

17:52  If the first and second line therapies fail, then Dr. Siebecker will recommend some testing, including a three hour lactulose SIBO breath test, a Functional Medicine oriented stool test, perhaps the IBS Smart serum test, and screening blood work.  Dr. Siebecker prefers using lactulose over glucose, since glucose is primarily absorbed in the proximal portion of the small intestine, so you don’t learn about the rest of the small intestine.  She prefers the three hour SIBO test, since any elevation of methane of 10 ppm or above even in the third hour is considered a positive.  Also, Dr. Siebecker mentioned that Dr. Pimentel uses a cutoff of 3 ppm for methane and Dr. Siebecker also thinks that a cutoff point of 10 is too high and thinks that it should be 8 or perhaps even 6.  Dr. Siebecker also said that while The North American Consensus on Breath Testing says that a positive finding for hydrogen requires a rise in hydrogen of ≥20 p.p.m. by 90 min, Dr. Siebecker considers a rise at 120 min positive for SIBO as well, esp. if there is reason to think that there is slow transit time, such as constipation.  She pointed out that this is the criteria that the manufacturer of the breath test recommends. 

24:42  What has become understood in the SIBO world recently is that methane is now being thought of as a different disorder and not necessarily SIBO. The methane may be in the small intestine, the large intestine or both. Even if they are primarily in the small intestine, since they are not bacteria but archaea, then it is not technically bacterial overgrowth.  Now we also need to consider that they are normal commensal bacteria in certain populations.  But on one level, it doesn’t matter if the methanogens or in the small intestine, the large intestine, or both, since the treatment is the same.

27:24  There is a blood test that Dr. Pimentel developed called the IBS Smart Test from Gemelli that helps to distinguish if the origin of SIBO is due to food poisoning and Dr. Siebecker said that also usually includes this in her initial testing for patients with IBS. This test will tell us if using a prokinetic is an essential part of the treatment.  Cyrex has also developed a similar test but that measures more antibody markers called Cyrex Array 22, but Dr. Siebecker said that she prefers the IBS Smart Test because it has been validated with published studies, while the Cyrex Test has not been.  Dr. Siebecker said that she has run organic acid urine testing, but she may not do it, since you will hopefully find out about fungal overgrowth from the stool test and she will also find out about parasites as well, that the organic acid test will not tell you about. 

36:12  Methane SIBO is so much more difficult to treat than hydrogen and Dr. Pimentel speculated that this may be because the archaea live down in the mucosal layer of the intestine and are harder for antibiotics or antimicrobials to reach. Also, we know that methanogens make biofilms. Dr. Siebecker said that she used to use biofilm busting enzyme formulations and did not notice much benefit, but she thinks that some new products that Dr. Paul Anderson designed may be more effective.  Dr. Andersen says this may be because you have to use stronger right products to break up the biofilms, including a product containing bismuth, which is also in Pepto Bismol.  Bismuth is a heavy metal that has a low level of toxicity and which is used to treat H-pylori bacterial infections and is considered an antidiarrheal agent.  Dr. Anderson has a prescription product called Biosolve-PA, which contains Bismuth and DMPS and also an over the counter supplement called Biofilm Phase-2 Advanced, which contains Alpha Lipoic Acid, bismuth subnitrate, and black cumin. 

40:05  Dr. Rahbar, who spoke at the last SIBO conference, at Los Angeles Integrative Gastroenterology, finds that his methane SIBO patients often have co-infections with viruses or Lyme disease or other parasites or mold toxicity or glyphosate toxicity. He thinks that methane SIBO is partially a form of immune dysregulation.  Therefore, taking IgG products, such as Serum Bovine Immunoglobulins, like ImmunoLin or SBI Protect, can be helpful.  Dr. Siebecker also finds IgG products very helpful for SIBO patients. Dr. Siebecker said she has been taking it and besides its benefits for the gut, it has helped lower her LDL cholesterol, which is genetic.  These IgG products are purified forms of colostrum, which Functional Medicine practitioners have been using to heal the gut for many years.  Also methane is related to TMAO levels, since TMAO, which is the latest marker for heart disease, is mostly manufactured in the colon by gut bacteria.  Higher levels of archaea result in lower levels of TMAO, which has led some to propose supplements of archaea, called archaeabiotics, to help lower TMAO levels.

48:03  Some Functional Medicine doctors have been using peptides to help with gut health, such as BPC 157, and Dr. Siebecker has tried it and she is not sure it is making much of a difference.

49:53  Visceral (gut) hypersensitivity is often a factor in SIBO and curcumin and bifidus infantis, that’s sold as Align, are both effective treatments for reducing this hypersensitivity.

51:38  To prevent recurrences of SIBO you can recommend a low dose of antimicrobials, such as 2 capsules of oregano daily on an ongoing basis. Dr. Siebecker pointed out that if patients are at 80% cured, if you do one more round of treatment, you can almost always get them to 90%.  She recommends prokinetics to prevent recurrence rather than antimicrobials. She said that the natural prokinetics are not as strong as the prescription prokinetics, like low dose erythromycin or prucalopride. These prescription prokinetics are more effective and prucalopride is also neuroregenerative and helps to heal leaky gut and to protect against cancer.  The other thing that patients will do as they are expanding their diet is to use digestive enzymes.

57:19  Dr. Siebecker is very excited about her new advanced course for practitioners to learn how to treat SIBO called the SIBO Pro Course.  It’s essentially a doctorate level course that she teaches at Naturopathic Medical School that she expanded.  It incorporates answers to all the questions she has gotten over the years and it is in a very organized format.  There are 2 versions of it. There is the self-study version that you do it on your own schedule and they she is also running it kind of like a college quarter over eight weeks and this version starts September 28. You watch 2 1/2 hours per week and you meet for office hours and this version includes learning enhancements, optional quizzes and study guides that you can use as you’re watching to help with the learning.  Here is the affiliate link if you would like to sign up the SIBO Pro Course: https://smpl.ro/al/7TEGvvBoGSzFtdoZLL7BGpGM/15770-Ben-Weitz.



Dr. Allison Siebecker is a Naturopathic Doctor and Acupuncturist and she is very passionate about education.  She specializes in the treatment of Small Intestinal Bacterial Overgrowth (SIBO) and she teaches advanced gastroenterology at the National University of Natural Medicine. She has the most incredible resource of research articles and information about SIBO on her website, siboinfo.com. Dr. Siebecker has a new course for clinicians   To sign up for this course, please use this affiliate link that will include a small commission for me: https://smpl.ro/al/7TEGvvBoGSzFtdoZLL7BGpGM/15770-Ben-Weitz

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 or go to www.drweitz.com.


Podcast Transcript

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 e-book 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 Apple podcasts and please give us a review and a rating. That way more people will find out about the Rational Wellness Podcast. Also, you can see a video version on my YouTube. If you go to my webpage drweitz.com, you can find complete transcripts and detailed show notes.

                                                Our topic for today is small intestinal bacterial overgrowth and irritable bowel syndrome, how best to understand these, what are some of the latest diagnostic methods and gain some insights into an integrative reproach to treating these.  This is the second interview with our special guest, the queen of SIBO, Dr. Allison Siebecker in a few months. I’m regarding this as part two, and I’m mostly going to ask questions, which we did not get to in part one, which is Rational Wellness episode 110; please check that out. To put it in another way, whereas Dr. Siebecker laid some very clear recommendations for understanding hydrogen and methane SIBO, how to treat them, I suspect that this episode will not be quite as clear since I planned to take Dr. Siebecker into some of the murkier waters related to SIBO where answers are not quite as clear cut.

                                           Dr. Allison Siebecker is a naturopathic doctor and acupuncturist. She is very passionate about education, and she has a wonderful new program for educating practitioners about treating patients with IBS and SIBO. She specializes in the treatment of small intestinal bacterial overgrowth. She teaches advanced gastroenterology at the National University of Natural Medicine. She has the most incredible resource of research articles and information about SIBO at her website, siboinfo.com. Allison, thank you so much for joining me today.

Dr. Siebecker:                    Thank you, Ben.

Dr. Weitz:                           So there’s a form of IBS and nobody ever talks about. It’s called podcast-induced IBS. Every time I do a podcast even if I’d just been to the bathroom when I’m about ready to get started, I have to run to the bathroom one more time even though there’s nothing there. It’s one of those stress-induced things. I note Dr. Pimentel doesn’t feel the stress is really a factor in IBS, but it’s got to be a factor.

Dr. Siebecker:                    It has an influence.

Dr. Weitz:                           Anyway, have you noticed when speaking to patients about IBS and SIBO that there’s a lot of confusion about some of the terms? When I interviewed Dr. Pimentel, I talked about the fact that there’s a range of different things people mean by constipation.  For some people, constipation means that they haven’t gone to the bathroom in three or four days.  Other people, they’re going to the bathroom multiple times but nothing is coming out. Then some people go to the bathroom and they just sit there for an hour straining. The same thing when we ask patients, “Do you have gas and bloating?”  I think for a while I would just say, “You have gas or bloating,” or they would check it off and I go, okay, that’s it.  Then the more I talk to patients, I realize that there’s a number of things they mean by gas or bloating. Some patients have abdominal distention due to gas. I think there’s some patients that feel bloated because they just ate a large amount of food and they have this thing about not having a lot of food. Some feel if they pass gas, they call that gas or bloating. I even had one patient that we have been going back and forth with. I’m trying to understand his bloating. By the time we’ve been testing him and treating him, I realize a part of it is just that he has a large stomach. He just feels it’s bloat and I think it’s really not.

Dr. Siebecker:                    So you just told me a little bit about this and these stories right before we started. I was like, “Oh, my God. This is so fabulous.” Because I agree completely with the importance of making sure we understand what patients mean that we’re on the same page with how we’re using the words of the symptoms. I have a whole section on this in my pro course, which is… So shameless promotion here. It’s starting September 28, and I invite everyone to join me– 20-hours and there’s a continuing education.  So let’s just go through with some of these symptoms. So for constipation-

Dr. Weitz:                           Hey, Allison, your volume is kind of going in and out a little bit. I think if you lean forward a little bit-

Dr. Siebecker:                    It’s better if I lean?

Dr. Weitz:                           Yeah, right there, yeah.

Dr. Siebecker:                    Why don’t I… I’ll just hold my microphone.

Dr. Weitz:                           Oh, okay.

Dr. Siebecker:                    You know what, everyone listening, Ben and I we’re just talking about having terrible IT problems with my webinars lately. So I’m just going to hold it so you can hear me well.

Dr. Weitz:                           Okay, good.

Dr. Siebecker:                    So constipation is defined by both the texture and the frequency. So when we talk to patients, we have to clarify it. Also, the easiest, really the easiest thing to do is to ask patients what do you mean, tell me more, just start with that, and then you can start in with your clarifying questions. So the texture has to do like texture in amount that has to do with whether it’s loose that will be more like diarrhea, or whether it’s formed that’s normal, or whether it’s in these little balls or pellets. So some people say rabbit pellets or balls or things like that. So that’s a form of constipation.  So a person could be having high frequency, so they’re going and sitting down on the toilet and having a bowel movement so to speak 10 times a day, but every time it’s one little pellet. So that’s mixed, that’s a mixture of diarrhea and constipation because then they have the texture of constipation but the frequency of diarrhea. So it’s weird how these things can all mix together.

Dr. Weitz:                           I tend to think of that as constipation, right?

Dr. Siebecker:                    It is, but there’s… It’s true, it’s more constipation, but they’re having a constant frequency thing.

Dr. Weitz:                           Right.

Dr. Siebecker:                    So then the frequency typically for constipation is less than one bowel movement a day. That is like how it’s defined by the experts in the papers. Now if we go over to diarrhea, I’ll come back to constipation in a minute, but if we go over to diarrhea, the texture there would be loose or watery and the frequency would be more than three times a day. So the normal range would be one to three. Now some people they don’t like three bowel movements a day, but that is considered normal. So it’s when you get above that.

                                           So the other thing has to do with the sensation, so the urgency and the straining. So another way to define constipation would be are they straining. Again, this is where we get into those odd little mixed pictures because a person might have loose texture but maybe they only go once a day. They sit on the toilet and strain and strain and strain and then out comes a whole bunch of water. What is that? That’s probably constipation with fecal loading, but it’s still considered mixed. The reason they came up with this terminology for mixed is to; because this is new, is to include these types of circumstances. Because previously what we have was alternating, so it’s IBS-A or IBS-C or alternating. That’s when you have some of days of constipation and then some amount of days of diarrhea, or sometimes it’s weeks some cycle. These mixed patterns are not that.  It’s odd, odd, joinings of texture, frequency and then straining or urgency. One last thing is the Bristol Stool Chart.  I have it here on my pencil holder.

Dr. Weitz:                           Only you would have the Bristol Stool Chart on your pencil holder.

Dr. Siebecker:                    I also have it on a mug, but I’m not drinking today. I just keep it here because then I can look at it, because I don’t really have it memorized like all these cool gastroenterology people. They’re like are you a type one or are you a type two. I don’t actually have it memorized. So type one is the balls, the constipation. Type four is three… Really four is normal and then up to seven is the watery. So you can just keep that handy and then just to remind yourself.  So that’s basically the thing with diarrhea and constipation. Sorting out the mixed I think is the thing. It doesn’t matter what you really call it or consider it. It matters that you and the patient are on the same page with what they’re calling what. Because I’ve had patients who have very frequent watery stools, but they strained before going, and they call themselves constipated. So like five, five watery stools a day of big volume and they call themselves constipated because they strained beforehand. So this is what we have. It’s like, okay, so sure. Just so long as you know what they’re talking about.

                                                So now the bloating. Technically, there’s two terms here, distention and bloating. Technically, distention is when the abdomen swells out with gas. Bloating is technically the sensation or feeling of bloating, basically of the abdomen swelling out like you get a feeling that your abdomen is swelling, but it may or may not be. So I definitely have patients who have the feeling that it swells out and it never does. It physically does not swell out and they’re terribly bothered by this. In fact, I think honestly the feeling… So this would relate to visceral hypersensitivity. The feeling is probably more bothersome because that’s a level of pain and discomfort. It’s very aggravating. Although the physical distention is also very aggravating because then sometimes throughout the day people have to change their pants. I used to have to do that because I have SIBO. When it wasn’t well, treated and controlled, I would have to bring… I would buy this like bands that go around the belly the pregnant women will wear so that they can open their buttons of their pants and put the band around it and still keep their pants up.

                                                So then I like to bring that to work and then in the middle of the day with the swelling I have to do that. It was terrible. So the other things that we could differential diagnosis with it would be edema, so particularly for women with menstrual cycle changes. Many women will retain water around their abdomen. This you can tell with physical exam. So one of the main things you can do here is; I’m going to put my microphone down for a minute, is just do a percussion on the abdomen in your basic physical exam. When you do this, you can hear a hollow tympanic sound when it’s gas and just compare. Go over your thigh and do this and then you know that’s not a hollow sound-

Dr. Weitz:                          You’re talking about with the stethoscope.

Dr. Siebecker:                    No, this is physically.

Dr. Weitz:                           Oh.

Dr. Siebecker:                    This is how you do percussion on the abdomen. So here’s the abdomen. You actually place your fingers right here and you go, and you put your ear next.

Dr. Weitz:                           Oh, okay.

Dr. Siebecker:                    So compare the swollen belly with air to the thigh or something, and you’ll hear that difference. That’s how you can sort of tell what if it’s edema from menstrual cycle or something. Then the other thing would be what if it’s just visceral fat or not even visceral fat, just fat not weight gain. It won’t sound hollow. It’s a distinctive sound. That’s the main way you can tell, is it gas in there, is it fat, is it water. So those are the things we have to pull apart.

Dr. Weitz:                           Great, awesome. So when you have a patient who comes to see you with symptoms of IBS, what’s your full examination, lab testing consist of?

Dr. Siebecker:                     Well, for me, it’s different because I’m a SIBO specialist. All I do is treat SIBO. My neighbor’s dog is starting to bark at squirrels. Can I close the window? Is it annoying?

Dr. Weitz:                           Yeah, you better close it.

Dr. Siebecker:                    I’m going to close the window, you guys.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    His name is Bandit by the way. You’ll probably hear my neighbor screaming at him-

Dr. Weitz:                           Bad Bandit.

Dr. Siebecker:                    Did you hear him scream? He’s a cute little thing, but boy he’s naughty, okay. So for me, it’s different because I don’t really have the opportunity to start from the beginning and do a workup. People come, I’m a second and third opinion kind of doc.  So people come after having failed multiple, multiple treatments.  So it’s a little different for me, but I’ll just give you my general recommendations.  Usually what most people do is they’ll start with first and second line therapies.  By the way, again, shameless plug.  This is all in my SIBO pro course.  I go through this in a very organized fashion.  So first line therapy of course is diet and lifestyle. That’s stress reduction, meal hygiene, are you chewing enough, stress reduction, exercise, fresh air and diet. So diet, so there’s a lot we can do to start with diet that’s simple.

Dr. Weitz:                           Before you get into treatment, what about testing?

Dr. Siebecker:                    I’m going to get there.

Dr. Weitz:                           Oh, okay.

Dr. Siebecker:                    Then next second line is supplements and low-risk modalities. So here’s where we would try things like digestive enzymes and hydrochloric acid and various things like probiotics, prebiotics, all that.

Dr. Weitz:                           By the way, can we take a diversion for one second? You just mentioned digestive enzymes and that’s spurred a question. So I think a lot of Functional Medicine practitioners use digestive enzymes and yet, I remember asking Dr. Pimentel about that.  He thought it didn’t really seem to make sense because there’s very few patients who have pancreatic insufficiency.  We know that pancreatic enzymes help because we’ve seen it and many, many doctors have seen it symptomatically.  So what do you think is going on with pancreatic enzymes?  Is it that the patients don’t have enough or maybe they’re having some benefits despite the fact that they might have adequate pancreatic secretion?

Dr. Siebecker:                    I think a lot of people don’t have adequate pancreatic secretion.

Dr. Weitz:                           Oh, okay, you think that they don’t.

Dr. Siebecker:                    The reason I think that is from all the years of running stool tests and oh, my God, now I’m forgetting the marker that is the marker for..

Dr. Weitz:                             Elastase.

Dr. Siebecker:                    Yeah, yeah, yeah, and we see it all the time. Also, the other reason why I think a lot of them are not having sufficient enzyme secretion is because hypochlorhydria is very common and that is very well-known. We need acid to stimulate the secretion of pancreatic enzymes. So just think about how many people don’t have enough acid, they’re not then having enough enzymes. That’s why we always say hydrochloric acid and enzymes. So it very well maybe what Dr. Pimentel is like, I don’t think he runs a kind of functional stool test we all run. So he’s not seeing-

Dr. Weitz:                            I’m sure he doesn’t.

Dr. Siebecker:                    … the elastase. He might be referring to maybe a more narrow window of what pancreatic insufficiency is more a full-blown disease sort of the functional pre.  Then the last thing would be, it’s just a matter of who even cares. It’s just a matter of, are they helping or are they not?  I find many people are helped and many people aren’t helped.  So this tails right back into what I was saying.  What most practitioners tend to do when someone comes in with IBS is they try first and second line therapies first before testing. They just do very simple measures before even wracking up cost and test to just see if they can make corrections, are you chewing your food, lets like they put you on organic and let’s have you not drink 10 cokes a day. You know what I’m saying here. Then if you move in for more forward, let’s try some enzymes, let’s try some probiotics, whatever.  A lot of people get handled this way.  So then it’s for when those first and second line therapies fail.  Here I’m just describing what most practitioners wind up doing. You don’t have to do it this way, but this is just honestly how it seems to go for most people. Then if those things failed, you move on to testing. So now testing. What I think makes a lot of sense is if someone has IBS symptoms is to run a SIBO breath test because 60 to 70% of IBS is caused by SIBO, so that’s very reasonable, and-

Dr. Weitz:                          Do you always do lactulose or do you sometimes do glucose or do you ever do both?

Dr. Siebecker:                    Let me answer that in a second.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    Then stool testing. So I think if you just at least do those and also, sorry also, screening blood work, which I can tell you some of the things I think are good to look for. If you just do those, you’re checking for so many things. So let me just answer your question now. I always do lactulose and it’s because, the reason why is, it assesses the entire small intestine. So if I’m choosing one test only, I want to choose the one that assesses the whole organ. Glucose is primarily absorbed within the first three feet [of the small intestine]. Some might go lower especially if somebody has fast transit or malabsorption issues. For the most part, that’s what I want to do.  I think in the best of all worlds because no one test is perfect, you do want both. I haven’t found I need that. What I think is good is when the lactulose and if you’re not sure about something, maybe you think there is a false negative, you could run a glucose as a sort of a backup, because there’s cost and the time and everything like that.


Dr. Weitz:                            I’ve really been enjoying this discussion, but I’d like to pause for a minute to tall you about our sponsor for this podcast. I’m proud that this episode of the Rational Wellness Podcast is sponsored by Integrative Therapeutics, which is one of the few lines of professional products that I use in my office. Integrative Therapeutics is a top tier manufacturing of clinician design, cutting-edge nutritional products with therapeutic dosages of scientifically proven ingredients to help our patients prevent chronic diseases and feel better naturally. Integrative Therapeutics is also the founding sponsor of TAP Integrative. This is a great resource for education for practitioners. I’m a subscriber to TAP Integrative. There’s videos. There’s lots of great information constantly being updated and improved upon by Dr. Lise Alschuler who runs it.

                                                One of the things I really enjoyed about TAP Integrative is that it includes a service that provides you with full copies of journal articles, and it’s included in the yearly annual fee. If you use a discount code Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99 for the year. Now back to our discussion.



Dr. Weitz:                            By the way, I’m assuming you do the three-hour test, that’s what everybody seems to be doing.

Dr. Siebecker:                    Oh, God, yeah. It’s absolutely for me essential because it helps so much with your methane diagnosis and figuring out what you’re going to do for treatment.  It really makes a difference and-

Dr. Weitz:                           Well, can you explain why that is?  Because anything past 90 minutes we ignore, right, because that means it’s in the colon.

Dr. Siebecker:                    God, no. No, no, no, no.

Dr. Weitz:                           So if there’s a spike at 120 minutes, you don’t consider that positive for SIBO?

Dr. Siebecker:                    Yes, let’s talk about this.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    The second reason why we need the lactulose is to diagnose hydrogen sulfide.  Now Pimentel is coming out with a new test, but it’s not out yet.

Dr. Weitz:                           Oh, yeah. He’s been saying that for a while.

Dr. Siebecker:                    I know. Also, so you have to see the third hour. So we can go through that. Also, even when that test comes out, it’s going to be offered by one lab. So it’s going to be years before people have that machinery and technology, so we’re still going to need to do three hours and look at that.  So let me go back to the methane.

Dr. Weitz:                            Okay.

Dr. Siebecker:                    So the diagnosis for methane is not just in the first two hours. It hasn’t been for years, for years and years. So I think it was the second SIBO symposium that I put on, in 2015 Dr. Pimentel said he uses three, a methane of three and the whole three hours of the test.  So since 2015, that’s been out there and that’s what all of us have been doing.  All of us meaning all of us who put on the SIBO symposiums, my colleagues who had SIBO center and all that. Absolutely that is what I would recommend.  Now I have to say I hardly ever see a case where it’s positive after, like in the three-hour, after the two-hour mark so after 120 minutes only. Occasionally, where you’re trying to see that is when you’re doing retests. Now you see proximal clearing and then you see some left down there and then you still work on that because you’re doing your retest.  Let me tell you what the actual diagnosis levels are. So three and above… So basically it was 12 and above was SIBO, right, for years. Then when Dr. Pimentel said he uses three, what we wound up doing was using three to 11 with constipation would be positive. Because basically what the lower level is indicating-

Dr. Weitz:                           Now that’s more liberal than the North American-

Dr. Siebecker:                    I’ll get there.

Dr. Weitz:                           … Consensus?

Dr. Siebecker:                    Yeah, I’ll get there.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    Hold on. Because basically what the lower level is showing is methanogen overgrowth and constipation, not necessarily SIBO. So that’s why we wanted to-

Dr. Weitz:                           Wait, wait, wait.

Dr. Siebecker:                    I’ll get there. Just let me continue. By the way, I have this laid out beautifully in all my slides in the Pro Course in a lovely organized fashion, so, okay, so. Then what happened was they all convened and they voted to, the experts, to bring it from 12 down to 10 and Pimentel tried to get them to bring it to three. They didn’t feel there was enough evidence so they brought it to 10 and that’s very, very good.  In my clinical experience, I knew 12 was too high. I think 10 is too high.  I’m absolutely sure about eight.  I’m absolutely sure about that from all of the tests and symptoms that have correlated. I’m not absolutely sure about three. So now it’s the same thing I described except it’s the 10.

                                           Now amongst all this discussion, what has come out is methane is now being thought of as a different disorder and not actually SIBO and that what they’re figuring out is the methane could be in the small intestine. The methanogens producing the methane could be in the small intestine, okay, then it’d be SIBO. If they could be in the large intestine only, then it’s not SIBO, and/or they could be in both the small and the large intestine. When Dr. Pimentel did culture studies, he found lots of methanogens in the small intestine.  It’s just that they might not be in a certain case and so this is why we need the whole three hours of the test.  We cannot go by just 90 minutes, absolutely not.  I don’t even use 90 minutes, I use 120 let me talk about that, so that’s the thing.

                                           Now does it matter that we’re distinguishing SIBO versus, or if they’re in the small intestine or not?  Well, one way you can kind of distinguish that is if you actually see the rise of the breath, of the gas in the small intestine time and then coming back down and maybe even another peak like a classic double peak.  Honestly, I see that a lot so I know that people are having their methanogens in their small intestine. The key thing here is that it doesn’t matter whether they’re in the small or large intestine or both.  The treatment is the same.  It’s just that the concept of it is changing and I think it’s good. It’s like they don’t want to call it SIBO anymore because first of all they are not bacteria. They’re archaea, so the B doesn’t fit, right?  Then they might not be in the small intestine.  Also, they want to change the name overgrowth because that means something different to the gastroenterologist.  It actually means small intestine only.  It doesn’t mean that to any other discipline out there so it kind of irritates me.  How come they get to make a name that just works for them but for the largest amount of people? I think it should be methanogen overgrowth. I like-

Dr. Weitz:                           By the way, there’s also methanogens in the mouth in some patients.

Dr. Siebecker:                    I think in other places actually as well.  They are normal commensal bacteria in certain populations.  So what I think is good about this is that we’ve always known that it’s very hard to treat and that it needs different treatment, and then we … Okay, right. Well, that’s because they’re archaea, they’re not bacteria.  So certain antibiotics are not going to work on archaea.  We have to find the ones that do.  Also, the main underlying cause is probably different. The main underlying cause for diarrhea and mixed type is food poisoning, not necessarily for methane.  So go ahead, I’ve talked about it.

Dr. Weitz:                           Okay, yeah. Because of that blood test that Dr. Pimentel developed that measures the antibodies, do you order that test frequently.

Dr. Siebecker:                    I used to. I’m on hiatus right now, well, on somebody’s project. I did it all the time. The way I used it… Oh, I should have mentioned. That’s also an excellent test to consider right upfront, so breath, stool, screening blood work, and the IBS blood test so ibs-smart, because it can tell you so much right away. The way I used it was to investigate underlying cause of SIBO so that I would know did somebody get it from food poisoning, and what that did for me was a couple of things. First, it would be that I know that their migrating motor complex is deficient because that is an indirect test for that if it’s positive. So then I know their physiologic underlying cause and then I know that prokinetics are absolutely essential part of treatment. While I always probably already knew that, then we could get into patient compliance. So when they have that test and then they know, now they know they need to keep taking their prokinetic and not stop it and they’re convinced why they need it.

Dr. Weitz:                           Do you usually use the ibs-smart test from Gemelli or have you used the Array 22 from Cyrex?

Dr. Siebecker:                    Well, that one has not been validated the way that Dr. Pimentel’s has. He spent years and years validating, so.  I want to use the one that I know for sure is validated.  However, what I like about the Array, the Cyrex one, is that it has some markers that that’s what Cyrex always does, right?  They always have alternate markers like their test for celiac with tTG.  They have two and six.  So I like that it could catch people that the other one might have missed, but I haven’t run it.  What I really need to do is run dual, side by side and see do they catch everything that ibs-smart is catching basically validated against the validated-

Dr. Weitz:                          By the way, the data that I saw from Cyrex is that they are able detect a larger percentage of patients with methane on their test.

Dr. Siebecker:                    That’s interesting. So I think at this point I wouldn’t feel comfortable. This is just me. By the way, I love Cyrex and I love Dr. Vodjani who created it.  I’m just talking as a practicing practitioner here.  I would use ibs-smart and then I would run Cyrex secondarily if a patient can afford that and start checking the validation.

Dr. Weitz:                          Right. Just since we’re on testing, one more question. Do you ever do organic acid urine testing?

Dr. Siebecker:                    Yes, I used to do a lot of that and that is another test that a person could consider running. I’m not sure I do it all at once in the very beginning. I think small intestine check and your large intestine and your screening blood work and take it from there. I think one of the other things is one would hope that the stool test would show if there were parasites and yeasts, because that’s such a big differential-

Dr. Weitz:                          Right, yeah, and that’s one of the things we got out of urine testing is evidence for candida or fungal overgrowth.

Dr. Siebecker:                    Not the parasites, so it’s like that’s why at least if you do the stool test you’re getting kind of both, so.

Dr. Weitz:                          The stool test, you get some other stuff too like you were talking about the enzymes. You can see if there’s fat in their stool, which means they’re not breaking down fat and maybe have bile insufficiency and-

Dr. Siebecker:                    Both of those are markers of SIBO actually that SIBO could be causing but could be caused by other things, too.

Dr. Weitz:                            Right, and inflammation as well.

Dr. Siebecker:                    I didn’t explain the hydrogen sulfide and the testing, but basically you just need to see the whole three hours for your methane. Not only that, but what if the methane in the beginning is three, eight, 10 and then towards the end in the third hour it’s 155. It utterly changes your treatment protocol, utterly, utterly. So you might choose a whole different treatment mix based on that.

Dr. Weitz:                            What if you have a patient, they’re very symptomatic, you’d swear they have SIBO, you run the breath test, everything seems to be normal and then right at the 120 minutes shoots up, do you ever say, “You know, I know technically it’s not elevated by 90 minutes but I know this patient has SIBO.”

Dr. Siebecker:                    Well, yeah, now first of all, I don’t use 90 minutes. I use 120.

Dr. Weitz:                          You do?

Dr. Siebecker:                    Yeah. So I always go to 120, that’s the manufacturer’s standard and I go by that. I’ve seen that proven time and time-

Dr. Weitz:                          The manufacturer’s standard, okay. Because most of the-

Dr. Siebecker:                    The actual maker of the breath test machine goes by two hours.

Dr. Weitz:                          Okay.

Dr. Siebecker:                    Yeah, so if individual-

Dr. Weitz:                          That conflicts with the North American Consensus?

Dr. Siebecker:                    It does.

Dr. Weitz:                          Okay.

Dr. Siebecker:                    Absolutely, it does. So I have a whole discussion on this, too in the Pro Course, we can get into it. Basically just it’s not a black and white. This is an art, not a science. I’ve seen so many times where… Now this is a judgment call if you’re going to between 90 minutes and 120 because of the breath test consensus. Before that, it really wasn’t. It was really two hours, but now I’ll call it a judgment call. I will say most often patients are positive by 90 minutes. Most often they are, so it’s going to be more rare cases where you have to think about it. Now but your question was nothing goes up until after, right, until-

Dr. Weitz:                          Right at 120.

Dr. Siebecker:                    … right at 120.

Dr. Weitz:                          It starts going up a little bit at 90 and then at 120 bam [it shoots up].

Dr. Siebecker:                    Yeah, this is often SIBO, often, and so it’s a judgment call. Now one thing you’d want to think about here is, is this a constipation patient, because they probably have slower transit and the lactulose didn’t more through as fast. So this would be hmm and you have to think about it. You take into account the history and symptoms and the whole picture, because that’s the art, right?

Dr. Weitz:                          Right, exactly.

Dr. Siebecker:                   The differential, well, I mean maybe are there other things positive, maybe you treat those first.

Dr. Weitz:                          By the way, you mentioned motility there. I wanted to try to get clarification. Is there a difference between the neurological and specific structural mechanisms involved in the cleansing waves that occur that we refer to as the migrating motor complex and the peristaltic activity that happens when you eat food? They both involve this rhythmic contraction of the intestines. They both involve increased secretion of hydrochloric acid, bile, digestive enzymes. I remember asking Dr. Pimentel when he came to our Functional Medicine meeting. He said basically they were the same thing except one happens when you’re eating and one happens when you’re not eating.

Dr. Siebecker:                    Wow, okay. So I don’t really know the answer, but I think the interesting thing for me would be how involved are the ICCs, the interstitial cells of Cajal and in food peristalsis. Is it the same exact mechanism it sounds like? Dr. Pimentel is saying it is. The other thing is what’s the rhythmic pattern, because the rhythmic pattern is very different. We’ve got phase one, two, three, sometimes four with migrating motor complex and I don’t think it’s that at all for peristalsis. Other thing is we have-

Dr. Weitz:                            Right, and by the way, that’s one of the reasons why if patients are taking motility agents especially nutritional ones; I assume for the prescription once as well. We want them to take those at night or in between meals and not during a meal.

Dr. Siebecker:                    Absolutely, because it’s during fasting. Such a good point, yeah. I was just going to say with peristalsis, there’s sort of these two aspects. One is this segmentation thing where it’s basically mixing and churning the food so that it gets presented to the walls where all the enzymes are and everything and then, then it moves down. It only moves down like this, a couple of inches. So I don’t know the actual physiology. It’s a great question.

Dr. Weitz:                           Hey, one more question. We were talking about the methane. This is funny. We were talking before are we going to have anything else to talk about in this?

Dr. Siebecker:                    Forever, we have so much.

Dr. Weitz:                          Dr. Pimentel was speculating that maybe one of the reasons why methane is so hard to treat is because the archaea are sort of down in the mucosal layer and harder for the antibiotics or antimicrobials to reach them.

Dr. Siebecker:                    Right, so this brings up the whole anti-biofilm issue, right?

Dr. Weitz:                          Right.

Dr. Siebecker:                    We know methanogens make biofilms. Of course, we know that. I think where I’ve seen the best effect is with anti-biofilms that actually use bismuth. I don’t know if you know the work of Dr. Paul Anderson. Have you heard him talked about this?

Dr. Weitz:                            I’ve heard of him.  I heard you talked about bismuth on the interview with Ruscio about the hydrogen sulfide.  I know that bismuth is part of the protocol for H. Pylori, the triple antibiotic thing.

Dr. Siebecker:                    Right. Well-

Dr. Weitz:                           By the way, what is bismuth?

Dr. Siebecker:                    What a good question. Heavy metal basically, I don’t know.

Dr. Weitz:                           Right. I mean, we can have bismuth toxicity in your brain.

Dr. Siebecker:                    Good question. I didn’t look up safety studies before I ever started prescribing it. There’s good safety data for the dose ranges we use and the time period we use, but still it’s a thought. That’s probably, I don’t know. It’s probably not a heavy metal. I just said that. I don’t what it is. I don’t want people… Sometimes I make joking comments or off comments and then because we’re on a podcast. People take it a gospel or something like that. Sometimes I make a joke and people didn’t know it was a joke. God, I guess my funny bone is not good enough but anyway, so, okay.

                                                So basically, Dr. Anderson… I had terrible trouble seeing that anti-biofilms helped any kind of SIBO, methane or not. I tried it for years. So I talked to him about it and he basically suggested that maybe the standard products that we use aren’t good enough. They’re not strong enough and those are basically digestive enzymes and NAC and EDTA. So he then suggested this method. So he had a prescription formula that he made that I used called Biosolve-PA. Then he now made one it’s in supplement form. It’s a priority one or something like that, advanced and so I tried. I tried the prescription version and I saw some difference. So it might be that we need a stronger anti-biofilm.

Dr. Weitz:                           Interesting. So bismuth is an anti-biofilm agent.

Dr. Siebecker:                    Yeah. In his prescription formally, he uses… There was BMPS also.

Dr. Weitz:                           Oh, wow.

Dr. Siebecker:                    Yeah, if I’m not mistaken. I could look it up.

Dr. Weitz:                           Which is a heavy metal chelator.

Dr. Siebecker:                    Yeah, I could look it up. Sorry I don’t remember-

Dr. Weitz:                           You put the bismuth and then you take the heavy metal chelator to get rid of the bismuth.

Dr. Siebecker:                    It is so. So I do think that that could be helpful, but I don’t think that the standard anti-biofilms were helpful. I tried, this patient had one, this patient didn’t, on and on. Myself, my colleagues, even Dr. Ruscio, we never saw any clinical difference in relapse rates or how fast we could get a test negative. Dr. Pimentel [Dr. Siebecker intended to say Dr. Ruscio] had an unpublished study he presented on where he saw that there was a slight reduction in hydrogen actually, but it was only on… It was statistically significant so he could say it, but it was a small amount. There was no clinical difference like the symptomatology didn’t change, it wasn’t.

Dr. Weitz:                            One more thing on the methane I wanted to point out. Dr. Rahbar, who is here in LA, he finds that his methane patients often have co-infections with viral infections and Lyme disease. He thinks that methane SIBO is partially a form of immune dysregulation.

Dr. Siebecker:                    He could very well be right. I was just telling you this that he presented in the spring on his thoughts of why methane is hard, basically one of the underlying causes of methane and I’ve included that in my course; we can go over it right now. He says Lyme and TMAO metabolism, which is new to me, and mycotoxins, so mold and mycotoxin exposure, general immune dysregulation high glyphosate; Paneth cells is quite interested in that, and parasites. I have several colleagues who believe that parasites are probably one of the first places you should look when somebody has methane especially if it’s hard to treat. Not all methane is hard to treat. Some people you give a round or two and it resolves when it gets troublesome. I think the two things that I’ve heard the most from my colleagues speculating on underlying causes with methane are Lyme and parasites.

Dr. Weitz:                            It’s interesting that we describe methanogens as this other thing. Normally anything we see in the gut that’s not a bacteria or virus, we call a parasite. So technically methanogens could be described as a parasite, can we?

Dr. Siebecker:                    Well, we have their whole own classification as archaea. So when you look at it, is it phylums? I don’t remember. When you look… Even if you’re in museums and you look on their wall display, it’s bacteria, archaea, and one other grouping.

Dr. Weitz:                           Oh, okay.

Dr. Siebecker:                    They have their special own classification.

Dr. Weitz:                           Right. I know that Dr. Rahbar told me that when he gets a case of methane SIBO before he does any other treatments, he might start with supporting the immune system and using a IgG type of formulation.  I heard Ruscio talking about using IgG and that seems to be getting more attention now, including that one non-dairy product that’s available out there.

Dr. Siebecker:                    I absolutely love this idea. I, myself, have gotten into it again. I heard about it years ago from Dr. Weinstock. He was having excellent results. He’s published… He had great cases resolved particularly when diarrhea was really hard to treat, and so it’s the serum bovine immunoglobulins. Actually, everybody who offers it no matter what brand it is, it’s a patented formula so it’s all the same actual formula. It’s called ImmunoLin. ImmunoLin is the item.

Dr. Weitz:                            Oh, okay.

Dr. Siebecker:                    Various people put it in their own label and put it in powder, so. I’m really pleased with it. I’m loving it for myself. It has so many benefits, leaky gut. I have genetic high cholesterol and it actually has helped to reduce that.

Dr. Weitz:                           Wow, interesting.

Dr. Siebecker:                    There’s actually a study on it reducing cholesterol. So it’s been very hard to budge because it’s genetic, so.

Dr. Weitz:                           So what particular marker did you see change? Was it your LDL-P or did your LDL particle size change, and what about Lp(a)?

Dr. Siebecker:                    It was LDL and total because of that. I can’t remember if I had the band size on my recent test. I don’t remember it. My type is type two-A so I have always high HDL so I always have that, but LDL was high. Something else was high, can’t remember I’m sorry, right now but anyway. It’s wonderful so I love that idea. For people who-

Dr. Weitz:                           By the way, this is kind of the newest version of colostrum, which Functional Medicine practitioners have been using for many years for digestive disorders.

Dr. Siebecker:                    This is just what I was going to say, for people…

Dr. Weitz:                           Great minds think alike.

Dr. Siebecker:                    Every time you ask a question, I was going there. Well, you know what the saying is, great minds think alike, and so do ours. Anyway, so for people who are vegetarian, there’s colostrum. There’s actually one brand that has the equal amount of the IgG in it, in its colostrum. Not all brands do and that’s NuMedica. It’s called PRP… I can’t remember the whole thing. It’s about NuMedica and it basically has a lot of IgG in their colostrum. So I have to say, I used colostrum for years in my patients, years and years, because it was kind of my number one leaky gut treatment because it has epithelial growth factors in it. I have to say I don’t think the results were as good as IgG, direct IgG, which is really actually surprising to me because IgG is purified out. I would have felt the whole colostrum it has so many things.

Dr. Weitz:                           It could be at the same maybe was helping the dairy was creating irritation to the gut.

Dr. Siebecker:                    Could be, absolutely good thought.

Dr. Weitz:                           Now you mentioned TMAO levels and TMAO is the latest marker for cardiovascular disease risk. Dr. Stanley Hazen from Cleveland Heart Labs developed this and he is testing it in the serum. TMAO levels are… TMAO it is contained in fish, but mostly it’s produced in the gut. It turns out that when you have higher levels of archaea in your colon, you have lower levels of TMAO. They actually are considering supplements of archaea which will be called archaea biotics-

Dr. Siebecker:                    Oh, my goodness.

Dr. Weitz:                            … as a consideration for this. I’m very dubious of this TMAO thing because if this hypothesis is right, I know this Stanley Hazen has a bunch of data on it, but it would mean that eating fish increases the risk for heart disease as well as consuming choline and L-carnitine. There’s so much data that those are so beneficial.  I think that one of the things that’s happened is there’s politics in nutrition like there is in everything.  We’ve got people who are trying to promote a certain way of eating as the way and so this another tool in the arm of those promoting a plant-based way of eating and so you hear that a lot.

Dr. Siebecker:                    That’s very interesting. I had never heard of it before. I heard Dr. Rahbar discussed some of his mixed theories and thoughts surrounding methane. So I was very glad for you to explain it because I look at it briefly and I’m like, “Wow, okay.”

Dr. Weitz:                           I talked to Dr. Bob Rountree about this. He actually thinks that TMAO is a marker for not having enough choline and it all has to do with the liver, but that will take us down another road. Have you used substances called peptides? These are basically strings of amino acids that are not long enough to be considered proteins. It’s really become a hot topic now especially in the integrative and anti-aging communities. One of the peptides is something called BPC 157 or Body Protective Compound 157 and some Functional Medicine practitioners are using it as part of their protocol to heal the gut. Have you used that before?

Dr. Siebecker:                    I got so excited about it. I heard a whole bunch of podcasts, webinars on it. I just got so excited and so I want to try it, but right now I’m not with patients. So I’ve tried it. Some of my colleagues are trying it and some of my friends and family members have tried it. So far in the people that I’m talking to, I’m not seeing any difference, but I just don’t think that you should listen to me. Because small of a sample size and not enough time, it would be really different if I’m in there with patients trying it. One of the problems is that it is fairly expensive. So it’s an expensive experiment, but I sure love what I’ve been hearing about it, really I do. I know that at our SIBO com, you and I were both there in the spring. We had two doctors presented. They’ve been using it, Dr. Rahbar and Doctor… What’s her name, Kristine… another doctor.

Dr. Weitz:                           Yeah, I can’t remember.

Dr. Siebecker:                    I’m so sorry. So people are starting to experiment with it and I’m sure we’ll hear more. I think it’s very exciting and I don’t know yet.

Dr. Weitz:                           Oh, one more thing that you mentioned. You mentioned gut hypersensitivity.  I saw a paper showing an herb called curcumin, which I’m sure you’re familiar with, down regulates gut hypersensitivity. I’ve started experimenting with using curcumin in some of the SIBO protocols and I think it’s having a benefit. Have you looked into and somebody at SIBOCON talked about gut hypersensitivity as well.

Dr. Siebecker:                    We had a whole presentation on it by my former student, fabulous doctor, Dr. Megan Taylor. She did the whole presentation on giving treatment options; curcumin is one. Another one is actually bifidus infantis that’s sold as Align. That’s been studied for visceral hypersensitivity. We have a whole bunch of stuff we can try. Curcumin often helps people. It’s a fabulous anti-inflammatory. Then there’s a subgroup of people that just really tolerate it poorly and it often causes vomi

Dr. Weitz:                           Exactly.

Dr. Siebecker:                    It’s so incredible. I think a lot of times liquid and lipid forms are often well absorbed and do well with that. By the way, I have about five, seven more minutes.

Dr. Weitz:                           Oh, okay. So in terms of preventing SIBO from coming back or what about… How about this? You have a patient and they’ve gotten 80% better. They feel a lot better. They still have a little bit of symptoms. Do you ever put somebody on or recommend that they do a little bit of an antimicrobial say they take one or two capsules of Oregano just every day for a long time, and they say it sort of seems to improve the way they feel?

Dr. Siebecker:                    Is this something you’re doing? You have some experience?

Dr. Weitz:                           I have been doing this with some patients.

Dr. Siebecker:                    So it’s working well.

Dr. Weitz:                           It’s interesting. I mean it seems to go against cycling and everything else, but-

Dr. Siebecker:                    So tell me how you’re doing it, you’re doing just two pills a day or something like that.

Dr. Weitz:                           Exactly, exactly. This kind of started because, as you know, you put patients on a certain diet and you go, okay, now we’re going to go. We’ll start broadening the diet. They’re like, no, no, no, no. I feel so good. I don’t want to eat anything else again for the rest of my life and I don’t want to stop doing anything that I’m doing and it’s like, no, no, no.

Dr. Siebecker:                    I think that that is so smart to just give them a little bit of antimicrobials, calm their fears. It takes care of any little bleeps of they tested, if they tried a food, tested it and didn’t work well. I know lots of practitioners that do that. I just wanted to say that if someone is at 80%, so I like to always try and get to 90%. The reason why is because I found that when patients weren’t 80% and this is their report, right? They’re saying they weren’t 80%, although we talk it through and kind of decide together. If I would do one more full round, I can almost always get people to 90%.

Dr. Weitz:                           Oh, cool.

Dr. Siebecker:                    I just wanted to mention that. Because 80% was sort of the gastroenterologist standard, but I just began finding usually you can get people to 90%. So this idea of the antimicrobials, it’s so funny because I have a whole section on this exactly.  Again, shameless plug for my course, a whole section on basically prokinetics versus ongoing antimicrobials for relapse prevention.  You can do it either way.  I think prokinetics can do the same thing.  Honestly, they really can. I think one of the problems that I’ve seen is that the natural prokinetics, the over-the-counter herbal ones, so we’ve got Iberogast, ginger and all the ginger-containing formulas; I think there are six now, prokinetic ginger-containing formulas [Motilpro, Motility Activator, SIBO-MMC, etc.] and that and LDN are often not strong enough especially for the more difficult cases. Sometimes they are strong enough, but they’re not always strong enough. So I think what I’ve seen is that a lot of practitioners were let down by prokinetics that wasn’t really doing the job so they returned to antimicrobials.  See for me, I can prescribe so I would use erythromycin or prucalopride, which are stronger prokinetics.  So I didn’t need the antimicrobials because they actually do work better.  They are more effective and I almost always will start with the natural ones because sometimes that works, also just depends on where someone’s went or when they’re coming in to me.  If they’re coming in to me and they’re terribly chronic, we just go right to the prescriptions.  So I think it’s interesting.  I also think there are practitioners that just either don’t know enough about prokinetics or just really don’t like the idea of them.  I sense a general distaste of prokinetics out there in the community and-

Dr. Weitz:                           Well, certainly they’re going to have a distaste for low dose erythromycin.

Dr. Siebecker:                    Yeah, because it’s a low-dose antibiotic. However, it doesn’t have antibacterial effects at that level, so-

Dr. Weitz:                           There’s also a lot of patients will tell you, oh, I took antibiotics and ever since then I’ve had problems, so they don’t-

Dr. Siebecker:                    They’re afraid of it, of course. Just like then they’re afraid to use rifaximin even though it’s so beneficial and isn’t like a normal antibiotic. We have to educate our patients, of course. Well, prucalopride actually regenerates nerves, so it’s neuro-regenerative. It’s neuro-protective. It heals leaky gut. It protects against cancer and tumors. So there should be no concern there.  Erythromycin, yeah, there can be distaste and concern. Honestly, I felt that way too in the beginning. I stopped feeling that way when I generally, I mean in principle I feel that way. Generally, I stopped feeling that way when I saw how much it helped the patients. The whole reason we use it is for this effectiveness. I just wanted to sort of make the point that it’s an interesting thing to think what’s worse even… Let’s even take the worst-case scenario of low-dose erythromycin that actually has no antibiotic activity. What’s worse? That, or something that keeps pounding the microbiome. It’s very interesting like prokinetics are meant so that you don’t have to keep doing antimicrobials. Do we really want to keep doing that?

                                           This is all me saying after I liked your idea. I’m just pro-ing and con-ing it here and that’s what we need to do as practitioners. It’s not like a life. There’s no answer and cases are different in each one in front of us. The other thing a lot of people would do if people are extending their diet and feeling nervous is they will use digestive enzymes as well and certainly some of the natural prokinetics like some ginger and things like that.

Dr. Weitz:                           Great. So can you tell everybody about your new program?

Dr. Siebecker:                    Yeah. By the way, the reason I keep saying shameless plus is because I used to listen to Car Talk. Did you ever listen to Car Talk? That was on NPR radio and it was two brothers.

Dr. Weitz:                           Oh, maybe two guys talking about cars?

Dr. Siebecker:                    Yeah. They were very funny and they would always say shameless plug for whatever, so that’s why I’m saying that. Here we go, shameless plug. Yeah, it’s called SIBO Pro Course. I’m so happy that I’ve spent so long working on it. I mean, I think over a year and a half. I’ve given this course. It’s a course that I created and teach at Naturopathic Medical School, so it’s a doctorate-level course, but it’s shorter there. It’s a six-hour course. Over the years that I’ve given it, I’ve given it a couple times outside of the school to practitioners and I’ve just listened to all the questions. As you can see, pretty much everything you brought up I have in the course. So I’ve listened to all the questions, what if people really want to know and I’ve put it right in the curriculum. I’m very organized that’s just my thing. I think good leaning is when everything is very organized. So I present it in hopefully a flow that helps a person understand and retain the material. So anyway, you can go to… Well, you’ll have a link here, right?

Dr. Weitz:                           Yes.

Dr. Siebecker:                    It’s The SIBO Pro Course [here is the affiliate link to sign up for it: https://smpl.ro/al/7TEGvvBoGSzFtdoZLL7BGpGM/15770-Ben-Weitz]. I’ve got two versions of it, my self-study just in case you just want to have it on your own, do it on your own schedule, and then I’m running it kind of like a college quarter where it’s over eight weeks and I’ve pasted out what the schedule, about a two and a half hours per week that you would watch. It’s optional. You can do it how you want, but I’m giving you a schedule and then we’ll meet for office hours. On that version, I’ve included learning enhancements, optional quizzes and study guides that you can use as you’re watching through, just to all to help with learning.

Dr. Weitz:                           Cool, that’s great.

Dr. Siebecker:                    So I hope everyone will join me. It’s just a wonderful course, I think. I think I did a good job.

Dr. Weitz:                           When this it start?

Dr. Siebecker:                    Oh, yeah that’s important. It starts September 28. It opens September 28.

Dr. Weitz:                           Okay, cool. Okay, awesome. Thank you, Allison.

Dr. Siebecker:                    Oh, you are so welcome. It’s so fun talking with you, Ben.




Anti-Aging with Dr. Sandra Kaufmann: Rational Wellness Podcast 122

Dr. Sandra Kaufmann discusses Anti-aging strategies 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. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

5:52  Dr. Kaufmann, in her book The Kaufmann Protocol, Why We Age, and How to Stop It,  breaks down the concept of aging into 7 different physiological pathways or tenets of why we age.  Dr. Kaufmann took the analysis of the aging process down to the cellular level. 1. Tenet one is DNA alterations. The ends of your chromosomes, referred to as telomeres tend to get shorter as you age and this is a major problem. Also, epigenetic modifications of your DNA tend to occur with aging. 2. Tenet two is your mitochondria and energy production. Important factors here include free radicals and nicotinamide deficiency3. Tenet three has to do with various pathways related to aging, including the AMP kinase pathway, which is activated by caloric restriction and fasting. These tell your body that you are starving and it puts yourself in a state of hibernation. And you can take agents that fool your body into telling you that you’re starving.  There are also 7 mammalian sirtuin systems. There is also the mTOR pathway that controls catabolism and metabolism, the breakdown and the building of tissues. 4. Tenet four is what she calls Quality Control, which refers to DNA and protein repair mechanisms, which also includes autophagy, which is the recycling of organelles.  5. Tenet five is security, which is your immune system, which can go waywire as you age. 6. Tenet six is individual cell needs. 7. Tenet seven is waste management, because glucose is an issue.  And you may get an accumulation of lipofuscin over time. Some anti-aging experts are obsessed with fasting and AMP kinase or with mTOR or with stem cells. But Dr. Kaufmann points out that if you don’t address all 7 categories of aging, you will fail. We need a more comprehensive program.

10:50  Dr. Kaufmann is involved with a project with Dr. Bill Andrews to sort through 400 different lab markers to figure out which ones are the most important to analyze where a person’s biological aging level is, to help target an anti-aging program.  On a previous episode of Rational Wellness, Dr. Russell Jaffe went through which predictive biomarkers he recommends to assess a person’s aging level in episode 100, Predictive Biomarkers with Dr. Russell Jaffe.  Dr. Kaufmann does think that the Telomere length test is one way to assess the level of our biological aging, though results may vary depending upon which company runs the test.  On average, we lose between 47 and 67 base pairs per year.

14:47  Dr. Kaufmann has a rating system for judging potential anti-aging compounds based on which ones affect which of the 7 tenets of aging, so each agent got a 7 digit rating. When we look at a given compound, we ask is it an epigenetic modifier, does it affect your genes, does it affect your mitochondria, etc. If it had no affect on that category, then a given agent got a 0 score. If it had a very significant effect on that category, then she gave it a 3.  Does it work in a test tube? Does it work in a small animal? Does it work in humans?  If it does all those things, then it gets a 3 in that category. Resveratrol is a very important anti-aging compound and it has a good rating number in most of the 7 categories and it activates most of the sirtuin pathways. Unfortunately, resveratrol has poor bioavailability because the half life is only one hour.  Dr. Kaufmann says that option one is to use Pterostilbene from blueberries, which is a cousin of resveratrol and it has better bioavailability.  However, resveratrol looks like its better if you have high cholesterol.  Dr. Kaufmann recommends that option two is to use a more bioavailable form of resveratrol, like a liposomal form with properly constructed nanomicelles.  Or you could take resveratrol in the morning and pterostilbene in the evening.

20:16  Astaxanthin is one of Dr. Kaufmann’s favorite anti-aging molecules.  It’s a carotenoid that comes from algae and its the strongest, naturally produced free radical scavenger we have.  She also recommends it to athletes, since they create so many free radicals, esp. if they are outside in the sun.  Astaxanthin will help protect your skin from the sun as well. 

25:50  Senescent cells are normal cells that accumulate DNA damage and go into shutdown mode.  One of three outcomes occur: 1. the cell is so damaged that it can’t fix itself and it commits cell suicide, 2. the DNA is fixed and the cell goes back to normal, or 3. we have these grumpy, senescent cells that are somewhat damaged but they start up again. These sensescent cells change shape and don’t function as well and produce evil cytokines. These grumpy, old cells accumulate over time and create more inflammation and pathology. There are xenomorphic agents that change how a cell acts and there are xenolytics that kill these cells and a lot of regenerative medicine can be focused around xenolytic therapy.

28:20  Dr. Kaufmann recommends taking nicotinamide riboside to stimulate NAD production.  She also pointed out that the seven sirtuins cannot function without nicotinamide, so NR is necessary to stimulate the sirtuins.  Nicotinamide is also necessary for DNA repair 

33:55  Curcumin is also an important anti-aging nutrient. Curcumin is a potent epigentic modifier, it helps mitochondria, it’s a free radical scavenger. It helps activate some of the pathways. It helps with DNA repair and it helps with lipofuscin accumulation. Over time, our mitochondria get beat up and when you make new mitochondria, your body squishes down the old mitochondria and extracts out the reusable pieces and what it can’t use, it squishes it in the back of the cell. Over time you get more and more accumulation of this gunk, which is lipofuscin.

36:47  Carnosine is also very important for anti-aging, which is a dipeptide of alanine and histidine.  It’s a acid buffer in our muscles and it’s a free radical scavenger. And its a transglycosylating agent, which means it plays a role in glucose control. When sugar combines with proteins and fats, they are referred to as advanced glycation end products.  You end up with sticky proteins and once a glob sticks to collagen you get destruction of anything that’s collagen-based in your body, which includes your skin, your heart, your blood vessels. This is one reason why caloric restriction and fasting are so beneficial. Dr. Kaufmann pointed out that in Europe there is an AGE reader that you place your arm in and it tells you how much glucose has been glycosylated into your arm.  This device which could be the future of tracking diabetes.  Dr. Kaufmann also recommends carnosine eye drops to reduce the risk of cataracts.

43:28  Dr. Kaufmann recommends taking Metformin, a drug prescribed for diabetes, for anti-aging purposes.  Metformin helps with controlling mTOR, which he calls the youthful pathway.  She does not recommend taking Rapamycin, which is an extreme blocker of mTOR, (which stands for the mammalian target of rapamycin), but it is a chemotherapy agent and has a lot of possible side effects.  The mTOR pathway is responsible for building tissue and turning over cells and if you block it, you put yourself in a state of preservation.  But if you block all growth and turnover, that can be problematic and you may become sarcopenic and if you don’t turn over your hippocampal cells, you will have trouble with memory.  There are many tissues that you want to turnover, like muscle, bone, and skin.  Dr. Kaufmann does not feel that berberine is a good substitute for metformin because while berberine helps with blood sugar regulation, it does not do a lot of the other things that metformin does, such as epigenetic modifications, it reduces the risk of cancer in diabetics, it reduces weight, it helps with menopause, it helps with PCOS, it stimulates AMP kinase, and it reduces inflammation.  Because metformin is a partial mTOR inhibitor and can result in muscle wasting, so she recommends that people also take leucine, one of the branch chain amino acids, or just take a branch chain amino supplement, and also take a B complex, since it reduces B vitamin absorption from the gut.

50:44  There is a product that is highly touted for anti-aging purposes, Astragalus TA-65, which is extremely expensive, but it can activate your telomerase to make your telomeres longer.




Dr. Sandra Kaufmann is an ND with a speciality in Pediatric Anesthesia. She is the Chief of Pediatric Anesthesia at the Joe DiMaggio Children’s Hospital. Dr. Kaufmann has an avid interest in Anti-Aging Medicine and has published an excellent book on Anti-Aging, The Kaufmann Protocol: Why We Age and How to Stop It  and her website is Kaufmann Protocol.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 or go to www.drweitz.com.


Podcast Transcript

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 e-book 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 Apple podcasts and give us ratings and review. That way more people can find out about our Rational Wellness Podcast. Also, you can watch the video version by going to YouTube. And if you go to my website, drweitz, D-R-W-E-I-T-Z.com, you can find detailed show notes and a complete transcript.

Our topic for today is anti-aging medicine, with Dr. Sandra Kaufmann. While there is a debate in the scientific community whether there is a limit to the human lifespan, it is generally thought to be 125 years, with only 48 people in recorded history making it to 110, and one recorded person making it to age 122.  In the US today, there are approximately 80,000 centenarians. Some anti-aging specialists distinguish between the lifespan and the health span, with the health span being the number of years the person is healthy. Others make a distinction between chronological age, which is the number of years you’ve been alive, and biological age, which is the measure of your physiological age of your functional and health status. And some experts feel that this can be measured with the telomere test or other tests. In the scientific community and the medical community, anti-aging refers to the slowing, preventing, and reversing of the aging process. Part of this means detecting, treating, and preventing the diseases associated with aging, like heart disease, cancer, and Alzheimer’s disease.

                                                But anti-aging medicine can mean different things to different anti-aging medical clinicians. For some anti-aging specialists the focus is on restoring the body’s hormones to the level of a 25-year-old, by taking bio identical versions of these hormones, like estrogen, progesterone, testosterone, thyroid, and even growth hormone in some cases. There’s been a lot of research in both animals and humans showing that caloric restriction may prolong life, 30 to 50% caloric restriction. But who wants to live longer and be miserable for most of that time? So, recent research has looked at fasting, and intermittent fasting, and even the fasting mimicking diet, all of which seem to promote some of the same anti-aging pathways as caloric restriction.   Others have explored the use of caloric mimetic substances, which might give us some of the benefits of caloric restriction without calorically restricting, including substances like resveratrol. For other anti-aging specialists, it means researching the reasons why aging occurs, and finding interventions, whether they be changes in diet, lifestyle, exercise, procedures like cryotherapy, infrared saunas, hyperbaric chambers, or the use of medications or nutritional supplements to positively impact these biological pathways and processes.

                                                Dr. Sandra Kaufmann is our special guest today. And she has a Master’s in tropical ecology and plant physiology, with a focus on cellular biology, and an M.D. degree with a specialty in pediatric anesthesia. She is the Chief of Pediatric Anesthesia at Joe DiMaggio Children’s Hospital, and also at Sheridan’s Health Corporation. She also has an avid interest in anti-aging medicine, and has published a book on anti-aging, The Kaufmann Protocol, Why We Age, and How to Stop It. It’s a very well-organized way of categorizing the most important molecular and physiological pathways of aging, and an analysis of some of the most efficacious, nutritional, and pharmaceutical compounds that can positively influence these pathways. She also has an app, and she constantly updates all of this information on her website, kaufmannprotocol.com. Dr. Kaufmann, thank you so much for joining me today. Dr. Kaufmann?

Dr. Kaufmann:                   Absolute pleasure. That was a fantastic introduction. Well done.

Dr. Weitz:                          Thank you, thank you. So, as a pediatric anesthesiologist, how did you find your way into the antiaging field?

Dr. Kaufmann:                   Well, people ask me that all the time, and the reality is, there’s absolutely zero correlation. I take care of kids every day. However, because I was a cell biologist and I spent a lot of time learning human physiology, and pharmacology, and all the -ologies having to do with medicine, I looked at myself, and I decided I didn’t want to age anymore. I decided that all of the information out in the literature when I started this project seemed like mumbo-jumbo. And I thought there had to be a way to look at it scientifically and clearly, and organize it and then make it practical. So, the reality is, it has nothing to do with being a pediatric anesthesiologist.

Dr. Weitz:                           Right. So, in your book, you break the concept of aging into seven different physiological pathways, or tenets of why we age. And then you talk about how we can slow down or reverse that aging process. Can you explain what these aging mechanisms, pathways are?

Dr. Kaufmann:                   Absolutely. And I know you’ve read the book, so feel free to stop me if I’m skipping anything that you found interesting or important.

Dr. Weitz:                          Okay.

Dr. Kaufmann:                   But to back up just a little bit, people, when they think about aging, they think about their skin, or their heart, or their organs. As a cell biologist, I took it down to the cellular level. And, whereas all cells are not identical, they generally function roughly, the same way. So, if you look at a cell … I looked at all the reasons that a cell ages, and separated them out. People argue that you can’t really separate them all out. If you think of a Venn Diagram, you’ve got seven overlapping circles. Sometimes you can pull things apart, and sometimes you can’t. So, some of my ideologies may be a bit of a stretch, but I think it simplifies it to make it easier to understand.

                                          So, that being said, so, tenet one, I call DNA alterations. People probably are already aware of this, but telomeres and such get shorter as you age, and that’s a huge problem. The other category in the DNA issues have to do with epigenetic modification. I don’t know if people are aware of that, but epigenetics changes. And that dictates what sort of DNA gets processed over time. The good news is, both epigenetic and telomere issues can be altered in a positive way if you know what you’re doing. So, that’s tenet one.

                                          Tenet two has to do with any energy production, which basically, boils down to your mitochondria. Rate limiting issues in this category are free radicals from the oxygen issue, as well as nicotinamide deficiency. Issue three is pathways. And I talk about innumerable aging pathways, and different people have their favorites. You referred to caloric restriction in your opening comments, and that’s basically activating your AMP kinase pathway. And that’s by telling your body that you’re starving, it puts yourself in the sort of state of hibernation. And that’s how caloric restriction works. And you’re absolutely right, we can take agents that fool your body into telling you that you’re starving, which essentially, just activate your AMP kinase. But there are also seven mammalian sirtuin systems. These are my particular favorites, because they do really cool things. And there is also the mTOR pathway, and that sort of controls catabolism and the opposite, which is building of tissues. Gosh, I’m losing my words today. I’m quite sorry.

Dr. Weitz:                          That’s okay.

Dr. Kaufmann:                   Let’s see, the next tenet I call quality control, which is DNA and protein repair mechanisms. Because over the course of time, things break, and we have to fix it. I throw autophagy into that category, which is the recycling of organelles. The fifth category is security, which is your immune system. Your immune system goes haywire over the course of time for several reasons. The sixth category, I think of as individual cell needs. What does a red cell need, versus a liver cell, versus a brain cell? And I also have recently thrown the senolytics in this, because it’s become a more active topic, and I just wrote a huge diatribe about that. So, we can talk about that more. And the last category is waste management, because glucose is an issue. And then you can get an accumulation of something called lipo fuscin over the course of time. And I know that’s a heck of a lot of stuff to swallow at one time, but those are the seven tenets of aging. I’m so sorry.

Dr. Weitz:                            No, that’s okay. There’s a ton of stuff in this book, really good stuff. And I know all we can do is hit some of the highlights. But interestingly, it seems like a lot of people are talking about number three. A lot of people are talking about the AMP kinase. We’ve had a number of discussions on the podcast about the ketogenic diet, which supposedly hits some of the same pathways as fasting does. And a lot of people are talking about mTOR, and how to block mTOR. And that’s, for some reason, seems to be where a lot of the recent discussion in anti-aging and the functional medicine world that I’ve been hearing.

Dr. Kaufmann:                   Oh, without a doubt. And I think what happens is people, especially the experts, focus on what they know. I call it the silo effect, of course. Some people are obsessed with, you’re right, the mTOR, they’re obsessed with rapamycin. Some people are obsessed with caloric restriction. Other people are obsessed with stem cells. And my take on the thing was, you’re going to age for seven categories. And if you don’t attack each of the categories, you’re pretty much spinning your wheels. And I don’t care if you starve yourself until the end of time, you’re still going to have issues with glucose, you’re still going to have sirtuin issues, your mitochondria are still going to fail. So, I like to think of it as the need to have a more comprehensive program.

Dr. Weitz:                            Right. So, is there a way to analyze sort of, where we’re at? How would a given person … Is there a series of tests that they could do? You talk about glucose, I’m thinking about hemoglobin, A1c.  Is there sort of a panel that you can do to sort of get an idea of where you are?

Dr. Kaufmann:                   That is a very excellent question, and we’ve been striving for that for many, many years. And if you go to readily available anti-aging clinics, they all have their favorite labs that they test.  What’s very interesting is, a lot of them mean absolutely nothing.  And I don’t want to pick on any one in particular, but what was very interesting is, I was recruited about a year ago.  I don’t know if you know who Bill Andrews is.  He is sort of, the telomere God. And I’m working on a project with him.  And one of the pieces of the project was to put together the most comprehensive list of anti-aging markers. So, between he, I, and a few other folks, we have a list of probably 400 markers.

Dr. Weitz:                          Wow.

Dr. Kaufmann:                   And we are initiating some studies to try to figure out which ones are the most efficacious.

Dr. Weitz:                          So, I was just asking you about, are there any tests so we can get a sense of where our level of biological aging is, and you were talking about the fact that you’ve been working on and looking at 400 different tests to sort of whittle down which are the most important ones. And I was just mentioning that I interviewed Dr. Russell Jaffe, and he felt that the eight most important ones were hemoglobin A1c, HsCRP, homocysteine, he had his lymphocyte response assay, which is his sensitivity test, and first-morning urine test for pH, vitamin D, omega-3, and 8 Deoxy-guanine.

Dr. Kaufmann:                   Well, that’s quite a nice list. I can tell you, I mean, everyone has their favorite list. And they’ll probably tell you exactly why. The reality is that no one knows quite yet. But I will tell you that based on my seven tenets of aging, and all the biochemical things I talk about in the book, I created a hierarchy of things to look for. So, it started at the cellular level. For example, we could measure DNA destruction rates, right?

Dr. Weitz:                          Wait, how do you measure that?

Dr. Kaufmann:                   So, there’s a chemical with an extremely long name, 8 OH, blah, blah, blah, blah, blah, blah, blah, blah, blah that I won’t bore you with, that you can actually measure DNA destruction rates.  So, the question would be, “Can you change that over the course of time?”  You can measure levels of sirtuins, you can measure mitochondrial rates, you can measure amazing things at a cellular level.  If you bump it up to an organismal level, right, what can we measure, in terms of GFR for your kidneys, for your lungs, for your heart.  We can measure all of those factors.  On a more systemic level, then you’re looking at CRP’s and that sort of thing.  And then, when you get to the higher level, you’re actually looking at full body function.  So, we have a huge unbelievably full list of labs. And as soon as we figure out what really is important, I will let you know.

Dr. Weitz:                          Okay. What do you think about the telomere test?

Dr. Kaufmann:                   I think the telomere test is fantastic. I think it depends on who does it. It’s not the same from the different companies, because we’ve tested a few different companies, and the answers sort of range from place to place. But I think it does give you a very good indication. As you know, we lose between 47 and 67 base pairs per year, which is horrifying. And so, it is an extremely important test. Is it absolutely linear as we age? No one really knows yet.

Dr. Weitz:                          Right. So, you have a rating system for judging potential anti-aging compounds. Can you explain what that is?

Dr. Kaufmann:                   Oh, gosh, yes. And I’m going to bore your audience to death, here. I am so sorry.

Dr. Weitz:                          No.

Dr. Kaufmann:                   This is called geeky science. No, so what I did is, I decided, for whatever reason, that these seven tenets should never change order. And after I figured out, or decided that this is what causes you to age, I started looking up every agent that anyone said had any anti-aging properties. Because everyone has their favorite. Uncle Schmo takes this. And what does it really do, right? Because this is the way people approach anti-aging. So, I would look up agent X, whatever it was, and I did a huge literature search in every category. Was it an epigenetic modifier? Did it affect your telomeres? What did it do to your mitochondria? etc. I mean, this took me an extremely long period of time.

                                          And it started out as a simple chart on my desk with pluses and minuses, and it got to be a little confusing. So, it turned into a numerical rating system. So, in any one given category, if an agent did nothing, for example, for your DNA, it got a 0. If it was amazing, it got a 3. And people say, “That’s kind of nonspecific.” And the way I sort of did this is, I call it the hierarchy of evidence. So, theoretically, does agent X work in a test tube? For example, a trans-glycosylating agent. Is there evidence that it works in a test tube? If there is no evidence, then it’s not going to do anything anywhere. If it works in a test tube, great. Does it work in a small animal model? Does it work in a culture? Those two things are backwards. And finally, does it work in humans? And if all of those things were true, it got a 3 in that category. Means it’s very efficacious, it’s awesome, right? Lots of evidence to support it.

                                          So, what happened, because there’s seven categories, each agent got a seven-digit rating number. So ultimately, these numbers became, I decided, additive, or synergistic, such that when you wanted to create a program for yourself, you would line up whatever agents you thought were reasonable, add up the numbers, and then it became clear that some categories would be over-represented and some would be under-represented. So, it serves as a good guideline to determine what each individual should be taking.

Dr. Weitz:                          Okay. So, let’s go through some of these more important compounds, starting with resveratrol.

Dr. Kaufmann:                   Okay. So, don’t expect me to have remembered all of the numbers for all of these, because there’s 30 or 40 of them…

Dr. Weitz:                          No, no. Forget about the numbers. So, for resveratrol, I remember regionally reading about it years ago, and I think David Sinclair found that it would mimic caloric restriction. And he was researching the sirtuin pathways, and it was going to be the big key to anti-aging.

Dr. Kaufmann:                   Oh, absolutely. And in fact, it is one of the keys of anti-aging, because it does many things. And the rating number is very good in each of the categories, for the most part. But the highlight is, in fact, what it does to your sirtuins. It activates most of the one through seven of the sirtuins, which is extraordinarily important. The issue with resveratrol, which is sort of unfortunate, is the bioavailability is very poor.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   And this is what has baffled people for a long time. So, there are two options. Option one was to alter the plan and go to something called pterostilbene, which is, I call it a cousin. Very closely related, higher bioavailability, it’s in blueberries instead of wine. I always laugh that it’s way less sexy, because who wants to talk about blueberries. But it is more bioavailable. There are some information coming out lately that if you have high cholesterol, maybe you should stick with resveratrol, over pterostilbene. I think that’s still in the beginning stages of understanding all that.

Dr. Weitz:                          Interesting.

Dr. Kaufmann:                   But certainly, I’ll direct one or the other based on your cholesterol status. If you do, however, decide to take the resveratrol, I think you need to make sure you’re taking something that’s more bioavailable than the standard. Because the reality is, is the half-life is about an hour, and you need it way more than that in your system.

Dr. Weitz:                          So, what’s a more bioavailable form?

Dr. Kaufmann:                   So, they put things in nanomicelles, which is my favorite way of taking these. There are a few companies that do this. And I don’t want to cite any companies on a podcast, because then I get busted by other companies. But, if you’re looking for something, you look for something that says bioavailable. Nanomicelles, nanomicelles, there’s a variety of different ways to package it.

Dr. Weitz:                          Yeah. I mean, when I hear of nanomicelles, I usually think of Quicksilver.

Dr. Kaufmann:                   Yeah, but … Yeah, that’s very true. But Rev Genetics does it, a variety of companies do it. It makes it a whiff more expensive, but it’s worth it.

Dr. Weitz:                          And then, what’s the kind of dosage you need for resveratrol?

Dr. Kaufmann:                   Well, it’s sort of depends on which one you’re taking, right? If you’re taking a regular one, you’re going to need more. If you’re taking one that’s more bioavailable, you need less. The half-life is probably about six to eight hours. So, if you really want to get a jump start, you could take it twice a day. Because daily dosing is based on half-life of the drug. It works in regular drugs, and it works for this, as well

Dr. Weitz:                          Okay.

Dr. Kaufmann:                   Some people, covering their bases, they take resveratrol in the morning and pterostilbene in the afternoon.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   It’s a little zealous, but it just depends on what people want to do.

Dr. Weitz:                          Right. And astaxanthin is one of those on your list.

Dr. Kaufmann:                   Oh, astaxanthin is my favorite. I love astaxanthin. It’s ridiculous. I have a love affair with the molecule. It’s really quite sad.

Dr. Weitz:                          Is basically, a carotenoid that comes from seaweed, right?

Dr. Kaufmann:                   It comes from algae, yeah.

Dr. Weitz:                          Algae, yeah.

Dr. Kaufmann:                   Algae. My kids like to call it angry algae. It’s silly, it’s the slime that you see in birdbaths. And when that slime gets stressed out in any way, as much as you can stress out algae, it makes this orangey-red substance. And the stuff is amazing. And basically, it helps the plant survive, or it helps the algae cells survive. And it helps us survive via the same mechanism. It’s the strongest free radical scavenger that we have at the moment, at least naturally produced.

Dr. Weitz:                          Right. And I saw in your book you also recommended it for athletes.

Dr. Kaufmann:                   Oh, 100%. So, athletes create more free radicals. Generally speaking, in your mitochondria, as you probably know, or as most people know, when you’re looking at the electron transport change, oxygen is the final receiver of the electron. So, that’s why you need oxygen. Unfortunately, for normal resting folks, 1 to 5% of that oxygen becomes radicalized. And that’s bad. In the world of good and bad, that’s bad. So, in athletes, you’re using more oxygen, so more oxygen gets radicalized. So, you’ve got more free radicals floating around. And experts that are lazy use this as a reason not to exercise, which is ridiculous. But athletes need more free radical scavenging, especially if you’re outside. Because it also protects your skin.

Dr. Weitz:                          On the other hand, some of the studies show if you take too many antioxidants, you may reduce the benefits of exercise.

Dr. Kaufmann:                   So, what people don’t understand as well, and Ben Greenfield, I love him dearly, but it’s hard to understand, exercise and aging are two very separate things. What’s good for one may not be good for the other, right? Some feedback of free radicals does, in fact, help your body work better. It does.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   But there’s truly no way to get rid of all of the free radicals. So, I think that’s a little bit ridiculous. But the example sort of holds true, as well, when you’re talking about the mTOR system, right? To not age, we want to shut down the mTOR system. To be an athlete, we want to activate the mTOR system.  So, you need to know what you want to do before you plan how to get there.

Dr. Weitz:                          Yeah, when I work with athletes, we usually try to time the antioxidants and not have them, say, if they’re exercising in the morning, not have them take it right around the time they exercise, and say, have them take it in the evening.

Dr. Kaufmann:                   Right. That’s perfectly reasonable. Absolutely.

Dr. Weitz:                          Because there have been several studies seeming to show that when you take these antioxidants, they blunt some of the benefits of exercise.

Dr. Kaufmann:                   That’s absolutely true.  But you need to also keep track of what type of athlete it is, right?  Is it a resistance-type problem? Is it an aerobic-type problem?  For example, my daughter, and I talk about her frequently, is a tennis player.  She is out in the Florida sun all the time. She’s a redhead, and she burns.  When she takes her astaxanthin, she does not burn.

Dr. Weitz:                          Cool.

Dr. Kaufmann:                   You know of course she forgets all the time, and then she turns into a beet. So, we know that it works, because we’ve done this controlled study now. So, it just is sort of … Again, it depends on what your absolute goal is.

Dr. Weitz:                          Right. It’s interesting, a lot of the focus in anti-aging medicine these days is all about cleaning up dead older cells, and putting your body in this mode in which it thinks it’s starving to death, so it starts eating up the old dead cells, autophagy, which is something that exercise also does, whereas, a lot of the focus 20 years ago in anti-aging was about doing things that increase your potential for growth. And so, a lot of the focus was more on giving testosterone, and growth hormone, and various strategies sort of that increase  growth. Because, as we get older, our cells break down and need to be replaced. So, I think there’s this kind of yin and yang between having your body being in growth mode and being in the opposite mode.

Dr. Kaufmann:                   I think that’s completely true. I think you’re mixing a whole lot of subjects there, so I’m going to try to tease out what I think is important. And I don’t mean that in a bad way at all. I think before 15-ish years ago, we didn’t know a whole lot about not aging. I really don’t. I think we do now. But people do have various opinions. And when you talk about all of the hormones, I think it’s … and people are going to hate me for this … I think it’s a little crazy, to be perfectly honest with you. Our bodies work on feedback loops. So, if you’re a young man and you take testosterone, your body perceives that testosterone, especially if it’s bioidentical, and says, “Oh, I don’t need to make anymore because I have enough.” So, it shuts down. So, you’re not going to end up with any higher levels of testosterone. And in fact, you’re going to hurt yourself over the course of time.

Dr. Weitz:                          Sure.

Dr. Kaufmann:                   I generally tell men, “Get the levels tested. As you are getting older and they fall, it is not unreasonable to replace them.” But trying to jack yourself up when you don’t need it is, I think, horribly painful. I mean, I think it’s just a bad thing.

Dr. Weitz:                          Oh, absolutely.

Dr. Kaufmann:                   So, I don’t believe in any of that. The other thing that you mentioned is clearing out the bad cells. And now, this is a huge new topic. And what you’re talking about is senescent cells. And I just spent months, and months, and months digging into this, so I could bore you to tears. But in general, a senescent cell is a cell that was a normal acting cell, and it had some DNA damage, and it decides to go into a shutdown mode, right? And the shutdown mode does then … The outcome is one of three things. Either one, the DNA damage is absolutely horrible. The cell can’t fix itself. It commits cell suicide. Call it apoptosis. It just sort of disappears.

                                          Or, the DNA is fixed, and then the cell goes back to doing what it should do. But in the middle, we have these things called senescent cells, where the cell starts again, but it’s not exactly the same as it was before. The analogy that I like to use is the grumpy old employee at a factory, right? He used to be young and vivacious, and now he’s the fat guy in the corner, right? So, these senescent cells, they change shape. They become larger, their organelles change shape, their production change shape. And what they do is, they produce something called an SASP. Basically, they put out what I call evil cytokinins. It’s a senescent associated secretory phenotype, for those geeks out there.

Dr. Weitz:                          Okay.

Dr. Kaufmann:                   But it’s actually, essentially, they’re just bad, evil, grumpy cells. But they accumulate over time. And they create a localized inflammatory issue. We think originally, they did this to bring in immune cells to get rid of those cells, but it doesn’t exactly work that way. And as you get older, these cells accumulate. And they cause more pathology, and more inflammation, and more damage. I’m not completely sure of this, but I developed a graph, where while you are still young, you have some senescent cells, and the increase is very small. As you get older, the slope of that increases. And then beyond some point, sort of, when people just feel old, it becomes moderately exponential.

                                          So, the question is, how do you get rid of these cells? And so, we’ve been looking at drugs. There’s xenomorphics, which change how a cell acts. And the good news is that there are xenolytics, that actually kill these cells. And it’s been shown in animal models that if you can kill these cells, where the cell was gets replaced by normal new cells. So, a lot of regenerative medicine can be actually focused around xenolytic therapy. So, I think that’s a really cool thing.

Dr. Weitz:                          Absolutely. So, another substance that you highlight is nicotinamide riboside, to stimulate NAD production.

Dr. Kaufmann:                   Ah, another one of my favorite subjects.

Dr. Weitz:                          Yeah, a lot of people talk about this. And then there is some controversy over which of the various compounds that are available are best to take, whether you’re going to take nicotinamide riboside, or whether you’re going to take NMR, or whether you’re going to take NAD, etc., etc.

Dr. Kaufmann:                   Yes. So, first we’ll start off with what it is and why it’s important, and then I’ll tell you what I feel about the other stuff.

Dr. Weitz:                          Okay.

Dr. Kaufmann:                   So, nicotinamide is important, because number one, it is very active in the electron transport chain in the mitochondria. So, as you get older and you have less nicotinamide, and we’ll talk about why that happens in a sec, you make less energy. You just do. Your mitochondria just don’t function efficiently, which is why a lot of older people just don’t have the energy they should have. So, that’s problem number one. Problem number two is that it is a necessary co-factor for sirtuins. So, the aging, or not aging pathways, the seven mammalian sirtuins, do not function without nicotinamide. So, you can take as much resveratrol or pterostilbene as you want, but without nicotinamide, you’re not doing anything. So, that’s number two.

                                                Number three is that, when you have DNA damage, you’ve got a big glob missing in your DNA chain, your body takes the nicotinamide molecule, chops it into pieces, and puts part of it back into the DNA so it fixes it. So, again, if you don’t have enough nicotinamide, you don’t repair your DNA, then you get cancer. And then, lastly, and this one’s hard to sort of quantify, serves as a communication device between your nucleus and your mitochondria. So, four reasons that you need more, because you have more damage, you need more energy, blah, blah, blah.

                                          So, as you get older and you have less, you, by definition, need more. So, the supply/demand chain makes it very difficult to keep up, which, you can actually get your nicotinamide levels measured. But it’s extraordinarily hard to do. We have tried to do this. There is one company in LA, I believe. We measured a gentleman’s nicotinamide, and it had to be immediately spun down, put on dry ice, and hand-driven to their company to do it. So, at the moment, it’s not exactly commercially available.

Dr. Weitz:                            And niacin levels are no reflection of that?

Dr. Kaufmann:                   Not at all. Completely different, completely different. My kids always tell me that, why can’t you just smoke a cigarette, because isn’t that the same thing? And the answer is, gosh, I hope not. And I hope other people don’t think that, either.

Dr. Weitz:                          Because nicotine, being a similar compound?

Dr. Kaufmann:                   Well, the word sounds kind of the same.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   And so, people think, “Oh, well, I smoke. I’ll be fine.” And the answer is, “Not exactly, actually not at all. And you’re making the problem way worse, because now you’ve got more DNA damage.”

Dr. Weitz:                          Right.

Dr. Kaufmann:                   Right. So, the question then goes back to, “How do you know that you’re short?” And the answer is, “Probably anyone over the age of 40.” People that say, “You know, I just don’t have the energy I used to,” that is probably nicotinamide deficiency. Do you really know? Not really. But it’s just likely. And then, of course, which one do you take, right? There’s no way of knowing, because there’s no way of measuring it. People are touting NAD infusions, and I think that’s kind of crazy, because I’ve worked in a hospital a really long time, but no one’s ever come in, in a stat nicotinamide deficiency. It just doesn’t happen, right? And giving something extremely quickly that’s going to get metabolized, and then it’s going to disappear, I’m not convinced that’s great for you, just from a pharmacological standpoint.  What I think you do need is slowly filling the deficiency, which you could do obviously, with oral supplementation, which then, boils down to, you’re right. Is it nicotinamide riboside or the NMN? And the answer is, we don’t know that either. There’s never been any head-to-head testing. There’s been a lot of studies that show that NR is very efficacious. They’re catching up on the other side. I think this is a war of companies. Because they both have their trademark compounds. We know that you need it in some form, and someone ultimately, is going to win. I wish they would do a head-to-head study, because people asked me all the time which is better. And the answer is, “I really don’t know. I wish I had an answer. But taking one of them, I think is crucial.”

Dr. Weitz:                          So, if you take nicotinamide riboside, what dosage do you like?

Dr. Kaufmann:                   That’s a good question. I think it depends on how old you are. I think it depends on how deficient you are. Just many, many things. For example, if you’re already 50, you’ve got some catching up to do. So, I recommend a higher dose. You probably would take maybe, two weeks to three weeks to catch up. When your energy levels sort of level off-

Dr. Weitz:                          What would would that higher dose be?

Dr. Kaufmann:                   I would say, it just depends on the bottle, too. I think it’s … They usually come in 250’s, I believe.

Dr. Weitz:                          Right, I think they do.

Dr. Kaufmann:                   So, I tell people, “Take two of them. Spread it out, one in the morning, one at night, for two to three weeks, until you feel like your energy levels are good. Back down to once a day. And if you still feel good after a month or so, take it every other day.” Because having too much isn’t good, either. This is not a, “who gets to have the most in their body wins” sort of thing. You need the right amount, but not too much. And the only way to do that is judge it by energy levels.

Dr. Weitz:                          Curcumin. That’s one of my favorite nutritional compounds. And I know that’s big on your list.

Dr. Kaufmann:                   Oh, I love it. Yes, absolutely.

Dr. Weitz:                          Yeah, we love curcumin as an anti-inflammatory, as an anti-everything, cardiovascular, cancer prevention, etc., etc.

Dr. Kaufmann:                   Absolutely. And I used to think that it was really crazy that one thing could do all of those things, but if you boil it down to the seven tenets, it does. It is a very potent epigenetic modifier, right? So, everyone should be on it. It helps your mitochondria, because it’s a free radical scavenger. It helps activate some of your pathways. It helps with DNA repair. It does everything it’s supposed to do. I won’t bore you with the details. Although, one of my absolute coolest favorite thing is, it’s the only thing that actually been demonstrated to help with lipofuscin accumulation.

Dr. Weitz:                          Okay.

Dr. Kaufmann:                   There’s a great rat study that looked at old rats, and medium old rats. And if they were on curcumin, not only did they not get a lot of, or get the same amount of lipofuscin accumulation, some of it was actually reduced, which I think is incredibly amazing. 

Dr. Weitz:                          Can you explain what lipofuscin is?

Dr. Kaufmann:                   Absolutely. I call it the kitchen drawer phenomenon. You probably read that in the book. It’s sort of a goofy analogy. So, when a long-acting cell responds to the environment, it changes the number and type of organelles it has. So, for example, over the course of time, your mitochondria get beat up, and your brain cell says, “You know what? I really need to make new mitochondria.” Squashes them down, extracts out the reusable pieces, and takes the rest that it can’t use, and squishes it in the back of the cell. And then over the course of however old you are, 90, 80, however old you are, every time you’ve recycled these organelles, you get more, and more, and more accumulations of just gunk sitting in the back of your cells that you can’t use.  And it really doesn’t do anything, it’s just a space occupying problem. And what I think is really cool is, you can age lobsters by lipofuscin accumulation. I mean, not that that’s really important to anyone, but it’s just really cool. It’s the most accurate way of measuring crustaceans. And the same with us, you cut open our brains when we are old, you can probably look at it and go, “Aha, 90- some years old, or 100, or however old we are.”

Dr. Weitz:                          Right. So, when you were talking about NAD, I believe a lot of people talk about it as a factor that affects mTOR, right? Is it a bio-blocker for mTOR?

Dr. Kaufmann:                   NAD should not be, no. Metformin is. That’s what you’re referring to.

Dr. Weitz:                          Oh, okay. Okay, we’ll get to that in a minute. Okay. So, next, we have carnosine.

Dr. Kaufmann:                   Aha, carnosine.

Dr. Weitz:                          Yeah.

Dr. Kaufmann:                   You’re hitting my top favorites here. This is great.

Dr. Weitz:                          Yeah, so, most people probably don’t know carnosine. They know carnitine, and carnosine is a little bit different.

Dr. Kaufmann:                   It is different. It is a dipeptide. It is alanine and histidine, So that’s a very simple peptide. The Russians are very, very fond of this. They gave it to all of their athletes behind the Iron Curtain, and honestly, they kicked our butts in the 80s. And I think it’s because of the carnosine. It does two major things. Number one, it’s a buffer in your muscles, and it’s a free radical scavenger, which is why athletes like it. But I’m in love with this because it’s a trans glycosylating agent. So, all of the glucose that we take in our system needs to get stripped, and it’s one of those things that can actually suck the sugar off of you, and you just excrete it, and you’re all the better for it.

Dr. Weitz:                            Okay. Yeah, we know that blood sugar, insulin resistance are major factors in antiaging. And we need to try to manage those. And I think that’s one of the benefits of caloric restriction, fasting, and probably of ketogenic diet, as well.

Dr. Kaufmann:                   Oh, without a doubt. Glucose control is extremely important. Obviously, we need glucose. It’s just like oxygen, we need some, but we all have far too much.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   Glucose falls into my waste management category, just because it’s everywhere. I tell people, “It’s sticky on the outside, it’s sticky on the inside.” You get glycation everywhere. I talk about AGE’s in the book a lot. One of my favorite abbreviations, it’s advanced glycation end products.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   Glucose sticks to protein, it sticks to DNA, it sticks to lipids. And it causes several problems. It causes the things that it sticks to, to lose function. And then the glob sticks to collagen. And once a glob sticks to collagen, you get basically, destruction of anything that’s collagen-based in your body. Your skin, your heart, your blood vessels. So, I think it’s one of the huge reasons that you age. So, by calorically restricting yourself, as well as taking less glucose, obviously, you’re causing fewer of those problems than you could normally.

Dr. Weitz:                          And when we measure hemoglobin A1c, we are measuring one of those glycosylated proteins, right?

Dr. Kaufmann:                   That is correct. So, basically, you’re measuring the amount of glucose stuck to a red cell. Red cells take about three months to turn over, so, it’s a transient snapshot of your glycation level. If you really want to know how coated you are, there’s a great machine, is called an AGE reader. They have it in Europe.

Dr. Weitz:                          Really?

Dr. Kaufmann:                   Absolutely. If I had a private clinic I would get one, but I don’t, so I haven’t.

Dr. Weitz:                          And AGE reader, wow.

Dr. Kaufmann:                   Is called an AGE reader. You stick your arm in it, and it tells you how much glucose has been glycosylated into your arm.

Dr. Weitz:                          Wow, fascinating.

Dr. Kaufmann:                   I think that’s the future of tracking diabetes. It just hasn’t made it to this country yet. It’s on our list of antiaging markers, so we’ll get to play with it. Is just not a popular item yet.

Dr. Weitz:                          You know, I’ve talked to some anti-aging doctors. I talked to Sarah Gottfreid recently and she likes to wear a continuous glucose monitor, just to continuously see where her glucose levels are. What do you think about using something like that so you can really fine-tune your glucose levels?

Dr. Kaufmann:                   I think it depends on your level of OCD. I know that sounds terrible. I mean, some people are very, very into this. And I applaud that. My whole plan of this whole thing was to live a normal life, and not to be too crazy. So, I think that would just drive me to drink, to be perfectly honest, which wouldn’t be good, either.

Dr. Weitz:                          Well, you’d get plenty of resveratrol, as long as you had red wine.

Dr. Kaufmann:                   Oh, absolutely. And there’s quercetin in white, so we’re covered either way. So that’s good.

Dr. Weitz:                          Oh, there you go.

Dr. Kaufmann:                   No, but … So, the way I approach it is, I block glucose going in, metformin. There are seven steps to glucose coming in AGE, and there are innumerable substances that serve as blocking agents. And then once you do have an AGE, there are several agents that can trans glycosylate to get rid of it. So, I don’t actually care what my momentary glucose is. I go on my Haritaki holidays, and I … Maybe I’m kidding myself, but I like to think that I’m sort of taking care of the problem.

Dr. Weitz:                          Cool.

Dr. Kaufmann:                   You’ve nothing to say to that, do you?

Dr. Weitz:                          Well, I just had something pop up on the screen that, Zoom sent me this note that, “We’ve just eliminated your 40-minute limit.” So-

Dr. Kaufmann:                   Oh, great.

Dr. Weitz:                          Yeah, there’s this weird thing, that if you have two people on a meeting, you get unlimited time. But if you get a third person, because you switch computers, it limits you to 40 minutes.

Dr. Kaufmann:                   Oh, no.

Dr. Weitz:                          And you didn’t see it, I guess. It said, “We eliminated that.” It’s like, “Thank you.” Okay.

Dr. Kaufmann:                   Oops.

Dr. Weitz:                          So, you mentioned carnosine eyedrops. I never heard of that. That sounds really fascinating, as a way to reduce risk of, I think you said cataracts?

Dr. Kaufmann:                   Right. So, again, this carnosine falls under the expertise of the Russians. And there’s some extremely zealous Russian dude with a ridiculously long name that I could never pronounce. And he loves carnosine. And he decided that cataracts, and I think by extension, presbyopia, had a lot to do with glycation in the lens. And interestingly enough, he formulated NAC, So, it’s N-acetylcarnosine. And he gave it to, I don’t know, 50,000 Russians. And they all said their vision got better.

Dr. Weitz:                          Wow.

Dr. Kaufmann:                   So, amazingly enough, it’s over-the-counter. There’s probably 17 versions of it on Amazon.

Dr. Weitz:                          I looked online, because I read about this on your website. But, what do you think is the best one to take?

Dr. Kaufmann:                   So, that’s a very … I tried a whole bunch of them, and I don’t know why some of them burn and some of them don’t. I get this one, and it’s … This is the most ridiculous ad ever. But it comes in a little metal bag. How about that? If you’re looking for it online, it comes in a little foil bag.

Dr. Weitz:                          Okay.

Dr. Kaufmann:                   I know that’s really silly. It says NAC. It’s a tiny bottle. I wish I could tell you exactly who made it. I can work on that, and I can send you a link.

Dr. Weitz:                          Okay. So now, in your list, most of your list of compounds are supplements, but yet metformin, which is a pharmaceutical drug, is-

Dr. Kaufmann:                   Wait, wait, wait. I have to interrupt you there, because this drives me absolutely nuts. Okay, so a supplement technically, is something that you already have in your body, and we are adding to it, right? And add you vent is something that your body’s never seen before, right? Then there’s vitamins, and then there’s minerals. So, I call them molecular agents, because everything falls into a different category.

Dr. Weitz:                          How about if we use the term nutraceuticals?

Dr. Kaufmann:                   That’s fine. We can use that.

Dr. Weitz:                          Okay.

Dr. Kaufmann:                   But see, metformin, the only difference of metformin is that somehow, it became controlled by pharmaceutical companies. As far as I’m concerned, it falls into the same categories.

Dr. Weitz:                          I’m sorry, that makes it evil.

Dr. Kaufmann:                   It does not make … well-

Dr. Weitz:                          I’m kidding.

Dr. Kaufmann:                   The only good news, it’s been around for a zillion years, so it’s extremely cheap.

Dr. Weitz:                          So, metformin helps with controlling mTOR. What about rapamycin? I’ve heard some anti-aging experts, I think Peter Attia, talk about, I think he’s been experimenting with taking rapamycin.

Dr. Kaufmann:                   Right. So, the mTOR pathway, I call it the youthful pathway. It’s about building.

Dr. Weitz:                          By the way, mTOR stands for mammalian target of rapamycin.

Dr. Kaufmann:                   Yes, yes it does. Yes it does. And I should’ve said that. In my world, that’s sort of a given, so I apologize. What the mTOR pathway does is, it builds. It builds muscle, it builds tissue, it turns over cells. It’s a very active system. It’s anabolic, right, versus other things that are catabolic.  As you get older, however, the system becomes obsolete.  And if you block it, you put yourself into a sort of state of not growing.  And that helps to preserve you, right?  Therefore, rapamycin is extremely potent, and it can do this, which is why we use it … It truly is a chemotherapy agent.  We use it and stents, so that you don’t regrow tissue in a coronary artery.  We use it to block issues after kidney transplant. It’s a heavy-duty medication.

                                        And if you block all tissue turnover, you may preserve yourself, however, I spent a ton of time looking into this. And the problem is that you block tissue that you need to turn over. For example, you tend to become sarcopenic, right? Because you’ve got muscle wasting, because you’re not turning over your muscle. And the other thing that’s a little bit worrisome is that you have to turn over your hippocampal cells to make memories. And, at least in experimental animals, if you block that ability, you’re not going to remember anything. So, I don’t necessarily agree with the rapamycin bandwagon.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   And other people will say different things, but that’s sort of my take on the situation.

Dr. Weitz:                          So, just practically, how would … You’re an MD, I’m a chiropractor. I can’t recommend pharmaceutical drugs anyway, but even if I were to suggest a patient take Metformin for anti-aging, I mean, practically, what are they going to do, go to their primary care doctor and say, “Hey, Doc, I want to live a long time. Can you prescribe Metformin”?

Dr. Kaufmann:                   So, the answer is yes. A study came out many … Four or five years ago by now, and it looked retrospectively at three groups of people. They weren’t diabetics on metformin, diabetics on sulfa ureas, and non-diabetics on obviously, no diabetic drugs.

Dr. Weitz:                          Right.

Dr. Kaufmann:                   And retrospectively, the diabetics on metformin did extraordinarily better. The morbidity was lower, the mortality was lower. So, clearly, people realize that metformin was doing something to help with not aging. And it certainly was not just the glucose. So, a lot of money and time has been dumped into figuring out why metformin does this. It does many things. It’s a epigenetic modifier, it activates your AMP kinase, and helps with glucose issues, it’s an anti-inflammatory. We know it reduces the risk of cancer in diabetics. It reduces weight. It helps with menopause. It decreases issues with PCOS. It is an extremely potent useful drug. And people are realizing that in a risk-benefit ratio, it really is a great thing to take. And I’ve actually gotten calls from a lot of primary care specialist saying, “People are asking about this. What should I do?” And I say, “You know what? Give it to them. Absolutely give it to them.”

Dr. Weitz:                          Well, there are studies showing that a natural compound, berberine, has been shown to be equally effective to Metformin in some situations. Could we take berberine instead of metformin?

Dr. Kaufmann:                   So, the answer is sort of. That plant, or that chemical, does actually help with glucose reduction. But it doesn’t do a lot of the other things. So, what you would have to do in order to substitute that is go to my numerical chart and find agents that helped in the categories that you are now not using from the metformin. So, this goes back to my idea that you don’t have to be on everything, but you have to just make sure all of the categories are covered.  So, for example, if you’re going to use berberine for glucose management, you need to use something else for the AMP kinase, or the inflammatory issues.

Dr. Weitz:                          Okay. Interesting.

Dr. Kaufmann:                   The caveat, and I just like to say this, because people run out, and then they buy metformin, or they talk someone into it. Because it is a partial mTOR inhibitor, you can get muscle wasting over the course of time. So, I recommend that people take leucine, one of the branched-chain amino acids, to try to prevent it.  And then secondly, you get decrease in vitamin B absorption in the gut from it.  So, I suggest people take sort of a generalized B.  People love B-12 for some reason, but you really need all of the B’s.

Dr. Weitz:                          Interesting. So, leucine.

Dr. Kaufmann:                   Mm-hmm (affirmative).

Dr. Weitz:                          There is some controversy about amino acids playing a role in aging, and some specialists, anti-aging folks, feel that certain amino acids like methionine, in particular, are contrary to an anti-aging perspective. What do you think about that?

Dr. Kaufmann:                   I think it goes back to what we talked about before. You have to define what you really want to get to, right?

Dr. Weitz:                          Right.

Dr. Kaufmann:                   Absolutely, amino acids cause you to build muscle.

Dr. Weitz:                          It’s one of the arguments for a vegetarian diet, in say, having anti-cancer effects.

Dr. Kaufmann:                   Right. And I get that. But again, you have to pick your battles. If you’re going to protein starve yourself, you’re going to become extremely sarcopenic, right?  And if you’re an aging athlete, you don’t want to become sarcopenic.  So, I tell people not to take all of the amino acids that you see in those big giant bulk cans for the bodybuilders.  But if you want to maintain some lean muscle, so that you’re not frail as you get older, the only one that you really have to focus on is leucine.

Dr. Weitz:                          So, you take the branched-chain aminos?

Dr. Kaufmann:                   That’s exactly what I do.

Dr. Weitz:                          Right, okay. So, we can’t go through every one of your compounds, even though they’re all fascinating. But I wanted to mention that Astragalus TA-65 compound that I’ve seen at some conferences advertised. And I’ve read some of the literature on it. I know it’s an extremely expensive one. Can you talk about that, and how efficacious is that as an anti-aging compound?

Dr. Kaufmann:                   Right. So, it is extremely important to activate your telomerase to make your telomeres longer. And the question, of course, is how do we do that? The natural agent, astragalus, as you mentioned, has pretty potent powers. Compared to the ones that we’ve concocted in the lab, it’s pretty weak. TA-65 is pretty good. You can thank Bill Andrews for those, because he invents them at Sierra Sciences, and then passes them along. The 818 is even better. But again, these things are ridiculously expensive. So, for those billionaires out there that really don’t care about cost, it is a great thing to do. It really is. For a regular human that just wants to stop aging, it probably is not going to be very affordable. I personally, stick with astragalus. Do I expect phenomenal things to happen? No. But the other really cool thing about telomeres, and I actually just learned this recently from a very brilliant scientist from Spain, is that as you exercise and you become transiently hypoxic, you actually activate something called your-

Dr. Weitz:                            What was that?

Dr. Kaufmann:                   When you are exercising, right?

Dr. Weitz:                            Right.

Dr. Kaufmann:                   And you feel that acidotic burn.

Dr. Weitz:                            Okay.

Dr. Kaufmann:                   You’re getting transient hypoxia in those areas, okay?

Dr. Weitz:                            Okay.

Dr. Kaufmann:                   That activates the-

Dr. Weitz:                            So, not enough oxygen in those muscles.

Dr. Kaufmann:                   Right. Contrary to what a lot of people think, more oxygen is not good for you. Sitting in an oxygen chamber, unless you’re a diabetic, is not so good for not aging.

Dr. Weitz:                            Because it’s reactive oxygen species, right?

Dr. Kaufmann:                   Yeah, for innumerable reasons, yes. Our stem cells like [crosstalk 00:52:32]

Dr. Weitz:                            … what’s good is bad, too, right? So, that’s why people use hyperbaric oxygen and ozone, because it’s inflammatory, but then it stimulates the healing, right?

Dr. Kaufmann:                   Right. I mean, again, you have to figure out what your endgame is to figure out what your therapy’s going to be.

Dr. Weitz:                            Right.

Dr. Kaufmann:                   And what’s good for one person is not necessarily good for someone else.

Dr. Weitz:                            Right.

Dr. Kaufmann:                   That being said, when you transiently become low in oxygen in your muscles as you are exercising, it activates something called the HIF Alpha factor. It also gets activated when you’re climbing mountains and you’re hypoxic. And that, through a series of enzymatic reactions, actually activates telomeres. So, simply by exercising, you are actually activating your own telomeres. So, that’s probably the most important thing that normal, reasonable people can do.

Dr. Weitz:                            Now, I think that there’s been studies showing a whole series of things about lengthening your telomeres, including multivitamins, fish oil, on, and on, and on. And so, I think it’s why some people would be a little skeptical about you telling me your hypothesis.

Dr. Kaufmann:                   Well, I think it boils down to, telomeres are much like epigenetic modification. Whatever your mom said was good for you, probably is a positive epigenetic modifier, and it probably helps your telomeres, right? And the other thing you have to realize is that all of your telomeres in every cell of your body are not going to be identical all the time, right? So, if you looked at a telomere from your brain cell, it’s going to be different than a telomere from your white cell, or from your red cell, right? It’s not an absolutely homogenous population. So, it’s just, you have to realize that once you have your telomeres measured, it may be different if you took a different specimen, you know what I’m saying?

Dr. Weitz:                            Yeah. So, the telomeres in the bloodstream may not reflect the telomeres in the brain versus the telomeres in the liver or in the muscles.

Dr. Kaufmann:                   Right, right. But, going back to what your mom said, right, clearly she said, “Don’t eat Twinkies.” We all ate Twinkies as kids. Twinkies are clearly negative epigenetic modifiers, and they certainly cause a lot of stress on your body. Stress causes decreased telomeres. So, again, all of this is what I like to think of as a giant overlapping Venn Diagram, where you can’t necessarily say, “This does this, but it doesn’t do that.”

Dr. Weitz:                            So, how do we put together a list? How would I put together a list, let’s say, for myself or for one of my patients, using your system? Bam. What’s the list of six, eight compounds I would come up with?

Dr. Kaufmann:                   Ah, excellent question. So, the first thing I do is, how old is someone, how zealous do they want to be, what medical problems do they have, right? Someone says, “You know, I’m middle-age, don’t really have too many medical problems, my back hurts, I’ve got disc problems, and I don’t have any energy.” I immediately put them on the panacea. And conveniently, it’s the panacea, because I rearranged some letters at some point, and kind of misspelled panacea on purpose, and it kind of worked. But it works.

                                                So, for the P it’s pterostilbene. A is astaxanthin. N is nicotinamide. And then, you throw in two C’s, which is curcumin and carnosine. And then for some people, I throw in the EGCG’s from green tea, because it helps a lot, as well. So, to a basic program, that’s a great place to start.

Dr. Weitz:                            Cool.

Dr. Kaufmann:                   But if you want to be fancy, right? Some people go, “I have a lot of immune problems.” Then you add more agents that score well in that category. Or if you’re a diabetic, pre-diabetic, like to eat a lot of junk food, then I add up a lot of things that score well on the waste management category. So, there is actually an app, and unfortunately, people are angry at me right now. My developer is kind of … It gets stuck on the subscription page. So, please don’t have anyone do it until I absolutely get it fixed, because I’m getting tired of getting hate mail. But, what it does is, you put in all of your personal information, and then an algorithm, based on what I have done, sort of tells you what you should take, and then where to get it. Trying to make it easy for people.

Dr. Weitz:                            What about the role of … We’ve been talking about supplements, and … Not supplements. We’ve been talking about nutraceuticals.

Dr. Kaufmann:                   Oh, there you go.

Dr. Weitz:                            But what about the role of diet, exercise, sleep, stress reduction techniques like meditation, for antiaging benefits?

Dr. Kaufmann:                   All of those things are good, right? The question would be, why? Well, exercise is good, right? We talked about telomeres. It actually activates your sirtuins, increases your circulation. It does a variety of fantastic things, right? You need aerobic, you need anaerobic, everyone knows it’s good for you. And I actually rated it at one point, to figure out exactly what it did in each category. It scores pretty well. Scores pretty well. Foods are important, because they’re epigenetic modifiers. They really are. And what’s really interesting is, if you take twins and you watch them grow up, they get more and more different as they age. And the reason is, it’s all epigenetic modification.  It’s their diet, or are they around polluted areas? Do they smoke? What do they do? So, you could absolutely do great things, right? Meditation and all those things, they reduce stress levels. Stress level reduces stress on cells. Cells work better, i.e., you’re not aging as much. So, it all ties together. You just have to boil it down to what exactly it’s doing to your cells.

Dr. Weitz:                            Cool. Awesome. So, I think that’s all the questions I have. I thought that was a lot of really good information to help us with aging better, and hopefully living healthier. How can our listeners get a hold of your programs, and your information, and your book?

Dr. Kaufmann:                   Excellent question. So glad you asked. And so, we’ll start from the beginning. As you well said, I am not an antiaging specialist, per se. I don’t have an office. This is a hobby.

Dr. Weitz:                            When is that office opening?

Dr. Kaufmann:                   That’s a very good question. This is really starting to not help my day job. I run an operating room, and every now and then I’ll get a phone call and they’re looking for me. And I’m, “Can I help you with an anesthetic?” And they’re, “No, I don’t want to age.” And then I’m sort of moderately perplexed, because it’s hard … anyway, whatever. So, what I do do is, the book is available. It’s on a regular book, it’s on an e-book. So hopefully, people can sort of get through that. The app … Don’t get it yet. I’ll tell you when. There is a website, kaufmannprotocol.com. It explains all of these things that I’m talking about.   I will be sending out updates. I’m sending out my … So actually, Bill Andrews is reviewing my diatribe on senolytic cells right now. He’s on a trip back from Japan. Assuming I get has blessing, that’s going to go out on the websites. I’m on Facebook, it’s Sandra Kaufmann. I’m on Instagram @ Kaufmann Antiaging.

Dr. Weitz:                            Is that a book or a paper?

Dr. Kaufmann:                   You know what? It started to be a paragraph, and it turned into 30 pages.

Dr. Weitz:                            Okay.

Dr. Kaufmann:                   So, I don’t exactly know what it is. It was all the information that I thought was important. My next project, I actually have a playbook for athletes, a specifically anti-aging playbook, or anti-aging for athletes, which is sort of interesting. And I’m working on a book for skin, because your skin ages for nine reasons instead of seven reasons. So, hopefully that will be out shortly. [crosstalk 00:59:47]

Dr. Weitz:                            I was very excited to do that pinching thing, and my skin didn’t-

Dr. Kaufmann:                   Uh-oh.

Dr. Weitz:                            It went back immediately. I didn’t have any line at all.

Dr. Kaufmann:                   Oh, fantastic. Then you’re doing well. Doing great.

Dr. Weitz:                            And I’m 61, so-

Dr. Kaufmann:                   Fantastic, fantastic. So, the really big question here is, what do you take?

Dr. Weitz:                          Oh, I take about 30 different things, yeah. I take a lot of these. I’m big on … A multi, curcumin, fish oil, I take vitamin E, vitamin C. I take the gamma tocopherol, vitamin E, I take C, I take berberine. I use that as a natural blood sugar control agent. I take astaxanthin, I take nicotinamide riboside, I take [inaudible 01:00:44]. I alpha lipoic acid.

Dr. Kaufmann:                   Excellent.

Dr. Weitz:                          And that was before I read your book.

Dr. Kaufmann:                   Oh, good. So you’re probably then, agreeing with all this crazy stuff, thinking, “Yeah, that’s why I do it.”

Dr. Weitz:                          Yeah, when I get up in the morning, I add a green powder, red powder. I put fiber, I put probiotics, I put modified citrus pectin. So, yeah, I do a lot of stuff.

Dr. Kaufmann:                   Perfect. That’s awesome.

Dr. Weitz:                          I take way more stuff than I would ever ask a patient to take.

Dr. Kaufmann:                   Well, you and me both. If people looked at my list, they’d probably have a heart attack.

Dr. Weitz:                          Absolutely. Okay. Thank you so much, Dr. Kaufmann.

Dr. Kaufmann:                   It’s been a pleasure. Thank you.

Dr. Weitz:                          Okay.



Hormones with Dr. Dominique Fradin-Read: Rational Wellness Podcast 121

Dr. Dominique Fradin-Read discusses Bioidentical Hormones 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. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

4:20  Perimenopause is the period during a woman’s life when her hormones start to decline and her period starts to become irregular. She may start to feel tired and moody and some women become miserable. Not only do her ovaries start to produce less hormones but her thyroid as well. Low thyroid function can lead to weight gain, sleep issues, moodiness, and anxiety. Progesterone is really the first hormone that starts to decline during the perimenopause. There are some natural methods to balance your progesterone, including eating yams and taking some nutritional supplements, including Vitex or Chasteberry, omega 3 fats, and also evening primrose oil.

9:00  During menopause some women have a very tough time and some women sail through menopause with very manageable symptoms. Genes play a role. In some parts of the world, like Africa, women don’t know about menopause.  The stress of our society tends to make menopause worse. Our stress hormone, cortisol, can interfere with progesterone.  Menopause is often a time of upheaval in a woman’s life.  Her kids may be leaving for college or moving out.  Such family changes are stressful and can add to how a woman feels. Dr. Fradin-Read said that she notices that women who get good support from their husband tend to do better.  Also, a poor diet and lifestyle can make going through menopause worse. 

11:46 After menopause, women do not produce very much estrogen. A small amount is produced by the adrenals. During the perimenopause a woman can have too much estrogen and be in estrogen dominance and they will have breast tenderness, feel bloated, have trouble sleeping, and feel anxiety. She likes using a supplement during perimenopause called DIM Detox from Pure Encapsulations, which contains DIM and broccoli extract and other nutrients to promote the detoxification of estrogen. 

13:50  Dr. Fradin-Read said that she does not prescribe hormones to women. She explains the benefits and the risks and lets the patients decide. She always believes in using the lowest dose possible. She knows that breast cancer is the biggest concern with taking estrogen, but she has never had any of her patients get breast cancer with the dosages that she recommends. Also, taking estrogen topically is much safer to reduce the risk of clotting and cardiovascular disease. Oral estrogen increases the risk of clotting. She screens her patients for clotting problems and also counsels them about diet, exercise, sleep, and stress relief. She provides a comprehensive approach to using hormones.

16:10  Dr. Fradin-Read tends to recommend bioidentical hormones. She likes to use a mixture of estriol and estradiol.  She never prescribes estrone, which has a much higher risk of breast cancer.  If a woman has a lot of hot flashes, she will tend to recommend a slightly higher dosage. If patients prefer the ease of an estrogen patch, she is also ok with that. She does not like pellets, because is the dosage is too high, you can’t take the pellets out. She likes women to be their own boss as to how much hormone they need on a given day. If they have breast tenderness, that means they need to decrease the dosage.

18:35  Dr. Fradin-Read will sometimes prescribe progesterone in a rhythmic fashion and sometimes she’ll use it daily since it helps so much with sleep, which is what she does for herself.  On the other hand, too much progesterone can cause depression and it can increase the risk of high sugar and insulin resistance, so for patients with a weight issue, doing progesterone for two weeks at a time per month may be favorable.  But it can bring back a woman’s period.  She has a few patients on the Wiley protocol where you try to mimic a woman’s natural cycle of hormones. You start low with the estrogen. You go progressively up to day 12, so just before ovulation. Then, you add progesterone at that moment at a relatively low dose, and you go up, up, up until day 20, 21. Then, both of them, you are done through the end of the cycle. It does involve a higher dosage of hormones and this tends not to work as well in women that are heavier, because they store estrogen in their fat cells.

23:26  There are various ways to test for hormones, including blood, urine, and saliva. Dr. Fradin-Read tends to do blood testing for hormones. She may test on day 3 or 4 to see the resolve of eggs with FSH at that time, on day 12 or 13 to see how to go with estrogen levels, and on days 19-21 when we are the highest with progesterone. Sometimes for women taking hormones topically she may do saliva testing.  On the other hand, for women not taking hormones, saliva testing does not make sense and can yield unusual results.

26:40  When Dr. Fradin-Read recommends hormones for her female patients, she tends to prefer Biest, a combination of estradiol and estriol, which is a less potent hormone. For women who have a lot of hot flashes and other menopausal symptoms, she might recommend 80% estradiol and 20% estriol. If a patient wants to take hormones who has a family history of breast cancer, she might recommend 80% estriol and 20% estradiol.

29:00  In order to reduce the risk of blood clots from taking hormones, Dr. Fradin-Read screens her patients for genetic clotting risk, like Factor Leiden V.  She asks about their history of blood clots and stroke and their family history of clots and stroke. She cautions her patients to drink a lot of water. The biggest risk factors are if they fly long distance, get dehydrated, or if they have an injury or sickness and are resting in bed for a while. When you go on a long flight, Dr. Fradin-Read recommends taking a baby aspirin, drinking a lot of water, and using compression stockings.

31:35  The best diet for menopausal women is the modified Mediterranean Diet that is lower carbs than the traditional Mediterranean Diet, but is rich in colored fruits and veggies. She sometimes uses a ketogenic diet for a short period of time with her patients, but it increases your cardiovascular risk because it has so much animal, saturated fat. She likes the pescatarian diet, which she uses for herself. 

34:02  Men sometimes have low testosterone and Dr. Fradin-Read does treat men as well as women. The first thing Dr. Fradin-Read looks at is their BMI and their belly fat, which if it is high, will reduce their testosterone levels.  She also asks if they are exercising and if they are sleeping well. Men make their testosterone when they sleep at night, so if they are not sleeping well, they can’t make as much testosterone.  Men also need to make sure they consume enough protein to make testosterone. A lot of alcohol can also decrease testosterone levels. If men are under too much stress, cortisol will lower testosterone levels. The first supplement she will look at this DHEA, which is a precursor for testosterone. There is a medication, Clomid, that can help with testosterone levels. Also, HCG, human chorionic gonadotropin, is an injectible drug that can increase testicular production of testosterone and it may also help them to drop some fat. She may prescribe bioidentical testosterone get or cream that you rub on your shoulders. But some men prefer the injectible testosterone and she may recommend 50 or 100 mg per week. If men take too much testosterone, it could increase PSA and increase their risk of prostate cancer.  Dr. Fradin-Read also pointed out that she monitors the red blood cells in men taking testosterone, since they will tend to produce more red blood cells and this can lead to clotting, so she monitors this (red blood cells and hematocrit)  regularly.



Dr. Dominique Fradin-Read is an Integrative Medical Doctor in Santa Monica, who is board certified in Preventative and Anti-Aging Medicine. Her clinic and website is VitalLifeMD and her office phone is 424.325.3368.

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 or go to www.drweitz.com.


Podcast Transcript

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, and for those of you who enjoy listening to the Rational Wellness Podcast, please go to  Apple Podcast, no longer iTunes, Apple Podcast and give us a ratings and review. That way, more people can find out about the Rational Wellness Podcast. Also wanted to make sure everybody knows that if you want to see the video version, you can go to my YouTube page and search for Weitz Chiro or the Rational Wellness Podcast, and there’s a video version on the YouTube page, as well as videos of a lot of our functional medicine meetings that are not included in the podcast. Then, if you go to my website, drweitz.com, there will be show notes and a complete transcript of every episode. I also just wanted to make sure the listeners know that I am currently open to accepting new patients in my functional medicine practice.

                                                Our topic for today is hormones and our understanding of what happens with hormones throughout life, particularly during perimenopause and menopause in women and in men during andropause, and then, what are the most effective and safest interventions especially for functional medicine-oriented practitioners to take with their patients.  Menopause is when a woman’s body is shutting off its reproductive capabilities. There’s a decrease in estrogen and progesterone production by the ovaries, which often results in a host of symptoms including hot flashes, night sweats, brain fog, mood swings, depression, weight gain, vaginal dryness, hair loss and fatigue. The long-term effects of menopause include risk of osteoporosis and of cardiovascular disease. Testosterone and DHEA also decline, but in contrast, they decline with … They also decline with age, but in contrast, not as precipitously with menopause as estrogen and progesterone do.

                                                Dr. Dominique Fradin-Read is board-certified in Preventative and Antiaging Medicine. She was born in France and started her medical practice in Belgium. She moved to the US in 1999 and did an internship in Internal Medicine at Loma Linda Medical School, Loma Linda University Medical School, and she’s currently an assistant clinical professor at Loma Linda Medical School. Dr. Fradin-Read has an integrative medicine practice in Santa Monica. Dr. Fradin-Read, thank you so much for joining me today.

Dr. Fradin-Read:               My pleasure. It’s a pleasure to be here with you, Ben, and with your audience.

Dr. Weitz:                          Can you explain what is a hormone, and why are hormones so important to our bodies?

Dr. Fradin-Read:               Well, hormones play a crucial role in various, various functions and various organs in the body. They are very small molecules, tiny little molecules secreted by various glands in the body, and they have targets, so they go to different organs, and they bring messages to these target organs. The organs will respond upon what that hormone tells them to do, so that’s why hormones are so important. They are messengers of good health.

Dr. Weitz:                          Great. What is peri, the perimenopause, and what happens to a woman’s hormones during this period?

Dr. Fradin-Read:               Perimenopause is the period where you are not fully, fully done with your ovarian function. There are still some eggs in your ovary, but they might not be as good qualities as the one you had when you were 25, and they are not doing the good job of having a regular cycle every month and helping you feel vital, healthy, young, full of life. Your brain is functioning well, so you have all kinds of decrease in functions in all these target organs I was talking about, so you start having mood issues. You start having some irregular periods because your uterus is not supported in the same way it used to be. You start feeling tired. Your thyroid might be a bit off too because they talk to each other with the harmony of your body that is a little bit imbalanced. It is a period where some women are miserable. They come to me crying and tell me, “What I can do, doctor? What can I do to feel better?” That’s an important period of their life too to help those nice women.

Dr. Weitz:                          How is thyroid involved in the perimenopause? How is that affected?

Dr. Fradin-Read:               Thyroid is often involved by a lower function. When we get older, all these hormones, they tend to go down, so low thyroid function is going to cause being tired, putting weight on in your midsection, sleeping issues, mood issues. Anxiety is a big one. Some women come to me and say, “I don’t know. I’m so anxious. I’m anxious about things that I was never anxious before. What’s going on with me?” I tell them, “Don’t worry. It’s not you. It’s your hormones. If you fix your progesterone that talks to the thyroid,” because they are all, again, in harmony, “You will feel better, and we have to adjust the thyroid, of course.”

Dr. Weitz:                          Progesterone is the first hormone that tends to decrease during the perimenopause?

Dr. Fradin-Read:               Actually, the first part of the changes in hormones in women, it’s a low luteal phase. The luteal phase is the second part of the cycle after ovulation. Most women still have some eggs, as I can see, that are there waiting to be expelled, but it’s hard. The ovulation is delayed, and you don’t have progesterone before ovulation comes, so if you are not ovulating very well, your progesterone goes down. Progesterone is the feeling good, feeling rested, feeling calm hormone. It’s the very, I would say, calming hormone among the two, so now, you’re on estrogen dominance. You’re going to be nervous. You’re going to be excited. You’re going to put weight in your midsection, so that’s why it’s very important to balance out your progesterone to the level that it should be at that moment of your life.

Dr. Weitz:                          Are there natural methods that we can use to balance our progesterone?

Dr. Fradin-Read:               Absolutely. There are some natural supplements, or eating a lot of yams can be a good thing in your diet. You can start with the diet. Then, there are some supplements that are going to help directly and some a bit indirectly. The one that I like are things like Vitex. I don’t know if your auditors know about Vitex.

Dr. Weitz:                          Yeah, I think we often refer to it as Chasteberry.

Dr. Fradin-Read:               That’s it, beautiful, and also, we have the evening primrose oil that does a really good job, okay? Make sure they have enough EPA DHA. That means Omega, they’re the good pills because Omegas are helping your hormones get at a good place. Make sure that you eat enough fruit and vegetables who have fibers to also eliminate some of the toxins that would interfere with your hormones, okay, so a good diet.

Dr. Weitz:                          What are the dosages of Chasteberry and evening primrose oil that you think are necessary to be effective?

Dr. Fradin-Read:               These are good questions. I would not answer directly because it’s very much patient-dependent.

Dr. Weitz:                          Well, just give us a range-say.

Dr. Fradin-Read:               Well, I would say 120 to 300, okay, for the evening primrose oil.

Dr. Weitz:                          Okay.

Dr. Fradin-Read:               The Chasteberry will be, I’m not sure. I’ll have to check on that one, okay? I will check.

Dr. Weitz:                          Okay. Okay, so what happens? Let’s go into menopause, and why do women often have very different journeys? Why do some women have a horrible time? Why do some women sail through menopause with not very manageable symptoms?

Dr. Fradin-Read:               Good, so first of all, there’s definitely a genetic component of it, okay? There are families where a woman goes through menopause with actually, with no issues, and you know families that’s the opposite. There would be women who suffer a lot, and it could be in good genes, but it could be also the way we were raised. When you heard your mom complain about menopause some years ago, you are more prone to focus on that and see what could happen to yourself, okay? We know also that civilization. Women who are away from civilizations make menopause much worse. In Africa, in other countries, in South America, they don’t know about menopause. They go through it with no complaints, nothing. Trust is a big one. In our civilization, we are running all the time. We are in the traffic. We are worrying about our kids, so this is definitely a big component because it implies the action of cortisol.

                                          Cortisol is the hormone of choice, which interferes with progesterone. It also is linked to the diet. As we were talking, your diet that help with lessening the symptoms, and your diet that make it worse if you have wasteful diet with a lot of fat and saturated fat and a lot of sugar, you are more prone to have symptoms. Lifestyle is a big one. Genetics plays a role. Environment, support from your environment. You know, I had noticed that when women are supported by their husband, for example, they do better. Hormones is there. Understand that their wife might go through a bit of challenge, and often, you know, I had a husband one time calling me, “My poor little wife, she’s going through the challenges. Can you help her?” “Of course, I will, but if you are close to her and nice with her, that’s the best support you can give her.”

                                          It’s not your fault if you’re having mood imbalances. On top of that, it’s the moment of life where this woman, they go through a lot of challenge in their family. The kids are leaving for college. All of a sudden, their life changes drastically. If you have hormone imbalance and all these challenges, no wonder you’re going to feel not yourself and feel bad.

Dr. Weitz:                          Do some women produce more estrogen during menopause than others? Then, what role also do environmental estrogenic substances play?

Dr. Fradin-Read:               Yeah, so in postmenopause, when it’s really done, normally, we should not have that much estrogen. In general, you might have a little bit to your adrenals. I had one day, today, I’m sorry, one patient today who still had a little bit of productions, but it’s really minimum, okay? We are not talking in that period of change before we go in full menopause, the perimenopausal, so some women have tons of estrogen, and this is the problem because as I said, when the progesterone is down, and now, you’re in estrogen dominance, so breast tenderness, feeling bloated, not sleeping at night, being anxious, being nervous, always on the go. These are some symptoms of estrogen dominance. We need to have that estrogen dominance go down. There are supplements that can help and balance out the progesterone.

Dr. Weitz:                          What supplement can help with that estrogen dominance?

Dr. Fradin-Read:               Well, one that I like is called the DIM, D-I-M, okay? I have one that is actually DIM Detox that I really like. They have a very good lab, which has also some broccoli extract, so everything that’s going to help detox the body. You are gaining too, so recommend that maybe we change the diet a little bit, okay? Women that abuse soy sometimes might have a little bit too high estrogen. Phytoestrogen can increase, or in some culture, we recommend estrogen yielding isoflavone. I tend to be a bit careful because that can make it worse, that period of perimenopause. It’s good after menopause but not before.

Dr. Weitz:                          Okay. What can we do if … First of all, is it safe for women to take hormones after menopause?

Dr. Fradin-Read:               That’s a very good question. Again, I need to say it depends on the patient. I don’t have a rule like for example, one does fit all does not apply, okay? Each patient is different, and we are going to talk to a patient with all the information that, that patient needs to do, to have, to receive to make their informed decisions. I do not prescribe hormones. I suggest, and patients decide. That’s always the way I practice here. If we stay at a reasonable dosage, the menopause society in America says start with the lowest dose possible. You lower the dose. We are talking about one major estrogen, and nobody … Sorry, everybody knows it’s basically breast cancer, so that’s the big thing. I’ve never had any breast cancer among my patients. I’ve been practicing that kind of medicine for years, and I have to tell you, with the dosage I recommend, so far so good. We never had any issue, so reasonable dosage, that’s one thing.

                                                The second thing, the kind of estrogen and the form that you’re using. We have tons of studies that show that through the skin, the estrogens are much more safe, much safer in the sense that they do not increase the cardiovascular way, so that’s the second risk that we are talking about. The risk of clotting. If you take estrogen by mouth, it goes through the liver. It increases the risk of clotting. Through the skin, it’s almost no risk or very little, except if you have thrombophilia. That, you need to diagnose before. Then again, it’s a question of putting the prescription in a global approach. I’m not giving just a prescription for hormones. I need to talk about diet, talk about exercise, talk about sleep, talk about stress relief. You have a comprehensive approach to hormone, not just a prescription that you give to the patient and bye, bye, see you next year.

Dr. Weitz:                          What type of … You’re talking about topical estrogen like creams and patches?

Dr. Fradin-Read:               Yeah, yeah, so we have different options, you know? We have, of course, the bioidentical hormones that are similar to the hormones that the body produces. Basically, the estriol and the estradiol, I never prescribe the estrone. The estrone is an old prescription that some doctors still prescribe. I avoid that one because the risk of cancer is too high. With the two others, in the good mix, something that is called, be estrogen biest, you can really manage most patients at a very low dose. Then, you increase as needed, okay? Some patients need more because they have a lot of hot flashes, a lot of symptoms. Some can stay low.

                                          If patients prefer to have a patch, that’s still very good because a patch is still bioidentical. It’s a bit more synthetic. It’s made by pharmaceutical companies, but it’s a good way to balance out a hormone and be very regular in the diffusion. Sometimes, if you apply a cream, morning and night, you can have some, I would say, more risk, or you won’t have enough in your body. If the patch is there all day, it’s a better coverage for the some women, okay?

Dr. Weitz:                          What do you think about pellets?

Dr. Fradin-Read:               The pellets, I personally don’t like them too much, okay? I know that some of my colleagues use them. I have the experience of woman that have put a pellet in, and they come to me, and their hormones goes super crazy high, so what do we do? Do we take the pellet out? Do we let them suffer with high estrogen and high testosterone until the pellets is gone? You don’t have much liberty to change. For me, what is important then is to have my patients be their own boss. I educate them. I tell them, “You are going to be the one deciding how much hormones you need today, so they know breast tenderness means I need to decrease a little bit. I feel a little bit down with my mood, maybe I’ll up a little bit. They have a prescription, and they are not going to use the same dosage all the time. They will balance out, like I do for myself and figure out what is best for them that one day.

Dr. Weitz:                          Do you like prescribing progesterone in a rhythmic fashion like have them take it two weeks in a month?

Dr. Fradin-Read:               Yeah, so it depends. Progesterone is excellent when patients cannot sleep well, so for those patients I will use progesterone as a sleep aid, and I would probably prescribe the whole month, okay? I do that for myself because I know that my progesterone is a good hypnotic, natural, never took any pill for sleep myself, but my progesterone is very, very important, so for those patients, you want to have a continuous dosage of the hormones, progesterone in particular. For those who are sensitive to progesterone, some woman get depressed on progesterone, so yes, you try to cycle them and you tell them, “You take two weeks hormones, okay?” You warn them, “You might have a little period, okay, because now, we are making a little bit of cycle, okay, in a way,” so they can have a bit of spotting, of bleeding. That’s normal when they do only two weeks per month.  It all depends on how the patients react and how much they need. We know that too much progesterone can increase the risk of high sugar and insulin resistance, so those patients with a little bit of weight issue, I sometimes prefer only two weeks per month because it limits the risk.

Dr. Weitz:                          Okay. Now, what about the concept that doing it rhythmically mimics a woman’s natural hormone cycle?

Dr. Fradin-Read:               I think you are talking about the Wiley Protocol here.

Dr. Weitz:                            Yeah.

Dr. Fradin-Read:               Yeah, so I have a few patients on the Wiley, okay, and what we do, we do exactly a mimicry of what happens with our cycle. You start low with the estrogen. You go progressively up to day 12, so just before ovulation. Then, you add progesterone at that moment at a relatively low dose, and you go up, up, up until day 20, 21. Then, both of them, you are done through the end of the cycle. That’s really copying, mimicking the woman’s cycle. Some women are able to do that, but it’s a lot of risk because you have to look at the package that you receive, and look each day how many lines of your syringe you need to apply on your body, so it works for some women. It doesn’t work for others. Also, I know very well Suzie Wiley. I like her, and her idea is great. The only thing, it’s a little bit on the higher end for these hormones in her protocol, so sometimes, some woman have some overload of these hormones and are not doing so good with the Wiley. Others do fantastically well.

                                                I have quite a few people on the Wiley Protocol, okay, and they like it, and they love it. Most of the times, these are women that are not overweight, okay, relatively thin. Then, they need a higher dose of hormones because they don’t pile the estrogen in their fat cells as others do, okay? We have that at a disposal, and I use it whenever it’s in demand or if I think that’s a good candidate for it.



Dr. Weitz:                            I’ve really been enjoying this discussion, but now, I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic research-based dietary supplements. Pure products are meticulously formulated using pure scientifically-tested and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners and preservatives.

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                                                Now, back to our discussion.



Dr. Weitz:                         How do you test for hormones? Do you use serum, urine, dried urine, saliva?

Dr. Fradin-Read:               Good, so that’s one question that I like because to tell you the truth, testing is important, but medicine is an option, okay? I think the experience of a physician with dealing with hormones and the instinct, what I call the clinical instinct, when you have a nice lady coming to see me, I need to say, “Tell me your story.” I’m not going to start taking their blood, okay? “Tell me your story. When did you have your first period? Do you have kids? How did you do with birth control pills?” Those kinds of questions. Then, we come to that moment of their life, “What are your symptoms now? Do you have hot flashes? Do you sleep good at night? Are you anxious,” are all the questions that I ask so that I see the clinical picture. Then yes, I do labs to help me, I would say, confirm or comprehend a little bit better what I have identified as a problem. Most of the time, the labs are just going to be a tool to confirm what I thought, okay?

                                                I do different testing. I usually do a blood test because it’s easy, and again, with clinical experience, a blood test is usually sufficient. You have to do the blood test at the right moment of the month, okay? You want to do a blood test sometimes on days three or four to see the resolve of eggs with an FSH at that time, the follicle stimulating hormone that tells me how far advanced we are in the changes. You need tools, so maybe do a blood test around mid-ovulation, on day 12 to 13 to see how high we go now with estrogen, for example. Then, we do a blood test at the 19, 20, 21st when we are the highest with the progesterone. Then, you have the full pictures of the blood test, and that usually is sufficient.

                                                For some women, I like to do saliva tests because essentially, once they are on treatments, it tells me how the skin absorbs the creams because sometimes, if you use creams, they go in your tissues and not necessarily in your blood, so you might miss a little bit of the evaluation if you do only blood. What I found really not helpful and a little bit ridiculous, to tell you the truth, is some patients, unfortunately, that’s not their fault, but they come to me with blood tests, with saliva tests and they are not even on hormones. The saliva test is going to show, sometimes, things that are a little bit erroneous. I have one recently. She’s not on hormones. She had high progesterone. What do we do with that? That’s her normal way to be, and she was told, “You have too much progesterone,” but it’s her own production. What is necessary to test like that when it’s not necessary. You just have to … Something like high progesterone does not really exist in the normal way to test, okay?

Dr. Weitz:                          You were talking about estrogen, and you were saying you don’t like to use estrone, and I think you were saying that you like to use a combination of estradiol and estriol. Is that correct?

Dr. Fradin-Read:               That’s what I like. It’s called Biest.

Dr. Weitz:                          Right, so do you use like the 80:20 version? Which one do you use?

Dr. Fradin-Read:               Again, I’m not going to answer that question because it really depends on the patient, okay? If a patient needs a little bit stronger estrogen, I will go more with the estradiol. It’s a more potent estrogen, okay, and less with the estriol, which is less potent. If you have tons of hot flashes, you might need an 80:20 but 80 of estradiol and 20 of estriol. Now, if you have a past history of breast cancer in your family, but you really want to go on hormones, and you do not have too much risk yourself, I might suggest, “Why don’t we stay on the conservative side, and I will give you 80 of estriol, the protective one.” We have studies in Europe that estriol may protect against cancer and a little bit less of the estradiol, the E2 that is more cancer risk although it’s not super high in cancer risk.

Dr. Weitz:                          We were talking about testing. What about, is there value in doing the urine testing so you can see the metabolites?

Dr. Fradin-Read:               It is. I will be honest with you. Every doctor has their favorite, okay, and what we learn in medicine is, do well what you know and stick to something, okay? I have not gone too much in the urine testing. I use urine testing maybe more for cortisol, for adrenal issues. That helps to see if you are in adrenal fatigue or adrenal exhaustion, these kinds of things, but the 24-hour urine cortisol, things like that. I am not using urine for the hormonal balance of the sex hormone. I personally do not find it the most useful in my practice, but it’s a personal opinion.

Dr. Weitz:                          Do you use the salivary cortisol testing?

Dr. Fradin-Read:               Absolutely, that’s my favorite, okay?

Dr. Weitz:                          Oh, okay.

Dr. Fradin-Read:               Yeah.

Dr. Weitz:                          Let’s see. How do we make sure that women decrease the risk of blood clots that could possibly be increased from taking hormones?

Dr. Fradin-Read:               Okay, so first of all, most of my patients, if I put them on estrogen, I test them for what we call Thrombophilia. Thrombophilia are a group of genetic changes in your DNA that can increase your risk, so the most known one is the Factor Leiden V, okay? Factor Leiden V, it’s rare, but still all are likely present. I had recently two young ladies that were diagnosed, so I know these ladies will never go on birth control pill. I had one 52-year-old that just turned into menopause, and she came to me with hormonal response of symptoms, and she’s a Factor Leiden positive, so I know with her, I will be very, very conservative. I gave her a baby dose of estrogen through her skin because I know that through the skin, again, the risk is lower, okay? That’s one thing. It’s to test first to see what is your population at risk. You also ask, “Have you had any clot in the past?”

                                           One of my patients had a clot because she had surgery, and after the surgery, there was some lacking treatment with any kind of anti-clot medication, and she had a thrombus. That’s also another risk that you have to take into consideration. Then, if everything is clear and clean that women are okay, you decide to give them advice. Drink a lot of water. Hydrate yourself. When you are on the plane, maybe take a baby aspirin before flying. That’s what I do myself each time I go long distance. I fly to Europe quite often. I take my baby aspirin. Sometimes, I take one over Greenland because it’s a long, long trip, okay? I tell them, “Put compression stockings.” I always have a hard time putting them on when I travel, but I put my compression stockings because the moments at risk are essentially when you fly long distance, when you get dehydrated, if you have an injury and you’re bed resting for quite a while, so those moments at risk, you have to prepare the patients to take all the precaution. In your everyday life, if you’re active and you exercise and you work, it’s not that big of the risk.

Dr. Weitz:                          What is the best type of diet for menopausal women to follow?

Dr. Fradin-Read:               Good. Well, I am very partisan. I mean to be honest with you, the Mediterranean diet has been proven to be the one with the longest longevity. I don’t know if you read the recent studies, but in France, you will live until 82 if you’re a woman, 83 if you’re a man, which is more than most civilized countries, and we use the Mediterranean diet. The one little difference that I do with the full Mediterranean diet, I tend to recommend a low carb Mediterranean diet because some of those, you have bread, you have couscous if you are in the Mediterranean Sea. You have a lot of potatoes if you are in the northern part of France. I think that a modified Mediterranean diet, if you have a little bit of higher lipids, high cholesterol, be careful with berries, for sure, okay?  Go with low fat yogurt. Don’t abuse any creams and any half and half but tons of veggies, tons of fruits, calored diet. The most colored diets you can, that’s the better, okay? Try to, of course, avoid any processed food. try to avoid too much sugar. It’s basically an anti-inflammatory diet.

Dr. Weitz:                          It’s very popular right now to recommend the ketogenic diet, which is a super low carb diet. What do you think about recommending that for menopausal woman?

Dr. Fradin-Read:               I use it on a short period of time, Ben, okay? I am very careful with women who have a tendency to have high cholesterol and high lipid because as you know, the full keto is basically a lot of animal fat, saturated fat, and it can increase the risk of cardiovascular disease in women because at menopause, our LDL goes up, okay? The reason being that our LDL is not used for our hormones anymore, so all of us, we have a little risk to have higher cholesterol when we go into menopause. What I like, what I call the pescatarian.

Dr. Weitz:                          Okay.

Dr. Fradin-Read:               Okay, that’s my favorite. I think I do that for myself, actually.

Dr. Weitz:                          You treat men in your practice as well, don’t you?

Dr. Fradin-Read:               Absolutely. Most of the time, it’s the husband that comes to me when the wife tell him to come.

Dr. Weitz:                          When you see a man and he has a lower total and/or free testosterone, what’s the first thing you’ll do?

Dr. Fradin-Read:               First of all, I see their BMI. I look at their belly fat, and I ask them, “Are you exercising? Are you sleeping well?” I look at all the reasons why a man would have low testosterone. Men make their testosterone when they sleep at night. Most of men do not know that, so if you don’t sleep well, if you party too much, the young ones, if you travel a lot and you’re often in jet lag, you might have very low testosterone just because you don’t sleep well. Second, “What is your diet?” If you have a lot of alcohol, if you like beer, you have these parties where you can drink quite a bit with your friends during the NFL or the NBA viewing, okay, so that’s going to decrease your testosterone. If you’re under stress, your cortisol impacts your ability to produce your testosterone. Do you go to exercise regularly? Men make more testosterone when they exercise.  Proteins are crucial. Some men do not realize that they need one gram of protein per kilo minimum just to keep their testosterone where it is. If you want to increase it, you need more proteins. All these things are going to be important elements to evaluate before I can judge what needs to be done.

Dr. Weitz:                          Are there supplements to raise testosterone levels or to raise free testosterone level? Do you tend to see more men with low total testosterone or free testosterone or both?

Dr. Fradin-Read:               I think it’s a combination of both, okay? Sometimes, men have a high binding, sex-binding protein that can decrease, of course, the …

Dr. Weitz:                          SHBG, sex hormone-binding globulin?

Dr. Fradin-Read:               That’s exactly it. Yeah, thank you. That is part of my patients, but when patients have low testosterone, the Low-T Syndrome, it’s usually both of them that go down, honestly, in majority, okay? We need to enhance the global prediction of it and free as much as we can because the free testosterone is the one that is available in your tissues, of course.

                                                In terms of supplements, the first thing, also, we need to look at is your DHEA, the Dehydroepiandrosterone. It’s basically a hormone. It was discovered in France by Dr. Baulieu when I was in first year medical school, if you don’t know. Dr. Baulieu was my professor, and he thought that it was the fountain of youth, the hormone that could repair everything in the body and rejuvenate the body.  DHEA is actually important.  It’s maybe not the fountain of youth, but it’s very important as a precursor of the testosterone. DHEA goes down when we are under stress. It’s a hormone that helps with stress. If you have low DHEA, of course, you cannot make your testosterone. One thing that I often do, push the DHEA a little bit if it’s down with supplements. You can buy supplements over the counter for good sources, of course, so write prescriptions for company pharmacy if you need a bit of a higher dosage. That, sometimes, suffice in young men to bring their testosterone up.

Dr. Weitz:                          Okay, so you find taking DHEA helps raise testosterone levels?

Dr. Fradin-Read:               Yeah, yeah, in some men, not in every man, okay?

Dr. Weitz:                          Right.

Dr. Fradin-Read:               It depends on the ability of their testes to make it, to make the testosterone, okay? If they are in testicular dysfunction, okay, or a little bit weakness, we need to help differently. We have ways to push through the Clomid. I don’t know if you know what Clomid is. It’s a medication.

Dr. Weitz:                          I do.

Dr. Fradin-Read:               Yeah, of course, and it’s basically something that is made to help with your testicular function produce more testosterone. Some men respond very well to HCG, the human chorionic gonadotropin. It’s a little injection that you have to give to yourself three times a week, it’s not a big deal, underneath the skin, and it helps also with the production of testosterone. It helps also with weight loss. HCG can also help with those men who have a little bit of belly, and they want to loose a bit of weight. Then, we have thos emen that need to have testosterone replacement because they are in testicular failure for different reasons, their testes is not responding.

Dr. Weitz:                          When is it appropriate to prescribe testosterone for men?

Dr. Fradin-Read:               Well, two categories. I would say some young men that, for any reason, have some important decrease in their production and you have tried all the natural approaches that I mentioned before. You have tried them on HCG or Clomid and they do not respond. That means that for a reason, sometimes, you find the reason. Sometimes, you don’t, but they need to have substitution. It’s important because they are young. They need their libido to be at the highest level. They need stamina. They need to preserve their muscle mass. Then, the one part of men that we definitely need, it’s like we female. Men go through something that is called andropause later than us female. Usually, 10 to 20 years later, okay, and they will have no more production in their testes. At that point, if they want to have some support, they need substitution.

Dr. Weitz:                         What type of testosterone do you usually recommend?

Dr. Fradin-Read:               Again, in wanting to be a bit varied if you ask me a question like that, because it depends on the patient. Some patients are not at all ready to inject themselves. They want something that is easy to do, so we have some gels and some bioidentical testosterone, I would say, formula that we can prescribe for them, and you rub that on your shoulders in the morning so that it gives you energy during the day. Some men tell me, “Give me the big game. Give me the big game. I want to go right away to the injections. I’ve heard about that. I’ve seen that on TV, the Low-T Syndrome.” Those men are going to have injections. Again, the dosage will depend on their needs. Sometimes, you give 50 milligrams a week. You give 100 milligrams a week. Sometimes, you give more depending on the patient’s need, and it’s a self-injection. We teach the patient to inject themselves. It’s pretty easy to do, and I have a lot of patients who are on self-injections weekly.

Dr. Weitz:                          Is there any worry about prostate problems arising from taking testosterone?

Dr. Fradin-Read:               When I treat a patient, my patient will know that they need to do a blood test at least three times a year, okay? Sometimes, I have to call them and say, “Hey, where are you? You need to come for your blood test,” because we need to look at various things. First of all, you have said it right, the prostate can be an issue. In majority of the men, it is not, okay, but a few cases in the past have raised their prostate specific antigen, which can be a sign of prostate enlargement in general, benign, but we need to be careful not to overdo the testosterone because that could [inaudible 00:42:20] increase also the risk of prostate cancer, okay?

                                           I had a man who went for a trip in Armenia recently, and he felt a little bit week, so he doubled his testosterone. He comes back. The PSA has doubled. I say, “Oh, let’s be careful.” Now, I’m always tracking his dosage until the PSA goes down. I want to retest him in six weeks from now. Then, we have basically other tests that need to be done, okay? It’s not just the prostate. You need to look at the red blood cells because as you know, some athletes use testosterone to enhance their testosterone, and not only the testosterone but their red blood cells, so that they have more oxygen, and they could climb the alps better. I’m not going to name anyone, but we know we are talking about.

Dr. Weitz:                          Can you say Neil Armstrong, Lance Armstrong?

Dr. Fradin-Read:               That was one of them, okay? I think they were all doing it, and the poor guy was taken on the spot, but definitely, it raises your red blood cells. If it raises your red blood cells too high, you are at high risk of clotting. It’s called polycythemia. You don’t want to go that high, okay? I look at my patient’s red blood cells three times a year just to make sure we are good. We need to look at the liver. Normally, testosterone would not increase the liver risk, but in certain cases, especially if men drink a little bit too much, that could have an impact on their liver, okay? I test their liver three times a year, okay? I also look at their liver to makes sure that they are not going to go crazy with the injection, to tell you the truth, okay?

Dr. Weitz:                            Great. I think those are pretty much the questions that I had prepared for today. Are there any other thoughts you want to leave our listeners about hormones?

Dr. Fradin-Read:               Again, thank you so very much for having me on board here, and I’m so happy to talk to you about the topic. The one thing I would like to summarize, we physicians, we are here to first do no harm. That’s our medical oath, so I’m not going to give you your health back as when you were 25.  I need to help you stay young and healthy, full of vitality but in a safe way. That’s very important. You talked about Loma Linda. I really love the logo, the motto that we have over there. It’s first, “Make man whole.” Again, a comprehensive approach to health, look at all the various thoughts of the health you can improve and not just jump on the prescription of hormones. That’s not the goal. It’s try to rejuvenate the body, your mind, your emotions, everything in a harmonious way.

Dr. Weitz:                          Great, so how can listeners get a hold of you and find out about … How can they contact you? Should they go to your website?

Dr. Fradin-Read:               Oh, actually, we do your website. We have a brand new website, I think, next week, to tell the truth, maybe a little bit more full of life because the previous one was a little bit, I would say, esoteric and very intellectual, so I had some counseling, and its going to be a bit more vital.

Dr. Weitz:                          Which website address?

Dr. Fradin-Read:               It’s basically www.vitalifemd.com.

Dr. Weitz:                         That’s great.

Dr. Fradin-Read:               You’re welcome.

Dr. Weitz:                         Is your practice open to seeing new patients?

Dr. Fradin-Read:              Absolutely. Listen, sometimes, I tend to say, “Wait a second,” or maybe overload with patients, but it’s not true. I select a little bit. I have to tell you, I have patients coming from all kinds of things. Gastroenterology issues, I can deal with that. I’ve done in the past, but I really want to focus on hormone and anti-aging and help my patients. The most important thing for me is to keep them healthy as they get older, add vitality to your life. That’s my motto here. Those kinds of patients, I will see them myself.  Other patients who want to have an integrative approach can see my assistant.  I have a wonderful nurse practitioner. Her name is Carley Cassiti, and she is fantastic, very well-trained.  She takes, probably, the patients that are a bit less into hormones.

Dr. Weitz:                          That’s great. Thank you, Dr. Fradin-Read.

Dr. Fradin-Read:               Thank you so much, Ben, and have a good day. Thank you for all your audience who are listening to us.

Dr. Weitz:                          Thank you.




Cancer Prevention with Dr. Nasha Winters: Rational Wellness Podcast 120

Dr. Nasha Winters discusses Cancer Prevention 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. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

2:15  Dr. Winters talked about her personal cancer journey that motivated her to pursue her integrative cancer career.  When she was a freshman in college she was having debilitating pain and she would even throw up and pass out from the pain in her abdomen and pelvis.  She went to the Emergency Room multiple times and she would bet dismissed as having endometriosis or Crohn’s or IBS and they would give her a pharmaceutical and sent out the door.  One time she ended up in the ER in tachycardia and labs showed that her organs, her kidneys and liver, were in end-stage shutdown.  She had a hugely distended abdomen because she had a grapefruit size lesion on her right ovary, lesions on her liver, and scattered lesions throughout her pelvis.  Dr. Winters was in stage 4 ovarian cancer and two oncologists both told her that chemotherapy would kill her and they recommended palliative, hospice care and gave her only three months to live.  She had no surgery, no chemo, and no radiation and now it is 28 years later and she is still alive!  She said that the two main things that she did that probably helped her body to fight off the cancer were fasting and she also did a family fast.  She did not fast on purpose, but was unable to eat because of the fluid in her abdomen.  She fasted for between 30 and 60 days on water only.  She had a dysfunctional, stressful family life, so she also cut all her ties to her family.  She noted that there is an Adverse Childhood Events questionnaire to see if you are growing up in a traumatic environment in your home.  If you have 3 out of 10 yeses on the questionnaire, you have a 400% increased likelihood of a chronic illness in adulthood, and Dr. Winters scored a 10 out of 10.

Dr. Winters noted that she also saw an acupuncturist who was also an RN 2-3 times per week, which helped a lot with her pain, stress management, and digestion. She also started working in the supplement section in her local health food store and started taking classes with a local herbalist. Dr. Winters got no traditional care during her cancer journey other than getting imaging, like MRI’s with gadolinium, which caused kidney problems because of the gadolinium toxicity.  She actually did not expect to survive at the time.

13:32  The key to Integrative Cancer care is to focus on the cancer terrain.  Conventional oncology focuses on the tumor, how to categorize it and name it, figure out which stage it is in, and recommend surgery, chemo, or radiation.  Dr. Winters explained that she doesn’t treat cancer or tumors.  She treats the terrain that is wrapped around those tumors and tumor cells.  Unfortunately, the standard of care oncology is really not making much progress with cancer, since the survival from cancer has barely improved in decades.  This is not to say that surgery and chemo and targeted therapies and hormone blockers and radiation are not powerful therapies.  Traditional oncology focuses on the cancer type to recommend care, but cancer researcher Mina Bissell has shown that instead of doing one biopsy, if you took the whole tumor out you would find maybe 5-20 different tumor types all in one, which is why a therapy that just targets one tumor type may not work long term.  Consider the VEGF pathway and the targeted drug, Avastin, that targets that pathway and lowers VEGF.  What often happens is that it often starts to work and then after 3-6 months, you’ll start to see VEGF go up, because the response to that drug leads to the creation of new pathways and new resistance, which is what happens in all of our standard of care practice. They also can make dormant cancer stem cells come alive, mutate further, and become less responsive to any of those standard of care treatments. Standard, modern oncology can seem like a game of wack-a-mole, since you block one pathway or response, and then you’re going to pop up another response. By focusing on the terrain, on the tumor microenvironment, we can help overcome some of that treatment resistance and enhance the standard of care therapies and make the person feel a lot better going through the process. 

19:43  While targeted medications can affect a particular molecular pathway or affect one specific gene involved in cancer formation, natural agents like curcumin can affect many pathways and genes, as pointed out by Dr. Nalini Chilkov in a recent appearance at our Functional Medicine Discussion Group meeting in May 2019.  See the video here of Dr. Chilkov’s talk: Cancer and Food.  Dr. Aggarwal is the famous curcumin researcher who was at M.D. Andersen said that we’re given the opportunity to do chemotherapy three times per day, which is what sits at the end of our fork.  The foods you choose can be either pro cancer or anti cancer and they can change the terrain in a way that increases inflammation or increases stress in the body or depletes the immune system or strengthens those patterns. 21:30  Dr. Winters said that some of her key blood tests to monitor the cancer terrain, include a simple CBC, and she will focus on the neutrophil to lympocyte ratio. More than a 2 to 1 ratio of neutrophil to lymphocyte leads to a poor prognosis. She will also get a typical chem panel and she will look at the kidney and liver markers and the alkaline phosphatase levels. An elevated alkaline phosphatase indicates that something is going on with the liver, the kidney, or the bones. Elevated liver enzymes could indicate liver metastasis or liver stress resulting from harsh medications they are taking.  A low hematrocrit also indicates a poorer prognosis.  Dr. Winters also looks at the sedimentation rate, the ESR, the lactate dehydrogenase, the LDH, and the high sensitivity C Reactive Protein, the HsCRP.  HsCRP should be below 1. ESR should be below 10. LDH should be under 175 or 450, depending upon whether it is run by Quest or LabCorp. All of these if elevated are markers for inflammation, chronic illness, and cancer.  LDH is an average of 5 different enzymes that can be pointing to lung health, red blood cell health, liver health, kidney health, and even tumor health. LDH may be the best standard cancer marker. For breast cancer Dr. Winters will look at CA 27-29 and CA 15-A as a baseline. Low vitamin D3 is a driver for breast cancer, esp. if it is less than 50. The therapeutic level is 80-100. Insulin should be below 3Insulin Growth Factor should be below 100. Hemoglobin A1C should be 5 or below.  Body fat percentage should be below 25%.

30:14  If you have an elevated IGF-1 the best thing you can do is fast and then make sure that you are getting enough sleep.  Even two nights of bad sleep can elevate your IGF-1

31:20  Dr. Winters believes that estrogen is a stimulator of cancer and she is not a big fan of bioidentical hormones and she says that they are neither safer nor more natural. They are synthetic, compounded molecules and they bind more strongly to our receptor sites than our endogenous hormones do.  Depending upon someone’s genetics, esp. if they have CYP1B1, CYP2D6, COMT, or ESR2 SNPs, they are more likely to metabolize their estrogen along an unhealthy pathway and you will see an increase in the 4 or the 16 hydroxyestrones, which increases your risk of cancer. She will occasionally recommend a small amount of estriol (such as .5 mg) used intravaginally for a limited period of time to restore their vaginal health.  If they also used personal care products that have parabens, if they drink out of plastic water bottles, if they have copper in their pipes, if they are eating pesticide laden food or food with glyphosate, they are more likely to metabolize their estrogen in an unhealthy way.

37:04  Dr. Winters is also not a big fan of women eating soy, even though some argue that soy contains phystoestrogens that is a weak estrogen and by attaching to estrogen receptor sites and blocks stronger estrogens.  Dr. Winters argues that there is no clean soy in the US and even organic soy is contaminated with glyphosate. This may be different for women who grow up in China who have a different estrobolome, a different microbiome, and they have a different response to soy than American women do.

40:22  She does think that consuming flax seeds are beneficial, but not flax oil. Dr. Winters says that it’s important to store the flax seeds in refrigerator and to grind them as needed, so they don’t become oxidized. Flax oil becomes oxidized almost immediately once it comes into contact with the air.  Also, the lignans in flax seeds are very anti-inflammatory, which are not in the flax oil.

41:30  For men with prostate cancer, Dr. Winters recommends avoiding consuming choline, because this is a good fuel source for prostate cancer cells.  The richest sources of choline are egg yolks and chicken skin.

43:33  Other data show that restricting methionine and glutamine may be helpful with cancer.  One simple way to reduce the intake of these is to do intermittent fasting. Dr. Winters says that much of what we’re dealing with in integrative oncology is that patients are overfed and undernourished.  And we don’t change what we eat based on the seasons. We can end up eating too much of the same foods over and over, like so many Americans now living off of soy burgers (referring to the Impossible burgers), which has never happened before.  Based on the need to restrict nutrients like choline, methionine, and glutamine, some practitioners will recommend a vegan diet, but Dr. Winters cautions that such diets tend to be based on a lot of grains.  Eating a lot of grains will tend to result in glucose, insulin, Hemoglobin A1C, and insulin growth factor levels all going up. You’ll see elevated LPS and autoimmune conditions flaring and the thyroid whacking out. Dr. Winters pointed out that she spent a month in the Mediterranean and she ate a Mediterranean diet, minus the grains. The real reason the Mediterranean diet appears to be beneficial is that this is a community of Orthodox Christians who spend 200 days of the calendar year in some form of a fast. 

48:44  Dr. Winters likes to use a Modified Citrus Pectin nutraceutical with many of her patients, including her patients with prostate cancer.  She will measure Galectin-s levels and if they are above 10, then she will definitely recommend a fairly high dosage–15-40 gms per day–until that level comes down and then she will maintain it with 5-10 gms per day.  If they have a biopsy or surgery coming up, she will recommend Modified Citrus Pectin and then keep them on it for at least a few months post biopsy or surgery.  It’s also a great binder and it pulls out exogenous estrogens and heavy metals, like lead. And it’s a good source of fiber for the microbiome.

50:17   Dr. Nasha likes to use a therapeutic ketogenic diet for patients with brain cancer, which is a super low carb, very high fat, and moderate protein diet. For brain cancer, you would like to keep your blood ketone levels over 3 to maintain the metabolic need of your brain.  For other cancer types, you might only need to be in a nutritional ketogenic stage, which is between 0.8 and 3 on your blood ketones.  We need to test to make sure we are in ketosis.  People often think that they are in ketosis when they are not.  You should start out with urine, but once you are keto-adapted after a few days or a few weeks, then you will not be showing ketones in your urine and you need to graduate to blood testing.  Dr. Winter recommends the Keto Mojo device, which is reasonably priced and measures both blood ketones and glucose.

58:28  Cachexia is when patients with cancer go into that wasting stage and they lose weight even when they are eating everything.  At that stage, the advice that is usually given is to eat whatever you want, including milkshakes with ice cream, or Ensure or Boost.  The cancer cells are taking over and starving the muscles of their glucose stores and they utilize it to grow tumors and starve the body.  If you look at labs, you will see protein levels below 7, albumin levels below 4, low calcium, and low creatinine levels.  50 to 75% of all cancer patients succumb to cachexia metabolic wasting.  But sugar and carbohydrates will feed this process. According to Dr. Winters, the only thing that Ensure and Boost do is to ensure a more untimely death.  You can eat 20,000 calories and calories alone will not stave off cachexia.  The three things that will accelerate cachexia are 1. Sugar and carbohydrates, 2. Inflammation, and 3. Angiogenesis, which is when the tumor is growing new blood vessels. Ironically, intermittent fasting and a high fat, ketogenic diet, perhaps with some extra protein, (depending upon the patient), will do better to stave off cachexia. 




Dr. Nasha Winters is a Naturopathic Doctor and a Fellow of the American Board of Naturopathic Oncology. She is an authority on integrative cancer care and she is currently involved in research using Mistletoe Extract, Hyperthermia, Cannabis, the Ketogenic Diet, and IV Vitamin C to treat cancer. Dr. Winters is a co-author of the best selling book, The Metabolic Approach to Cancer and she is at work on a second book on therapeutic diets for cancer and a third book on Mistletoe therapy. She now consults with clinicians both one on one and through an intensive 4 month mentorship program to learn integrative oncology and her website is Dr.Nasha.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 or go to www.drweitz.com.


Podcast Transcript

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.  Rational Wellness Podcast. Thank you so much for joining us again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple podcasts and give us a ratings and review. That would be very much appreciated, that way more people can find out about the Rational Wellness Podcast. Also, you can go to YouTube and there’s a video version and if you go to my website, dr weitz.com you can find detailed show notes and a complete transcript.

                                                I’m very excited today that our topic is, we’ll be talking about how to prevent and reverse cancer with Dr. Nasha Winters. Dr. Winters is a licensed naturopathic doctor and a fellow of the American Board of Naturopathic Oncology. She’s also a cancer survivor herself. Dr. Winters is a sought after speaker and an authority on integrative cancer care and she’s currently involved in research on using mistletoe extract, hyperthermia, cannabis, ketogenic diet and IV vitamin C to treat cancer. Dr. Nasha is a coauthor of the bestselling book, The Metabolic Approach to Cancer, which is an amazing book and she’s finishing a second book on therapeutic diets for cancer. Dr. Nasha is on a mission to educate and empower the nearly 50% of the population expected to have cancer in their lifetime. And prevention is the only cure. Dr. Winter, thank you for joining me today.

Dr. Winters:                        Thank you so much for having me here. It’s a lot of fun already. Before you started recording, we were already in a good space.

Dr. Weitz:                            Good. Can you start by telling us about your own personal cancer journey?

Dr. Winters:                        Sure. I think that most of us who come to the field of medicine, especially something more of an integrative or functional medicine sort of like you and I, we didn’t just say, “Hey, I woke up one day and decided this is a career for me.” It’s usually some story of our own personal experience or someone we’re very close to that brings us to this. And I’m no different than that. For me, I just was sort of started off in the world a lot of health care issues, struggled with that all my childhood and into my teenage years. To the point where my symptoms, my digestive symptoms, my hormonal symptoms were, they became just commonplace for me. I didn’t even recognize that I was sick. Right? It was just put on another medication or just ignore it or just cope with it.

                                                By the time I started having some really intense symptoms that I wasn’t, I was someone who had a pretty strong, I still do have a very high pain threshold and avoid medications at all costs and different things. But there was a time in my freshman year in college where I was debilitated with pain that would make… Literally I would pass out. I would throw up from the pain in my abdomen and my pelvis. I would show up in the ER on several occasions over about a nine month period of time. And each time they sort of patted me on the head and said, “You’re histrionic, it’s maybe your endometriosis is still flaring, maybe you’ve got Crohn’s or IBS.”  And it just sort of like, “Here’s another pharmaceutical.” And send me out the door.  It just happened over and over until finally I landed in the ER with tachycardia. The lab showed my organs, my kidney and liver were in complete end-stage.

Dr. Weitz:                            Wow.

Dr. Winters:                        I had a hugely distended abdomen. I know. And that’s when they realized, “Oh God, this woman has liters and liters of fluid built up on her gut in her abdomen.” When you see that sign now as a doctor looking back, that is ominous in all situations. It’s always cancer. I can’t think of a single time when it wouldn’t be. And so that’s when they finally did proper workup and had to give me… delivered the bad news that they’d found a grapefruit size lesion on my right ovary, lesions on my liver, scattered lesions all throughout my pelvis and basically said, you’re in end stage organ failure with further testing of the ascites fluid a biopsy and multiple lab tests and diagnostic imaging came to the conclusion I was in stage 4 ovarian cancer. This is 19 going into my 20th year on this planet.  That was the official diagnosis came October 21st, 1991.  And we’re coming up on 28 years out from that.

Dr. Weitz:                           Awesome.

Dr. Winters:                        Right? I know, whop. And the creepy part is I was so sick, I was so far gone that they said at that point, even a single dose of chemotherapy would kill me. The recommendation was hospice, palliative care. They would give me a second, give me into an oncologist for a second opinion. But they knew that I had three months with no treatments at best and likely at treatment, if I started to try to do chemo, it would probably kill me outright because my organs were shut down. So that made sense and really what they could offer me was palliative support with draining the fluid on my abdomen and basically keeping me comfortable. I think again, in my world, when you’re given no choice many other choices open up. And that sent me on what has become a very long and powerful journey for me, but not only for myself, but also for thousands and thousands of thousands of other patients and colleagues that I’m now working with mentoring and learning from as well. And it’s again, we find our purpose in the most odd ways. Right?

Dr. Weitz:                            What do you think were the most impactful therapeutics that helped you?

Dr. Winters:                        Huh. Well, in retrospect now there are two main ones. The first one was I had so much valuable real estate taken up by the fluid in my abdomen that I could not eat. I could not keep anything down. And so there was… I fasted, not on purpose, not by thoughtful desire or devised on medical scientific wisdom. It was out of necessity that I probably fasted it for 30 to 60 days in that first period of time.

Dr. Weitz:                            Wow.

Dr. Winters:                        It was weeks. I meant what little bits I could take in were very small amounts and water only. What we now know in retrospect, looking back in fact another study just came out this week of the use of intermittent fasting with cancer treatment and enhancing in all conventional therapies as well as other therapies. That was probably one of the most profound things I could’ve done for myself.

Dr. Weitz:                            Wow.

Dr. Winters:                        And it was not thought out, right? That was just, it just happened. Kind of like animals in nature, we observe that kind of do what they need to do to take care of themselves. I was an animal in nature doing that. The second thing, which is often more challenging to discuss is understanding of the psychological reasons for why these things happened. In fact, I was a Biology, Chemistry major, Premed in Medical school and this event woke me up so much that it switched me to a Psychology Biology major and basically a self created major in Psychoneuroimmunology.

                                                This is when the work of Candace Pert. Deepak Chopra’s book is actually one of the first books I ever read in this field. Bruce Lipton, all of these things started to help me understand where I was coming from. And ironically, I worked as a detox counselor at that time, worked in the realm of addictions, was raised in a pretty traumatic environment.  If you and your listeners are at all familiar with the adverse childhood events, the ACE questionnaire or the ACE score.  Basically the studies or research shows that about 64% of our population has at least one significant adverse childhood event that’s really significant. And that alone can increase their risk of conventional diagnoses of chronic illness in our adulthood. Basically you have three or more yeses to that 10 questionnaire. You have like a 400% likelihood of having a chronic illness in your adulthood.  Just to give context, I was a 10 out of 10. So it was no wonder and actually, but of course that I had that diagnosis. I was… Something in me understood that at a very young age when this wasn’t a common discussion out there in the world. One of my other big, what did I do for myself processes was I did a family fast for almost two years. Not only did they have a food fast out of necessity, I also had a family fast. I went into kind of a lock down of deep support for myself because I… A couple of things I knew from the get go is a lot of the people in my circle would have made this much more about them than me and I wasn’t ready to deal with that. I didn’t have the financial support, I was uninsured.  I didn’t have any… I was putting myself through college. Well, the first person in my family to go to college. There were so many factors here that I physically moved away from the trauma and the place that created a lot of this for me. I wasn’t going to go back… was not about to go back into that. It just sort of worked out that it was a perfect time for me to sort of cut off all those ties and start my own new tribe of resources and support. So fasting in a variety of ways became very instrumental in my health and wellbeing.

Dr. Weitz:                            Did you seek integrative care at that time?

Dr. Winters:                        It’s interesting because when I started learning about it that time was my… The pain was probably my largest physical symptom and the nausea and digestive upset and I found an acupuncturist and she was an RN in our community. She’s since retired, who I was seeing her two to three times a week for acupuncture and she was doing stuff for my digestive tract and for my pain management and then side effects, stress management and other things. And it became a really powerful tool of support for me. And then I started working in a health food store and I worked on the vitamin aisle, the supplement section. I started learning everything I could about herbs and nutrients and supplements and we had a local herbalist in our community. I started taking classes with her, started working with a rolfer. I mean I just started exposing myself to concepts and modalities because I wasn’t given any choices in the Western medical model. So I thought, well want to be-

Dr. Weitz:                            You got no Western care, no chemo, no radiation-

Dr. Winters:                        Outside of labs, some imaging, I’m ongoing imaging, which then later, because at that time the imaging we used was in MRIs so I blew out my kidneys.  Thanks to that, I still have a lot of kidney issues because of gadolinium poisoning.

Dr. Weitz:                            Oh.

Dr. Winters:                        We didn’t know that back then we… That’s a tough one. I’ve been working on trying to get gadolinium out of my system for 28 years and it’s like-

Dr. Weitz:                            Wow.

Dr. Winters:                        … holding on for dear life. At least I had my kidneys fortified enough that they are functioning okay. It takes a lot. So those are exactly it.  When I actually didn’t expect to survive, number one, let me just be that… I was not on a mission to treat this. I was more on a mission to understand this. That has been what has really informed the way I approach today is I believe that empowerment, knowledge is very good medicine.  And so to understand the why I got to where I was, was just as important, if not more important than what I was going to do about it.  Today I have a lot of colleagues out there doing great like, “oh, I can do this out of these, I knew this treatment and I spent $70,000 over here in this country doing all these therapies and yet still are sick.”  That’s missing one of the critical pieces of this journey is why did you get sick in the first place?  What about your construct allowed for this to take root and flourish? What can we do? We can’t heal from the same soil in which we got sick. So what needs to happen now?  Understanding where we came from is really powerful to help us understand where we need to go.

Dr. Weitz:                            Interesting. That’s really fascinating. I just recently interviewed in last week’s podcast was with Dr. Alan Goldhammer and he has a long term fasting program.  He puts patients on a water only fast for up to 40 days and he has some documented cancer cases.

Dr. Winters:                        Yeah. And it’s interesting because I know that he has certain ideologies around the type of foods you should eat when you are eating again-

Dr. Weitz:                            A little bit different in the type of food…

Dr. Winters:                        Yeah, I was laughing. I’m like, “Oh good. You have me on right after so we’ll be like the yin and the yang in this.

Dr. Weitz:                            We went to battle pretty good.

Dr. Winters:                        Oh, that’s beautiful because what I-

Dr. Weitz:                            Yeah.

Dr. Winters:                        … people don’t understand is there are multiple ways to reset your metabolic center system. There are a variety of ways to restore health.  There is no one way.  And so because I’m such an avid tester, if someone’s like, “Hey, I’m doing vegan raw food, great, well let’s see if that’s working for you. Let’s look at your labs.  Let’s look at your genetics.  Let’s look at your constitution. Let’s see if that’s working.” Just the same way people are like, “I’m a hardcore carnivore.  Okay, well, let’s take a look and see how that’s working for you.”  There are so many surprises under the hood.  You can’t look at someone and say, “Oh, your going to be great on this.” Right?

Dr. Weitz:                            Absolutely.

Dr. Winters:                        That’s what… When people start to get dogmatic and into, frankly, a pissing contest, what’s the best way to go about it?  I’m like, “Just show me the data.” I’m trying to-

Dr. Weitz:                            Absolutely. Let’s test you and let’s see how you doing. How are you Lipids? How are your inflammatory markers?

Dr. Winters:                        Yeah. Nailed it.

Dr. Weitz:                            Conventional oncology focuses on figuring out the diagnosis, do you have cancer, what kind, what stage is it in and what the proper treatment, whether it be surgery, chemo, radiation?  But you focus on the terrain, the situation in the body in which the cancer is growing. Can you explain why we should focus on the terrain?

Dr. Winters:                        Sure. You said it, you really introduced the concept well is that Western medicine, standard of care oncology is expert at the tumor and the tumor cell. They are spending billions of dollars every year understanding all of the components of the tumor cell, all the different individual pathways and the different targets on those cells. Yet we’ve barely moved the needle on the dial of really changing survival outcomes and the diagnoses of this to begin with. So just to give an example stats to you listeners, one in two men, one in 2.4 women are expected to have cancer in their lifetime in the United States and World Health Organization’s statistics show that cancer worldwide is expected to double by 2030. That does not show me that we’re making a lot of headway with the way we approach cancer from the get go.  All right? Not to say that those therapies aren’t powerful, but they need to be brought into context with the whole organism.

                                           So my expertise, I don’t treat cancer, I don’t treat cancer types, I don’t treat tumors. I treat the terrain wrapped around those tumor and tumor cells. I want to understand the why. It’s interesting because that might sound a little hooey or hokey to a lot of your listeners, but here’s what’s interesting. There was a woman by the name of Mina, M-I-N-A, Bissell, like the vacuum, that has been in oncology research for going 35, 40 years at this point. She is expert in extra cellular matrix tumor micro environments–basically being what soil is that tumor living within. And she has been showing has some beautiful Ted talks and other YouTubes on her understanding as a cancer researcher, to show that we have been putting all of our attention in the wrong place.

                                                What is also very interesting is what we’ve learned in the last 15 years or so is that even an individual tumor has multiple tumor types. It’s this concept of heterogenecity.  Basically it means you might get one biopsy that shows this one target and yet, if you kind of took the whole tumor out and you dissected it down to all these little infinite particles, you’d probably find 5 to 20 different tumor types all in one. The concept of how we treat with these targeted therapies or a hormone block, disruptive therapies or chemotherapy or surgery or radiation is number one, it only impacts the target they’re shooting for. And you’re only getting party information, so you might get lucky, right? But 70% of the time, if you have success the first time around, 70% of the time you’re going to have a recurrence and you’re not going to get super lucky because it comes back a bit louder and a little bit more obnoxious and a little bit more resistant. All right.  The other thing is that there are multiple patterns and processes happening even within each of those targets.  So when we start to play what we call the whack-a-mole game, you push one down, you’re going to pop up another response.  A good example is angiogenesis inhibitors like VEGF inhibitors like Avastin. Okay. You will watch in these labs because I watched their labs and I watched their blood biopsies, through companies like  Guardant360.

Dr. Weitz:                            Right.

Dr. Winters:                        Well look about VEGF and if it’s normal or elevated when they started Avastin. After three to six months, you’ll start to see that, VEGF go up and up even on the drug because that drug is now starting to create new pathways and new resistance. That’s what happens in all of our standard of care. Let them come in and do the targets and do the treatments that are affecting those fast proliferating cells because chemo, radiation, surgery only address fast proliferating cancer cells.  They also at the same time make dormant cancer stem cells come alive, mutate further and become less responsive to any of those standard of care treatments. It’s in the extra cellular matrix, I call it the terrain, some people call it the tumor microenvironment. That if we put attention there, we can help overcome some of that treatment resistance. We can actually enhance outcomes of standard of care therapies and we can certainly make the organism feel a hell of a lot better while they’re going through the process. That’s where I put my focus. That’s where my expertise lies.



Dr. Weitz:                            This is really an excellent discussion, but I’d like to take just a minute to tell you about our sponsor for this episode. For this episode of the Rational Wellness Podcast, we partnered with Headery, a collaborator in university studies on CBD with their own two unique formulas available to the public. Good morning and snooze, designed for around the clock wellness. They featured CBD infused with specific terpene combinations to help you manage negative thoughts and experience clarity throughout the day and night. Visit Headery spelled H-E-A-D-E-R-Y.com and use the coupon rational for 20% off. Now back to our discussion.


Dr. Weitz:                            I also think it comes to the difference between individual molecular pathway with one drug that hits one pathway versus which Jeffrey Bland has called systems biology.

Dr. Winters:                        YES.

Dr. Weitz:                            I was in a seminar that Nalini Chilkov gave a few-

Dr. Winters:                        Oh.

Dr. Weitz:                            … weeks ago.

Dr. Winters:                        Well my girl.

Dr. Weitz:                            She spoke at our Functional Medicine meeting a couple months ago and she put up this chart, which she got from one of the big pharma companies and it had, they’re working on this pathway and they have this one drug that might hit this pathway. And then they had all these genes and this might hit this gene, this might hit that gene. Then she put up a chart of curcumin and it hits like 40 different pathways.  None of them is as strong as these targeted drugs, but the amazing power of diet and lifestyle to affect so many different pathways.

Dr. Winters:                        Yes. That’s just it is people like Dr. Mina Bissel showing up. But even Dr. Aggarwal, who was at M.D. Anderson for years. He was the famous curcumin researcher, but he also has some pretty great quotes that says, we’re given the opportunity to do chemotherapy three times a day. Which is what sits at the end of our fork. Right? It’s like the foods you choose can either be pro cancer or anti cancer and not like they are cause or effect. It’s not that, but they enhance or change the terrain in a way that increases inflammation or increases stress in the body or depletes the immune system or strengthens those patterns. That’s how we think about things, at the way we can use integrative therapies as ways to enhance the overall system’s response to a standard of care approach.

Dr. Weitz:                            In your book, you talk about the 10 aspects of the terrain and there’s so much great detail in this book that we could talk about it for hours and I encourage everybody to get this book and read it twice. But maybe we can just touch on, you know, one or two things from each of these chapters.

Dr. Winters:                        Perfect.

Dr. Weitz:                            To begin with though, when you assess the terrain, you have a questionnaire in your book, but I wonder is there an ideal cancer biomarkers lab panel?

Dr. Winters:                        Great question. My patients have coined the term the trifecta and this is a combination of testing I’ve done for over 20 years in myself and in my patient population, that gave me a personal indicator, an indicator light to say cancer’s in the driver’s seat or the train is in the driver’s seat. To give an example it really quickly, I’ve had many patients who’ve gone through standard care treatment who all by all accounts on their tumor markers and their scans are no evidence of disease. Net. Right? And they’re super happy. Then I look under the hood and I’m quivering in my boots. I’ve seen the other be true where I’ve had patients, myself included, who have things on scans and still may have elevated tumor markers, but the terrain looks gorgeous, which basically means that they’re in the driver’s seat and the cancer just is maybe in passenger seat and it’s not causing problems. It’s not growing, it’s not going away, but it’s stable.

                                                The key of us changing the cancer conversation is around stability and maintenance and treating this like a chronic illness like anything else. And great if we accidentally get to a no evidence of disease, that’s a great side effect. That is not the end all goal in a terrain centric approach. That being said, there are what I call my monthly labs. When someone had initially had a consult with me or now I consult with doctors on behalf of their patients to teach them how to do this, I look at five main tests to begin with. Good old, simple CBC. That’s your complete blood count that’s looking at… and I want it with the differential. That’s looking at your white blood cells, your red blood cells, hemoglobin, hematocrit, platelets, your RDW, your percentages of monocytes, eosinophils and basophils and your percentages of neutrophils and lymphocytes. That little out-of-pocket $12 test, then that information can be make or break on somebody’s prognosis just in that one test.

                                                An example is if somebody has what’s called a poor NLR, a poor neutrophil to lymphocyte ratio. You could simply go Google that right now on PubMed and you’ll see hundreds of papers that come up saying that a poor neutrophil to lymphocyte, meaning more than two neutrophils for every one lymphocyte is poor prognosis in all out mortality across the board of all the populations. We should be screening, just taking a look at that in every one of our patients. For instance, if you have say 65 neutrophils and 28 lymphocytes, you’re in trouble whether you have cancer or not. If you have 55 neutrophils and 32 lymphocytes, you’re in a really beautiful zone. All right, so these are simple things we can test on that.

                                                The other thing I look at is a metabolic panel, which is going to have your glucose, it’s going to have your liver enzymes, it’s going to have your electrolytes. Those just show me how in your kidney function, that’s like, how are your organs holding up amongst this battle, right? Not too long ago, if you recall, right? 15, 20 years ago, when we ran a chem panel, it used to be a Chem 20, okay , that used to include things like magnesium, sedimentation rate, lactase dehydrogenase, GGT, which is a particular liver enzyme, way more specific and sensitive than an AST or ALT. Today you only get a Chem 14 at best. We usually have to then add those other two key players is SED rate and the LDH into the mix. But that chem panel can show me a lot of what’s going on mostly metabolically what’s going on. If we start to see elevated Alk-phos, we know there could be things with the liver, the kidney, or the bones.

                                                If we see elevated liver enzymes, that could be things like liver mets, that could be liver just overwhelm of whatever medication it’s on. If we see chronically low white blood cells, that’s usually indicative of chronic heavy metal or chronic infection issues. If we see a low hemoglobin that can give us false readings on our hemoglobin A1c levels so it might look like someone’s doing great metabolically on their blood sugars, but their hemoglobin is so low that it’s giving you an erroneously low level. Or we might see low hematocrit, which is also prognostic. People with low hematocrits also have poor prognosis and mortality rates are higher. These are some simple things. Both these tests together 20, 25 bucks.

                                                The trifecta I alluded to already is the sedimentation rate also known as the ESR or the LDH lactate dehydrogenase, sometimes on your test as the LD. And the third one is the CRP, the C reactive protein. That’s the trifecta. Now again, if you went into PubMed and you looked at any of those individually, like what does an LDH mean? What does an LC… Any of those by themselves are good markers for cancer and chronic inflammatory, chronic illness processes. But if you have all three of those tested regularly, I have my patients retest those labs until their trifecta is perfecta. And by perfect I want to be in my functional optimal ranges. For instance, a C reactive protein, some are high sensitivity, which might have a range of up to 0.3 and some are just regulars, which might have a range of up to three. We ideally want that under 1 or 0.1 at its highest. Anything above that, it’s what you want to get a quantitative because if it just says below three or below 0.3 that means nothing. I need the exact number.

                                                Same thing with the SED rates. SED sates should always be below 10 and lactase dehydrogenase or LDS should be, depending if it’s a Quest or a LabCorp should be under 175 or under 450. One of them goes up to around 600 the other one goes up to 220. You want them well within the limitations. When I’m looking at somebody who’s labs and one of those trifectas are out, that usually points to, hey, I just broke a leg or I just got over an illness or I just had an autoimmune flare. For instance SED rate shows how quickly do blood cells fall out of solution. If it takes a while, if that number is higher because it takes longer for those cells that’s thick sticky blood inflammation, high fibrinogen, and those little scaffoldings that allow cancer cells to move about the building, right?   We want that low. We want really nice thin moving blood. If LDH is high, that could be a multitude of things. It’s an average of five different enzymes throughout the body that can be pointing to lung health, red blood cell health, liver health, kidney health, even tumor health, like to what’s going on. My husband who’s a biochemist will say if the LDH is on, basically if it’s elevated then the mitochondria are off. That’s a really good rule of thumb and it’s probably the most profound marker we have for all illnesses, especially in the cancer world. In fact if you have lymphoma or melanoma or multiple myeloma, LDH should be the standard cancer marker that’s being run every month for you. I rarely have ever see that happening in the oncology world, which is just absolutely malpractice in my opinion because it’s a really good way to see if you start to see an LDH go up in your cancer patients, you know cancer’s on the move again and then C reactive protein we already talked about.

                                                Those three along with the CBC and CMP give me a lovely base camp of the terrain for about a hundred bucks and we’ll retest those every month until they stabilize. And that’s a starting point. Now, depending on the person’s history, tumor type age, what types of therapies they are taking, I may very well add in a lot of other tests to this, but like typically let’s use breast cancer as an example. I’ll want the markers. A lot of women don’t even ever get their breast markers done. I want CA 27-29 and CA 15-3 as your baseline. But the three main drivers of most breast cancers is a low vitamin D3 three so anything below 50 is a problem. I want it more at a therapeutic level, at 80 to 100 if they’re dealing with chronic illness, an insulin above three is a problem. An insulin growth factor, well above a hundred is a problem. And a hemoglobin A1C above five is problem pretty much in all cancer types, but for sure in the breast world.  Then a body fat index, not a BMI, BMIs are BS. But a body fat index above 25% these are key metabolic drivers of things like breast cancer, a lot of colorectal cancers, pancreatic, brain tumors, et cetera. These are some other parameters that we can really test and assess and address in a profound way to change the terrain, to change the soil so that whatever treatments you’re doing for the tumor has a better chance of taking hold.

Dr. Weitz:                            Interesting. What do you do if you have an elevated IGF-1?

Dr. Winters:                        Ah, well one of the best and free things is fasting. Yes. Yup. I love that just when I see those moments happen where it can be something fast, fasting, the high intensity interval training can do the same, proper sleep. Know that two nights of bad sleep can throw your insulin growth factor off the charts. If sleep is an ongoing issue for you, make sure you’re addressing that. Stress will also kick up, so cortisol will kick up insulin growth factor and so will estrogen and androgen dominance. If women or men are taking exogenous hormones, even for optimization, their insulin growth factors are going to be high. That’s not good if you’re dealing with a cancering process. Right? We don’t want things that make things grow, right?  These are some really simple things that you can take a look at, but a lot of people are just trying to use diet to lower the insulin growth factor, but there are other things that it will stimulate it as well.

Dr. Weitz:                            Yeah. I did notice that, I wanted to go step by step but I don’t know if I-

Dr. Winters:                        I recall all over.

Dr. Weitz:                            I did notice in your chapter on hormones, you were talking about how estrogen is a stimulator of cancer and you’re not a big believer in bioidentical hormones. I even pulled out a quote from where you said that bioidentical hormones are neither safer, more natural than their synthetic ones, which is in stark contrast to most practitioners in the functional medicine community. Can you explain yourself?

Dr. Winters:                        I can. Now, believe me, I have a lot of hate mail from colleagues in this arena and I’m here to say, Hey, I’m giving bink. Because here’s the deal, I’m the one who’s cleaning up your cancer patients. They might not be cancer patients as they start with you, but they certainly are after they’ve worked with you. If they’re, if you’ve not looked at their snips, if you’ve not looked under the hood, you’ve not at the way they metabolize or hormones, you are messing with fire. So you bring it like I said, data like people saying it began to fight cancer. Let me see the data. You’re telling me hormones are safe, let me see the data. It’s not okay. I look at a lot of data. Here’s what I mean by this. This is what I’m on my soapbox now then Ben. When people say bioidentical hormones, I’ve been at huge medical conferences where I’ve asked the audience, how many of you think that bioidentical hormones are natural hormones?  These are doctors. Almost all of them raised their hand. What gets me is that these are synthetic compounded molecules that are the… Why they’re called bioidentical is they so strongly mimic our own endogenous hormones, that that’s why they’re termed bioidentical.  But the caveat is they bind almost irreversibly or at least more rigidly to our receptor sites than our endogenous hormones do.  So my coauthor Jess has got some great analogies about, think about the garages. Think about your receptors as a garage when you park an exogenous hormone in there like estriol or estradiol. Okay. And like a bioidentical E1 E3 combination. It’s like putting a giant suburban into a place that there’s not even room to open the doors. We can’t let in more information, other things to help pluck it off there and degrade it and move it through the system.

                                                If somebody has snips like CYP1B1, CYP2D6, COMT snips, ESR2 snips, these mean that folks basically taking hormones in and they keep them parked in the garage irreversibly. That starts to kick up things like more sixteens, hydroxy estrones and more four hydroxy estrones, which are the toxic estrogen quinones. If they have certain things like CYP1B1s, they will also take their progesterones and their testosterones and immediately convert them into estrogens and then park those right inside the suburban as well. That is where until you really know the way your patient metabolizes their hormones and know their snips and know their exposures, like are they lathering their body with parabens every day? Are they drinking out of plastic? Do they have copper in their pipes? Are they eating pesticide laden food? Are they getting glyphosates in all of their diet? They are just adding insult to injury with those exogenous soups they’re taking it. Unless you have the money, if somebody likes Suzanne Somers who can basically test your labs every few months and adjust accordingly, you really shouldn’t be messing with this. And-

Dr. Weitz:                            So what if you are, what if you’re doing, you’re doing urine testing and you’re measuring your estrogen metabolites and you’re making sure that you’re metabolizing estrogen in the most efficient way mostly along the two pathway.

Dr. Winters:                        Yeah. If that’s the case and you have good snips around this and someone’s also looking at your fibrinogen. at your thyroid hormone function, your adrenal hormone function, looking at your circadian rhythm patterns, looking at your liver enzymes in particular your GGT, and to look at your trifecta and making sure that all that’s looking good. Then probably you can get away with it. But I’m here to tell you after reviewing hundreds of thousands of labs and tens of thousands of patients, I’ve never seen that be the case. I’ve never in 28 years needed hormones to bring my patients back to balance exogenously.

Dr. Weitz:                            What about as estriol versus estradiol?

Dr. Winters:                        Now that is the one caveat is every once in awhile when my patients have not responded to all of my tricks to the trade to bring some good juiciness back to life, so to speak. I might very short term use some estriol topically. Just to give you an example, most people give two milligrams and they just have them do it every day, two milligrams topically. I have those same patients do 0.5 milligrams for two weeks nightly, then twice a week for two months nightly and then once a month for two months beyond that. Guess what? It works every time. So less is more in that category. Though I’m testing those folks, I have had a handful of patients where even estriol kicked up their 16s and their 4-hydroxy estrogens because they had such significant snips in this department. But it was enough where I’ve had women who were like tissue paper taking all like vaginal… That was what it took and we were able to restore their function safely and effectively. And interesting as we’re changing the rest of the terrain around the imbalances, that little bit of estradiol that we brought in for that short term really changed the game and they never had to go back to it because it’s a terrain centric process as well.

Dr. Weitz:                            Now you’re talking about the fact that the estrogen gloms onto the estrogen receptor sites very strongly.

Dr. Winters:                        Yeah.

Dr. Weitz:                            But I noticed in that chapter you’re also not very big on soy and the argument for consuming soy is that it’s a very weak plant estrogen that gloms onto the estrogen receptor sites, thus blocking stronger estrogens. Why isn’t that a good thing?

Dr. Winters:                        Well, first of all, in the United States, it’s a near impossibility to find clean soy. Organic soy does not mean, I will tell you there has been multiple studies showing that all of our soy, 100% organic or not, is contaminated with glyphosate. Glyphosate does not recognize a fence that says this is organic. It has a two mile spread through the air, a two mile spread through the soil and it’s in all of our water sources. Soy because of that it is the nature of glyphosate, it’s sequesters in soybean crops, all legumes, and all grains. That’s its favorite place to hang out. We’re using these foods in the plant based movement. We’re using these foods to kick up our fight, like “Oh my word. We’re actually just gobbling up things that are turning on those insulin growth factors, those estrogen receptors even more.”   You might be getting the benefit of a little bit of supportive at soy. But you’re getting all the things that are frankly making it pee in the wind. So there’s that. Number two, one of things we’ve found, and I have a lot of colleagues out there in integrative oncology who are basically are data driven research readers who say, the studies really show that it may not be harmful because there were many years in the camp of saying soy causes cancer. I don’t believe that. I just believe it’s…

Dr. Weitz:                            Wasn’t it the largest study ever done with women with a history of breast cancer from China and those women who consumed the most soy had the least risk of recurrence of breast cancer?

Dr. Winters:                        Exactly and here’s why. They have an estrobolome, a microbiome from a cultural background. I was not… I was raised in Kansas. Yes, I have soybeans growing all around me, but I did not start eating tofu in Wichita, Kansas at three years old. Right? That was not happening. Unless you were raised in an environment that’s culturally the… You were getting through your breast milk, your mother’s tempeh and gorgeous non glyphosated soybean, that’s a whole different ballgame. I had just made the blanketed statement in the United States because of the nature of our farming industry. A lot of these are industry-driven responses that it’s, we have so many things that work better and are far safer and I don’t even want a question because I do test and I do see that soybeans. It’s like if my folks are eating a lot of edamame or a lot of tofu, I see that their IGF1 is high. I see that their estrogens are high. I see their blood sugars are high. I see, I mean I see it, so I’m not making these assertions blindly.  I think it’s not necessarily that the soy is the problem, it’s what we’ve done to it and the fact that we’re not literally wired in our own microbiome and estrobolome to deal with it.

Dr. Weitz:                            Cool. But you do think that flax seeds are beneficial for hormone metabolism.

Dr. Winters:                        Flax seed, right?

Dr. Weitz:                           Yes.

Dr. Winters:                        Not oil.

Dr. Weitz:                           Yes.

Dr. Winters:                        Thank you. Mostly because it’s just a good a binder, a good fiber.

Dr. Weitz:                            Okay.

Dr. Winters:                        And the lignans are pretty anti-inflammatory. But you again, quality is going to be cure. You want to make sure it’s been vacuum sealed that you keep it in the fridge, that you grind it as needed.

Dr. Weitz:                            Right.

Dr. Winters:                        Because it oxidizes very quickly. When it oxidizes that actually kicks up your omega-6s versus what we’re going for. Which is in our world today, we about 1850, our omega-6 to 3 ratio was about 3 to 6 to 1 of omega-6 to 3s. Today it’s about a 30 to 1. That is so much of how we adjust sort of mic monocropped our food sources and put just crappy oil, oxidized oil in everything. That’s also when such an anti flax oil kind of gal because it’s pretty much oxidized that second you open the bottle and it just adds more insult to injury.

Dr. Weitz:                            Yeah, totally agree. But I think I’ve given it up the idea of hitting everyone of these 10 points. So I’m just going to, I’m just-

Dr. Winters:                        You want to do nine more of these sessions. I’m sorry.

Dr. Weitz:                            I’m just going to grab some points out of your book that I thought would be interesting talking topics. In your chapter on genes you happen to mention that the nutrient choline which is a vitamin like essential nutrient. It’s an important methyl donor. It’s really important for liver health. We had a discussion on the podcast about fatty liver and choline is one of the most beneficial things for that. We’ve gone round and round with the TMAO being caused by choline. We’ve had a number of discussions on the podcast about choline, but you talk about the fact that some of the data seems to show that men with prostate cancer, that the choline exacerbates their prostate cancer. Can you talk about that?

Dr. Winters:                        Sure. This is, I’m really glad you brought this up because this actually feeds into a couple other specific nutrients that the data says, hey, this is probably a good fuel source for cancer cells as well. There is actually a load of literature on choline driving prostate cancer and choline is going to be richest in eggs, poultry skin. Those are kind of the main ones where we want our… Because the data is so strong, I just encourage my men to avoid, with prostate cancer, to avoid those things.

Dr. Weitz:                           Particularly the egg yolk.

Dr. Winters:                        Exactly. We can kind of get away with some of the albumen by itself in the egg white. But the egg yolk is definitely the choline rich aspect of it.

Dr. Weitz:                           Right?

Dr. Winters:                        I’m not… And again, I explained this to people that for the short term let’s see if it makes a dent. I don’t have enough long term data to show, hey, that’s significantly turn on or off the cancering process, but there is enough data out there to suggest that it’s worthwhile pulling it back. Again, that’s not forever. In my mind it’s something that’s easy. There’s still a lot of other choices and it doesn’t create a lot of stress in the patients.  Other things such as glutamine, other things such as methionine. There’s discussions about those being drivers of metastatic processes and of cancer fuel sources as well. What I love about all the data around this is why, again, going back to the freebie, intermittent fasting is going to choline restrict, methionine restrict, glutamine restrict, glutamate restrict. It’s going to pull all those things that we worry about.

                                                Here’s my mindset, there was a time when we all just sort of ate whatever was available whenever it was available seasonally. We were not having access to three to six meals a day every day of the year, whatever we wanted, papya in Colorado in the winter. Those weren’t happening. It was definitely seasonal, local, regional and just what was available. And so we went through many, many moments of fasted states. We never ODed on any one particular nutrient. Right? I think today, so much of what we’re dealing with in the oncology world and the concern is that we’re way overfed and undernourished and we’re overfed in ways that keep our sort of balance, weight tilted. Just like Americans living on soy burgers in the United States. When has that ever happened in our culture? Right?

                                                It’s like just the same in like when have we ever had six meals a day in our history. That’s where even some of my gentlemen are like, “Oh my God, I ate an egg.” And they’re all freaked out about having an egg in their keto pancake or what have you and like, “Well, are you fasting? Are you getting in your 13 hours a day minimum, 16 to 18 hours twice a week, maybe a three day a month water fast, you’re likely fine. What the data has shown me over 28 years is that’s probably the case.

Dr. Weitz:                            Right, you do realize that there’s a lot of practitioners out there who are saying, “Ah, we have to restrict methionine. We have to restrict choline.  That means we need a plant based vegan diet and I know that you’re a big fan of the ketogenetic diet.  How do you reconcile those?

Dr. Winters:                        Yeah, well it’s easy because it’s not… and I’m not really, I got labeled as such as the ketogenic diet, because first of all our publisher wanted us to have that on. It’s in the title. But I mean I’ve been using it what I would call a metabolically flexible diet in myself, in all my patients for all these years. My sister in law is a perfect example. Last night she heard her ketones were off the charts high. This is one that she’s been trying to do a ketogenic diet for the last three years to no avail.  She’s a very stubborn metabolic process. When she would fast it would actually make it worse. Her insulin growth factor goes up and her chemistry, when we start looking at her SNPs and other things, we started understanding that she had some very unique attributes. What is funny, what will shake my sister into ketosis is a three day meat diet or 3 day protein diet.

                                                Nothing routine for three days shifts her chemistry in such that she’ll drop physical weight. Her glucose goes way into normal range and her ketones go up. If I did that, I would be the opposite. I’d go into gluconeogenesis, my insulin growth factor goes up, my insulin goes up, my glucose goes up and my ketones go down. This is the place that we all need to titrate to our own metabolic precision individuality process here. When folks start to say, “Oh, we have to restrict this, restrict this, restrict this.? Guess what? If you end up on a fruitarian diet or a high plant based diet with a lot of grains, because plant base in that realm usually needs a lot of grains and legumes as well. You are invariably going to see high insulin. You’re invariably going to see high insulin growth factor, high hemoglobin A1c, high glucose. You’re going to see patterns such as elevated lipopolysaccharides, autoimmune conditions flaring, thyroid whacking out, which is going to change the metabolic burner even more.

                                                Because I’m testing, I can watch. That’s why the pendulum drives me crazy as all these camps in there are fighting with one another. Look at this person’s entire process and see what works best for them and know that it needs to change as they do. Whether it’s the season, whether it’s their condition, whatever. That’s why, again, a process where we have naturally used intermittent fasting since the beginning of time. A lot of people get excited about the Mediterranean diet. Well I just spent a month in the Mediterranean and I ate on the Mediterranean diet, all but the grains. The real issue that they’re finding it may be why the benefit of the Mediterranean diet is this is a community of Orthodox Christians who spent 200 days of their calendar year in some form of a fast. That actually may be more of where their medicine is versus the foods they’re eating or not eating. That’s what I think is really profound and we can go back, I mean in ancient, ancient times, fasting has been a way of life out of just simple necessity. Just like the beginning of our conversation, I couldn’t fit anything in and so I didn’t and it made a huge difference for me. Just like the gentleman at true health or TrueNorth.  He has been profound things because sometimes putting in nothing is precisely what the doctor ordered.

Dr. Weitz:                            Since we’re on the topic of prostate cancer, what do you think about modified citrus pectin for prostate cancer? Since I just put up a podcast interview with Dr. Elias.

Dr. Winters:                        First of all, right on, I use it very almost all every single patient, but I also test, I get a galectin-3 and if it’s above 10 then we are definitely using modified citrus pectin. If they have a biopsy coming up, if they have a surgery coming up, I will definitely preempt them with that and keep them on it for at least a couple of months post biopsy or surgery. Then our goal is to get the galectin-3 down and we’ll use anywhere from 15 grams to 40 grams a day depending.

Dr. Weitz:                            Oh, wow, 40 grams a day.

Dr. Winters:                        I’ve used it in those types of situations where I had extreme metastatic like a galectin-3 of 35. We were able to watch every month as it came down and down. Then we were able to maintain it 5 to 10 grams a day, once we hit the sweet spot. It’s a very profound support. What I think it’s also doing, and maybe Elias talked about this, I don’t know, but is that, it also is a great binder, a great fiber. It’s going to be pulling out a lot of the exogenous estrogens, like the hormones, the heavy metals. It’s going to be resetting the microbiome. We’re getting a lot of pre and probiotics with that pectin as well. There are a lot of sort of uncelebrated side victories of this supplement that I think are very helpful in a lot of cancer types, not just prostate.

Dr. Weitz:                            Yeah, he definitely talks about that and they have some data showing that it binds with lead and other heavy metals.

Dr. Winters:                        Yeah. Cool.

Dr. Weitz:                            Let’s talk about the ketogenic diet a little bit.

Dr. Winters:                        Yeah.

Dr. Weitz:                            The ketogenic diet is a super low carb, very high fat, like 75% fat diet. Right?

Dr. Winters:                        That’s a therapeutic ketogenetic diet because you can get into ketosis in a multitude of ways. But a therapeutic ketogenic diet is somewhere between 5 and 10% carbohydrates and anywhere from 70 to 90% fat. Then sort of the protein makes up for wherever you are in that equation. That is very specific with, as a therapeutic treatment for epilepsy. On what we call kind of like a 4 to 1 ratio of fats to carbohydrates in like the pediatric population. It’s also where important treatment that particular ratio and using a therapeutic ketogenic diet is very critical in my personal experience and opinion and what the literature shows in brain cancer patients. Those are kind of like the places where you’re going to get on a ketogenic diet, a therapeutic ketogenic diet, you’re going to stay there for the rest of your long, long, long life is always what I tell patients.

                                                You might be able to moderate your fat intake a little bit over time, but ultimately you’re going to need to keep your ketones, your blood ketones well over 3 to maintain the metabolic need of your brain at that time. Now for other cancer types, you might need only be in a nutritional ketogenic stage, which is of between 0.8 and 3 on your blood ketones. Hopefully what your listeners are hearing here is the key is if you’re going to implement a ketogenic diet for whatever reason, cancer or longevity or overall health and vitality and fitness, you must test. You are not… Most people think they’re in a ketogenic diet when they come see me, they’re no where close. We’re so ingrained to think that we’re eating low carb. I always tell people that before 1850 we were all low carb naturally,

                                                About 30% of our calories came from starches, carbohydrates, tubers like legumes, honey, that we had to work very hard to get, right? After the industrial food revolution kicked in and we started milling sugar and flour that changed and now we’re all stuck in sugar burning mode and we are not readily moving into fat burning mode. Today our caloric intake, it’s about 70% to 80% of our calories come from carbohydrates, especially if you are lower, if you are vegan or vegetarian, that’s for sure the case. That shift is… That’s a big shift, right? What’s fascinating to me is you can actually create, like I just gave the perfect example of my sister who’s eating meatballs right now for three meals a day and got herself into ketosis where being in true 90% fat intake, ketosis didn’t work. She has several SNPs that prevents her from using fats to utilize and create the beta hydroxybutyrate ketones. For her it was a whole different ball game. We have a lot of patients like that that are out there.

Dr. Weitz:                            You mentioned blood testing for ketones.

Dr. Winters:                        Yes.

Dr. Weitz:                            Can you talk about the difference, because a lot of patients are using these urine tests.

Dr. Winters:                        Yes. Urine testing is where I start everybody. That’s where your first morning, you’re going to pee on a stick. It’s like a $6 bottle of a urine keto sticks from Amazon and you’re going to use those sticks until you start to see moderate to high ketones on the urine. Once you see that, that’s when you graduate to the blood testing. There’s several devices out there. The cheaper, there’s anywhere from $50 to $120 for a blood monitor and anywhere from 99 cents to $5 for a ketone strip. I always want people to shop around because this isn’t CME. I think I’m okay to, can I say the name of the company I like?

Dr. Weitz:                            Yeah.

Dr. Winters:                        I use Keto-mojo because their price point fits. And because they’re also a blood ketone and blood glucose monitor and they’re very well calibrated and very reliable. We can even make them reliable to in office being a straws as well. That’s why I use it. Before that I use precision for years, but the price point was often prohibited for most of my patients. Kudos for the Keto-mojo guys for making it more accessible. But what happens when you start to become efficient as you start to become a fat burner? If you are, because anybody can make, like I said, anybody can make ketones, right? But that doesn’t mean you’re in ketosis. That does not mean that you’re metabolically flexible and it does not mean you’re in a fat adapted state. Once you become fat adapted, you should not be showing ketones in your urine anymore.

Dr. Weitz:                            Right?

Dr. Winters:                        This is key. If we are like, “I still show,” everyone thinks they’re in ketosis and we’re like, you know what? I could go out drinking the night before and show high ketones in my urine. That’s what people are doing. They’re out there like, “I’m in ketosis. I pull, I’ve drank three bottles of wine last night and I’m good to go.” I’m like, “No, you’re still showing that you’re actually not in a ketogentic adapted stage, or not metabolically flexible.” That’s where it changes. What you’re seeing in the urine is a acetoacetate. What you’re seeing in the blood is beta hydroxybutyrate and what you’re seeing in breath is acetone. So acetone, even a piece of gum can alterate it in your breath or an alcoholic beverage or just the simple state of not eating for a few hours can kind of blow it up. But it’s not a true marker of your metabolic flexibility. Really the gold standard is and can only be blood, It’s these little guys are little tiny finger prints that really don’t hurt. They’ve got a really good jouster on the keto-mojo.

                                           It’s actually quite painless and it’s just the first one’s the hardest. It’s just that psychological barrier. But once you start to test, you can start to really analyze. One caveat for your listeners, we’re so accustomed to testing our blood sugar first thing in the morning or our ketones on the stick first thing in the morning. Your blood ketones, you want to check your glucose first thing in the morning, but you want to actually wait for three to four hours at the very least to check your blood ketones because we have something called the Dawn effect, which can sometimes make people’s ketones erroneously lower or the testing in the morning. It’s just again, not in everybody that it can happen. Our ketones tend to go up, if we’re metabolically flexible, they tend to go up as the day goes on.  I kind of tell people maybe 11 noon, 11 or noon or 3 to 4 in the afternoon is a good time to check your blood ketones.

Dr. Weitz:                            That’s even if you are having breakfast?

Dr. Winters:                        Exactly. Exactly.

Dr. Weitz:                            Okay. And so-

Dr. Winters:                        Also it’s really great is that if you’re weren’t eating through trying to eat to the… I tell people, don’t eat towards the ketone monitor, eat towards your chemistry and see how the ketone monitor is giving you that feedback. It’s like a biofeedback device, that’s all. Letting you know how far or close you are to metabolic flexibility, which is the fountain of youth.

Dr. Weitz:                            That’s great. You’ve seen real therapeutic benefit in terms of improving the environment in your body that the terrain in terms of helping the body to fight off cancer with the ketogenic diet.

Dr. Winters:                        Here’s some really cool data that’s coming out and has been for a while is that being being in a fasted state or having elevated ketones at the time of your radiation or your other therapies will actually enhance outcomes. It’s actually… It’s almost like the Trojan horse that drives the treatment into the cell and sensitizes the cancer cell to those treatments. Whereas I think it’s malpractice that doctors are not checking insulin, hemoglobin A1C and insulin growth factor on all their patients getting ready to go through radiation, because it’s well documented that if you have elevations in those parameters that you are desensitized to the effect of the radiation and you make far more aggressive Stem cells and more aggressive mutated cancer cells that are already in the system.  It’s like, how can we not do this? Luckily I keep meeting, almost every cancer conference I go to, I keep meeting more and more radio oncologists that are getting hit to this and employing huge genetic diets in their hospitals around the country to put their patients on at the very least through radiation with a recommendation of staying on it for at least six months after, because radiation is still doing its thing six months to a year after you’re completed.

Dr. Weitz:                            Wow. It’s great.

Dr. Winters:                        Right?

Dr. Weitz:                            Cool. I’d like to ask you one more question and I’m going to have to wrap. Can you explain what cachexia is and why drinking Ensure, and milkshakes with ice cream are not the best answer.

Dr. Winters:                        Another soapbox, and actually that’s in our next book, we plan having an entire chapter on this. It’s probably the most misunderstood concept in nutrition and metabolic health and cancer care out there. I believe it’s the biggest myth to overcome. The big advice often given to our patients is just eat whatever you want, don’t lose weight.

Dr. Weitz:                            What is cachexia?

Dr. Winters:                        Exactly, that’s what I was coming to. What the doctors are worried about is they’re worried about weight loss. But there’s a difference of like, hey, I’m not eating and I’m losing some weight, and there’s cachexia, which is, I’m eating everything and I’m still losing weight. They’re different and that they’re metabolically based. When cancer cells take over, the mitochondria take over the system, they basically changed the fuel sources and they basically start to starve the muscles of all of their glucose stores, and they start to gobble up everything they can of sugar that’s coming into the body, that’s coming out of the muscles that’s hidden in storage, that’s out of the liver, and they start to utilize it to grow tumors and starve the body, that’s its job.

                                                The irony of this is it’s driven by three main mechanisms.  More carbohydrates, so sugar definitely feeds this process.  Angiogenesis is a particular process of growing new vasculature tumors that also will kick up cachexia and inflammation.  If you’re extremely inflamed and you have lots of blood flow coming to your tumors and not to the rest of your body and you’re eating high carbohydrate diet, you are absolutely making this process.  Where she can eat 20,000 calories a day and you will not stave this off. Okay. What weight you do gain is going to be the fat and not the good diet.  You’re just creating little storage tanks for more cancer cell proliferating stimulators, so that’s a biggie. Things like-

Dr. Weitz:                            Let me just… But in… For patients who don’t know that cachexia is when you see these cancer patients who lose a lot of weight quick, their face gets really thin and usually that means the end is near.

Dr. Winters:                        Exactly. In fact, depending on the studies, anywhere from 50 to 75% of all cancer patients succumb to cachexia metabolic wasting. If you’re in the physical fitness world, you might’ve heard this as sarcopenia. But basically we see this for a lot of chronic illnesses such as congestive heart failure, cancer, AIDS, HIV, those are stages where suddenly the metabolic shifts away from nourishing the body to starving the body. That’s a very different process and it’s not responsive to calories in.  The only thing that Boost and Ensure do is it they ensure an even more untimely death. That’s the key here is that, ironically, even intermittent fasting will help stop this process. For sure of a high fat diet, so like a therapeutic ketogenic diet will stave this off, and even a little bit higher protein depending on the patient and their needs at the time, especially if they’ve got a lot of liver mets they might actually need a little bit more protein, but that becomes a case by case. But it’s something that’s really misunderstood and is treated, and it’s one of the things that actually your conventional team feels very helpless about. But their way of overcoming, their way of making themselves feel better, it’s, just say eat whatever you want, and that’s not helping anybody, and definitely not help me. I’m always, I think the people who need to be educated in this the most are the loved ones of the patient going through this.  Because as you watch your loved ones start to lose weight, people freak out, right?

                                                I tell people skinny is not scary, metabolically sarcopenic and muscle wasting is scary. You can see the difference of that on a laboratory assessment. If protein levels drop below seven on your metabolic panel and if albumin levels drop below four, you know you’re on the edge of cachexia. And then when it’s really bad cachexia: you’ll see very low albumin, very low protein, very low calcium, and very low creatinine. When you see that, you know that the body is already just dissolving it’s muscle mass as quickly as possible. And then it’s even more likely that if you put in a feeding tube or you give them Boost or Ensure that they’re going to die very rapidly.

Dr. Weitz:                            Awesome. It’s been a great podcast…

Dr. Winters:                        Awesome topics. Thank you for that. My goodness.

Dr. Weitz:                            Tons of great information. I have about 30 more questions.

Dr. Winters:                        Excellent.

Dr. Weitz:                            For listeners who want to contact you, where would you like to steer them?

Dr. Winters:                        Sure. So definitely go check out my book, The Metabolic Approach To Cancer that I coauthored with my friend and colleague, ah, there you go, Jess Higgins Kelley. We’ve got two more books coming out in the next year, year and a half in that arena. And then I also have a co collaborative book on mistletoe coming out, which will be a whole another topic. We’ll come back together on that. And then they can also go to Dr Nasha, D-R N-A-S-H-A.com. All my social media handles are in that same realm. That is where I try and keep… There’s a ton of other, like your podcast will be on here and all the other media events as well as events coming up, conferences coming up, it’s also a place where we have a really great newsletter where we’re bringing you up to speed on the latest research in the arena of integrative cancer, metabolic health, mitochondrial function, longevity, intermittent fasting, ketogenetic diet, and a lot of that realm, we just kind of grew that on that. So would look forward to seeing any of your listeners start following me there.

Dr. Weitz:                            Are you accepting new patients?

Dr. Winters:                        I’m accepting new doctors to support-

Dr. Weitz:                            New doctors.

Dr. Winters:                        … and that’s where I want… Because I was on the one on one forever and I did a lot of retreats, which I’ll… we’ll be starting back up in 2020, so I can see things directly, which I’m excited about. But where I find the bottleneck is our healthcare providers. They need to be trained because the patients are savvy, they’re finding this information, they know what they’re up to, and they’re not finding practitioners who can support them on this journey. So my job is to teach the teacher.

Dr. Weitz:                           Do you have a particular program or it’s a one on one type of situation?

Dr. Winters:                        Both. Right now I’m doing some one on ones, but starting in January, I have a four month intensive training for physicians that I’ve worked with. You can only kind of get into the lineup if you have already done some consulting with me so you can see if there’s resonates. Because I’m not for everybody, and that’s okay. I want to be for everybody. I don’t have that energy to be for everybody. If the book resonates with you, if you have patients that are demanding,  you consult with me on their behalf and you resonate within an hour conversation we have and you realize this can not just help that person but hundreds if not thousands of patients in your practice, then I’d look forward to doing it. I’m joining you in a deep dive mentoring program that starts in 2020.

Dr. Weitz:                            Awesome. Thank you Dr Winters.

Dr. Winters:                        What a great time, and I love your podcast. I was able to geek out on it a little bit before our time today and I’ll be following you for sure.

Dr. Weitz:                            Great. Thank you. Thank you so much.



Mold Toxins and Chronic Illness with Dr. Sandeep Gupta: Rational Wellness Podcast 119

Dr. Sandeep Gupta discusses Mold Toxins and Chronic Illness 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. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

3:36  Dr. Sandeep Gupta explained that he fell into the field of mold toxins and chronic illness by accident based on a personal experience.  In 2012 his home was flooded and his partner became ill from mold toxicity and was so sick that she was unable to function normally and was unable to do anything except lying around all day.  He found out about Dr. Richie Shoemaker and he arranged to be trained by Dr. Shoemaker remotely.  He ended up having to do the training at 1:00 or 2:00 am via Skype.  It was a steep learning curve and Dr. Shoemaker sent him a 1000 page document to read to start with.  It was a difficult learning process and now his goal is to simplify the concepts and information so that more patients and practitioners can have access to it.

7:45  Dr. Gupta explained that what tends to make him suspect that a patient may have an underlying mold problem and Chronic Inflammatory Response Syndrome (CIRS) is when they have a multi-system illness, meaning that they may have some superficial symptoms like cough or sinus congestion and also some bloating and abdominal pain and diarrhea, and also joint pain, and fatigue, and difficulty sleeping and some skin rashes, etc.  Another clue is a lack of response to nutritional therapies, such as a typical set of Functional Medicine protocols.  They are on a healthy diet. They’ve improved their gut. They’ve fixed mineral and nutritional deficiencies and improved their omega 3/6 balance, etc., and they are still sick. That’s when you start thinking there must be an inflammatory trigger.

12:35  When you have a patient who has done all these lifestyle things to improve their health and are taking a good regimen of nutritional supplements and they are still not well, this is when you should start looking at their history and see if there might be some environmental toxin like mold that is playing a role in their condition.  You need to do an environmental history, but Dr. Gupta has found that if you simply ask someone if they live in a moldy home, they will tend to say no, because they don’t want anyone to think that they don’t clean their home. They might take that question as an insult. So Dr. Gupta found he had to be more subtle and ask questions like, how old is the building? Has there been a history of water events or hurricanes or flooding. Have there been any leaks in the roof or around washing machines or refrigerators or under the sink or in the bathroom or in the basement or in the crawl space?  The other big thing is if how do they feel when they go away from their home for a period of time?  If they feel better when they leave for a weekend trip, that would be a clue.

15:32  The next step is to do a thorough examination and look at their tongue, their nails, and at their skin.  Do a brief neurological examination and ask them to hold their arms out straight and if they have a tremor, that may be a sign of an elevated TGF beta 1.  If they sit on one of those lattice back chairs and they get up and they still have the imprint of the chair on their back for some time, that’s called dermatographia, and that could be a sign of elevated C4A, which could indicate CIRS.  Dr. Gupta will also look for signs of Ehlers-Danlos spectrum disorder, by looking for signs of joint hypermobility.

19:15  The next thing to do is the Visual Contrast Sensitivity (VCS) test, which can be done online through SurvivingMold.com Dr Gupta recommends having the patient do the test in your office, since it will be more accurate that way.  If they fail the VCS test, that’s quite a strong indicator that CIRS may be present. If they don’t fail it, it doesn’t exclude it. And you need to check to see if they have above average eyesight, that’s the most common reason that they will still pass even if they still have CIRS. Then the next thing is the symptom cluster questionnaire.

22:03  Then you should do some lab work.  You can order a nasal swab for MARCoNS (Multiple Antibiotic Resistant Coagulase Negative Staph) and the sample should be sent to Microbiology DX in Massachusetts. Blood biomarkers that are recommended include:  1. C4A, 2. TGF-beta 1, 3. MMP-9, 4. MSH, 5. VIP, 6. ACTH, and 7. ADHIf you have a positive visual contrast test and symptoms of CIRS and you have 3 or more abnormal markers, then you can make a diagnosis of CIRS and you can start them on a treatment program.  Even though this indicates CIRS, which is an activation of the innate immune system, it’s not 100% specific for mold toxicity.  That requires testing the home or having a mold sabbatical where the patient leaves their home for 5-7 days and feels better. If they feel a lot better while on the sabbatical and their symptoms are reproduced when they go back to their home, that is a strong indication of mold toxicity. 

27:15  Testing of the home can be helpful, but it’s not perfect.  Dr. Gupta recommends the ERMI test, which can be quite sensitive.  But even if there is evidence of mold, we still do not know that that amount of mold affects that person. Also, if a person gets a test result that shows a lot of mold, it may send them into a panic that may make their symptoms worse. And we have to consider that mold is not the only cause of CIRS. We have to consider a similar condition, Mast Cell Activation Syndrome, that can cause some of the same lab results as CIRS.  We also have to consider stealth infections such as Lyme Disease and its co-infections, Bartonella, Babesia, and mycoplasma. We also have to look for parasites and viruses and retroviruses. But mold is a really important and under recognized trigger for chronically unwell patients who seem to be resistant to care.

31:29  It makes sense to do a urine mycotoxin test for patients where you suspect mold exposure, such as the Great Plains MycoTOX profile.  Some practitioners recommend doing a challenge, such as with glutathione 500 mg twice a day for a week prior to the test, since sick patients may have their mycotoxins sitting in their cells and not being eliminated so the test can detect them.  But Great Plains recommends not doing a challenge prior to the test.  And you also cannot exclude a food source of mycotoxins for the findings of the urine test.

34:52  Treatment should start with moving out of their home or office to get away from mold exposure or at least doing a mold sabbatical and leaving for at least 5 days.  If you can’t move out or do a mold sabbatical, then use air purifiers and get the home remediated. It’s not a bad idea to do a liver detoxification program to make sure the liver is producing plenty of bile for the binders to work properly. Dr. Gupta prefers to start with the prescription binders, Cholestryamine and Colesevelam (Welcol), though he may recommend the nutritional binders later, like charcoal, bentonite clay, and Zeolite.  He often recommends his patients do coffee enemas and liver gallbladder flushes. For the liver flush he will have them take Premier Research supplements Liver-ND and Gallbladder-ND first for about a month.  Then he will get them to have green apples and then drink Epsom salts and then take a drink of olive oil and citrus, which will get the gallbladder to have a huge squeeze. If they are very unwell, though, this can be a very aggressive treatment and can make them feel worse.  Dr. Gupta’s favorite binder is Welcol and he will typically do it until their VCS is normal.  If their VCS test is normal, he will stop the prescription binders. At this point, he may do a urinary mycotoxin test and if it shows that they are still excreting mycotoxins, then he may continue with ongoing natural binder treatment.  

44:39  Dr. Gupta may add some form of natural gut support to his patients to make sure that the mold gets excreted.  He will check if the patient has parasites or mold or candida and, if so, he will typically use natural antiparasitic agents and natural antifungals.  He also finds supplements of Betaine HCL and digestive enzymes very helpful. He will often work on the gut as the same time as they are taking binders.  Towards the end of treatment after most of the exposure to mold is over and they have done enough binders and VCS test is normal and they have cleared nasal MARCoNS and other infections, and sometimes he will use ozone theory.  The treatment for the MARCoNS is generally things like silver, an EDTA nasal spray, botanical nasal sprays like Biocidin, and then nasal probiotics using a product with lactobacillus sakei, which is the strain found in Kimchi.  Some people just place a little bit of Kimchi in their nose, but this may burn. Then they are ready for the final phase of treatment.

50:05  For the final phase of treatment, Dr. Gupta will often recommend Vasoactive Intestinal Peptide (VIP), which is taken as a nasal spray.  He will often have his patients get a special kind of MRI called a NeuroQuant, which is a computerized analysis of a brain MRI, and it looks at a number of different brain regions and compares them to age and sex match controls.  If they’ve got shrinkage or atrophy of the brain, this can pose a risk for Alzheimer’s Disease, so we want to return that to normal and VIP can be effective for that.  And VIP may also help to de-escalate some of the remaining inflammation.  They may need to take VIP for several years.  They may also benefit from brain retraining methods, such as the Gupta program designed by Ashok Gupta at GuptaProgram.com There are a number of other brain retraining programs, including Annie Hopper’s DNRS system and the program from Norman Doidge, who wrote the book, The Brain That Heals Itself.



Dr. Sandeep Gupta is an integrative MD with a practice focus on mold and chronic illness, including the Chronic Inflammatory Response Syndrome (CIRS).  Dr. Gupta has physician training certification with Dr. Ritchie Shoemaker in Chronic Inflammatory Illness and a Masters of Nutrition with Dr. Gabriel Cousens. Dr. Gupta is in practice in Maroochydore, Queensland in Australia at Lotus Holistic Medicine and he established a Physician Training program for learning about treating patients with mold illness at Mold Illness Made Simple and also atLotusInstituteHH.com   Dr. Gupta is also a part of the Functional Diagnostic Nutrition group, which is dedicated to educating people about health.

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 or go to www.drweitz.com.


Podcast Transcript

Dr. Weitz:           This 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 e-book 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 Apple podcasts and give us a ratings and a review. That way more people find out about the rational wellness podcast. And you can go to YouTube and see the video version of this podcast by looking at Weitz Chiro or searching for Rational Wellness podcast. And if you go to my website, DrWeitz.com, you’ll find detailed show notes and a complete transcript.

                           Our topic for today is mold and chronic illness with Dr. Sandy Gupta. Exposure to mold and mold toxins, mycotoxins, affects many people and often is a undiagnosed underlying trigger for many other symptoms and conditions. Many people are unwittingly living or working in water damage buildings. And this exposure can be caused by negative, can be causing negative effects on your health, including coughing, wheezing, these are some of the symptoms, respiratory symptoms, shortness of breath, skin rashes, headache, vertigo, fatigue, memory and other cognitive deficits, abdominal pain, nausea, diarrhea, so those are some of the GI symptoms, joint pain and muscle aches, increased urinary frequency, weight gain, electric shock type paints. There’s a bunch of others.

                           Mold or mycotoxin exposure can results in a chronic condition referred to as Chronic Inflammatory Response Syndrome. Quoting to an article written by Keith Burnstein M.D., who has studied with Dr. Richie Shoemaker, you have to have the following criteria before being diagnosed with Chronic Inflammatory Response Syndrome. One, you have the history, signs and symptoms consistent with biotoxin exposure. Two, you have a genetic predisposition to biotoxin related illness. Three, you have abnormal visual contrast sensitivity testing. And four, you have positive biomarkers on lab testing consistent with the neuro immune vascular and endocrine abnormalities that characterize Chronic Inflammatory Response Syndrome.

                           Dr. Sandeep Gupta is an integrative M.D. with a practice focused on mold and chronic illness, including the chronic inflammatory response syndrome. Dr. Gupta has physician training certification with Dr. Richie Shoemaker in chronic and inflammatory illness, and he has a master’s of nutrition with Dr. Gabriel Cousins. Dr. Gupta established the Lotus Institute of Holistic Health in 2017 to provide training in integrative medicine.  Dr. Gupta, thank you so much for joining me today.

Dr. Gupta:           Thanks for having me, Dr. Weitz.

Dr. Weitz:            Excellent. So how did you get interested in studying mold and dealing with patients with mold toxicity?

Dr. Gupta:           Yeah, I actually fell into this field more or less by accident, and it really started with a personal experience of water damage to a house in that my house was flooded, and I think it was around 2012 here in the Sunshine Coast of Australia. Basically, our whole bottom floor of the house was inundated with water and we lost quite a lot of possessions and so on. But more importantly, my partner at the time became very, very unwell. She was basically in a lying around most of the day, unable to function at all.  Really, I couldn’t understand what had happened. I didn’t really have a good model for understanding that, and so I started researching, as would anyone who wants to help out a partner or a family member. And actually, a patient came in and finally told me about Richie Shoemaker and suggested that perhaps I could learn a little bit about Richie Shoemaker, and become certified, and help a whole bunch of people in Australia. And I thought, “Well, yes. I mean, why not?” I mean, I’ve got someone who’s really, really unwell from what appears to be a water damaged building, and I have nothing else I know, or you know, I had no one else I know to refer her to or no other real approaches.  I contacted Dr. Shoemaker, and it took quite a while to connect actually to start with, and there was some logistic difficulties and so on. I ended up having to do the training at around 1:00 or 2:00 AM in the morning, I think I was telling you.

Dr. Weitz:            Wow.

Dr. Gupta:           Via Skype, once a month. It was a really steep learning curve, man. It was like… I didn’t know what he was talking about to start with. He was throwing acronyms like C4A and TGFBeta1, and MSH, and MMP9, and so… And then he sent me a few thousand page documents to read. Not 100, 1000 as far as I remember. Like the WHO guidelines, and the GAO guidelines, which is the Government Accountability Office guidelines for water damaged buildings. Yeah, I mean my motivation was big enough. And that’s the thing. To get into a new area, you need motivation, otherwise I guess it’s… I guess for most physicians, if you don’t have that motivation to learn new and innovative areas, you just stay to what you know and you just tell everyone, “No. No. There’s no problem with mold.”

                                But for me, I needed to have a major life situation happen to give me enough motivation to go and really take the time to speak with Dr. Shoemaker, read a whole bunch of documents, and take the time to just make a model for myself in my head. It was a very difficult learning process, to be honest.  I think since then, I really tried to simplify the whole thing for my patients and also other practitioners, which is probably something we’ll talk about later. But it can be simplified quite a lot, and through that understanding or going through Dr. Shoemaker, I was able to offer a version of this protocol for people in Australia, and many people did find benefit, which was very heartening to see.

Dr. Weitz:            That’s great. Yeah. It definitely can be quite complicated and difficult to kind of sort through. Hey Doc, I might want to suggest that maybe if you looked up a little bit we could see your face a little better.

Dr. Gupta:           All right, sure. Yeah, no problem.

Dr. Weitz:            Thanks. When you suspected a patient may have an underlying mold problem as part of their health struggles when you’re seeing patients in the clinic, what are some of the first things that make you alert to that possibility?

Dr. Gupta:           One of the first things actually is just the fact that they’ve got what we call a multi system illness, and then I think you’re eluded to that when you’re talking about the symptoms that it wasn’t just one body system. And I think when you started talking about the symptoms, you first started off with talking about things like cough and sinus congestion and so on. And that’s what a lot of people relate to to this sort of problem you might get through mold, but that’s just really just a very superficial level you could say of symptoms. You know and…

Dr. Weitz:            Oh I’ve got the mold, I’ve inhaled it, so it’s affecting my respiratory system.

Dr. Gupta:           And yeah. I guess, pretty much anyone who’s exposed to enough mold will start getting those kind of symptoms, and that’s often just due to the colonization of the mold in the body. And even whether or not you’re genetically susceptible. However, that’s not CIRS. CIRS is when you have a whole host of bodily systems involved, and you mentioned the gut. You mentioned energy.

Dr. Weitz:            And CIRS is the Chronic Inflammatory Response Syndrome. This is this chronic sequella of…

Dr. Gupta:           Oh yes, thank you. Yes. Thank you. That’s the acronym, or even we’d even go further and call it CIRS because you get really lazy after a while. There’s many body systems involved. So if a person comes in and they say, “I’ve just got some bloating and I’ve got some diarrhea and so on.” Well, that’s not CIRS. That’s just one system. But if they say, “I’ve got some bloating and I’ve got some abdominal pain and diarrhea, but I’ve also got joint pain, and my energy’s gone, and I’m not sleeping. And I’m getting these funny rashes on my skin.” Okay, then that’s starting to sound more like it. That’s multiple systems involved.

                                Now, one of the second things, which Dr. Shoemaker doesn’t talk about as much, but it is really important is the lack of response to nutritional therapies. That’s a really important point that I’ve found through the years. And one simple thing is if basic nutritional medicine and Functional Medicine has already been instigated and it hasn’t been successful, in my view, that’s also a very strong point to the fact that there’s a lot of inflammation going on, and that’s blocking some of the pathways whereby functional medicine protocols would otherwise be useful.

Dr. Weitz:            Right, so for example a patient comes in with fatigue, and maybe you do a nutritional analysis, and you find out they’re lacking certain nutrients, and you give them some extra nutritional support, and they still feel fatigued.

Dr. Gupta:           Yeah. That’s exactly right. And so that in itself is a pointer towards it, the lack of response of other protocols. And so that’s another really important thing. And just the duration of time they’ve had it is also really important, you know? And so with patients who just come in and they’re quite new to the world of functional medicine, I will often still try simple things to start with. I look at their mineral balance, I look at their gut health, I look to see if they have parasites, et cetera. This is not the only thing I look at for sure. But the further they are along the functional medicine journey, the more I will start to look at CIRS earlier on and jump straight into that.  So if they tell me, “Look, I’ve already seen 20 doctors including 12 functional medicine doctors. I’m on the best possible diet you can ever imagine. It’s totally… I haven’t eaten sugar for 20 years. I’m not on any grains. I’m on the basic supplements.” They pull out their supplement lists, these are all the tests I’ve had. And you know, you’ve had patients who come with a…

Dr. Weitz:            Oh sure.

Dr. Gupta:           Oh yeah. The water results, that figure, or that’s kind of a clinical side of CIRS, right there. So that means to me they’ve been through the mill of the standard Functional Medicine approach. They’ve already had their gut health improve, they’ve got their diet on track. Often they’ve had their mineral balance instigated and they’ve treated things like pyroluria, they’ve really got their… They’ve got biosis working a lot better. Maybe they’ve looked at their Omega-3 and Omega-6 balance, and all these things are coming in place. But they’re still not well. That’s when you start thinking, “Okay, you’ve got an inflammatory trigger here. You’ve got a big biotoxin problem most likely that’s preventing those biochemical pathways by which Functional Medicine would usually work to actually be effective.” And that’s where often in those patients I would jump straight into evaluation for CIRS or CIRS.

Dr. Weitz:            Okay, so how do you work up your patients for that? What’s the first thing you look at?

Dr. Gupta:           Yeah, so the first thing is just simply that we discuss it. Is it a multi-symptom illness or is it more single system? The other really important things is doing an environmental history, and it takes a little bit of practice because when I first started doing this, I used to ask people do you live in a moldy building? And universally the answer to that question is, “No, of course I don’t. What do you think I am? Some kind of person who doesn’t clean their house?” It’s almost taken as an insult.  I realized one had to be a bit more subtle and start asking about the history of their home and their workplace. Firstly, how old is the building? Has there been a history of water events or tornadoes or anything like that that I guess you’d be asking about in America. We call them cyclones here in Australia. Or flooding events, has there been a flood in the area? Has there been leaks? Either of the roof, or white goods, such as a refrigerator, or a washing machine. Are they aware of any musty smells or any type of unusual odors in the house anywhere? And are there any areas of the house where they can see some patchy discoloration on the walls at all? And how about the crawlspace? How about the basement? Do they notice they don’t feel well when they got into those areas?

                            There’s a bunch of questions like that that can give some clues. Of course, that’s not definitive, but that can most definitely help. And the other big thing is how do they feel when they go away from their home for a period of time? And of course, very sick patients may well not be able to leave the house. They may not have done that for some time. But some people do travel and if they have for instance gone away from their home for five or six days, they may not have connected the dots, but they may be like, “Yeah doc actually I felt a lot better when I left my house and I went to that conference in Orlando a couple weeks ago,” Right?  These are all clues. These are clues. And so I start with that side of things. There are some more specific symptoms. One of them is more like electric shocks or a vibratory sensation and other kind of more neurological symptoms are thought to be more specific for more toxicity. And so I ask about those. Also fevers at night is thought to be somewhat of a specific one. Do they get a lot of thirst and do they have excessive urination, that’s another one that’s somewhat specific, not 100%. So that’s the first part is just the history as with any evaluation.

Dr. Weitz:            And what’s the next step after that?

Dr. Gupta:           The next step after that is getting into examination, and as much as I think the examination is excluding other possibilities. I do a nutritional examination. I look at their tongue, I look at their nails, I look at their skin. I look to see if there’s obvious inflammatory signs. Now one really important sign that you do as part of that is ask them to stretch their arms. And if they have a fine tremor like that, that might be a… that may be a sign of elevated TGF Beta1 levels. So that’s a clue. There can be other things that cause it as well.  There’s something also called dermatographia. If you can see that, for instance, if you have them sit on one of those lattice back chairs, and if they stand up and you can see they’ve still got the imprint of that chair on their back for some time, that’s also dermatographia, and that’s a sign of elevated C4A. So there is some little signs like that.

                                The other big thing is looking for do they have signs of hyper mobility. And hyper mobility or joint flexibility is part of Ehlers–Danlos syndrome and Ehlers-Danlos spectrum. And it also means that their arm span is longer than their height or their wingspan. And so you can measure that. But also just having a look at how far can they move their thumb, how far are they able to extend their wrists, and various other joints. If there’s a significant increase in the joint mobility, that’ll be a strong pointer towards an Ehlers-Danlos spectrum disorder.  Some people are not actually that hyper mobile, but they just notice they’ve always had sore joints, and they’ve just got… they’re aware that there’s a history of Ehlers-Danlos. That’s actually very, very important. There are some other subtle signs you can do like looking for signs of mast cell activation.

Dr. Weitz:            Let’s say if they have Ehlers-Danlos what does that have to do with it?

Dr. Gupta:           That is actually a risk factor, a genetic risk factor.

Dr. Weitz:            Okay.

Dr. Gupta:           And particularly, actually for Mast Cell Activation Syndrome.

Dr. Weitz:            Okay.

Dr. Gupta:           But it seems it is for CIRS as well. Because one of the things that’s being described is that their collagen in their connective tissue is less well-linked, they tend to release more TGFB to one. So it’s more likely they’re going to have a high TGFB to one, but also it’s more likely they’ll have Mast Cell Activation Syndrome, which is like a sister syndrome to CIRS. And also what we call Postural Orthostatic Tachycardia Syndrome, or POTS. So there’s a bit of trifecta where Ehlers-Danlos syndrome, Mast Cell Activation, and POTS. It just points you in a certain direction of investigation.  There’s also some specific treatments from Ehlers-Danlos, for some people are quite useful and effective. I find that very important to look at.

Dr. Weitz:            Yeah. Interesting. Increases the risk for SIBO as well.

Dr. Gupta:           Right. Yeah. That’s right.  So there’s a whole bunch… Yeah. SIBO could also almost be put into that trifecta.  There’s a really interesting recent paper actually where a patient with Ehlers-Danlos and had MCAS and POTS and SIBO, and was treated with antibiotics and intravenous immunoglobulin.  We call that IVIG, and low-dose naltrexone.  The combination of those, and it was reported that they made a complete recovery just by it.

Dr. Weitz:            Wow.

Dr. Gupta:           Yeah, which is actually quite difficult in those syndromes. So there is some interesting research going on in those, in that area. So anyway, moving down the CIRS line a little bit further. The next thing is to do what I call the Visual Contrast Sensitivity test, of the VCS test. And you can get one of those kits online from SurvivingMold.com. And patients can do that test online as well at that website, but in my opinion it’s more accurate if you have one in your office to use that in person. You get an idea and sometimes you can make some subtle adjustments to the test based on their eyesight and so on. I do believe it’s more accurate overall.

                            If they fail the VCS test, that’s quite a strong indicator that CIRS may be present. If they don’t fail it, it doesn’t exclude it. And you need to check do they have above average eyesight, that’s the most common reason that they will still pass, if they still pass the VCS test but they still have CIRS. Yeah, especially if they’re quite young and they’re in artistic and other professions. And I generally find females tend to have better eyesight in general for some reason. So that may be a reason that VCS is normal or at least a pass despite them still having CIRS.  In the cases where it’s abnormal then it becomes a very useful progress marker because you need to follow it during the treatment and make sure it goes to normal. If it’s not abnormal, then it’s not as useful as a progress marker. In some cases, it’s very useful. In some, it’s not as useful unfortunately.

                                Those things I do, and then based on those, you can actually make quite a good assessment of whether they do have CIRS or not. There’s also a symptom cluster questionnaire you can use from Dr. Shoemaker where you’re looking at symptom clusters, and if they have seven or more, you generally want to evaluate them for CIRS, but really that symptom cluster just goes to the, just speaks to that idea that it’s very multi-system. So you can actually just do that evaluation. So if it’s very multi-system and they fail the VCS, you’re already looking that it’s highly likely they’ve got CIRS.

                                And I think Dr. McMahon, Scott McMahon, did a study saying that even with those things, and he also did, added something called anti-gravity testing where you actually will push down the shoulders of the patients and found which arm fatigued first. And if it’s the dominant arm that gets fatigued first, that was called a positive test. And he found with the combination of those three signs that it was somewhere around 95% accurate for predicting CIRS. So even just that part is very useful.

                                The next thing I would usually be to order some lab work. And in a Australia, it’s not quite as simple as in America. But basically… A very simple thing a functional medicine practitioner could do would be to order a nasal swab and see if the patient has a bacteria called MARCoNS, which is it starts for Multiple Antibiotic Resistant Coagulase Negative Staph. We send that to a Micro Biology DX in a Massachusetts. And then the thing after that would be to decide if one wants to do the classic CIRS testing and-

Dr. Weitz:            What about the urine mycotoxin test?

Dr. Gupta:           Yeah, so that… I was going to get onto that in a moment. Do you mind if I first just cover the blood biomarkers?

Dr. Weitz:            Sure. Yeah.

Dr. Gupta:           The blood biomarkers are the classic way of diagnosing CIRS. And as you mentioned with Dr. Keith Bernstein’s essay, those things that he’s talking about are the blood tests. They’re the blood tests. And so what he’s saying when he’s saying the typical blood test that show the typical neuro hormonal changes of CIRS, that means there’s an increase in the inflammatory markers. So we call them, they’re compounds that fuel the fire of inflammation in the body, and that includes C4A, TGF beta 1, and MNP9. They’re available through Quest and LabCorp, and there’s very specific labs for each one that’s recommended. There’s also another called C3A, but that’s generally only raised in acute bacterial infections, and I haven’t found that to be a very useful marker overall.  And then there’s a number of different tests or hormones which are lowered in CIRS. And they’re basically compounds which put out the fire of inflammation in the body, but they’re too low. So it’s like you’re firefighters are not working. And so they include MSH and VIP and ACTH. There’s also another one called ADH or Anti Diuretic Hormone. That’s the typical pattern is that there’s a bunch of compounds that are elevated, and there’s a bunch of compounds which are lowered. Now…

Dr. Weitz:            Does anybody have a panel putting all of those together?

Dr. Gupta:           Yeah, I think Life Extension have like a panel. But they’re still only sending to LabCorp. And yeah. And so yeah generally speaking, I think, I don’t know anyone who’s put the panel of both of the… The Functional Diagnostic Nutrition group, or FDN, which I’m a part of, is looking closely at developing a panel for CIRS. And I think they now have developed a panel, which is again mainly through LabCorp, but we also have access to Quest for functional medicine practitioners. So that’s a classic thing-  

Dr. Weitz:            Okay. Can we just review those really quick one more time?

Dr. Gupta:           Yeah sure. So there’s a bunch of markers that get elevated, that includes C4A, TGF-beta 1, and MMP-9 And then there’s a bunch of compounds which are lowered, which includes MSH, and VIP, and ADH

Dr. Weitz:            Okay.

Dr. Gupta:           And so one other is ACTH. And yeah. I won’t go through which ones exactly are ordered through Quest and which ones through LabCorp because I think that just becomes too confusing. But the classics things is if you’ve got the other elements that Dr. Bernstein talked about in his essay and you have at least three or more abnormal markers, then you can make a diagnosis of CIRS. And you start people on the treatment program.

                                Now to be honest, it’s not 100% specific for mold toxicity. I want to make that clear. It really just shows that you have an activation of the innate immune system, and then you do need to do some more detective work. You do need to find out if the person does have a water damaged building, and you may want them to get an inspection of their building or at the very least, have a closer look at it. And in many cases, a very useful thing to do is to ask them to leave the home for five or seven days and do what we call a mold sabbatical. And ideally, they go camping. I guess that’s probably only amenable to certain areas of the U.S. more than others, and if they can do that, and go camping, and make sure they’re away from any water damage items. You don’t want to get them to take everything from their old house to the tent because that may be a source of exposure still.  If they feel a lot better during that mold sabbatical, and then their symptoms are reproduced by going back into their home, that’s a very strong pointer to the fact that mold toxicity is a big part of this inflammatory response syndrome that they’ve got. So that’s very important.

Dr. Weitz:            And do you recommend testing of their home for mold?

Dr. Gupta:           Yeah, I do. I mean, testing… The thing is testing has its pros and cons, and it’s not perfect, but the ERMI test, which is a form of PCR testing is quite sensitive. But again, even with the testing, it’s still only a statistical number. You still need to find out is the person themselves being affected by that amount of mold in their home. And that’s why I found the mold sabbatical is very, very useful.  And it also becomes the person’s personal experience. And there’s a couple of psychological factors here that don’t get talked a lot about a lot. But one is the fact that if the person can start to feel that they understand their body and how it’s responding to mold, I think that gives them a lot of power and feeling of, I guess off having control, having this syndrome in their… They’re able to get on top of it, basically.

                                However, if you get a test, someone gets a test that’s very, very high, often that can send them into panic. And the panic in a sense and that activation of their limbic system, that’s actually part of the whole inflammatory response. So there’s some subtle sides of it which have taken me a while to get a full understanding of. But one thing is you not only want to find out that they’ve got it and treat them, but you want to put them on a pathway whereby they start to de-escalate in terms of the panic associated with it, that there’s a sense of calm, and there’s a sense that they know what to do and they can go about doing it.  And so, so it’s a bit of a way up. But I’m moving more and more towards the mold sabbatical as a way of working out how much mold toxicity. There is a bunch of other things like looking at Mast Cell Activation Syndrome. That can actually give the same kinds of elevations and lowerings of those markers that CIRS can. So it’s very much a sister syndrome, and the treatment is quite different. And then looking for stealth infections, such as Lyme Disease and co-infections, Bartonella, Babesia, mycoplasma, those things are very, very important. Also looking for parasites of different types, and then looking for viruses and retroviruses is also very important.  There’s a whole grouping of causes, not just mold toxicity, but mold is a really important and under recognized one that’s often playing a part to some degree in most people who are chronically unwell and can’t get better.



Dr. Weitz:            Cool. I’ve really been enjoying this discussion, but I’d like to pause for a minute to tell you about our sponsor for this podcast. I’m proud that this episode of the Rational Wellness podcast is sponsored by Integrative Therapeutics, which is one of the few lines of professional products that I use in my office. Integrative Therapeutics is a top tier manufacturer of clinician designed cutting edge nutritional products with therapeutic dosages of scientifically proven ingredients to help our patients prevent chronic diseases and feel better naturally.

                                Integrative Therapeutics is the founding sponsor of TAP Integrative. This is a great resource for education for practitioners. I’m a subscribe to TAP Integrative. There’s videos, there’s lots of great information constantly being updated and improved upon by Dr. Lise Alschuler who runs it. One of the things I really enjoy about TAP Integrative is that it includes a service that provides you with full copies of journal articles, and it’s included in the yearly annual fee. And if you use a discount code Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99 for the year.  And now, back to our discussion.



Dr. Weitz:           And then would the next thing you do would be to order one of these urine mycotoxin tests?

Dr. Gupta:           Well, you can consider it for sure. And it’s actually something that’s just come onto the scene most, fairly recently. And there’s three different companies now that are offering it, at least three. Maybe there’s more by the time this podcast gets out.  But the original lab was called Real Time Laboratories, and they were using an ELISA test for looking at subfractions of the mycotoxins in the urine. And then the second lab that came out is Great Plains Laboratory, and they used a different and more sensitive technology called mass spectrometry.  And they seem to have a higher rate of positives and then now we’ve got Vibrant Labs, who’s also doing it.

                                In general, I think the test has been found to be somewhat useful by many of the practitioners. Although, again, it’s not a perfect test. And I want to really emphasize this fact. None of the tests are perfect in CIRS.  And really there’s a lot of clinical acumen that needs to go into it, and nothing really substitutes for just the clinical experience of working with people with the syndrome. So yes, you can do a urine mycotoxin test.  Great Plains is often the lab we recommend.  Some people are recommending different forms of provocation, such as using glutathione, 500 milligrams twice daily orally for a week before hand, and or sauna or hot baths. You can do that. It still hasn’t been well tested. Great Plains themselves are not really recommending that you do the provocation.

Dr. Weitz:            Yeah, in fact they’re recommending that you not do that.

Dr. Gupta:           Yeah. That’s right. That’s one little point of controversy. But I guess the problem is that some people, some of the sickest patients will be negative, and so the idea is that if you can provoke them. And you know Dr. Nathan I think is one of the advocates of that, then it’s more likely that because the problem with the really sick patients is they’re not moving their mycotoxins. They’re just sitting in the cells causing inflammation. And so that’s one of the problems with it is that a negative result may actually mean that the patient’s quite sick from mold and not able to clear it. And maybe we’ll find other methods of provocation in future.

                                But the other part of it is that you can’t totally exclude a food source to the mycotoxins that are in their urine. I think it’s very important that the person is on a very clean diet, like a mycotoxin free diet before you ask for that testing. And then if you see, and a small amount of ochratoxin, maybe up to eight or 10 is still fairly normal and I think could be put down to just overall daily exposure from food and general incidental exposure if you like. If you find that the levels are a lot higher than that and you’ve got a number of other mycotoxins, that may be a pointer to where the presence of mold toxicity, either present or past.

Dr. Weitz:            Okay.

Dr. Gupta:           Yes, that definitely is another test that can be done, and it’s interesting, but I want to emphasize it’s not perfect.

Dr. Weitz:            Right. So now what about the treatment?

Dr. Gupta:           Yeah, so once you’ve decided that mold toxicity… I’m going to sort of separate the two things. The first one being mold exposures and mold toxicity, and when I use that term mold toxicity, really what I mean is that firstly you’ve identified that they’re being exposed to mold, and there’s clearly a symptomatic response to mold. Okay?  If they’ve got mold toxicity and they’ve got CIRS, then using a modified version of the Shoemaker protocol is still quite useful. So there’s different… Basically, what Dr. Shoemaker found is that the pharmaceutical binders were the most effective. I’ll actually track back a moment first before I go onto binders. The first thing and the most important thing is that they get away from the source of mold exposure.

Dr. Weitz:            Right.

Dr. Gupta:           That’s actually the first thing. 

Dr. Weitz:            And that’s probably difficult for a lot of patients.

Dr. Gupta:           Yeah. It is. It is. And that’s why, for instance, if you get them to do mold sabbaticals, maybe you can get them to do a number of mold sabbaticals. One thing is it becomes their personal experience. And I think that’s really important. Somehow that seems to have a more beneficial effect on the psyche than just seeing like an ERMI test that’s off the charts and a urine mycotoxin test that’s off the chart because it’s sort of… It’s just… I don’t know if you work with patients that have this. It’s just something that’s quite confusing and panic inducing for them because they haven’t really necessarily personally had the experience that mold’s got anything to do with their symptoms, but their tests are saying so. So it creates this huge disparity and panic.

                                While on the other hand, if it becomes their personal experience and they go and do a mold sabbatical, they feel heaps better, they come back and they notice a reproduction, they can start to… What often happens is their sense of smell starts to improve and they start to smell it all of a sudden. Then you’re starting to get… They’re starting to get it, personally. And it’s not so much… They’re not so much in panic around it. They can be pretty confident that they’re being affected by mold and simply they understand then what they need to do is get to a place like the place that they went for the mold sabbatical. Now it may not be living in a tent, and I think that has some negative psychological effects for most people. But it means getting into a home that’s much, much safer.

                                In some cases, it may mean using air purifiers and different types of air purifiers for sometime as an intermediary step. And maybe even the new home that they get to if they’re not able to have their current home remediated, may need to have air purification running all the time. But the key is you need to basically be in a house that’s not fundamentally water damaged.

Dr. Weitz:            Right. And now you were about to say something about binders as one of the treatments. I’ve heard a number of practitioners recommend doing some sort of liver detoxification and support for bile secretion as a precursor before using binders. What do you think about that concept?

Dr. Gupta:           Yeah. I think that’s pretty sound because binders need to bind onto the bile. And if you’re not producing much bile, there’s nothing for them to bind onto, very simply.

Dr. Weitz:            Right. Now I guess there’s different kind of binders, but some of the binders are bile acid binding resins, right?

Dr. Gupta:           Yeah. That’s right. They’re more the pharmaceutical version, and as I started to say before, Dr. Shoemaker and his research team found them to be the most effective, Cholestryamine and Colesevelam was marketed as Welcol in America. But it’s actually known by different names around the place. They are generally the most effective, especially if someone is still getting exposed to mold.

                                The other method… There are multiple other binders, and some people do have bad troubling side effects from these, particularly if they have Mast Cell Activation Syndrome or multiple chemical sensitivity, they may not be able to tolerate hardly any Cholestryamine and Colesevelam, and it’s very important to start with a low dose and build up. And I think Dr. Neal Nathans kind of introduced that idea to the mold community, and I think it’s very valid. Start low, build up, and don’t go any further than a dose that starts causing significant reactions.

Dr. Weitz:            Now at the strong pharmaceutical binders are creating symptoms, might it make more sense to start with some nutritional ones first?

Dr. Gupta:           Yeah. There’s no problem with doing that. I generally don’t find they’re very effective if they’re still being massively exposed to a water damaged building. But yes, there’s basically charcoal, bentonite clay, Zeolite, and various others that have been trialed. And some people also select the binder based on the urine mycotoxin test. And generally my approach, and you could say to some degree I tend to get some of the more serious patients, but my approach has been to use the pharmaceutical binders to start with, especially in the first part of their treatment when they’re still often being exposed to quite a lot of mycotoxins. And then once their VCS test has become normal, that was the point in which the old Shoemaker protocol you would stop using binders totally, I might consider doing a urinary mycotoxin test at that point to see if it appears they still have a number of different mycotoxins in the system, and then consider having ongoing natural binder treatment.

Dr. Weitz:            So what’s your typical course of treatment for the binders? Do you start with- 

Dr. Gupta:           Yeah, so let’s say it’s six months on Welchol. Welchol’s actually my favorite now. I think it’s much better. 

Dr. Weitz:            Will you automatically say we’re going to do six months and then reassess?

Dr. Gupta:           Well no, I won’t say we’ll do six months. I’ll say let’s start this and let’s see how long it takes your VCS test to be normal and for you to be away from a water damaged building.

Dr. Weitz:            And if they say is it going to be for a couple of weeks, what do you say?

Dr. Gupta:           I say yeah, welcome to the real world.

Dr. Weitz:            Okay.

Dr. Gupta:           Wakey wakey. Unless they’re not in a water damaged building, but that’s very few.

Dr. Weitz:            Right.

Dr. Gupta:           Yeah.

Dr. Weitz:            Okay. And then do you support the liver in bile secretions in some way as part of…

Dr. Gupta:           Yes. Yeah.

Dr. Weitz:            How do you do that?

Dr. Gupta:           Well one thing I do really recommend is the use of coffee enemas.

Dr. Weitz:            Okay.

Dr. Gupta:           And that’s the main way that I use because basically when you’re doing the coffee enema regularly, it causes your gallbladder to squeeze and release bile. It’s actually been shown endoscopically that there’s an increase in bile secretion and it appears to increase glutathione or one of its enzymes, glutathione s transferase, very significantly. I actually find that to be very, very effective, and more effective than actually giving glutathione in fact.

Dr. Weitz:            Do you give glutathione as part of your protocol?

Dr. Gupta:           Sometimes. Not usually though. Not usually.

Dr. Weitz:            Okay.

Dr. Gupta:           It’s not a standard part of it. I would say if they do the coffee enemas, I would not do glutathione specifically.  I would just get them to do that, and then often if they take the binders just a little before doing a coffee enema, then they get pretty much assured that they’re going to have enough bile there for the binders to bind onto.  That’s a very useful way.  I know other methods have been used and utilized.  I don’t know if you yourself use other methods to get the bile moving.

Dr. Weitz:            Yeah.  We use herbal bitters and a lot of times we’ll use glutathione and some other liver support, milk thistle.

Dr. Gupta:           Right. 

Dr. Weitz:            I think sometimes we’ll actually do a two week liver detox and make sure they’re… Clean out some of the other toxins that might be in there and make sure their liver detox pathways are working well.

Dr. Gupta:           Yeah. I think that’s perfectly valid as well.

Dr. Weitz:            And maybe we’ll use phosphatidylcholine as well to support bile flow.

Dr. Gupta:           Yeah. I think those things are also useful. They’re just not part of my thing. But I do get them to do the coffee enemas and liver gallbladder flush which does include some of those things. And because their liver and gallbladder is often very affected by this whole syndrome.

Dr. Weitz:            How do you do your gallbladder flush?

Dr. Gupta:           Well, there’s a whole protocol, but it basically includes having some herbs for about a month first. The ones I use are the premiere research liver ND and gallbladder ND, and then get them to have apples on the morning of the… quite a few green apples, and then drink Epsom salts, and then they take a big drink of olive oil and citrus. And that gets their gallbladder just have a huge squeeze. Some people who are not well, that can be very aggressive and can make them quite unwell. For others who are strong, it can speed up their progress quite a lot. I do that from time to time, but it’s not so routine. I try and just gently, and just gently using the coffee enemas and doing gentle binders will be more tolerable for the majority of patients.

Dr. Weitz:            Yeah. Do you do some sort of gut support? And in particular, some of these binders can be very constipating?

Dr. Gupta:           Yes. Absolutely. And one of the thing is to start with is to just make sure that they don’t have a gut full of parasites, or a gut full of mold, or fungus, or candidas. And that’s really a separate problem to CIRS. So mold colonization is not something that was described in the original model of CIRS, but certainly I’ve found that some patients can colonize and have a significant fungal infection. Generally speaking, I use natural antiparasitic agents and natural antifungals to try and clear that. Sometimes there might be use of some pharmaceutical antifungals. However, I think just trying to support the gut that way and then

Dr. Weitz:            Will you do that at the same time as having them on the binders?

Dr. Gupta:           Oh yeah. Yeah. You can mix the two for sure. I mean, definitely. But you generally use a lower… To start with, as I say, you just go low and start slow. But also things like betaine HCL and digestive enzymes and so on can be extremely useful.

Dr. Weitz:            Ox bile.

Dr. Gupta:           Yeah, all that kind of thing can be extremely useful because people’s digestion is often very impaired by the inflammation that’s going on and just all of the different factors that are going on in their body.

Dr. Weitz:            Yeah. And then when do you recommend the use of vasoactive intestinal peptide?

Dr. Gupta:           Well that’s towards the end of treatment.

Dr. Weitz:            Okay.

Dr. Gupta:           You generally want to make sure they’re out of any exposure to water damage buildings, or any significant exposure I guess. It’s very hard to be 100% away from any exposure. And that they’ve been significantly bound in terms of the mycotoxins and other elements of the water damage buildings, or they’ve had enough use of binders, VCS tested normal. There’s another thing that we still look at, which is the nasal MARCoNS, which, generally, you want to have eradicated. That’s not 100% ruled out. We have found that in some patients, you can’t eradicate that easily. Using more VIP early in those patients, and co-existing it with, or co-prescribing it with the MARCoNS still present hasn’t been a major problem in our group of patients, even though that was a caution that was given by Dr. Shoemaker and his group.

                                And then the other thing, I think, it’s very important to have already addressed steal infections. And that includes parasites, that includes fungal infections in the body, and that includes bacterial infections such as Borreliosis, Bartonella, Babesia, mycoplasma, Rickettsia, Erhlichia, it’s another whole vegetable or alphabet soup.  And then also viruses and retroviruses are very important to address as well. And that’s something that’s only quite recently come into my awareness.  And so once you’ve done a lot of that, sometimes ozone therapy can be extremely useful.  Dr. Raj Patel in California really put me onto that idea that using that in patients and at that stage of the treatment can…

Dr. Weitz:            What type of ozone do you like to use?

Dr. Gupta:           Well, I just get people to get their own machine and to do their own insufflations like ear insufflations, and nasal insufflations, and rectal, and so on. And that can be a very useful adjunct, and also using herbal treatments.  In a minority of patients, we still do find we have to use antibiotics, or antiparasitics, or antivirals that are pharmaceutical. But that’s not a main…

Dr. Weitz:            What’s the treatment for the MARCoNS?

Dr. Gupta:           The treatment for the MARCoNS is generally just things like silver, an EDTA nasal spray, sometimes using botanical nasal sprays such as as the Biocidin can be quite useful. And then actually using nasal probiotics after that’s done.

Dr. Weitz:            Interesting.

Dr. Gupta:           Treating it more and more like the- 

Dr. Weitz:            Nasal probiotics. That’s a new one for me.

Dr. Gupta:           Oh right, yeah. That’s actually been quite successful. Well it’s a lactobacillus sakei product.

Dr. Weitz:            Okay.

Dr. Gupta:           So that’s something which is the strain that’s found in kimchi. So if people want to be really brave, you can put a little bit of kimchi juice in your nose but I think it burns.

Dr. Weitz:            You definitely won’t smell like anybody else.

Dr. Gupta:           So we’ve used a product called lacto sinus that contains this probiotic.

Dr. Weitz:            Oh really?

Dr. Gupta:           And get people… And that’s just like a powder. And you get people to put that on like a cotton bud and just apply that into their nasal passage.  That doesn’t seem to irritate nasal passages. Treating it more holistically now, think of it as all nasal microbiome just as we think of the gut microbiome.

Dr. Weitz:            That’s great. 

Dr. Gupta:           So we’re not as focused just on one bug. It’s more the entirety. So yeah, I think that’s very important. As I talked about, there’s other stealth infections. If you can eradicate them or at least them into a state in which they’re not causing major immune disfunction, that’s very, very useful. And then we often instigate VIP treatment at the end. One of the things about that is also to try and normalize their NeuroQuant scan, which is something I briefly spoke to you about.

                                In many of these patients, we get them to do a scan called NeuroQuant. That’s a computerized analysis of a brain MRI, and it looks at a number of different brain regions and compares them to age and sex match controls. And if they’ve got significant shrinkage or atrophy of the brain, we really want to return that to normal. It’s the same thing that they can have significant areas of swelling or hypertrophy as well. We also want to return those to a normal size as part of the treatment. We believe, and Dale Bredesen agreed with me that if they’ve got ongoing shrinkage in their brain, that could actually pose a risk for Alzheimer’s disease in the future.  That’s why in some cases I actually give VIP for several years

Dr. Weitz:            Interesting.

Dr. Gupta:           Yeah, to try and get all those brain areas normal. And then it also just helps to de-escalate any remaining inflammation that’s there.

Dr. Weitz:            This brain neuro, this MRI NeuroQuant, is this something that the average MRI lab will offer or is it only special MRI labs?

Dr. Gupta:           It’s something that an average MRI lab can offer if they want to.

Dr. Weitz:            Okay. Okay.

Dr. Gupta:           Because they have to get connected to Cortechs Laboratories in San Diego, and they have to get the arrangements in place. They need to get the settings. But basically as far as I understand, almost any MRI machine can be configured to do NeuroQuant, and they just need to get in touch with Coretechs Laboratories and be able to send their images to that laboratory and have it converted to NeuroQuant and be able to receive the results. And often, Dr. Shoemaker said it’s only something like $50 or $60 in addition to a standard brain MRI, so it’s not very expensive.  In Australia, it’s usually about $500 for the whole scan, and some people can get some kind of rebate on that, insurance rebate. It’s quite useful overall. I mean, it’s not absolutely essential, but if people can have it done, if they’ve got full-blown CIRS, it is very useful. And we want to see that their brain has come back to normal. And part of this also can be looking at brain retraining methods as well. And that can include things like the Gupta program, that’s another Gupta by the way, Ashook Gupta. That’s not me.

Dr. Weitz:            Okay.

Dr. Gupta:           In the U.K. who’s created a system, which I think is very, very useful. And I’ve been in touch with him closely, and he’s… That’s something that people can find online at TheGuptaProgram.com. There’s another one. There’s various other neuro retraining systems-

Dr. Weitz:            Wow, the Guptas are taking over the world.

Dr. Gupta:           Yeah. There was actually something called the Gupta Empire I’ve heard.  Maybe it’s coming back. If you read Indian history. Anyway.  DNRS is another system created by Annie Hopper that can be quite useful. There’s a whole bunch of other things people can do. I’m very much into people doing psycho emotional work as part of this. Often the trauma of CIRS has a very significant effect, and it can also bring up past trauma. I’m a big fan of them doing that kind of work as well. Really, we try and take a very holistic approach.

Dr. Weitz:            There’s also some protocols that chiropractic neurologists can use as well.

Dr. Gupta:           Okay. What are they exactly?

Dr. Weitz:            It has to do with eye exercises and other simple exercises that help to retrain the brain. There’s a whole program that’s been taught. The chiropractors go through this chiropractic neurology program.

Dr. Gupta:           Okay. Great. So yeah, look at all different practitioners have different tools. I think just because all of them haven’t been studied, that doesn’t mean they haven’t been studied in grandiose controlled trials, that doesn’t mean that they have no value. I think some of the other methods to help retrain the brain, and you know, this guy Norman Doidge who has the whole program, he wrote the book, The Brain that Heals Itself. Some of those methods can be quite useful. One’s also called firelight, where people put a fire infrared device in their nose, and there’s a little head. I guess it’s almost like a little helmet that delivers far infrared light to the brain. That can be also very useful for healing the brain effect. A couple of additional little pointers there that can be helpful for getting the brain back to a more normal state of functioning. That’s one of the areas that often takes a little bit longer for people.

Dr. Weitz:            Cool. Excellent. So this has been a very interesting discussion Dr. Gupta. Thank you for sharing with us. How can practitioners get a hold of you and find out about your programs?

Dr. Gupta:           Yeah, so the website-

Dr. Weitz:            Not just practitioners. Patients as well.

Dr. Gupta:           Oh okay. Yes. Patients who want to find out about our clinic, the website for our clinic is LotusHolisticMedicine.com.au. So that’s LotusHolisticMedicine with no W .com.au. And also check out my online course, which is www.moldillnessmadesimple.com. And that’s spelled the American way for any people outside the U.S. M-O-L-D madesimple.com, and you can also check out my institute at LotusInstituteHH.com. Stands for holistic health.

Dr. Weitz:            Oh okay.

Dr. Gupta:           We’re actually doing a face-to-face training here on integrative medicine in general. But really it’s about dealing with a complex and toxic patient. That’s going to be in Sydney in October. I’m very, very excited about bringing in some of the new insights. I’m dealing with these complex patients to some of the practitioners of Australia.

Dr. Weitz:            Cool. Excellent. Great. Thank you so much and I’ll talk to you soon Dr. Gupta.

Dr. Gupta:           Thanks for having me Dr. Weitz.




Type I Diabetes with Lyle Haugen: Rational Wellness Podcast 118

Lyle Haugen discusses Type I Diabetes, 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. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]


Podcast Highlights

8:15  Lyle talked about how he took a job working on an oil drilling rig and he got blown up, shortly after which he was diabetic.  He was living in camp and he was drinking milk or juice because the water was so highly chlorinated and because of the Muskeg, the water has a tea color.  He was drinking a lot of milk, which he knows he shouldn’t be eating, and a lot of bread, pastries, and sandwiches, which increases the likelihood of leaky gut and of diabetes. Lyle explained that newly diagnosed diabetics still can produce some insulin and if you can identify them and intervene with diet and lifestyle change, you may be able to reverse some type I diabetes.  He believes that if you can interrupt the autoimmune attack on the pancreas that leads to type I diabetes, you can potentially stop the damage and allow the pancreas to heal and start producing more insulin.

18:50  Of the four variables (insulin, diet, exercise, stress management) that we need to manipulate to help manage patients with type I diabetes, the first one is insulin.  The normal pancreas is constantly putting out small amounts of insulin to match what is needed.  The old system of trying to match the amount of insulin with the amount of carbohydrate in the meal and having the two curves match perfectly doesn’t work very well, according to Lyle.  The best thing to do is to first have a good long-term, background level of insulin and Lantus is the best for this.  With the standard diet that was recommended for diabetics, which was 50-60% carbohydrate, he was consuming about 50-55 units of insulin per day.  This much insulin tends to make you fat and is bad for your health.  Lyle said that the same goes for non-diabetics–anything that spikes your insulin will make you fat.  He found himself to a low carb diet out of necessity, since he was working a job in the back country in the oil and gas business.  Lyle had to pack his food for a week or so and he brought a bunch of energy dense foods like pulled pork and smoked salmon and did not bring any bread.  He increased his basal insulin (the Lantus) and he did not need very much short acting insulin.  Now his diet is about 60% fat, 20% carbs and 20% protein.  And diet is the second important variable to control.  Lyle explained that you don’t want too much protein, since this can convert to carbs, and since diabetics have a higher risk of kidney problems, too much protein could stress out your kidneys.  By taking less insulin, Lyle dropped 35 lbs. If you want to gain weight, take more insulin. He now takes 36, 37 units of lantus and only has to take maybe 2 units of short acting insulin per day if he doesn’t do his walk in time or eats something he shouldn’t. He maintains his blood sugar levels in the range of 70-110 and after a meal it will drift to the low side of 140 and then drop back down.  His last A1C was 5.7. It used to be 13.2, which is not where you want to be. That’s when you get all those side effects of diabetes.  Lyle preached the importance of testing your glucose multiple times per day whether you are a type I or a type II diabetic and not just in the morning, unless you use a continuous glucose monitor.

29:01  The third variable for type I diabetics is exercise. Lyle said the key to exercise for diabetics is that they need to do about the same amount and intensity of exercise every day, and you have to be careful not to do too much.  He finds about 30 minutes of walking daily to be an easy amount to fit within your reserve capacity.  If you want to do some higher intensity, longer duration exercise, such as doing an hour of weight training or a high intensity exercise class, it is an advantage, since all of these different muscles utilize glucose and you even upregulate the GLUT-4 receptors.  You don’t want to have a roller coastering of your blood sugar and insulin if you do it inconsistently.  If you are using a lot of short acting insulin, sometimes you will get pockets of insulin that were not absorbed that will be pushed into the blood stream by the exercise, thus lowering sugar levels too much, so you have to be careful with such higher intensity and longer duration exercise. This is especially the case if you are relying on a lot of short acting insulin.  The same thing can happen if you get into a hot tub or sauna. 

33:20  The fourth variable for managing type I diabetes is stress, which Lyle described as the wild card.  He explained that one way to help stabilize the food is with the high fat breakfast shake he developed that contains hemp hearts, avocado, and three different nuts (usually pecans, walnuts, and Brazil nuts) and that shake is usually all he needs to eat for 6 hours.  Here is the recipe: The Shake. Because it is a high fat, low carb shake, it is like a timed release of energy and allows him to have a nice flat line of insulin without any snacks. Most of the carbs in the shake come from blueberries.  He also has a high fat cracker recipe that he makes with pumpkin seeds, sesame seeds, chia seeds, and sunflower seeds and he will often have a few of these crackers with some almond butter and this will take him to dinner.  Dinner will consist of a piece of well-sourced protein and at least half a plate of greens and some fermented veggies like sauerkraut or pickled cauliflower or broccoli. This helps to make your gut healthier, which also helps in managing diabetes.

45:15  One of the sources of stress for diabetics is trying to get their blood sugar to stay stable through the night, so Lyle has developed an energy bar that he often eats at night. If your glucose goes too high at night, you lay awake at night, tossing and turning and sweating and with leg cramps. If your blood sugar goes too low during the night, you’re drenched in sweat and in full blown shock. This is what stimulates your adrenaline and cortisol stress response.  Without the bar, his blood sugar will tend to drop some time during the night. Lyle said that he like GABA for type I diabetics since many are in sympathetic mode and often have anxiety.



Lyle Haugen is a Type I diabetic and a registered nutrition health coach.  He also suffered with some of the associated conditions of type I diabetes, including eye problems, Crohn’s Disease, and diabetic gastroparesis. He realized that in order to get his health back on track, he had to figure out a way to manage his condition better than it was being managed by his health care providers. Lyle developed a system to manage his insulin, diet, exercise, and lifestyle factors to get his type I diabetes under control and he has been teaching others as a health coach. His website is Type I Simplified.com where you can get a free report to learn how to sleep through the night, including a recipe for his delicious snack bar that helps you maintain stable blood sugar.

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 or go to www.drweitz.com.


Podcast Transcript

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. For those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple Podcasts and give us a ratings and review. I’d really appreciate that. That helps move us up in the rankings and more people will find out about the Rational Wellness Podcast.  You can go to my YouTube page, Weitz Chiro, and see the video version of this podcast, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Our topic for today is type 1 diabetes, and we have Lyle Haugen with us today. I’m very excited, this is the first time we’ve talked about type 1 diabetes. We’ve talked several times about type 2 diabetes and insulin resistance, but we’ve never had a detailed discussion about type 1. We’re going to discuss what type 1 diabetes is and how best to help patients manage it from a diet, exercise, and lifestyle perspective.  For most of us in the functional medicine world, we are likely to see quite a higher percentage of patients with type 2 than type 1 diabetes, because only about 5% of diabetics have type 1. Type 1 diabetes used to be known as juvenile diabetes, but it’s better described as insulin-dependent diabetes. In this condition, the pancreas produces little or no insulin. Insulin is the hormone that signals the muscle cells to pull sugar from the bloodstream to enter the cells to use for energy.  It’s generally understood to be an autoimmune condition, and while it usually appears during childhood or adolescence, it can develop in adults. The cause of type 1 diabetes is controversial, though it is generally thought to be autoimmune in origin. 90% of those with type 1 diabetes have at least one of the HLA-DQA1, HLA-DQB1 and the HLA-DRB1 genes.

There’s some relationship between type 1 diabetes risk and both gluten and dairy intake. For example, there’s an increase in type 1 diabetes risk in countries that drink, primarily, A1 milk, as compared to A2 milk. Viral infections appear to be triggers for the onset of type 1 diabetes in a percentage of patients. Exposure to toxins may be triggers for the onset of type 1 diabetes, and some integrative doctors feel that vaccines may be triggers, though the studies so far don’t seem to show this. Children with type 1 diabetes tend to have less diversity of the bacteria in their gut, and they also tend to have leaky gut.

Type 1 diabetes has quite a number of possible complications, especially if the blood sugar levels are not properly managed. Diabetic retinopathy is the most common cause of blindness. Diabetes can lead to nerve damage referred to as neuropathy, sometimes leading to impaired sensations in the hands and feet. This is why diabetes is the leading cause of amputation of the feet. Diabetes increases the risk of high blood pressure and heart disease. It increases the risk of digestive problems and erectile dysfunction. Diabetes is also the leading cause of kidney failure.  Helping to manage a patient with type 1 diabetes is quite a bit more difficult than managing a patient with type 2. Patients are all taking insulin, and hypoglycemia, low blood sugar, is as much of a concern as hyperglycemia, which can occur, but it is less common in type 2 diabetics until they start needing to take insulin. Then they become more like type 1 diabetics to manage.

Lyle Haugen is a type 1 diabetic and registered nutrition health coach.  He also suffered with some of the associated conditions of diabetes including eye problems, Crohn’s disease, and diabetic gastro-paresis. He realized that in order to get his health back on track, he had to figure out a better way to manage his condition than it was being managed by his healthcare providers. He developed a system on how to manage insulin, diet, exercise, and lifestyle, to get his type 1 diabetes under control, and he’s been teaching others as a health coach.  Lyle, thank you so much for joining us here today.

Lyle Haugen:                   Thank you so much for having me, Dr. Weitz. How are you?

Dr. Weitz:                        I’m good. Lyle, can you tell us when you first discovered that you had type 1 diabetes?

Lyle Haugen:                   Well, I was 22 years old. I was just back from dive school. I went back to work in the oil and gas industry, I spent most of my early childhood and young manhood in northern Canada. I was about 15 miles from the Northwest Territory’s border. I opened the building, one day the building blew up. I was flown out of there. Two, three days later, the numbers on the house across the street started to get fuzzy.  I was urinating frequently, my thighs were burning, because the bathroom was upstairs in the little apartment that I had. Every time I had to urinate, I had to walk up a set of stairs. I was thirsty and, what do you do when you’re thirsty? In those days, I don’t know if you remember this, this was 1984 or five, we didn’t have bottled water, and in northern Canada the water was highly chlorinated, so you drank everything but water.  What did I drink?  Well, apple juice.

Dr. Weitz:                        There you go.

Lyle Haugen:                   Smart Lake Tractor. I think my first initial reading when I finally … but I knew what it was, because when I was down going to dive school, I took the secondary course. It was quite intensive and I became a diver medic. When you’re in a diving situation, I’m trained to 1000 feet plus on mixed gases. Even though you’re on a ship and you’re really not that far away, technically, you’re a half an inch of vessel material away from being outside. You might as well be halfway to Mars, because it’s 28 days to get out of there.

Dr. Weitz:                        Oh wow.

Lyle Haugen:                   28 days-

Dr. Weitz:                       Wow.

Lyle Haugen:                   … and that’s if you decompress smoothly.

Dr. Weitz:                        Wow, that’s crazy.

Lyle Haugen:                   Well, yeah, and it could be longer. It could be 33, 35.

Dr. Weitz:                         Wow.

Lyle Haugen:                    They trained guys to, basically, be almost the hands of a doctor inside. I was trained to suture, do tracheotomies,…, reinflate lungs, pretty cool stuff. Pretty cool stuff. It was the middle of winter when I got done. I had a job lined up in the Bull Fort. They were starting to do some drilling up there and the new Canadian laws mandated that there was a diver medic on every shift.  There was, basically, three people would run in the bell. There was always an extra person in the bell.  Along comes another job I have to take, get some money.  This is where I get blown up, to make a long story short. How did that relate to my diabetes?  Well, let’s do a little bit of a lifestyle.  You’re living in camp.  Remember I talked to you about the water. It’s even worse when you’re out in camp because, you don’t put milk in the coffee, because it turns green. If you ever been in the back country…

Dr. Weitz:                        I’m not sure what that means, I’m not sure I want to know.

Lyle Haugen:                   If you’ve ever been in the back country, and you maybe haven’t, where there’s… like there’s muskeg up in the country where I live, which is like a bog.

Dr. Weitz:                       There is what?

Lyle Haugen:                   Muskeg, it’s called.

Dr. Weitz:                        What is that?

Lyle Haugen:                   Tundra. Muskeg.

Dr. Weitz:                        Okay.

Lyle Haugen:                   It’s just like bog or peat material. All the water is kind of tea color to begin with, and that’s what they used to… We didn’t have very good work standards back in those days.

Dr. Weitz:                         Okay.

Lyle Haugen:                    I was drinking a lot of milk, and I’m in my early 20s, I shouldn’t be drinking milk at all, but I’m drinking a lot of milk. I’m eating a lot of bread. They’ve got a lot of pastries out. You’re taking sandwiches for lunch. You see where this is going, right?

Dr. Weitz:                         Yeah.

Lyle Haugen:                    You mentioned it in your preamble there, you talk about leaky gut, and that’s my biggest thing. My biggest passion would be to get a hold of brand newly diagnosed diabetics, because I remember what it was like. I remember it was this honeymoon period once I got the insulin in me a little bit, and it’s stable, and it stabilized a little bit, and that, I believe, is our window. If we could totally change the diet, right at that point, I think we can rescue some of the pancreas. How do you feel about that?

Dr. Weitz:                        Yeah. I agree. Some of the data definitely seems to show that, at the beginning, type 1 diabetics still have some ability to secrete insulin, it’s just not enough.

Lyle Haugen:                   Right. Right. If we go with the same premise that we’re an autoimmune-

Dr. Weitz:                        Right, and if you could interrupt that autoimmune attack on the pancreas…

Lyle Haugen:                   Exactly, but on the other hand, if we don’t, then you end up with that grocery list that you told everybody about that I got.

Dr. Weitz:                        Right. Yeah. For example, we know that coeliac disease is associated with type 1 diabetes, but kids who have coeliac disease, who completely eliminate gluten, don’t get type 1 diabetes.

Lyle Haugen:                   Right. I have a client that had… first diagnosed with lupus, then type 1.

Dr. Weitz:                        Very common, you get one autoimmune disease, you get another.

Lyle Haugen:                   But I think it’s only common because we’re not stopping the leaky gut.

Dr. Weitz:                        Right.

Lyle Haugen:                   Statistically from genetics, what I’ve read is, if you’ve got 1, it’s almost astronomical statistically to get 2, from genetics.

Dr. Weitz:                        I think you’re right. Definitely, it’s the leaky gut and then, once the immune system starts getting in that attack mode against your own cells, a lot of times there’s cross-reactivity. Your body reacts to the gluten, and then that gluten molecule looks similar maybe to some proteins in your pancreas, and so that those same antigens start attacking your pancreas.

Lyle Haugen:                   Or even maybe this vision, I had this vision of what’s large is small and small is large. If you are continually expressing proteins into your system, and your immune system is battling the battle of all times, Armageddon, there’s going to be collateral damage.

Dr. Weitz:                        Yes.

Lyle Haugen:                   There’s got to be. You just can’t be pummeling yourself that hard for that long.

Dr. Weitz:                         Absolutely. You’re not supposed to have those large molecular weight proteins floating around in your bloodstream. You’re going to create problems.

Lyle Haugen:                    That is, I think, part of the underlying problem with the management and the treatment for type 1. We’ve got, what is it now, I think I read 135 or 137 specialties now in the medical field. Everybody out there, visualize yourself chopped up into 137 pieces, right?

Dr. Weitz:                        Sure.

Lyle Haugen:                   It makes it difficult for anybody to find the whole picture of the whole package with that.

Dr. Weitz:                        I’m the GI doctor. I only look at the guide. I’m the one guy, only look at the lung.

Lyle Haugen:                   Yeah, exactly. Actually, my doctor, kind of a funny story on that, I asked him, “Why didn’t you specialize in it?” It turned out he had an eye condition from birth and he had to wait till he got to adulthood before they could do anything with it. He was actually in med school at the time, and he was thinking about being an ophthalmologist.  Then he found out that there was two or three different types of ophthalmologists. One for the front, one for the back, one for center, I believe. He was aghast. He just couldn’t believe that. I don’t know, it’s a shame. But anyways, getting back to why-

Dr. Weitz:                        So you think your trauma actually played a role in the trigger for your diabetes?

Lyle Haugen:                    Well-

Dr. Weitz:                         I mean, I know it’s hard to … yeah.

Lyle Haugen:                    … short answer, yeah. Would you like me to describe what happened?

Dr. Weitz:                         Yeah.

Lyle Haugen:                    All right. Let me see. It was 42 below that morning. I got into a rubber tired backhoe. I drove 52 kilometers to this location, well site. It was what’s called a dehydrator building. There’s some big pipe towers on one side, there’s a fire on the other end and what’s called a re-boiler. There’s circulating glycol.  What it does is the glycol removes the moisture from the natural gas coming up out of the ground and then it’s dry going through the pipeline, so it doesn’t freeze off the pipeline. That’s the equipment. I get there in the rubber tired backhoe because, remember I was talking about muskeg and tundra?

Dr. Weitz:                        Yeah.

Lyle Haugen:                    The unit was sitting on piles, on steel pilings, but the pad had sunk and took the stairs with it. You’d get to the top of the stairs and then you still had to reach straight up to get into the building just to undo the latch. I first get there, and my job as an operator is see what the unit is doing and make sure everything, record numbers, do all that kind of stuff. I get there and I reach up.  I tried to get into the building, I take one glove off, reach the hardware, open the door, reach inside, grab the panic hardware on the inside of the door, the big bar across the door. Inside here onto the sill, pull myself up, and just as I pull myself, I catch a glow, a little orange flash glow from the backside of the re-boiler. What had happened was the building was completely full of gas, the glycol had disappeared, because of a problem with the system. The pump was running away, it cracked a line. That’s what put gas into the system. The re-boiler lost all the glycol. We had a run away. We had a Chernobyl come in on here.

Dr. Weitz:                        Wow.

Lyle Haugen:                   All I had to do was give it the old O2. You’ve got to visualize this now, it’s 42 below. I’ve been on this back hoe, which in 1985 was not heated and not like you see today. It wasn’t a comfortable ride. I had all kinds of equipment on, I was dressed to take 40 below. There was just a bit of my face and the back of this hand, this hand was exposed.  That orange glow, I knew exactly what it was as soon as I caught it and it just went… It basically went off. If you [inaudible 00:15:49] this. I started to turn around like this, but I had all these clothes on and I’m standing in front of it. It’s a three-foot door, but everything that could pretty much block this door. I mean, what’s the first thing you do before you put a cannonball in a canon? You put some wadding in there.  I was like the wadding around, and I was just standing in the door jam. Well, Dr. Weitz when that thing lit up, I took off. It punched the wind right out of me.

Dr. Weitz:                        Wow.

Lyle Haugen:                   I’m flying through the air. As I’m flying through the air, the flames are coming past me like this, because I don’t travel as fast as they do. I mean, it was shooting straight out of this door. It was like literally being shot out of a cannon.  And because the floor was so high, it was probably, I would say eight, nine feet above the ground. You could do the math on that, but I landed halfway between the building and where the wellhead was drilled, which was 80 feet, so 40-something feet before I-

Dr. Weitz:                        Wow.

Lyle Haugen:                   Then I went in, and I closed all the valves. You get into that adrenaline mode, panic mode, right?

Dr. Weitz:                        Yeah.

Lyle Haugen:                   Because you just had this experience, and even walked right in behind the dehy, like four feet from a wall that was in flames, and I closed the pipeline valve. I closed all the valves off, so nothing ran away. Then I had to get back into the backhoe and drive back 52 kilometers.

Dr. Weitz:                        Wow.

Lyle Haugen:                   But, that’s a whole other story.

Dr. Weitz:                        Okay.

Lyle Haugen:                   That’s how I got blown up.




Dr. Weitz:                        I’ve really been enjoying this discussion, but now I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office.

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Dr. Weitz:                        Now, back to our discussion. Let’s get right into it. What are the four variables that we need to manipulate to help manage patients with type 1 diabetes?

Lyle Haugen:                   Great question. First thing we got to stabilize the basal, the background insulin amount. If you analyze what a normal pancreas does, it constantly exudes a little bit of endocrine. It’s always managing constantly. It’s a very fluid thing. It’s changing every second of every minute. To manage all of the metabolism in the background, when I first started, we didn’t have a good background insulin. We didn’t have a good long-term, sustaining, flat-lining insulin, I call it. We now have Lantus and that does really well, but prior to that we had too many curves that we had to follow and, literally, you’ve got to be a math pro.

If you don’t understand geometry, if you don’t understand mathematics, good luck on trying to meet the amount. How many years did it take to be able to have one missile coming from this country and another one from here and shoot it down? That’s what you’re doing when you’re putting carbs into your system and then taking some insulin. You’re hoping the two curves are going to meet exactly at the same time, and they rarely ever do. They never do in a person that’s not diabetic, that’s eating high-carb content, right?

Dr. Weitz:                        Yup.

Lyle Haugen:                   What is good for people that aren’t diabetic is good for the diabetics and vice versa? That’s where I learned how to manage that insulin, so we stabilize that blood sugar levels. I’ll give you an example. I used to be on about 24 units of background or basal insulin. Every meal you do the carb counting or calculating or choicing, whatever the system was of the day, because they always come up with a new system that never works. Sorry, I’m a little cynical here on this, but it didn’t, it never worked.

Dr. Weitz:                        Right.

Lyle Haugen:                   If you can visualize, you’ve got sort of a flat line going along and then you’ve got these peaks of ingested carbohydrate that you’re supposed to get, this curve that doesn’t look anything like the curve that the peaks of the absorption rates are here. You’re trying to get all that to coordinate it and you’re switching it every meal, every time. So,… 

Dr. Weitz:                        Let me just help people who don’t know what we’re talking about. Type 1 diabetics have to try to manage your blood sugar and part of that is, you try to match insulin to the amount of carbohydrates that you’re consuming. You’re using a certain amount of long-acting insulin to try to have some ability to control your blood sugar, but not too severely. Then you’re using a shorter-acting insulin that you’re trying to time with the amount of the carbohydrates that you’re consuming with that meal.  Correct?

Lyle Haugen:                   Correct. You nailed it. You nailed it. Much better explanation than I did. Thank you.

Dr. Weitz:                        Okay.

Lyle Haugen:                   When I took a total value of all the insulin I was consuming in a day, you’ve got 24 here, you’ve got some for this meal, some for that meal. We’re looking at like 50, 55 units a day. The standard diet that was always taught to every diabetic, and here’s the bad part, whether you’re type 2 or type 1, back in the 80s and 90s and into the 2000s was about 50 to 60% carbohydrate. That’s what killed my mother, because that came out in the early 70s when she got diagnosed, right?

Dr. Weitz:                         Right.

Lyle Haugen:                    Horrible. We didn’t know that, we rely on the professionals. I didn’t know.

Dr. Weitz:                         Right, and that was pretty much the story until pretty recently.

Lyle Haugen:                    Until very recently.

Dr. Weitz:                         With the Diabetes Association, right?

Lyle Haugen:                    Exactly, and they’re still a little reluctant to come out with it, because they’ve been on the wrong track for so long. It’s been horrible when, if you go back and you study a little of the history, they were on track right about the time they were discovering insulin, because they knew back then a ketogenic diet you could stay alive a little bit longer. Right?

Dr. Weitz:                         Correct.

Lyle Haugen:                    Not a whole bunch longer, but you could definitely get a little bit better. There was a few guys back in the 20s that worked in conjunction with insulin and still that same diet, because they weren’t sure how the insulin worked yet. Roll ahead to today, now we’re a lot smarter. The interesting thing is, in the area I was at, we had no internet. I didn’t have access to any of this stuff seven years ago.  Ironically, I stumbled on this on my own. I just went out to work one day, I had the new job. I was going to be gone for seven or eight days, running this unit 24 hours a day. This kind of the business of the job that I had, I needed to pack all my food. I just took that particular trip, everything that was energy dense. I took some pulled pork, I had some smoked salmon, I took a couple of things here and I left out all the bread, all the stuff that I would require short-acting insulin for.

I just sat there out in the middle of nowhere, kids, don’t do this at home, because I had nobody around me to help me. Then, I just slowly started to jack up my background insulin. If you took an accumulation of my insulin at that 50 mark, I figured, well, at some point, if I take out that high peak with the carb, I can take some of that carb, jack up the oils over here, use a moderate amount of protein, because I already know if you take too much protein you’ll need insulin for it, because it breaks into carb too, right?

Dr. Weitz:                        Absolutely. Gluconeogenesis: the body will convert protein into carbs.

Lyle Haugen:                   And all diabetics are running the risk of a little bit of a kidney issue, so we shouldn’t over-protein ourselves anyways, so just stay at a moderate level. 20% is, I think, pretty good. It seems to be good for me. In doing that, you’re able to control the meal, so that gets into number two, which is talking about the diet program. You switch from a 60 whatever the heck it was, 5% fat, I think and 3 to 5% protein.  I don’t know, it was a weird diet. Now, what I am, a pretty much 60, 20, 20 as far as macros are concerned and that’s just fats to proteins to carbohydrates. But if you combine them right, then you can stretch that out, which means then you can raise up your basal insulin to the amount where you have a consistent amount exuding into the system. Example, I’d take 36, 37 units of Lantus a day instead of my previous 50 total.

Dr. Weitz:                        The less insulin you take, the better it is for you-

Lyle Haugen:                    I dropped 35 pounds.

Dr. Weitz:                         Yep.

Lyle Haugen:                    They’re directly proportional. You want to gain weight, take more insulin. That’s it. That’s simple. You want to lose weight, back off on the insulin, and it works the same in non-diabetics. Whatever’s spiking your insulin, stop it.

Dr. Weitz:                        Right.

Lyle Haugen:                   That’s the best thing that I’ve seen in everybody, because that was the thing, after I figured out what was going on with me, people was like, “What are you doing,” because I looked horrible, Dr. Weitz.

Dr. Weitz:                        Let me get this correct. Now that you have it, you self-stabilize, you don’t use any short-acting insulin?

Lyle Haugen:                   Only if I get a little silly or if I don’t take my walk in time or… We’ll get through all four things here, but I have a little bit of short acting on the side, but I rarely take more than two units additional a day.

Dr. Weitz:                        Okay.

Lyle Haugen:                   The reason I only do that is because now I’m in a range where I’ll take a unit if I’m 135, even though that’s normal range to everybody.

Dr. Weitz:                        Now, what’s your target range you’re trying to keep your glucose in?

Lyle Haugen:                   Me? Well, counting the numbers, four to six, seven, and yours would be about 70 to 110, 115.

Dr. Weitz:                        70 to 110, even after a meal?

Lyle Haugen:                   No, they’ll probably drift to the low side of 140.

Dr. Weitz:                        Okay.

Lyle Haugen:                   Right?

Dr. Weitz:                        Right.

Lyle Haugen:                   They’ll drift to the side, about 140, but then they’ll pop back down.

Dr. Weitz:                        You’re saying 70 to 110 is like in between or away from meals?

Lyle Haugen:                   Exactly. My last A1c was 5 7.

Dr. Weitz:                        That’s great.

Lyle Haugen:                   It’s just on that edge of being classified as a diabetic, but I used to be 13.2, and that’s just not the place you want to be either.

Dr. Weitz:                        Absolutely.

Lyle Haugen:                   That’s where all that bad stuff you were talking about-

Dr. Weitz:                        Now, how do you monitor your sugar? Do you prick your finger, or do you use a continuous glucose monitor?

Lyle Haugen:                   Great question. They’ve just been approved in Canada. We’re a little behind everybody.

Dr. Weitz:                        Oh, is that right?

Lyle Haugen:                   We’ve never had the option, so I still prick my finger, and that was the one thing I did. Had I had a… that was not very good English… A CGM would have been really nice seven years ago when I turned myself into a guinea pig and a bio hack, right?

Dr. Weitz:                        Right.

Lyle Haugen:                   Because that’s what I did to myself, but I was testing 10, 12 times a day to figure this out, because you need to be able to establish a trend. I think the worst advice is a little off track, but all the type 2s that are out there listening to this, you need to test more than once a day, and morning’s not always the only one.

Dr. Weitz:                        Oh, absolutely. It’s just hard to get them to do it.

Lyle Haugen:                   Fair enough. Fair enough, but if you can get that correlation between… Look, if you do this and you know where you’re at… If you went on a trip, wouldn’t you have a little plan of where you were headed? You know?

Dr. Weitz:                        Absolutely.

Lyle Haugen:                   If you don’t check the map and correlate, “Oh, am I there now? Okay, now we’ve got to go here,” you know?

Dr. Weitz:                        Right.

Lyle Haugen:                   You got to plan this stuff out a little bit. Getting on with our, we talked a little bit about the diet, this is number two, if you want to move on to that. The third thing now is-

Dr. Weitz:                        I do want to get more into the diet.

Lyle Haugen:                   The diet? Okay.

Dr. Weitz:                        Yeah.

Lyle Haugen:                   Good.

Dr. Weitz:                        Let’s go ahead and continue. The third thing is what, exercise?

Lyle Haugen:                   Exercise, and it doesn’t have to be crazy. It’s just got to be consistent. 

Dr. Weitz:                        Right, the same amount, and intensity, and do it every single day?

Lyle Haugen:                   Yeah, every single day. You can change up the intensity a little bit. I mean, there’s a little bit of a burst. All I’m talking about is walking and then hit a hill.  30 minutes seems to be a good number, because you’re not going too far with a diabetic. If you look at it this way, and I look at it from my petrochemical background and engineering background, your blood sugar level, between low and high, is a tank.  That’s your tank amount. That’s your reserves. Then, beyond that is your level and your muscles, and all that kind of stuff, but when you’re on insulin, and especially if you’re on short-acting insulin too much, that tank disappears like that if you’re not managing it right. That’s why I love doing a long-acting basal. I just take one shot a day, Dr Weitz. Just one.

Dr. Weitz:                         That’s great.

Lyle Haugen:                    Some of my clients, they like two. I have them on a split Lantus, that allows them to change it up a little bit, but they love the same thing too.  Getting into the food now, I’ve developed a couple of recipes that…

Dr. Weitz:                         Hang on a second. On the exercise, let me just poke you a little more on that. What if they wanted to do an hour of exercise, would that be more beneficial?

Lyle Haugen:                    Absolutely. We could get into…

Dr. Weitz:                         If they do some…

Lyle Haugen:                    Anything that’s muscle resistant.

Dr. Weitz:                        Right. Isn’t it an advantage to working the different muscles in the body since they all utilize glucose?

Lyle Haugen:                   Well, they do. What you’re also going to do is you’re going to up-regulate your GLUT4 receptors. The challenge with that is, if you do it inconsistently, then you suffer from rollercoastering because, all of a sudden you up-regulate your GLUT4s, and you’re taking too much insulin.  If you do it consistently, you can finally back off on your insulin to a point where it’s going to start to match, but then once you quit doing that, then you have to up-regulate your insulin because as you lose your receptors, you don’t uptake the glucose as easy. Great question.

Dr. Weitz:                        You think it is an advantage to do a longer exercise session and, potentially, adding resistance training with, say, the walking, as long as you do approximately the same amount every single day?

Lyle Haugen:                   For example, myself, I really target on everyday walking 30 minutes and then, addition to that, I play pickle ball. I do that about three times a week, and I typically play an hour and a half to two hours doing that. I’ve rarely have come out of that with having to deal with the blood sugar. That’s the beauty of it. Before, this is something that maybe a lot of type 1s won’t… They’re scared to exercise and I know.

Dr. Weitz:                        Because they’re worried that their blood sugar will get too low.

Lyle Haugen:                   Well, if you look back to number one with the insulin regime, if you’re stacking a bunch of… that three meals a day, a whole bunch of short-acting insulin in there, not all of it absorbs, and then you start moving and then you get these little pockets of insulin start exuding into your system. You can prove this by saying another thing, I found this out by stepping into a hot tub, that’s a great way to have a low blood sugar on that other insulin regime.

Dr. Weitz:                        Is that right?

Lyle Haugen:                   Oh yeah. All of a sudden all of them little pockets of insulin that maybe haven’t absorbed yet throughout the day, they’re everywhere. It was like clockwork, five to seven minutes, I’d have a little blood sugar and hot up. Now I take one twice a day, because I’m on that nice stable insulin and that just helps soothe the muscles. It’s hydrotherapy, So it’s wonderful that way.

Dr. Weitz:                        Okay, cool. I want to go more into the diet in a few minutes, but maybe we could talk about number four, which is stress.

Lyle Haugen:                   Yeah, that’s the wild card. Now we’ve got to number four, any of the mathematicians out there, that’s a whatever you call that, quadratic formula, right?

Dr. Weitz:                        Yeah.

Lyle Haugen:                   You’ve got four variables, and just to pick on my best past regimes that were recommended to me, when you change all four variables all the time, how do you get a calculation? You’ve got to stabilize one to actually run the numbers.

Dr. Weitz:                         Correct.

Lyle Haugen:                    That’s where I stabilized the insulin in front. Next thing we’re going to do is, we’re going to stabilize the food in the sense that we’re going to mix it, so that it slowly releases any of the carbohydrates available over a longer period of time. Greater quantity of oils, which you need insulin for as well. You need a little bit of insulin for all of that, but it stabilizes everything.  The shake that I developed, I can get, on eight ounces of this, six hours before I have to refuel. I’ll be at a four or five, 80, 90. Eat that shake, I’ll drift up to about a 130, back down, six hours later, I’m down to about 90. I never used to be able to go six hours without having to have two snacks in between that, because you had the insulin doing this all the time. That’s just one example. By the way, that shake is a great way to get people off wheat.

Dr. Weitz:                        What shake are we talking about?

Lyle Haugen:                   Oh, I had sent you that. I actually just…

Dr. Weitz:                        No, I know that. I’m just…

Lyle Haugen:                    I just-here, sorry. I just call it a breakfast shake. We can come up with a name for it at some point in time. I’m not terribly creative that way. I just call it a breakfast shake. It contains some really good ingredients like hemp parts, avocado, three different nuts. I use, usually, pecans, walnuts, Brazil nuts.

Dr. Weitz:                         Basically, these are all good sources of healthy fats.

Lyle Haugen:                    Absolutely, great fiber too. Right?

Dr. Weitz:                         Right.

Lyle Haugen:                    Believe it or not, when you look at the numbers on this thing, I think it rings out at like 550 or ’60 calories, if you’re looking at it from a caloric point of view.

Dr. Weitz:                         Correct. Yeah.

Lyle Haugen:                    But it’s like a time release, and that time release works in perfect conjunction with a nice flat line of insulin, so everything in your background metabolic is getting taken care of. Your incoming digestion is getting taken care of and things are getting tucked away nicely where they’re supposed to be and there’s no rollercoastering going on.

Dr. Weitz:                        That’s because glucose enters the system, causes a blood sugar spike, then you have to have the insulin to bring it down, and fat takes a long time to break down, and digest, and get turned into energy, so you get a much slower increase of energy over time.

Lyle Haugen:                      Exactly, exactly, and you don’t have that… For years, Dr. Weitz, the only time I ever saw a 90 or a 100 was either on my way to five or on my way to 50. It was like going like this. I got a client right now in North Carolina and she’s so grateful right now, but she’s about, I just sent her week number five, but it blew her away, and she was just diagnosed two years ago. She had been through three different endocrinologists. She’s on a CGM.  She was taking Lantus and short-acting insulin, but she described it this way. She said, “You’d look at my CGM and it looked like a heartbeat, the way the blood sugars were going up and down.” She said, “And then I met you and it just flat lined.” I went, “Well, if I was a cardiologist, I wouldn’t have used that.” I wouldn’t use that example, but for blood sugars, that’s fantastic.  Literally, she would show me her graphs.  She was drawing like 80, right through the night, steady, you know?

Dr. Weitz:                        Right.

Lyle Haugen:                   She’d never been like that before.

Dr. Weitz:                        When it comes to diet, is ketogenic the best diet, paleo, how low should we go on carbohydrates?

Lyle Haugen:                   Well, if you’re looking at 20% and if you go by the 2000, I don’t eat that many calories a day, to be honest with you. I don’t think I eat more than about 1500, because I really don’t need it and I don’t think any of us really need it. Depending on what kind of work we’re doing.

Dr. Weitz:                        It depends upon your metabolic rate.

Lyle Haugen:                   Yeah, and it depends on what kind of work we’re doing. For me, I don’t need that much, but I would guess carb wise if you were looking at a number, it’s going to be higher than keto. Keto gets a little tricky with us, because we really have to be a lot more into that. Up-regulate those GLUT4 receptors, be out lifting weights, be out grunting, and for quite a period of time. If you’re willing to do that, it’s a great way. Then you can really, you can probably go for… If I did that, I could probably drop to 18 units.

Dr. Weitz:                         Wow.

Lyle Haugen:                    If I did a lot of that, but I’m 57 and not really in the mood to do that much anymore. I love playing pickle ball, because it’s social and it’s fun. I like exercising when there’s a laugh to be had.

Dr. Weitz:                        Yeah.

Lyle Haugen:                   I don’t like exercising just for the sake of having a hard workout. It’s just not my style. I’ll do it for my health, absolutely, but you know what I’m saying?

Dr. Weitz:                        Yeah. I’m a gym guy. I love going to the gym. I’ve trained with weights for decades and decades. I need 3000 calories, or I lose weight.

Lyle Haugen:                   Well, yeah. That’s a great example. I don’t have to do that much anymore.  Also, I don’t know.  I don’t know how much different our age is, you look quite a bit younger than I am.

Dr. Weitz:                        I just turned 61.

Lyle Haugen:                   Oh, well, see?  There’s a plug for you.  I don’t have any hair anymore.

Dr. Weitz:                        I appreciate that.

Lyle Haugen:                   That went by, but no, that’s fantastic. I think that’s probably the thing that really has to ring out the loudest is, I don’t really know if I look 57 either. Especially, when you know that I’ve been diabetic for 35 years.

Dr. Weitz:                        Right. Yeah, diabetes…

Lyle Haugen:                   That’s how they do aging, is with diabetics. They do rapid aging with diabetics. That’s how they do… 

Dr. Weitz:                        Absolutely.

Lyle Haugen:                   Anyway, so talking about number four.

Dr. Weitz:                        Give me an idea of your… what do you have in the morning for breakfast?

Lyle Haugen:                   Okay. I have a shake. That’s typically what I have. Usually six days a week I’ll have a shake in the morning.

Dr. Weitz:                        What are the carbs in the shake, is fruit in there or not?

Lyle Haugen:                   Yeah, I’ve got berries in there, typically. I get most of my carbs from berries, so usually blueberries.

Dr. Weitz:                        That’s one of the lower glycemic, higher phytonutrient fruits.

Lyle Haugen:                   High antioxidant, ORAC, whatever they call that level. Right through the roof. Up here I get wild Canadian ones. Well, they’re little tiny blueberries. They’re just really tiny, but they just explode with flavor. I put about a two inch piece of banana in there, half an avocado, and then those nuts, coconut or coconut milk. I will put a little bit. I use those little, what do you call, a bullet kind of thing, or a NutriBullet?

Dr. Weitz:                        Yeah. Yep, yep.

Lyle Haugen:                   It’s about 16 ounces. That’s two servings. When I build this thing, I’ll try to get the avocado, so the pit pole is up and then I just fill that with a little bit of maple syrup.

Dr. Weitz:                        Okay. There you go.

Lyle Haugen:                   That’s how I do all that. I came from, pardon me, I’m going to digress for a second. All my previous teaching was you had to weigh all your food. You had to do all this stuff, and by the time you got your meal, it was cold and horrible. For everybody out there, never eat a piece of protein bigger than the size of the palm of your hand without your fingers and thumb and cut off the wrist. Same size.  That works well for almost everybody. Never eat more than that for a meal. I was taught this, you take that, that’s the size of your stomach right there. You only have so much acid resting waiting in the stomach. I found, me the less protein I ate, the more benefit I got from it.

Dr. Weitz:                        So that’s your breakfast and then…

Lyle Haugen:                   Yeah, then that’ll take me five or six hours.

Dr. Weitz:                        Okay.

Lyle Haugen:                   I’ve got a cracker recipe that I use. It’s just four seeds. It’s really easy. It’s just pumpkin seeds, sesame seeds, chia seeds, and what’s the other one, pumpkin seeds, sesame seeds, sesame seeds, chia seeds. Those are the four, right?

Dr. Weitz:                        Right.

Lyle Haugen:                   Is that the four? The chia is going to stick it together. It’s just like a half a cup of each and one cup of water, is the ratio. It’s a real simple ratio. Spice the thing, cook it for about an hour and a half at about 300.

Dr. Weitz:                        Yeah. Yeah, I’ve seen some of those at the market.

Lyle Haugen:                   Oh, they’re great. They’re real low carb. If you have a cookie sheet of those and you cut it into 24 pieces, they’re less than four grams of carbs. I’ll have a couple of those maybe with some almond butter, and believe it or not, that carries me for enough hours to get to suppertime.

Dr. Weitz:                        Okay.

Lyle Haugen:                   Then that’s typically when I take my shot, so then that’s when I have, from that time before I go to bed, that’s when I have the little bit bigger curve and the Lantus. That’s also my bigger meal, too.

Dr. Weitz:                        What’s dinner look like for you?

Lyle Haugen:                   Usually a piece of protein, well-sourced. Fish a couple of days a week. I do still do pork, but I get raised pork a couple of miles from the house, so I even see how they’re being raised. Oh yeah, that’s why I moved here. We’ve got the same thing with beef, but beef doesn’t agree with me anymore, so I don’t do beef.

Dr. Weitz:                       Okay.

Lyle Haugen:                  Some people are like that, I don’t know. Maybe I got that bug where beef doesn’t taste good, wasn’t it? Wasn’t it that you get bit by a bug, or… ?

Dr. Weitz:                       I think I did hear about that, yeah.

Lyle Haugen:                  Yeah. Beef doesn’t taste good anymore, or something, right?

Dr. Weitz:                       Right. Yeah.

Lyle Haugen:                  I think there’s something like that. I’m not sure if that’s it, but it just doesn’t digest well is what I’m getting at. And it is hard to digest, right? We’ve always known that.

Dr. Weitz:                       Right.

Lyle Haugen:                  But there’s, at least half a plate of greens. I’m big on fermenting. I make a lot of sauerkraut or pickled cauliflower, broccoli-

Dr. Weitz:                       Kimchi.

Lyle Haugen:                  Yeah, exactly. Change it up. Put a little ginger in there, put a little garlic in there. Variety, lots of colors is what I try to go for.

Dr. Weitz:                       Yeah, fermentation is good for the gut bacteria.

Lyle Haugen:                  And you know what it’ll do? I believe, and we should do some research on this, or somebody should, that the lactobacillus and that will actually lower your blood sugar. Because what does it do? It likes to eat sugar.

Dr. Weitz:                       Yeah, that makes sense.

Lyle Haugen:                  If you study the process of how fermenting works, the salt water brings out the moisture. It’s got a little glucose with it. They proliferate, way they go.

Dr. Weitz:                       There you go.

Lyle Haugen:                  But balancing the gut, I think that’s where a lot of confusion comes for a lot of people, is why can’t they balance their blood sugars? When this isn’t right, you never will.

Dr. Weitz:                       Right.

Lyle Haugen:                  You never will. It’s going to be too many variables. There’s going to be too many surprises.

Dr. Weitz:                       Are there any carbohydrates with that dinner or just… ?

Lyle Haugen:                  Not usually. Because, then what I do is then I go to the evening-

Dr. Weitz:                       Right. And then one of the issues for diabetics is, if your blood sugar gets too low in the middle of the night, you might have trouble sleeping and-

Lyle Haugen:                  It disrupts everything. Whether you’re high or whether you’re low. If you’re high, you’re going to be laying awake, toss and turn and sweating, leg cramps, that kind of stuff. If you’re low, well, you’re low. You got to do something about it. So, now you’re awake, right?

Dr. Weitz:                       Right.

Lyle Haugen:                  You’re awake and in the fridge and doing something about it, and depending on how low it goes, because every time you go low, if you’re just in a shallow low, you won’t trip number four. You won’t trip an adrenaline event. You won’t work your way down to the hypothalamus and be in lizard mode. But if you get low enough in the blood sugar, there you go. You’re just drenched in sweat, you’re in full blown shock. Because that’s what it is, is shock. Shock is shock. Doesn’t matter whether insulin causes it, or you cut your arm off. It’s the same shock.

Dr. Weitz:                       So, how do you make sure that your blood sugar stays as even as possible through the night?

Lyle Haugen:                  Well, that was one of the miracles I came up with. I developed a bar recipe, and I have that on my website. It’s a free download. It’s a free report. That thing is wonderful. It’s, once or twice, you’ve got to build it, and then you’ll get comfortable building it, but it’s marvelous. People eat the thing and they go like, “Diabetics supposed to eat that?” Well, it does. It’s got like a cup of honey in there. Actually, by the time you get the topping and everything else done, there’s about two cups of honey and maple syrup combined in the whole thing. But it’s a huge bar. It’s a huge recipe. It’s about three inches by a half an inch. I eat two of those at night, flat lined my sugars right through the night.

So, there’s a lot of nuts and seeds in that. There’s ham parts again. There’s coconut shredded, there’s coconut oil, holds it together. I use cacao, cocoa butter, and either honey or maple syrup for the chocolate topping. Did I get everybody with the chocolate topping? That usually stops everybody. I had them with the chocolate topping. But, it’s wonderful. It’s decadent, but it’s not, because you make it with your own hands. It’s the minimalist of ingredients and the maximalist, if I could use that word, of nutrition. People that aren’t even diabetics, when I feed them that bar, the next day they talk to me they’re like, “You know, I had the best sleep last night.” Just think about it. What’s the body doing when asleep?

Dr. Weitz:                       If you didn’t have that bar, what would happen to your blood sugar during the night?

Lyle Haugen:                  Well, being on-

Dr. Weitz:                       Let’s say you just had dinner, and then you went to sleep three hours later.

Lyle Haugen:                  I would eventually have a low. So, that’s the deal. You’re pre-filling the tank in a slow burn.

Dr. Weitz:                       Right. Now, what if you were just to consume some fat at that point, do you think that would be as good or not necessarily? You have to have some of the carb in there.

Lyle Haugen:                  Yeah. It’s good to have a little bit of everything, I think. But definitely, you’re looking at that 60% mark of fat, and probably that 20% of carbohydrate. Between that, and the protein or fiber, let’s not forget that.

Dr. Weitz:                       Right.

Lyle Haugen:                  And that being kind of part of the carb, obviously, but if you stretch that with that load of oil in there, you really flatten that thing out. There’s no spiking going on. And that’s how this all comes together. If you can get a flat line of insulin and a flat line of… or a slow increase, almost like a swell of an ocean, right?

Dr. Weitz:                       Right.

Lyle Haugen:                  Then, that’s great. And then, you were talking here earlier too, the fourth thing is these adrenaline events, right?

Dr. Weitz:                       Right.

Lyle Haugen:                  What happens when they come along?

Dr. Weitz:                       Yeah. So, when you’re under stress and then your body secretes cortisol.

Lyle Haugen:                  Your gut shuts down. All bets are off, man.

Dr. Weitz:                       Right.

Lyle Haugen:                  All bets are off at that point. I found that out when I was diagnosed with the gastro-paresis, because I wasn’t really having those kinds of things. But I’d take a shot, I’d eat, 40 minutes, 50 minutes later I’m having a low. And that was back when I was eating a lot of carbs, and I’m like, “What’s going on here?” Well, nothing was moving. That’s an interesting thing to deal with, because now you’re full, now you’ve got to eat more.

Dr. Weitz:                        Yeah. Wow.

Lyle Haugen:                   Because you’re still full. You can’t really eat anything anymore, but now you got to eat more. And then by the time you do that to get your sugar to come up, well then the other stuff finally goes, moves through and digest.

Dr. Weitz:                        And so the gastro-paresis has to do with stress, you said, or… ?

Lyle Haugen:                   Well, it can be partially stress, but mostly that’s from long-term mismanagement of blood sugar levels.

Dr. Weitz:                        Okay.

Lyle Haugen:                   So, the gastro-paresis is a condition where the muscles, the peristaltic muscles-

Dr. Weitz:                        Yeah, the motility of the gut.

Lyle Haugen:                   They get weak.

Dr. Weitz:                        Yeah. I treat a lot of patients for SIBO, IBS SIBO, and motility problems are a major contributor to that.

Lyle Haugen:                   Yeah, and I think wheat’s a big contributor to that, like white bread. It just doesn’t want to move through. It just won’t move. It’s like squeezing toothpaste.

Dr. Weitz:                        Well, it’s actually an autoimmune condition where you get cross-reactivity and it ends up attacking the nerves and the structural proteins that control that motility.

Lyle Haugen:                    I did not know that. Thank you.

Dr. Weitz:                         Yeah. Actually, Dr. Pimentel came up with a test for that auto-immune factor.

Lyle Haugen:                    Oh, wow. Okay.

Dr. Weitz:                         It’s an anti-vinculin, anti-cytolethal distending toxin serum test.

Lyle Haugen:                    Boy, that’s a mouthful.  Okay.  Have a couple of toddies and try saying that. It sounded like you’re from Scotland.

Dr. Weitz:                         So, you had this decreased gut motility-

Lyle Haugen:                    Right.

Dr. Weitz:                         So then, even though you consume the meal, your carbohydrates weren’t getting into your system and you had low blood sugar. Wow. So, that was really hard.

Lyle Haugen:                    Oh, it’s a management nightmare. I had been in business most of my life, and I had my own business in the oil industry before I had this premonition, and basically let’s move on and changed fields here five, six years ago. In that industry, there was just that background, always on stress, always on call. When you went, like I was telling you, when I figured this out, I was gone for eight days straight, 24 hours a day. I would sleep in the unit that was my truck. Oh by the way, this unit that I built was… Here’s the irony. I developed a process for cleaning natural gas dehys, that thing that blew up.

Dr. Weitz:                        Yeah.

Lyle Haugen:                    I developed a process to fix the reason why it blew up.

Dr. Weitz:                        Interesting.

Lyle Haugen:                   It was a cleaning system that I developed that I would go around and basically sit on the units for days cleaning up and filtering their glycol, and getting everything clean and removing oils and balancing pHs and all those kinds of things. So, chemistry was kind of my deal, which was kind of an easy carry over into this.  If you don’t understand the chemistry, it’s a little mind boggling.

Dr. Weitz:                       Yeah. Boy, that must have been some exposure to a host of chemicals.

Lyle Haugen:                   Well, that could be the whole other factor, too. Back in the 80s I probably bathed in methanol more than once.

Dr. Weitz:                        Oh Wow.

Lyle Haugen:                   It’s 40 below out there. Things aren’t working, you take the gloves off to work, you can’t work on anything else. We didn’t have rubber gloves in those days. You had the leather gloves and if it got too fine and it was too small to work, you just took them off and you worked with it. We worked with xylene, and toluene, and all these things that would melt waxes, and things that you shouldn’t be pelting in your body probably, too. We’ll just leave it at that.

Dr. Weitz:                        Exactly.

Lyle Haugen:                   It was a dangerous industry for deadly toxins. Now the thing about getting on to the stress, you can have that long-term stress is what I was saying, running my own business, you have that long-term, constant stress, that background continual burn, you’re going to have a really hard time managing your sugars, because you’re going to end up lifting your basal rate up to a point to tolerate that, and then, if you get a good day, you’ll be riding low.  Developing strategies, I do that with my clients, help them develop strategies, and how to work with those… I find for the immediate thing, GABA’s wonderful.

Dr. Weitz:                        Okay, cool.

Lyle Haugen:                   Even as a prophylactic, I’ve got one client who would take one, because associated with, I think all diabetics, especially type 1, is huge anxiety, because we’re almost in the sympathetic mode all the time.

Dr. Weitz:                        Right.

Lyle Haugen:                   Because, if you think about it from a metabolic point of view, if you’re above range, you’re freaked out. The body is freaking out. A lot of people, here’s a little tip for everybody out there, a real quick one, if you’re hungry, check your sugar, you’re probably high… period. And if you’re high, why are you eating? Just take a little bit of insulin and wait it out, and prove me wrong that you’re not going to get satiated, and ill guarantee you, you drop below eight, you’ll be like “Oh, I don’t like that guy anymore.”  That’s the way it works. If you live between 70, 140, you’re never ever hungry.

Dr. Weitz:                        So what are some of the other things you can do to manage stress besides GABA?

Lyle Haugen:                   Well, you know that walking works really well. Getting out in nature. Don’t take yourself so serious sometimes.

Dr. Weitz:                       Yeah. They call that forest bathing.

Lyle Haugen:                      Well, the thing is, we’ve got a lot of stuff to do in the day just to actually exist, right?

Dr. Weitz:                         Yeah.

Lyle Haugen:                      And I think this is the hardest disease that ever preyed upon people that are disorganized, because it’s hard on them. The poor people get it when they’re five, six, seven years old. I didn’t get it until I was in my 20s. I already knew a little bit of lifestyle, what I wanted to do, it was nice to pick up, and go, and do this whenever you felt like it, but you don’t get to do that anymore.  You’ve got to plan stuff. You’ve got to work on things, so there is a lot of extra time, and that weighs on people a lot. I think that builds a lot of anxiety. That builds a lot of resentment. I think every type 1 diabetic, regardless of how it’s brought on, is in a mild form of PTSD. Depression runs rampant in our field, and I think some amino acid therapy is somewhat helpful in that. I believe we’re in this rollercoaster, and all we’re doing all the time is we’re taking insulin, we’re taking sugar to counteract the insulin that we took, and where’s the nutrition?

Dr. Weitz:                        Yes.

Lyle Haugen:                   We’re not getting any of the proper amino acids when we’re chasing the high blood sugar, to low blood sugar, to high blood sugar, and obviously dipping into the donuts isn’t really going to give you amino acids, but you really want one when you’re down in the low blood sugar, it looks pretty good at that time, right?

Dr. Weitz:                        Yeah, and amino acids can be precursors for serotonin, and dopamine, and…

Lyle Haugen:                   You bet. Yep.

Dr. Weitz:                        Really

Lyle Haugen:                   And that, getting into the sleep-

Dr. Weitz:                        Depression, and anxiety, and everything, yep.

Lyle Haugen:                   Right, and then we get into that sleep. That all night sleep report that I have covers a little bit of all of that, and it’s really mostly about trying to get into good blood sugar balance, because if you’re running the bed, and you’re high, you’re just going to toss and turn all night.  IF you don’t have the right balance going in and you get a low, you’re going to wake up. You’ve got to get those blood sugars balanced, and if you fix this, you know what it’s like, you’ve seen it. It always amazes me. It always amazes me.

Dr. Weitz:                        Yeah. So, this has been a great podcast Lyle. I appreciate you providing us a lot of interesting strategies, and ways to think about how to manage type 1 diabetes. How can our listeners get a hold of you and find out about some of the things that you offer?

Lyle Haugen:                   Oh great, thank you. Type1simplified.com, that’s my website. Download the free report. Great information for the sleep, and if anything, the chocolate energy bars.

Dr. Weitz:                        When are you going to market those? When are you going to put those on the market?

Lyle Haugen:                   Everybody asks me that, and-

Dr. Weitz:                       You’ve got to put those on the market. You have to.

Lyle Haugen:                   The problem is, when you try to put them on the market, you’ve got to change the formula sometimes to satisfy the industry, for market conditions.

Dr. Weitz:                        Maybe, maybe not. There’s bars that are in the refrigerated section of some of the market…

Lyle Haugen:                   I see that now. I don’t know, you may have something there. Try them, please, try them. Try them out. Let me know what you think of them. Pass them on to your clients.

Dr. Weitz:                        How do we get the recipe for the bars?

Lyle Haugen:                   It’s in that free report.

Dr. Weitz:                        Okay.

Lyle Haugen:                   Okay, and my shake is on the website. There’s a little article that I just wrote, and I just recently got the website up, so I don’t have a lot of articles in there, but it’s about ibuprofen and either having the shake in the morning. It’s a little story about pickle ball.

Dr. Weitz:                        Oh, okay.

Lyle Haugen:                   I had some friends that, she was taking a lot of ibuprofen, and her and her husband, they were visiting town, they were pros in pickle ball. They were coming for training, and teaching, and stuff, the instructors. I fed them a shake in the morning, and then we’re down playing, and about an hour later I hear them giggling, and laughing, and he’s like “Why are you shooting out?” She goes “I don’t know, I’m loose.” All of a sudden, they were over hitting shots because they didn’t have that inflammation anymore.

Dr. Weitz:                        I think you put some tumeric or something in there, right?

Lyle Haugen:                   There’s tumeric, there’s cinnamon to help your insulin work a little better, increase the efficacy of it. There’s a little bit of everything there. I put iodine in there. It’s kind of my carry all for… And then the winter time, this is a quick one if we can get this out, vitamin D, folks, for diabetics, got to have vitamin D.

Dr. Weitz:                        Are there a set of supplements that you like to use for type 1 diabetics?

Lyle Haugen:                   Vitamin D, magnesium, GABA, 5HTP.

Dr. Weitz:                        Okay.

Lyle Haugen:                   The 5HTP is a precursor to serotonin. Take that in the morning, and then when the blue light shuts off, we get our melatonin from that. That’ll help your sleep, and if you’re really stressed out, take a GABA.

Dr. Weitz:                        What do you think about some of the blood sugar stabilizers that we typically use for type 2 diabetics? You know, the supplements, and if things like chromium, you mentioned cinnamon, vanadium, lipoic acid…

Lyle Haugen:                   Copper and zinc is very important. Everything in proportion. Everything in the ratios that it’s supposed to be. I think that would be great. Again, we get back to this. I think most of us, being in the condition that we’ve gotten to at that point, are nutritionally deprived, so if we can get most of it from the diet, great, but up front, when they’re not feeling good, I think they need that little help. What do you think?

Dr. Weitz:                       Yeah.

Lyle Haugen:                   I think they need that extra supplementation.

Dr. Weitz:                        Absolutely. I think it would be helpful.

Lyle Haugen:                   Yeah, for sure.

Dr. Weitz:                        Good. Awesome. Thank you, Lyle.

Lyle Haugen:                   Thank you, doctor.