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Reversing Type II Diabetes: Rational Wellness Podcast 174

Dr. Candice Hall speaks about Preventing and Reversing Type II Diabetes with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

2:32  Dr. Hall defines type II diabetes as a condition when people cannot get glucose into their cells, so glucose backs up into the blood. So much glucose leads to a lot of circulating insulin, which leads to the cells resisting any more insulin entering. It will eventually damage the blood vessels and the ability to get oxygen and nutrients to the organs, eventually leading to organ failure. There are a lot of factors that can contribute to causing diabetes 

 

 



 

Dr. Candice Hall is Doctor of Chiropractic and a leading Functional Medicine practitioner in Orange County, California. She is the founder of Next Advanced Medicine and Natrueal Products and she has written 2 books, The True Diabetes Solution and The True Thyroid Solution. Her website is NextAdvancedMedicine.com.  

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.

 



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest and cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.  Hello, Rational Wellness Podcasters, thank you so much for joining me again today. For those of you who enjoy the podcast, please give us ratings and review on Apple Podcast. If you’d like to see a video version, go to my YouTube page. And if you go to my website, you can see detailed show notes and a complete transcript. That’s drweitz.com.

                                Today, our topic is how to prevent and reverse type 2 diabetes with Dr. Candice Hall. Diabetes and pre-diabetes are epidemic and increasing in the United States and around the world. According to the CDC 2020 statistics, 34.2 million Americans or 10.5% of US population are diabetic and 88 million folks have pre-diabetes or 34.5% of the population, which means that 45% of Americans have either diabetes or pre-diabetes. And I suspect with the coronavirus pandemic that this rate is increasing.  I heard the CEO of Kellogg’s on CNBC at the end of April bragging about how increasing numbers of Americans are eating cereals like Frosted Flakes and Fruit Loops for dinner as well as breakfast. Isn’t that great? Diabetes is associated with serious complications including heart disease, stroke, blindness, kidney failure and lower leg amputations. Diabetes is now the seventh leading cause of death in the United States.

                                Dr. Candice Hall is a leading functional medicine practitioner in Orange County, California. She’s a founder of Next Advanced Medicine and Natrueal Products.  She’s written two books, The True Diabetes Solution and The True Thyroid Solution. Thank you so much for joining me, Dr. Hall.

Dr. Hall:               Thanks for having me, Dr. Weitz. I’m really impressed with what you’re doing. So, I feel privileged to be here.

Dr. Weitz:            Very good. Why don’t you explain what is type 2 diabetes?

Dr. Hall:               Type 2 diabetes essentially is when people cannot get glucose into their cells. And so as a result, the glucose backs up in the blood … glass on the blood vessels and eventually destroys them and destroys the ability for oxygen and nutrients to get to the organs. And so, organs slowly fail. It’s just not a good way to die.

Dr. Weitz:            Now, a lot of people define diabetes as a state of insulin resistance. Is that how you see it?

Dr. Hall:               No.

Dr. Weitz:            No?

Dr. Hall:               A resistant to insulin for sure, but their answer and I shouldn’t say no. Certainly, the cells are resistant to insulin. So an insulin, for those of your listeners who don’t quite understand, I know that you have a large functional medicine population-

Dr. Weitz:            Perhaps you could explain the process by which somebody ends up with type 2 diabetes.

Dr. Hall:               I think they might find interesting is there’s quite a lot of different things that lead to type 2 diabetes, but essentially, think of yourselves as having a doorway for insulin and the insulin has to open the door, and that’s what lets the glucose in. Well, sometimes there’s so much circulating insulin, it’s kind of like a key when you wear out a lock by using a key over and over and over again, the key doesn’t work anymore.  And so, essentially, that’s what’s happening to the cells with insulin is you just … The insulin can’t open the door because the key doesn’t work anymore. And so, the body is then having to produce more and more insulin-

Dr. Weitz:            Well, isn’t that which commonly meant by insulin-resistance?

Dr. Hall:               Yes. When I hear people understand that my patients say things like, “Well, my doctor says I don’t make enough insulin.” The lay person commonly hears insulin resistance in the same manner that they hear, “I don’t make enough insulin,” which those are very different things.

Dr. Weitz:            “I don’t make enough insulin” is late stage, after years of having too much insulin circulating around?

Dr. Hall:               Yes. So what most type 2 diabetics don’t realize is they’re making so much more insulin than someone like you or I who does not have that problem. So much insulin that eventually, they can actually wear out their pancreas and even become a type 1 although that’s not common. The other thing that happens is by the time they start injecting insulin, as you know when you put hormones into the body and then your body can stop producing its own and that can be problematic as well.

Dr. Weitz:            Of course, that’s why the most common drug for type 2 diabetes is metformin because it’s a drug that increases the cell sensitivity to insulin.

Dr. Hall:               Supposedly.

Dr. Weitz:            Supposedly? You don’t think it does that?

Dr. Hall:               Well, there’s a lot of studies out about insulin and the consensus seems to be they don’t really know how metformin really works, which is a little disturbing.

Dr. Weitz:            That it’s touted as an anti-aging drug too as well as the most popular medication for diabetes.

Dr. Hall:               It is. But there is also research that it damages the mitochondria, because I have patients who are not diabetic and want to take it as anti-aging and they asked me if I give them that. I do not. I like mitochondria.

Dr. Weitz:            Personally, I take Berberine, which is this sort of natural form of metformin for anti-aging purposes.

Dr. Hall:               Very much so.

Dr. Weitz:            So what is pre-diabetes?

Dr. Hall:               Pre-diabetes is essentially the same thing. The numbers are not just as high. There’s really not much difference between pre-diabetes and diabetes. What that means is that you’ve turned on the problem. I mean oftentimes, if they really put in some habit-changing, change the way they’re eating, they can get those numbers down.   What we seemed to see is once you turn on that disease, there are deeper things at play than just diet. It’s always diet-exercise, diet-exercise, but we’ve had patients, hundreds of them, who’ve dieted, exercised, lost a 100 pounds and the A1c goes up two points. It’s a very frustrating disease. There’s a lot more underneath diabetes than just diet and exercise.

Dr. Weitz:            Why is diabetes so prevalent today? Why is it increasing?

Dr. Hall:               Well-

Dr. Weitz:            Especially in the US.

Dr. Hall:               A loaded question. So certainly the standard of American diet, what we call the SAD diet plays a role. There’s a lot of sugar and so, too much sugar in the body can create insulin resistance. But there’s lots of studies showing that air pollution is very connected with type 2 diabetes.  Mold illness, biotoxin illness, there are genetic factors when someone cannot detoxify the body well that lead to diabetes. So there’s a lot of different reasons why the numbers are going up.

Dr. Weitz:            Does obesity lead to diabetes?

Dr. Hall:               It certainly can, yes.

Dr. Weitz:            Do you think saturated fat plays a role in diabetes?

Dr. Hall:               I think anything that creates inflammation that … Remember diabetes happens at the cellular level. If your cells are inflamed, then the receptors on them don’t work very well.

Dr. Weitz:            When you get a patient and comes into your office with pre-diabetes or diabetes, what are you thinking about as you’re doing the consultation with them, what their root causes of their diabetes might be?

Dr. Hall:               Well, I start by just asking them when did they get it. I do like to see if there’s a family history of the disease, but that’s not nearly as important to me as their environment and their habits. Are they a truck driver? Are they sitting in smog every day? Are they commuting on the 405 Freeway? Are they working in a carpet factory? What is their environment and what kind of toxins are they around? That’s one of my first questions.  I always like to see where they grew up, if they grew up somewhere on a farm where there was a lot of pesticides. Did they have a lot of antibiotic use? Those are areas where I start. I like to see if they have a thyroid problem. Thyroid problems can lead to diabetes and vice versa. So those are the types of questions I like to start with.

Dr. Weitz:            As well as their history, you’ll look at what their eating and their lifestyle, their exercise?

Dr. Hall:               Yeah. But we always assumed that the diet has to be improved. It’s rare that I’ll meet a diabetic who’s really eating a good diet. But I do meet diabetics that have really cut their calories or tried intermittent fasting and it’s not working for them. And those are the patients that you have to dig deeper on.

Dr. Weitz:            What is a good diet for a diabetic? Is there a good diet?

Dr. Hall:               It’s funny that you ask me that because you see-

Dr. Weitz:            Does it depend on a person?

Dr. Hall:               It does actually depend on the person. We got to take out inflammatory foods like sugar, dairy. We’ll look at taking out those types of foods, grains, if needed but we always test the patient because there’s a lot of research around the fact that when you eat certain foods that your immune system doesn’t like that you make antibodies, blood sugars will go up anywhere from three days to 12 weeks from one exposure to that food.  The immune system plays a large role in the elevation of blood sugar as well.

Dr. Weitz:            It sounds like you’re placing an equal importance on toxins as you do for blood sugar?

Dr. Hall:                Well, when you’re looking at the-

Dr. Weitz:            Most people when they talk about diet for diabetes are saying, they’re advocating a ketogenic diet or super low carb diet or some specific diet that it has a direct effect on glucose regulation or insulin sensitivity.

Dr. Hall:                That’s a good comment. What I would say is there are patients who do really well on a ketogenic diet and there are patients that don’t do well at all. If I have a biotoxin patient, meaning they have been exposed to a toxin and they carry a particular gene where they can’t rid the body of the toxin. Now, these are living toxins, things like mold, Lyme, certain types of bacteria.  Then I put that patient on a keto diet. They’re already not processing their fats correctly. And so, the cholesterol just goes up and the blood sugar does not come down. It depends on the patient. There’s not a single one of our patients who’s on the same diet. I have to look deeper at the patient and find out which diet we’re going to put them on.

Dr. Weitz:            What’s your workup? Somebody comes in your office with diabetes or pre-diabetes, how do you decide what tests you’re going to run?

Dr. Hall:                Let’s say, obviously, you’re not diabetic. You look very healthy. But let’s say you were diabetic and you come in. I get your history and based on that history, I would determine which tests to do. So let’s pretend that you’re someone who’s … Well, give me a scenario. That’d be a fun way to play it. Give me a hint of diabetic.

Dr. Weitz:            I’m a 50-year-old guy who’s been eating standard American diet, really haven’t had a lot of time for exercise. I was exercising a little bit but I stopped during the pandemic. I work in the tech industry, but yet I’m having rising hemoglobin A1c and my doctor wants to put me on hemoglobin. He wants to put me on metformin and my blood sugar is like 98, my fasting blood sugar. What would you do?

Dr. Hall:               You mean like 198? That person’s blood sugar is at least 198 if they’ve been eating through COVID especially Frosted Flakes. Well, that’s an easy workup. That’s really easy. And then when you say you work in the tech industry, are you in front of a computer all day?

Dr. Weitz:            Yeah.

Dr. Hall:               And then I’d be asking you how do you sleep? Do you sleep well at night?

Dr. Weitz:            Yeah, I get a full four hours.

Dr. Hall:               Four hours. So do you wake up in the middle of the night or you only sleep four hours every night and then you get up and go to work?

Dr. Weitz:            Yeah. But I don’t have time for any more sleep.

Dr. Hall:               Okay, so you’ve been sleeping four hours. There’s no helping you and I would just stop.

Dr. Weitz:            We’ve had a lobotomy.

Dr. Hall:               So certainly it’d be very difficult. People who work nights have a massively increased risk for diabetes because how it switches their hormones, the hormones that regulate Circadian rhythm play a huge role in regulating blood sugar. If someone is only sleeping four hours a night, I’m going to go in on that first.  And then I’m going to look at their hormones especially even though you’re male, you make estrogen. We’d look at testosterone levels. We’d look at all these-

Dr. Weitz:            Let’s say my testosterone is low, my estrogen is high, my sex hormone binding globulin is elevated.

Dr. Hall:               Then I would you know you’re a diabetic. Yeah, male diabetics, they can be very estrogen-dominant which is what increases their risk for prostate and colon cancer. So when a male diabetic’s sugars are high, they’re literally converting their testosterone into estrogen. And we have to look at that pattern. It’s also what causes the erectile dysfunction that most male diabetics end up going through.  But we’re looking more at cause at this point. So we’re looking at the hormone-

Dr. Weitz:            At that point, do you try to fix the hormones or do you try to fix the sugar?

Dr. Hall:                Well, the hormones are part of what’s dysregulating the sugar. So we have to hit it from all angles. So I’m going to test this patient’s hormones. I’m going to test their stool. I’m going to test their blood. I’m going to-

Dr. Weitz:            Tell me what tests you’re going to run. How are you going to test my hormones? You’re going to do serum hormone testing?

Dr. Hall:                I do serum and I do saliva because you’re only sleeping four hours a night. So it would depend on your symptoms. I do serum and saliva.

Dr. Weitz:            You’re going to do saliva testing? What, you’re talking about for cortisol?

Dr. Hall:                I want to do cortisol and also it’s a good way to look at the free fraction. It’s a good way for us to kind of see … It gives us two different windows. Some people prefer saliva and some people prefer blood but it really kind of depends on what I’m looking at. But I do like to look at cortisol through saliva. And then sometimes too we’ll do, depending on the patient, we’ll do four times a day-

Dr. Weitz:            Yeah, that’s pretty much the standard or now, it’s six times a day with the first morning, the cortisol … What’s it called the cortisol … The first [crosstalk 00:16:32] which one?

Dr. Hall:                The cortisol rhythm?

Dr. Weitz:            No. You take the first test before they get out of bed. I forgot what it’s called. It’s six. You do one before they get out of bed. Then you do one 30 minutes out of bed. Then you do one morning, hit noon, afternoon, and evening.

Dr. Hall:                I’m not sure what word you mean-

Dr. Weitz:            Anyway. Well, let’s-

Dr. Hall:                The DUTCH test, it’s a urine test but it’s a really good way to look at cortisol. And then we see [crosstalk 00:17:07]. Cortisol plays a large role in regulating blood sugar as well. We’ll do those tests and then we’ll do the blood test. We’re looking at about 60 different markers.

Dr. Weitz:            So are you using a specific lab you can talk about or have you just set up your own panel?

Dr. Hall:                No, I don’t use my own lab. I used LabCorp most of the time for blood. I used Doctor’s Data for stool at times and then I also use the [inaudible 00:17:38] out of-

Dr. Weitz:            Yeah, diagnostic solutions.

Dr. Hall:                … diagnostics, yeah, diagnostic solutions. And then I’ll use for the stool tests, again, it depends on symptoms which company I’m going to use. For saliva, I use Diagnostics and I use Lorisian for the food intolerance testing. That’s a company out of UK that I really like the way that they perform their test.

 

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 validating ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners and preservatives. Among other things, one of the great things about Pure Encapsulations is not just the quality products but the fact that they often provide a range of different dosages and sizes which makes it easy to find the right product for the right patient especially since we do a lot of testing and we figure out exactly what the patients need.  For example, with DHEA, they offer 5, 10 and 25 milligram dosages in both 60 and 180 capsules per bottle size which is extremely convenient. And now, back to our discussion.

 

 

Dr. Weitz:            On a blood sugar on a serum testing, what are the key factors you look at?

Dr. Hall:                Well, certainly A1c and fasting blood sugar but we want to look at … Like a lot of our patients, the ones on insulin anyway, we’re always going to look at the antibodies to the pancreas. A lot of patients are what we call a 1.5 diabetic. They’re not even a type 2. They’ve been misdiagnosed. And so they’re being treated as a type 2 and as a result, they’re getting worse.  I have patients who make antibodies to insulin that are taking insulin and that’s obviously very bad for them. So we’re trying to … Those patients, we want to get off the insulin right away. Those blood markers, looking to see if they’re making antibodies to their own insulin, to the islet cells, to the pancreas itself. We want to see their C-peptide, how much are they actually able to produce. We’re looking at homocysteine because obviously, diabetes can inflame the brain and cause problems with the heart.  We’re looking at C-reactive protein. We’re doing a CBC to see if there’s an underlying infection, if the eosinophils are elevated. And commonly the gut infections are part of what’s driving the inflammation created by the immune system that’s been causing problem with the cells.  You can see it’s quite a bit deeper than just putting them on a diet. The diet makes up about 30% of reversing a patient. What we’re doing is getting in and saying, “What is really driving all of these?” Think of how many people are obese and eat a terrible diet but are not diabetic? Looking deeper and finding out what’s driving it is really the goal.

Dr. Weitz:            And then you mentioned toxins. How do you screen for toxins?

Dr. Hall:                Well, biotoxin illness is really one of the … When a patient is getting stuck, let’s say you have a patient that you do the normal stuff and their numbers aren’t with me or you plateau. Often, underneath that is something called biotoxin illness.

Dr. Weitz:            Which is mold, right?

Dr. Hall:                Which is what?

Dr. Weitz:            Mold.

Dr. Hall:                It can be … So if the patient is what we call a multi-susceptible, sometimes it’s not mold at all. But mold would be a common cause of biotoxin illness. But we have Lyme patients. We have patients who have what’s called resistant MARCoNS. So then we’ll look for those toxins. Also, we have people who are … No, I had one patient, her job was to count the amount of product in someone’s truck. So they back up the truck, keep the truck on and then she’d go look and see what was in the truck and she did that all day.

Dr. Weitz:            Breathing in all that diesel?

Dr. Hall:                Yeah, she was one of the sickest patient. Through Great Plains Laboratory, they have some really good test for environmental toxins, the GPL-TOX is good. We’ll do a MycoTOX on patients with biotoxin illness. But it’s amazing how many patients have that as their underlying driver and they just can’t get it all out. Their environment has gotten so much worse.

Dr. Weitz:            Your testing is going to be pretty extensive and pretty expensive too, huh?

Dr. Hall:                I mean, we get discounts on certain labs. I get a $1,700 blood test for $149 because we order so many of them. LabCorp gives me a great reduction. Certainly the testing, understand that when I’m seeing a patient, it is their history that determines the testing. And so I have a patient who spent $300 in testing. I have a patient who’s spending $900 in testing.

Dr. Weitz:            Let’s say, you got a patient. This patient is pre-diabetic, and they have some evidence of biotoxins. What’s your next step? Are you putting them on a diet and working on the biotoxins? Do you try to clear out the biotoxins first? What’s your procedure?

Dr. Hall:                Good question. We’ll start with the VCS test to see if their brain is actually inflamed because that will determine how we’re going to treat them.

Dr. Weitz:            Maybe you could explain what that is real quick.

Dr. Hall:                Sure. A VCS test is the visual contrast study. So when someone has biotoxin illness, the posterior portion of the eye can begin to swell. And if it does, then the person will lose the ability to see lines as they get closer together, they’ll lose that contrast, not that they can’t see the difference between gray and white but these lines as they get smaller, they’ll have trouble distinguishing them. That along with certain symptoms indicate about with 98% accuracy whether the person has biotoxin illness or not.

                                So let’s say that’s what’s happening. Then we’ll go through to do the genetic testing to see what specific toxins they are unable to detoxify. One of my patients for instance, he can detoxify mold but he cannot detoxify Lyme. So then we did the co-infections for Lyme and Lyme, and he does have Lyme disease. So, we have to start treating that. We’ll also determine what diet he should be on or do …

                                We can help determine that through the blood test. What do the inflammatory markers of like? What does the cholesterol look like? We’ll fractionate out the lipids, see what that looks like. And then put them on a customized diet. And then we will start working with their habits.

Dr. Weitz:            As far as diet, is pretty much everybody on some version of a lower carb diet or some people on a high carb diet?

Dr. Hall:                I would say all of our patients are not eating grains. They’re not eating grain. They’re not eating sugar. As we get into patients who have autoimmunity and things, we’re taking out inflammatory foods. So, it is definitely not a high carb diet. Yeah, we have certain patients that can tolerate specific grains. So when we test them of their specific grains and we let them know how much they can have. But for the most part, I think patients do better off of grains.

Dr. Weitz:            So, as far as grains, you’re talking about food sensitivity testing? Is that what you’re talking about?

Dr. Hall:                We do food sensitivity testing. I had one patient, she had an A1c when she started at 7.4. When we got her by month four of her program, she was down to a 5.4. She was off all six of her medications. Her blood sugars have been under 100 for three weeks. She was doing really well, off all her meds. On Sunday night, her blood sugars spiked to 196. So, there’s two things that will do that. Either she has an infection or she ate something she makes an antibody to. Those are the two things.

                                So, we start digging in and find out her husband had marinated her steak in vinegar and oil dressing, which is fine. She can have vinegar and oil dressing but the one he used was full of soybean oil and she makes antibodies to soy. So now, we have to work with her immune system or we’re not going to get her blood sugars down. So, she did not have any sugar at all, and that’s what happened.

                                So, the antibody testing I think makes a really big difference in how it is that we customize someone’s diet.

Dr. Weitz:            Another thing I found is stress. They can get a spike in cortisol. And by the way, the test I was trying to think of is a cortisol awakening response, the CAR.

Dr. Hall:                Oh, okay.

Dr. Weitz:            Let’s say somebody has Lyme. How are you going to deal with that? You’re going to use the herbal botanical protocols?

Dr. Hall:                We use a lot of ozone in our practice. If it’s in the beginning, we are going to have the doctor prescribed antibiotics obviously or a good defense in the very beginning if they have the bull’s-eye rash.

Dr. Weitz:            But that’s pretty rare that you see him at that phase?

Dr. Hall:                It’s funny to say this because I just had a patient two days ago. Friday, sorry, it was Friday. She had the bull’s-eye rash and everything. I’m like, “Perfect, this is so much easier.” And I have to tell you, so I am actually a Lyme expert but one of the doctors in my clinic is very good at it. So we just refer them to that doctor.

Dr. Weitz:            We just had Darin Ingels at the meeting speak on the last podcast about Lyme.

Dr. Hall:                Yeah, I tuned into that. That was pretty cool.

Dr. Weitz:            He gave a great presentation. So, Lyme could take a long time, it seems, to treat. He said three months to a year.

Dr. Hall:                Yeah. And if it’s intracellular, man, those patients can really struggle.

Dr. Weitz:            I want to ask you a few more questions about diet. Is it better for patients to have a small meal? And this is in general, is it better for patients to have a small meal every three hours to keep their blood sugar even which by the way we preach for years because I’ve been doing this for 32 years. I’m older than I look, and so when I first started, the big thing about why everybody was overweight was because everybody skipped breakfast and then they ended up eating too much at dinner and that’s why everybody was fat. They went too long without eating so then they would have this blood sugar spike. It would drop and then they would eat too many carbs.

                                So the answer was that they had to eat within an hour of waking up. You have to eat every two to three hours with a small meal or snack to keep your blood sugar stable and that’s going to be the key to losing weight. And of course now, the most popular trend is to skip breakfast and do intermittent fasting. Anyway, so from your perspective for diet, is it better to have small snacks or is it better to have gaps in eating throughout the day?

Dr. Hall:                I feel bad. I feel like every time I answer you, I’m not giving you a direct answer because I know that’s what your listeners want to hear.

Dr. Weitz:            No, if it depends on the person, that’s a completely valid answer.

Dr. Hall:                Yeah, it does depend on the person. So let’s say for instance that … Let’s say you’re somebody who’s having high blood sugar and low blood sugar. So, when someone is diabetic, there’s a couple of things that can happen. When someone starts getting low blood sugar, that can be a sign that diabetes is coming later because they’re having trouble regulating hormones that regulate their blood sugar.

                                Most of the time when people get diabetes, they just have high blood sugar. They don’t get lows because if they’re getting lows, they’re getting sicker. If somebody is getting highs and lows, we are going to feed them more often because the lows are really very bad for the body. It’s bad for the heart. It’s bad for the brain. So, we don’t them having low, so we’ll feed them more often and smaller meals.

                                With our patients, we don’t really regulate how much they eat typically. We just tell them as long as their plate is about … We really want them moving towards about a good 60% to 70% of their plate is vegetables. We’ll push them, depending on the patient, even up to 80% vegetables. But typically, it’s a 70-30 split between protein and vegetables on their plate. And then we determine the amount of fat depending on the labs.

                                But for those patients, we won’t really limit how much they eat.

Dr. Weitz:            How do labs determine how much fat they should have?

Dr. Hall:                I don’t want to be misleading. If the cholesterol is high, we only absorb about 6% to 8% of the cholesterol we eat. But if you’ve got somebody who’s really inflamed, cholesterol obviously is still an inflammatory marker as well. But if they’re not processing their fats well which you can see on just by looking at just even the LDL and cholesterol, and again with the diabetic, if they can’t get glucose into the cell, then part of what happens is they’re converting it into cholesterol.  And so, you have to take that into account too. But when the lipids are high like that, we generally will not put them on keto.

Dr. Weitz:            And is that because saturated fat causes heart disease?

Dr. Hall:                No. But that’s what they want us to believe. No, it’s because when the people are ingesting fat-

Dr. Weitz:            They’re not processing it.

Dr. Hall:                … those lipids correctly. And so it’s creating more problems. So we don’t put them on a high fat diet.

Dr. Weitz:            Right. So, you mentioned snacking or eating certain foods to maintain the blood sugar. One of the issues for diabetics can be that their blood sugar can drop at night and that can create a real problem. Have you had patients like that? And do you have a strategy for something they can eat at night?

Dr. Hall:                I do. So, it’s interesting, when the blood sugar is dropping … I mean everyone’s blood sugar drops when we sleep but we don’t drop to 40 and think we’re going to die. But by the time that’s actually … So when someone is waking up in the middle of the night, even somebody who is not a diabetic, it is generally most often a blood sugar problem. So, what’s happening is they’re not making … Let’s say you’re somebody who is just really stressed, or you’re diabetic that’s really stressed … That’s even worse … and you’re just pumping out cortisol all day to try to regulate your blood sugar and your stress.

                                Then come nighttime, cortisol was the hormone that regulates your blood sugar when you sleep. But if you’re just kind of maxed out and you can’t make anymore, then what will happen is the person will just, come 2:00, 3:00 a.m. depending on when they ate dinner, boing, they’ll just wake up and they can’t go back to sleep. Well, that’s because the body is now secreting adrenalin because you don’t have enough cortisol to bring your blood sugar up.

                                So, when that’s happening, that is very damaging to the brain. So, it’s one of the precursors to Alzheimer’s, so we want to get that person sleeping through the night. What we’ll do, let’s say they’re waking up at 3:00 a.m. As crazy as it sounds, we’ll have them set an alarm for 2:30 and eat four grapes. Just get up, eat something with a little bit of sugar in it and go right back to sleep. And as we do that, as we start eventually within a short period of time, they stop waking up at night. But that’s only because during the day, we’re also regulating the blood sugar.

Dr. Weitz:            What about intermittent fasting?

Dr. Hall:                I love it. It just, again, depends on the patient. Some patients do better with intermittent fasting at night, dropping out that six o’clock meal. Most patients prefer to skip breakfast but that’s not always the best meal to skip. And if patients are on insulin, intermittent fasting can be great but it can also be dangerous. So you’ve really got to watch them. With the patient on insulin, we’ll usually do a smaller window, for sure.

Dr. Weitz:            What about fiber?

Dr. Hall:                Fiber is great for the gut as long as you don’t have SIBO.

Dr. Weitz:            What about fiber for blood sugar regulation?

Dr. Hall:                I think it’s great. I think the more fiber there is, the better your blood sugar is going to do.

Dr. Weitz:            Let’s see. I think we pretty much covered diet. Perhaps you can talk about supplements for diabetes.

Dr. Hall:                Well, you mentioned one, berberine. Apex makes a product I like a lot called Glysen. And then Biogenetix makes one called Glucostatic Balance. And that has a really nice mixture of supplements that are helpful for blood sugar.  When we’re using supplements … Every patient is on different supplements, again based [inaudible 00:36:46]. In our practice, every single patient we accept is going to be put through about a four-week de-inflammatory cycle. It’s all really focused on giving them things to open up their methyl pathways to dump as much inflammation as possible. And then we’ll start customizing what supplements they’re going to be on.

Dr. Weitz:            You’re kind of doing sort of a detox. Is that …?

Dr. Hall:                Mm-hmm (affirmative).

Dr. Weitz:            And what does that consist of?

Dr. Hall:                I use a lot of Apex, and I use a lot of Biogenetix. So, Biogenetix has a product called … Isn’t it funny you use something so much?

Dr. Weitz:            I know.

Dr. Hall:                So, they have a detox, it’s pretty great.

Dr. Weitz:            Like a powder?

Dr. Hall:                It’s a powder, and then there’s supplements that go with it. The ClearVite through Apex is very similar and coming with that is like a BileMin. We’ll use that to help clear the toxins from the lymph to the gallbladder. We’ll use Adaptocrine to help the adrenal glands. We use Methyl-SP to help open up the methyl pathways and then we use the ClearVite shake to start really pushing the toxins out and the inflammation. And the hormones, my goodness, a female with diabetes has so many excess hormones.

Dr. Weitz:            And so, how many times a day will you have them use the ClearVite or other detox shakes?

Dr. Hall:                We have them start with one time a day, then we’ll go up to two times a day, then we’ll go to three times a day and then we start backing down from there.

Dr. Weitz:            And this is over a four-week period?

Dr. Hall:                Yeah.

Dr. Weitz:            Basically, you start everybody on essentially 28-day detox?

Dr. Hall:                Yes.

Dr. Weitz:            And that’s a way to start to clear out toxins?

Dr. Hall:                Yes. And then the next thing we’ll do is we really prioritize based on the labs. What are we going to go after first? Is the gut the major problem, or toxin is the major problem? Is the hormones the major problem? We’ll prioritize from there and we’ll manage it [inaudible 00:38:54]. If the hormones seem to be the biggest problem, we’ll try and manage those first. If it’s gut, then we’ll manage that.

Dr. Weitz:            So, you see a patient. You put them on this one-month detox. You haven’t got labs. It come back in a month and then you start basing your protocols on their history and labs at that point?

Dr. Hall:                Yes. That’s exactly right.

Dr. Weitz:            Okay. Let’s say they have some other sort of … Let’s say they have mycotoxins. How do you deal with that?

Dr. Hall:                Well, we have them take an ERMI test and see where the mold is coming from. It’s really hard to get the patient well if-

Dr. Weitz:            He’s got mold in their residence-

Dr. Hall:                The first thing we’ll do is test their genetics and see what they cannot detoxify. We suspect the molds, certainly we want to rule that out. Once we’ve ruled out mold, then we’ll dig deeper and see what other toxins are sitting in there or whatever.

Dr. Weitz:            Is that part of your screen, heavy metals?

Dr. Hall:                If they are biotoxin, yes, then we will. Or if they’re showing signs of cognitive decline, we will certainly test metals.

Dr. Weitz:            How do you test for metals, with serum?

Dr. Hall:                I like Quicksilver because it’s doing three. So it’s doing serum, hair and blood.

Dr. Weitz:            You mean for the tri mercury one?

Dr. Hall:                Well, yes and also when you’re looking at how much … It gives us an idea of how much the person is actually able to get rid of in the urine. So, a lot of people don’t do that test. They just look and see how loaded they are. But what we found is that it doesn’t … Unless we’re doing like a glutathione challenge or something, it could be so stuck in there that you’re not really seeing a real picture of how much is in there and how much they’re able to shed.

Dr. Weitz:            Right. You’re talking about doing a glutathione challenge before you do a urine test for metals?

Dr. Hall:                Before we do any of the testing for metals, we’ll do a glutathione challenge first to really try and push it out and see what we’re dealing with.

Dr. Weitz:            And then you’ll do a Quicksilver, a Doctor’s Data or something?

Dr. Hall:                I like Quicksilver. I like them best.

Dr. Weitz:            We got Chris Shade speaking at our meeting this month. We’re going to talk about heavy metals.

Dr. Hall:                Chris is brilliant. He’s really brilliant.

Dr. Weitz:            He is. He really is, absolutely. Okay, great, I think I’m pretty much done with the questions I had. Is there any other topics or things you’d like to tell our audience?

Dr. Hall:               I would say from years-

Dr. Weitz:            How about this, what do you think a lot of practitioners often miss when they’re dealing with patients with diabetes?

Dr. Hall:                I think they missed the underlying causes. I think they assumed it’s diet and don’t go digging deeper to find out what’s really wrong with the cells.

Dr. Weitz:            They go straight to low carb diet and that’s the end of it?

Dr. Hall:                Because it typically works, but I mean these patients when they eat any carbs, their blood sugar still just go up. So they’re still not really managing their blood sugar great. But what I would say after, I’ve been doing this a really long time and I got into functional medicine because I became very, very ill at one point in my life and functional medicine is how I found my way out of it.

Dr. Weitz:            What were you ill with?

Dr. Hall:                First, I had what I thought was a bladder infection which went on for about three years. I was a competitive swimmer in college and I just thought it was from being in the pool all the time. And then I ended up … I had an autoimmune disease called interstitial cystitis and I had done a tremendous amount of antibiotic use at my doctor’s orders. At that time I was young. I was just in college and then, you know how that messes the immune system.

                                And then shortly after, I was diagnosed with Hashimoto’s and then shortly after that, diagnosed with multiple sclerosis. So, functional medicine, it’s a long story but I believe I had mold illness way back then. It’s really what helped me find my way out and I know a lot of people suffer with that disease and don’t find their way out. So, I feel very fortunate there.

                                But after years of working with patients, I would say one of the things that patients should do … People in general should be doing regularly, is some level of a binder. Chris Shade makes a great one called Ultra-Binder. And there are good ones out there but with the amount of toxins that are in our environment now, I mean 50 years ago, we were not dealing with anything like this. I mean it is really causing some serious health problems.

                                So, being on a binder regularly and making sure you’re not getting constipated from the binder, like making sure you’re getting enough magnesium, et cetera, to keep your bowel movement, I think that would be … That’s something I think every doctors should be looking at with their patients. And most people don’t know. You can’t have a binder like charcoal or something like that around your food or your supplements. So, I’ll meet people, “Oh, yeah, I do that all the time with breakfast.” I’m like, “That’s not good. Don’t you [inaudible 00:44:28] breakfast.”

Dr. Weitz:            By the way, charcoal now is being found increasingly in foods, in toothpaste, in consumer products.

Dr. Hall:                Yeah. It’s funny you said that, I just brushed my teeth with charcoal before I did this.

Dr. Weitz:            There you go.

Dr. Hall:                Hey, thanks for having me on, Dr. Weitz. This is really fun.

Dr. Weitz:            Absolutely. So, how can folks get a hold of you if they want to get in touch with you and work with you?

Dr. Hall:                They can either just go to nextadvancedmedicine.com, or they can just call our office. Our number is 949-786-5050.

Dr. Weitz:            Sounds great, Dr. Hall. Thanks for joining me.

 

 

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The Science of Chiropractic with Dr. Leonard Faye: Rational Wellness Podcast 173

Dr. Leonard J. Faye speaks about the Science of Chiropractic with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

2:59   The type of chiropractic technique that I practice is Motion Palpation, which I learned from Dr. Faye and other doctors he had trained who worked with the Motion Palpation Institute, which he founded. Motion palpation is a repeatable, scientific way to analyze the spine and other joints and it gives you a direction to perform your chiropractic adjustments at a specific location and in a specific direction. Then after the adjustments you could repeat the motion palpation procedure to see if you had accomplished what you were trying to do, which was to restore better motion to the joints.   It didn’t require taking a bunch of X-rays or having the patients come in five times a week for months on end and it fit better with my active life in motion perspective. 

5:30  Dr. Faye, who was born in Canada, contracted rheumatic fever when he was 16 years old and he had such severe polyarthritis that he was in bed for three months.  Today this condition can be cured with antibiotics, but at the time they placed him on 3 aspirin every 4 hours and he couldn’t digest any food and all he could eat was soup. He was down to 100 lbs after having been a very competitive hockey player and tennis player.  Dr. Fayes SED rate was at 47 and the Medical Doctor told Dr. Faye’s dad, “You know, Leonard isn’t doing very good and 42% of the kids that have this die and 85% of the survivors have serious heart trouble.”   Dr. Faye’s dad called a chiropractor who came with a portable table and adjusted him from T1 to T7 while he was lying face down.They lifted him back into bed and the next morning when he awoke his joints were half as swollen and half as painful.  Three days later he walked to the bathroom and he was on the path to recovery.  He recovered fully without any heart problems and he is now 82 and only finished playing hockey at 76. He was so impressed with chiropractic that he enrolled in chiropractic college after grade 13. 

8:47  Chiropractic manipulation serves a lot of functions, including reversing post traumatic restrictions of motion in joints in the body, not only in the spine.  Chiropractic manipulation puts a demand on the tissues to become more mobile and stimulates the mechanoreceptors in the joints to improve the range of motion and to reset normal muscle function.  Chronic inflammation in the body is often driven by over stimulation of the sympathetic nervous system and this can result from spinal dysfunction that affects the sympathetic ganglion chain along the cervical spine.  If you adjust the cervical spine to restore flexion and anterior to posterior rotation you can reduce sympathetic facilitation and this will allow many inflammatory conditions to heal. 

15:42  There was an article in the Los Angeles Times on July 7th by David Lazarus entitled “No, A Chiropractor Can’t Cure COVID-19 or Diabetes For That Matter” that criticized a few chiropractors who had claimed that getting regular chiropractic adjustments might protect patients from getting COVID-19 or from having a severe infection and I agree that there is no research to prove that this is the case and I think his criticism is appropriate. Unfortunately, Mr. Lazarus went on to quote from D.D. Palmer, the person credited with starting the chiropractic profession in the 1890s, who described chiropractic treatment as a religious system.  Then, Mr. Lazarus attacked chiropractors who help patients to modify their diet and lifestyle using a Functional Medicine approach to help patients with Type II Diabetes, which is essentially a disease caused by poor diet and lifestyle.  This is an entirely reasonable way to approach patients with diabetes. Mr. Lazarus says that chiropractors are not endocrinologists, which is true, but endocrinologists are not nutrition experts and just giving prescriptions for Metformin and other insulin and glucose regulating medications for a diet and lifestyle condition without also making a serious attempt to get such patients to modify their diet and lifestyle is also reckless and irresponsible medicine. 

Dr. Faye points out that D.D. Palmer was practicing chiropractic in 1895 and medicine was not in a good place at that time either. Surgeons were barbers and really didn’t know what they were doing. In fact, it took 100 years to get surgeons to wash their hands before they did surgery. It wasn’t until Flexner came along in 1935 and cleaned up medicine and closed about 50% of the medical schools because they were just teaching nonsense.  Unfortunately D.D. Palmer made up a story and his son, B.J. Palmer propagated that story into the late 30s and opened a chiropractic college based on those stories. [Palmer Chiropractic College]  It became the busiest chiropractic college in the United States. They were espousing a concept of universal intelligence, which was God, which expressed itself in the body and this was referred to as innate intelligence.  It was said that spinal misalignments were blocking innate from its life force being spread around the body.  Dr. Faye points out that we know that it’s just complete nonsense and hopefully today since we have chiropractic colleges all over the world, usually in a university setting, all that dogma has been dropped and we’re starting to find out more and more science evidence for what can explain the results. Fortunately chiropractic is slowly going through this paradigm shift. There is absolutely no evidence that chiropractic can help an acute condition like COVID-19.  Some chiropractors have claimed that chiropractic helped patients with the Spanish Influenza of 1918 survive. In Canada at the time, some chiropractors were making housecalls to patients that had the Spanish flu three and four times per day and they survived. But we don’t really have ac curate statistics and we don’t know how many would have survived withut any treatment at all. But the interesting thing is that after this experience that chiropractors in Ontario, Canada got their licenses. The people who survived the Spanish Flu who received chiropractic adjustments demanded that parliament license chiropractors, so they passed the Drugless Practitioner’s Act.

28:17  With respect to helping patients with Type II diabetes, it is clear that it is a condition related to diet and lifestyle factors and there is no reason why we could not help patients with changing their diet and lifestyle and adding exercise and losing weight.

35:05  The use of nutrition in Chiropractic practice.  When Dr. Faye went to chiropractic college CMCC was a naturopathic college as well and he learned the principles of naturopathy Royal Lee, who started Standard Process Labs used to come and speak at his school. Royal Lee was a dentist and he had done a bunch of experiments with cats.  He took a family of cats and he gave half the offspring a really good cat diet with lots of animal protein. Then he gave the other brothers and sisters a really bad diet. By the second generation of those cats, their jaws in the poorly fed were smaller, their teeth were overcrowded.  The cats fed the healthy diet, these cats looked all the same all the way down the generations. Their jaws and facial bone structure, everything was the same. Their builds, their looks. So, he showed through this research in 1957 that nutrition could actually affect our genetics. When it comes to vitamins and minerals, while there is a minimal daily requirement, which is amount of vitamin C to prevent scurvy, etc.  But why would you want to take the minimal if you want to function optimally?  But to this day, there is no optimum daily requirement.

 

 

 

Dr. Weitz:            Absolutely. That whole concept is ridiculous. You could say, “Why don’t we just figure out how much we urinate and stop drinking water so that we don’t urinate because we’re just wasting all that water?”

Dr. Faye:              Oh I know. These were basic principles I learned. So, I try and function off that as opposed to specific supplements and things like that. But I do supply patients with certain supplements. I know for a fact we’re all Vitamin D deficient because the skin cancers and whatnot. They’ve stopped us from going in the sun. We used to all lie in the sun. Now nobody does. So now we’re all D deficient.

Dr. Weitz:            [crosstalk 00:40:44] out of the sun. We use sunscreen.

Dr. Faye:              Then I found out Vitamin K about four years ago was really essential to get that calcium into the bones. I used to wonder why patients I put on good calcium magnesium tablets, they just kept getting osteoporotic. Well, I was missing the K2. I found out about that and different things. I’m trying to think of the mineral that people get overweight if they don’t have enough of it.

Dr. Weitz:            A mineral that [inaudible 00:41:29]

Dr. Faye:              I had a patient that was a nutritionist at UCLA and she came in one day and she said, “You know, we found out all our obese patients are zinc deficient and they also have this other” … I can’t remember the name of the mineral. But this other mineral that’s …

Dr. Weitz:            Iron, selenium.

Dr. Faye:              Selenium. Yeah. They’re deficient in zinc and selenium. When they put people on those minerals, they started losing weight. So, I’ve been doing that ever since. That happened about 30 years ago.

Dr. Weitz:            Yeah well check chromium levels for patients who have trouble with blood sugar regulation. That’s another super important one.

Dr. Faye:              Yeah. Chromium is another one. Yeah. So, I put people on a multiple mineral tablet that are having weight issues. I don’t know if you can send blood off and find out if they’re deficient in those three, but I just clinically apply it.

               



 

Dr. Leonard J. Faye is a Doctor of Chiropractic and he is a legend in the chiropractic world. He revolutionized the thinking in chiropractic by developing the concept of motion palpation and he created an institute to teach this method to thousands of chiropractors around the world. Dr. Faye has given over 350 seminars around the world, has published hundreds of articles, and he wrote Good Bye Back Pain and he co-wrote Motion Palpation and Chiropractic Technic and he continues to mentor chiropractic doctors. His next book, Chiropractic Odyssey–A Journey of Practice, Observation and Reading Research and will be available in October 2020.  Dr. Faye’s website is chiropracticmentor.com.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.

 



 

Podcast Transcript

Dr. Weitz:            Hey this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  Hello Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who have joined the podcast, please go to Apple podcasts and give us ratings and review. If you’d like to see a video version, you can go to my YouTube page and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

                                So, today we’re going to talk about chiropractic which is a, even though I’m a chiropractor, I actually haven’t had too many discussions about chiropractic and we’ll also it will involve nutrition as well with one of the most famous chiropractors of all time, Dr. Leonard Faye. So, Dr. Faye is one of my mentors so I’m very proud that he’s here joining us today. I recall when I first went to chiropractic college and I was in my first chiropractic technique class.  The instructor started going on about DNA and chiropractic philosophy and in my mind, he was describing the basis of chiropractic in almost religious terms. I challenged him and he told me that I could not be a chiropractor without that philosophical belief system. So, I pushed back and told him that I was interested in the scientific basis of chiropractic and had no interest in such religious or spiritual beliefs.

                                I did become very proficient in performing chiropractic adjustments despite him and merely shut my ears when discussions of the innate came up. I found my way to a version of chiropractic known as chiropractic biophysics which is a very scientific way of understanding chiropractic based on the shape of the ideal spine and then trying to draw lines on carefully taken X-rays, patients who have been carefully positioned and then using a combination of very specific adjustments, forms of traction and exercises, we would try to reshape their spines to these ideal shapes.  This form of chiropractic had a scientific rigor that appealed to me. But it was really too rigid and it really didn’t account for individual variations in form and function.

Then I learned about motion palpation and a motion palpation institute which taught the principles of how to analyze the motion or lack of motion of joints in the various directions of motion that occur. Not only in the spine, but all the joints of the body.  I took a bunch of these motion palpation classes. It was a repeatable, reasonably scientific way to analyze the spine and the other joints. It then gave you a direction to perform your chiropractic adjustments at a specific location and in a specific direction. Then after the adjustments you could repeat the motion palpation procedure to see if you had accomplished what you were trying to do which was to restore better motion to the joints.   It didn’t require taking a bunch of X-rays or having the patients come in five times a week for months on end and it fit better with my active life in motion perspective. For teaching me this and for creating the Motion Palpation Institute, Dr. Faye, I will always be indebted to you.

Dr. Faye:              Thank you.

Dr. Weitz:            Dr. Leonard John Faye. Graduated from Canadian Memorial Chiropractic College in 1960 and he practiced in England for 14 years, in Canada for 12 years and in Los Angeles for the last 34 years. Dr. Faye is a legend in the chiropractic world. He revolutionized our thinking by developing this concept of motion palpation and created an institute to teach this method to thousands of chiropractors around the world. Dr. Faye has delivered hundreds of seminars, he’s published hundreds of articles and he wrote Goodbye Back Pain and he also co-wrote the book, Motion Palpation and Chiropractic TechniqueHe continues to mentor chiropractors around the world and he will soon be publishing his next book. Dr. Faye, thank you so much for joining me today.

Dr. Faye:              It’s a real pleasure and it’s so much fun for me to hear somebody that’s done so well and has become such an expert doctor.  Forget chiropractor and hopefully I’ve started a lot of people down that path and they more than surpassed my knowledge that it’s terrific.

Dr. Weitz:            That’s great. So, perhaps you can tell us how you came to decided to become a chiropractor.

Dr. Faye:              Yes. As a 16 year old, nearly finished grade 12, I contracted rheumatic fever and had the polyarthritis that put me in bed for three months. The treatment in those days, it wasn’t antibiotics which has wiped out that condition, but I was on three aspirin every four hours around the clock for three months. So needless to say, I couldn’t digest any food. I was drinking consume soup. I was down to 100 pounds having been a really good hockey player and tennis player.  So, I was quite an athlete and the doctor said who had taken my sed rate the week before and it was still 47.

Dr. Weitz:            Wow.

Dr. Faye:              On the scale at the time, 8 to 12 was normal and he then said to my dad, “You know, Leonard isn’t doing very good and 42% of the kids that have this die and 85% of the survivors have serious heart trouble.” So when he left, my dad called a chiropractor and he came in with a portable table and adjusted me from T1 to T7 and I was lying face down so some of my neck moved as well. They lifted me back in bed and the next morning, I woke up, my joints were half as swollen, half as painful.  Three days later, I walked to the bathroom and on recovery. I’m now 82 and I only finished playing hockey at 76 so my heart wasn’t involved and that really impressed me. I thought, “My God, I got to learn to do this. The people should know about this.”  So, I entered chiropractic college after I got grade 13 which is what’s called matriculation.

Dr. Weitz:            Wow.

Dr. Faye:              Yeah. It went on from there. When I got to chiropractic college, I had the same experience you had. It was just religious concepts. God was doing this and that and every other damn thing. Because he had no hands, we were using our hands were the hands of God, right? It was unbelievable what was being told to us. But the manipulation I knew there must be some scientific evidence for this. If there wasn’t I dedicated myself to trying to figure out what the heck was going on and support research and to try and help people get into research which did happen over the years.   A lot of our top researchers that bumped into me when they were in chiropractic college and decided hey, we got to find out what this is all about.

Dr. Weitz:            So maybe you can tell us for a lot of people, they don’t really understand much about chiropractic. What is chiropractic? What does chiropractic manipulation do?

Dr. Faye:              Well, it has a lot of different functions. If there’s just post traumatic changes in the joints, that’s producing restriction of ranges of motion, the manipulation puts a demand on the tissues to start reversing and becoming elastic and mobile. The mechanoreceptors around those joints start to talk to the brain so that the muscles can be recruited that move the joints that the body has been ignoring and setting up adaptive changes.  So, if you couldn’t raise your shoulder to put a bottle of milk in the refrigerator, you’re automatically would lean over and your hand would go up and the bottle wouldn’t get to the right height and you could put it on … You didn’t have to think about doing that. That was just adaptive mechanisms for the loss of mechanoreceptors coming from your shoulder and in that kind of a condition, we increased by manipulation the shoulder movement and the whole shoulder girdle and deal with the soft tissue changes and eventually with time and increased ranges of motion, the inflammation clears up, the mechanoreceptors and proprioceptors become active.

                                Your body learns to recruit properly and the whole thing reverses. However, there’s also a effect of the areas of the spine where the sympathetic ganglion chain is and it turns out that the ganglion chains can be irritated mechanically from dysfunction in the spine and this causes a facilitation of the sympathetics and two guys named Basbaum and Levine up at San Francisco discovered that chronic inflammation is often driven by the release of norepinephrine from the end of the sympathetic nerves.  In their experiments, they took dogs and cut the sympathetics to an arthritic knee and lo and behold, the arthritis started to heal because it was no longer getting this norepinephrine. Then they discovered the norepinephrine caused the mass cells to release PG2 and PG2 was driving the inflammatory response. So, we had known for a long time that if you adjusted the cervical spine to restore flexion and A to P rotation, anterior to posterior rotation, these were the limitations that would irritate the superior sympathetic ganglion chain and cause chronic inflammatory conditions in the shoulder or levator scapulae tendinitis, tennis elbow, carpel tunnel.  All these chronic inflammatory conditions down that extremity on the side where the sympathetics were facilitated, then manipulation and other soft tissue procedures would lessen that and remove that sympathetic facilitation and then those tissues would heal and of course, patients would take Advil which is a PG2 blocker or surgeons would go in and then put people on an NSAID and it would heal up and so there’s other ways of doing the same thing, but nothing nonsurgical, nondrug like our chiropractic procedures.  [Here is one reference I found to one of their papers:  The contribution of neurogenic inflammation in experimental arthritis.  JD LevineMA Moskowitz and AI Basbaum. 

                                The trouble is that a lot of chiropractors don’t know how to do that and don’t even know that the sympathetics can be facilitated and if they’re in the old paradigm, then they’re cracking away and quite often, they’re not doing flexion and A to P rotation from the lower cervical spine. The same thing can go on in the lumbar spine or the lumbar sympathetic chain and a chronic tendinitis of the knee can often be improved by adjusting the cervical lumbar junction.  It’s not always the way it is because there are direct traumas that cause inflammatory conditions, but it’s sad that we haven’t penetrated into the whole diagnostic world as to what it is that we are actually doing because unfortunately, we haven’t standardized our education so that all chiropractors know about sympathetic facilitation. If you hear my phone ring, I won’t be answering it. I’m at the front desk. So sorry about that. So that’s kind of a … There we go. Yeah. So, then in the modern chiropractor is not only changing the function of the joints, but is then going into rehabilitation facilities, getting patients to use the muscles into so that they do recruit in the normal order and weakened muscles become stronger.  It’s become now a whole process rather than just cracking the spine.

Dr. Weitz:            So, the next couple of questions are going to take a few minutes for me to set up because I want to describe some statements that were made in a recent LA Times article on chiropractic and ask you to comment on a few of the claims. So, I think some of the public gets confused about who and what chiropractors do. In fact, it sounds like a number of chiropractors are confused as well. We’ve recently seen articles attacking claims by chiropractors that they can prevent COVID 19.

Dr. Faye:              You were cutting in and out. Do you want to repeat that?

Dr. Weitz:            Oh okay. So, let me start again. So, Dr. Faye, the next few questions are going to take a few minutes to set up. I’m going to describe some statements made in recent LA Times article on chiropractic and ask you to comment on a few of these claims that were made. Some of the public is confused about what chiropractors do and who we are and there was recently an article that appeared in the LA Times on July 7th by David Lazarus that was titled, “No, A Chiropractor Can’t Cure COVID 19 or Diabetes For That Matter.”  In this article, Mr. Lazarus made some reasonable critiques of some claims by chiropractors that getting chiropractic adjustments regularly might protect patients from getting COVID 19 or from having a severe infection. Mr. Lazarus goes on to explain that the person credited with starting the chiropractic profession, D. D. Palmer claimed in a memoir that the basic principle from 1914 that the basic principles of chiropractic were passed to him during a seance by a long dead doctor.  Palmer described chiropractic treatment as a religious system that imparts instruction relating both to this world and the one to come. Then Mr. Lazarus conflated this attack complaint about chiropractic to chiropractors who advertised to be able to help patients with conditions like Type II Diabetes.

                                So, on the one hand, he’s criticizing chiropractors who are claiming that they can prevent patients from getting COVID 19 or ensure that they’ll have a better outcome if they get regular adjustments. He also threw into the article that chiropractors who are offering diet, lifestyle and a nutritional approach to helping patients with diseases that are like diabetes that are essentially caused by poor diet and lifestyle and I think it was very unfair to throw both of those critiques in together as though they were along the same lines.  So, he attacks doctors of chiropractic saying that they are not endocrinologists. Well, that’s true. Chiropractors are not endocrinologists. But endocrinologists are not nutrition experts and just giving prescription for Metformin and other insulin and glucose regulating medications for a diet and lifestyle condition without also making a serious attempt to get such patients to modify their diet and lifestyle is also reckless and irresponsible medicine.

                                I know that was a long setup Dr. Faye, but perhaps you could comment about chiropractic and you’ve already given us a little information about how chiropractic can affect the body as a whole, but perhaps you can comment about both of these and then maybe also talk a little bit about how nutrition can be a part of a chiropractic practice.

Dr. Faye:              Right.

Dr. Weitz:            So, take that where you’d like.

Dr. Faye:              Well, first of all, D. D. Palmer was 1895.

Dr. Weitz:            Okay.

Dr. Faye:              At that time, surgeons were barbers and medicine was in a mess. It wasn’t any wonder that he didn’t know what he was doing because nobody really knew what they were doing. It wasn’t until Flexner came along in 1935 that cleaned up medicine and they closed about 50% of the medical schools because they were just teaching nonsense and he managed to get a couple of results. So, he [D.D. Palmer] made up a story and unfortunately, his son [B.J. Palmer] propagated that story into the late 30s and opened a chiropractic college based on those stories. [Palmer Chiropractic College]  It became the busiest and put out the most chiropractors in the United States. They were still espousing all those universal intelligence which was God and expressing itself in the body is innate and these little misalignments were blocking innate from its life force being spread around the body. It’s just complete nonsense and hopefully today since we have chiropractic colleges all over the world, usually in a university setting, all that dogma has been dropped and we’re starting to find out more and more science evidence for what can explain the results.  

                                They used to get good results with certain conditions. They just had a ridiculous religious explanation. Right? Today, we still have two colleges. Sherman and Life that espouse to these old concepts and old dogmas. Unfortunately, that’s the way it is until we get it cleaned up completely. We’re probably 85% scientific and rational and only maybe 15% in the old paradigm. I’ve been connected with this paradigm shift since 1962 so I know how slow paradigms shift.   One doctor said to me, “Well, you know it took surgeons 100 years to wash their hands before they did surgery.” That was 100 years just to get them to wash their hands. God, the English sailors were eating limes and lemons to stop getting scurvy. In the rest of the world, the sailors were coming down with scurvy right, left and center because nobody would look into the vitamin C in limes and lemons. That’s why Englishmen are called limies. I don’t know if you know that.

                                But anyways, then he went on about COVID 19. It’s absolutely ridiculous that we could be dealing with a crisis that the COVID 19 causes in the body where we’re asking the body to make a healing response but it’s going too fast and it’s an irreversible pathology for some people. I was taught at CMCC that we’re a drugless and surgeryless therapy only for conditions that are irreversible. Not reversible conditions. Lifestyle conditions are reversible if you catch them early on.  But once the pathology becomes irreversible, then we’re stuck where we can’t … My philosophy is that we should be seen up front and once it becomes a disease pathological process, then medicine has really good expertise in managing diseases. They manage diseases really well. Let’s face it. If you had a heart attack, you wouldn’t run to a chiropractor. You’d run to the hospital. Right? So, we have to decide just where we are in this society as a healing profession, but because we still have 15% saying we can help COVID and there’s no evidence that we can help COVID.  We should all be evidence influenced if not evidence based in our practice. It’s just we have to stop these people from making these statements. In Canada, you would lose your license for doing that. In Denmark, you would lose your license. In Norway and Sweden, you would lose your license. Until we get those kind of laws that stop these people, it’s just unbelievable what they’re saying and what they advertise. Some of them don’t take any exam. They just crack people three times a week for life at so much a month fee.  In Canada, that guy would lose his license in a heartbeat. You can’t not examine patients to see what you’re treating and then declare that everything that happened is due to your manipulation. Now, the virus thing is confusing because in 1918, with the huge flu epidemic, the chiropractors-

Dr. Weitz:            You talking about the Spanish Influenza of 1918

Dr. Faye:              Spanish Flu.

Dr. Weitz:            Yeah.

Dr. Faye:              The chiropractors in Toronto did house calls three and four times a day to patients that had Spanish flu and they survived. Now, we don’t know how many they treated. We don’t know how many survived because people survived without any treatment. So, there’s no statistics about it. The only thing that happened was that because there were enough survivors from chiropractic, they demanded at parliament that there become a licensing for chiropractors. It was through that Spanish flu that chiropractors in Ontario, Canada got their licenses. It was called the Drugless Practitioners Act.  It wasn’t even for chiropractors. It was for naturopaths and everybody. Drugless practitioners. But we don’t know how many they treated. We don’t know how many survived and how many didn’t survive that were treated. There was no evidence really. So, you can’t say because some chiropractors in Toronto treated some people that survived that it was their chiropractic that made them survive. So, we have no evidence but that’s what you occasionally hear that story and people are saying, “Well, there you go. See? We cured people in the Spanish flu.” Well, we didn’t. So, that’s where that all comes from.

Dr. Weitz:            Yeah. I have heard that.

Dr. Faye:              As far as diabetes II, I’ve helped patients with their diet, exercise, getting their weight down, doing a lot of things that improved their diabetes II. I also did manipulation. Whether the manipulation, we don’t have a study where we changed people’s diets, get them exercising, lose weight and don’t manipulate them and then have a group that we do manipulate that get all those things. Then we have a group that don’t get any of that and start comparing and see what happens.   So, we have no evidence. Who’s fault is that? It’s our fault. Right? We keep on doing research on low back pain. It drives me crazy. There’s 52 studies on low back pain. There’s not one study on a whole lot of other things that we can help. So, I don’t know when the research is going to catch up to the practices, but as clinicians, we can be evidence influenced and then we have to go by our experience.

Dr. Weitz:            Right. Because there isn’t enough research.

Dr. Faye:              No. There’s not enough. What a lot of the researchers believe, until we get a place at the table for back pain, we don’t have the right to come to the table for headaches and paresthesias down the arm and things like that. Discs. They reckon in Switzerland that 95% of discal surgeries could have been helped by a chiropractor in three to five months without surgery. The chiropractic college there is in a university in a hospital setting. So, they’ve done studies on patients with major MRI proven discal budges, herniations, and submitted them to chiropractic care and 95% never went to surgery. It was a good study and it was done properly.  So, that’s hard news to bring to orthopedics. They don’t want to hear that. It’s unfortunate, but that’s the way it is. It’s just like stints. They’ve shown stints aren’t much good, but they still use stints and bypass surgery.  So, we’re not the only ones but I know that that becomes a straw man argument.  So, straw man arguments aren’t worth a damn, but let’s face it.  We’re all in this fish bowl together.  So, we have to be looked at in the same light.

Dr. Weitz:            Yeah. No, I think what you’re hinting at is most people don’t realize this, but even though drugs are subject to randomized control trials, the majority of procedures that are performed in any physicians office have not been subject to randomized clinical trials.

Dr. Faye:              That’s right. I was once approached to go into the cancer ward at Cedar Sinai to help with pain control because somebody there read a paper that manipulation has a down regulating of pain.  So, I was being interviewed and then an orthopedic.  An old guy. He started on about chiropractic. I said, “Well, could you quote one paper about surgery, one that has a control group, a nontreated group and a surgical group?”  He didn’t know one.  It’s what you just said. Their procedures are not put through the same rigor that drugs are put through.  There’s a reason for that. It would be unethical to take somebody that needed a surgery and then let them be the control group with no treatment.  So, ethics do come into it.

Dr. Weitz:            Right. Essentially what you’re saying and I don’t think people realize this is a perspective randomized clinical trial that is the type of trial that’s done to show efficacy and safety for pharmaceutical interventions, that type of study was designed to test drugs. Applying that to things other than drugs like chiropractic manipulation but equally trying to apply that to surgery or other procedures performed within medicine, it’s very difficult or impossible to do.  So, really we need to think about scientific efficacy for procedures. It can’t be based on the type of study that’s designed to test pharmaceuticals.

Dr. Faye:              Yes. Rand has been doing studies on chiropractic for about the past 15 years. They’ve tried that old formula. They have now gone to pragmatic studies. So, they look at the outcome. The outcome where you had manipulation or you didn’t have manipulation. The outcome where you had manipulation plus exercise or you didn’t have manipulation with exercise. Then see what the results are. Then after that, you can start figuring out what caused what. But to start with, we need to show do we have an effect on sciatica?  It needs to be a pragmatic study. So, that’ll come.

Dr. Weitz:            Right. Yeah. Good. So, how about the use of nutrition? How does nutrition play a role in a chiropractic practice, in your practice?

Dr. Faye:              I was very lucky. CMCC at the time I went there was a naturopathic college as well. So, I had four hours every week for four years on naturopathic principles. Nutrition was one of the things that was looked into. We were lucky enough to hear Royal Lee speak who started Standard Process Labs. He had done experiments with cats. He took a family of cats and he gave half the offspring a really good cat diet with lots of animal protein. Then he gave the other brothers and sisters a really bad diet. By the second generation of those cats, their jaws in the poorly fed were smaller and the teeth were overcrowding.  Because Royal Lee was a dentist and the facial structures were such that you couldn’t recognize these cats were related to the grandparents. But on the good nutrition side, these cats looked all the same all the way down the generations. Their jaws and facial bone structure, everything was the same. Their builds, their looks. So, he showed through this research that nutrition could actually affect our genetics.  Now that in 1957 was a huge breakthrough. You couldn’t read that anywhere.

Dr. Weitz:            I know. That’s amazing [crosstalk 00:37:10]

Dr. Faye:              But we saw the pictures of these cats and what he’d fed them and whatnot. It was really interesting. We all went, “Holy mackerels. We are what we eat.” Right? It can actually change our genes. Everybody knew it could make you fat or skinny or it could be energetic or not energetic, but nobody knew that it could affect the genetic structure in us and actually affect our offspring. So, we were all going by a formula. Eat 50% raw, right? At least 50% raw. We weren’t vegetarians, we weren’t vegans. But we knew that we had to eat a lot of vegetables and fruits and nuts and everything raw.  That’s the diet I’ve followed. I’ve eaten a lot of meat, but I also have eaten a lot of raw fruits and vegetables and nuts. So, that was kind of the basics they put in. Then they went through all the conditions that were recognized in pathology texts. Pellagra, scurvy. One nutritional element missing could make the body be a complete mess. Right? Completely destroy the human body with vitamin C missing.  So, then the question was well, what else? Then the concept that we got was that if we know what the body needs and we do, why don’t we supply it? That’s got to be logic number one. I don’t know why that’s missed. So, with these basic understandings and then we discussed minimum daily requirement. Well, why would you want the minimum to function optimally?

Dr. Weitz:            Right.

Dr. Faye:              Right? There must be an optimum daily requirement. Well, you can’t find it anywhere. [crosstalk 00:39:24] It doesn’t exist to this day.

Dr. Weitz:            This is true.

Dr. Faye:              So, you have to overdose and make sure your body kicks out what it doesn’t need. Oh, well that got ridiculed as producing expensive urine. Well, I’d rather produce expensive urine than have a minimum daily requirement that makes me function less than optimally.

Dr. Weitz:            Absolutely. That whole concept is ridiculous. You could say, “Why don’t we just figure out how much we urinate and stop drinking water so that we don’t urinate because we’re just wasting all that water?”

Dr. Faye:              Oh I know. These were basic principles I learned. So, I try and function off that as opposed to specific supplements and things like that. But I do supply patients with certain supplements. I know for a fact we’re all Vitamin D deficient because the skin cancers and whatnot. They’ve stopped us from going in the sun. We used to all lie in the sun. Now nobody does. So now we’re all D deficient.

Dr. Weitz:            [crosstalk 00:40:44] out of the sun. We use sunscreen.

Dr. Faye:              Then I found out Vitamin K about four years ago was really essential to get that calcium into the bones. I used to wonder why patients I put on good calcium magnesium tablets, they just kept getting osteoporotic. Well, I was missing the K2. I found out about that and different things. I’m trying to think of the mineral that people get overweight if they don’t have enough of it.

Dr. Weitz:            A mineral that [inaudible 00:41:29]

Dr. Faye:              I had a patient that was a nutritionist at UCLA and she came in one day and she said, “You know, we found out all our obese patients are zinc deficient and they also have this other” … I can’t remember the name of the mineral. But this other mineral that’s …

Dr. Weitz:            Iron, selenium.

Dr. Faye:              Selenium. Yeah. They’re deficient in zinc and selenium. When they put people on those minerals, they started losing weight.  So, I’ve been doing that ever since. That happened about 30 years ago.

Dr. Weitz:            Yeah well check chromium levels for patients who have trouble with blood sugar regulation. That’s another super important one.

Dr. Faye:              Yeah. Chromium is another one. Yeah. So, I put people on a multiple mineral tablet that are having weight issues. I don’t know if you can send blood off and find out if they’re deficient in those three, but I just clinically apply it.

Dr. Weitz:            Yeah you can. We do a lot of those nutrition panels as part of our practice.

Dr. Faye:              Yeah I think obviously that’s the way to go.

Dr. Weitz:            Yeah.  One of the founders of functional medicine, Dr. Sidney Baker, he said a long time ago, medicine is basically the principle to make people healthy is find out what they don’t have enough of and give it to them.  Find out what they have too much of and let’s remove some of that.

Dr. Faye:              Yeah. Yeah.

Dr. Weitz:            So, if they have too many toxins or too much et cetera.

Dr. Faye:              I know.

Dr. Weitz:            Poor diet, sugar, et cetera. Yep.

Dr. Faye:              So, you can’t treat patients without looking at their nutrition. It’s impossible. Even a dentist should be doing that. Let alone medical doctors and chiropractors.

Dr. Weitz:            Absolutely. You got people coming in with cavities and gum disease and we know that nutrition is a major factor. If you don’t clear that up, you’re never really going to help them.

Dr. Faye:              That’s right. That’s right. I’ve always given patients stretches and had them walking or if they’re athletic going to the gym and getting themselves fit. So many patients are unfit it’s ridiculous.

Dr. Weitz:            Yeah. Sedentary lifestyle is one of the big killers today for sure.

Dr. Faye:              Yeah. 70% of patients in hospital are there because of lifestyle conditions. Now admittedly, they do get to a pathology status where they do need medical care.

Dr. Weitz:            Sure.

Dr. Faye:              Right. Just because that’s what put them in there doesn’t mean that you can just take them out and start their nutrition going. It’s too late.

Dr. Weitz:            No. Absolutely. In fact, there are people in nursing homes who can’t get out of bed and the only thing wrong with them is that they are too weak. They have sarcopenia. They’ve lost all their muscle from lack of activity.

Dr. Faye:              Yeah.

Dr. Weitz:            That’s sad.

Dr. Faye:              Yeah. I read a study last year, even 90 year olds can build muscle.

Dr. Weitz:            Oh absolutely.

Dr. Faye:              If they do exercise. It’s never too late to increase your strength.

Dr. Weitz:            Absolutely. Everybody should be doing regular exercise and one component that exercise should be some sort of strength training, cardiovascular training, flexibility training and balance. All four of those should be included in everybody’s regular exercise program.

Dr. Faye:              Yeah. I don’t know why medical doctors can’t tell patients that. But they just don’t.

Dr. Weitz:            Well, unfortunately our healthcare system is largely controlled by insurance companies who are pressuring medical doctors to spend no more than 10 minutes with a patient and they simply don’t have the time. They’re stuck in this system. Patients don’t realize [crosstalk 00:46:04] it’s the insurance companies in the United States that are making the rules.

Dr. Faye:              Right. In Australia, my wife had to go to a gynecologist and the sign on his desk was my fee is based on 15 minutes. If you go over 15 minutes, you’ll be charged a second fee. So, maybe that’s what should happen for people that [crosstalk 00:46:30]

Dr. Weitz:            Well, you don’t get 15 minutes in the United States. That’s a long office visit.

Dr. Faye:              Right. It’s terrible. Anyways, I’ve got a new book coming out.

Dr. Weitz:            Good.

Dr. Faye:              Chiropractic Odyssey A Journey of Practice, Observation and Reading Science.

Dr. Weitz:            Awesome.

Dr. Faye:              I go through all the books and papers that I read that changed my behavior from 1960 onward. So, I think it’ll be an interesting read.

Dr. Weitz:            That’s great. I’m looking forward to it. When is it going to be out and where-

Dr. Faye:              September 15th.

Dr. Weitz:            Okay.

Dr. Faye:              The pre-publication is on offer now at www.chiropracticmentor.com.

Dr. Weitz:            Okay.

Dr. Faye:              So, it’s a reduced price and it’ll be a hard cover. When the real book comes out, it’ll be soft cover for $20 more. So, there’s a benefit from buying it up front.

Dr. Weitz:            Oh. I’ll be heading over there and getting it [crosstalk 00:47:41].

Dr. Faye:              I’m always selling something. You know me.

Dr. Weitz:            I’ll be sure to give you a review, doc. So, is it going to be self published or do you have a publisher? Is it self published?

Dr. Faye:              Yeah. I’m self publishing it because I don’t want it to go to the public. It’s all about the paradigm shift.

Dr. Weitz:            So, it’s for the chiropractic profession mostly?

Dr. Faye:              Yeah and students I hope. Students I hope will read it and understand why they have to become evidence influenced and not listen to the bullshit, but the references … Have you heard of Davis law?

Dr. Weitz:            No.

Dr. Faye:              No. Davis’s law is a [inaudible 00:48:36] of the law that states that bones grow according to the stresses-

Dr. Weitz:            Oh. Yeah, yeah, yeah. Yes. Yes. Yes. Yeah.

Dr. Faye:              Right. So, soft tissues can change according to the stresses of movement.

Dr. Weitz:            Yes.

Dr. Faye:              I quote the literature that people have done those experiments. Drilled holes in rabbits knees and put some in a cast and some in a treadmill and some in a mobilized cast and the healing changes were dramatic and the motion of the continuous passive motion of cast caused a complete recovery of the highland cartilage in a joint. Those experiments and those facts are not mentioned in the modern chiropractic education. So, how can you expect a chiropractor to want to deal with developing increased ranges of motion in a joint that’s paining and degenerating and doing all kinds of pathological pathogenesis of the lack of motion that is reversible? They don’t understand it. So, it doesn’t give them the need for learning to do really specific manipulation into the directions of loss of motion.

                                That’s just one example. There’s so much old literature that was well done that isn’t unfortunately read today. Barry Wyke-

Dr. Weitz:            Cool. cool.

Dr. Faye:              Barry Wyke discovered that mechanicoreceptors override nociceptors. So, once the joint starts to move, it feels a whole lot less painful. He did all that work. You ask the modern chiropractor who Barry Wyke is-

Dr. Weitz:            That was the famous white and [inaudible 00:50:48].

Dr. Faye:              Yeah. No. Wyke. W-Y-K-E.

Dr. Weitz:            Oh okay. Yeah. Yeah. Yeah.

Dr. Faye:              Barry Wyke. He was an English joint neurologist.

Dr. Weitz:            Okay.

Dr. Faye:              Amazing.

Dr. Weitz:            Cool.

Dr. Faye:              These were not old studies to be thrown away. They back up a lot of what we do. If you don’t know that, then you won’t think that manipulation is worth a damn because the modern research, these controlled studies do three adjustments on somebody that I would treat 30 times. How did [inaudible 00:51:30] migraine headaches relieved in three visits? It’s impossible.

Dr. Weitz:            Right.

Dr. Faye:              How do you get it if you don’t even know if chocolate, red wine and old cheese is one of the trigger factors?

Dr. Weitz:            Right.

Dr. Faye:              They don’t even ask anymore. They just think, “Oh, we can’t help migraines.” Well, we can help a lot of migraines. It’s just you have to know the references. So, this book is full of them.

Dr. Weitz:            Awesome. Great. So, what’s the website they go to for that?

Dr. Faye:              Www.chiropracticmentor.com.

Dr. Weitz:            Okay. Awesome. Thank you so much Dr. Faye.

 

 

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Heavy Metal Detoxification with Dr. Chris Shade: Rational Wellness Podcast 172

Dr. Chris Shade speaks about Heavy Metal Detoxification with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

5:19  Dr. Shade talked about his experience as a farmer and how he studied mercury while earning his PhD in Environmental Science.  He developed a patented a way to separate out and test for different forms of mercury, including inorganic mercury found in amalgam tooth fillings from organic mercury found in fish.  The key is that mercury never exists as a free ion but is always bound to something, such as cysteine or glutathione.  Also, he realized that the body has an innate system for detoxification, the glutathione system and also the methionine system and rather than using chelators, you can upregulate your natural system.  When Dr. Shade was going to school for his PhD and he had 17 mercury amalgams in his mouth and he could feel the effects and he used chelators to reduce the mercury and they made him sicker. This inspired him to develop a better way to get rid of heavy metals in the body.

11:10  Testing for Heavy Metals.  Since metals can be stored in our bones and organs, doesn’t it make the most sense to take an oral chelator like DMSA to liberate those metals and then measure urine before and after the challenge?  Dr. Shade explained that even though there may be more metals in the tissues than in the blood, there’s a dynamic equilibrium between what’s stored in the tissues and what’s in the blood. Further, these chelators like DMSA do not go into the tissues and the cells, but they simply go into the blood and plasma and they make the kidneys more filterable.  And no matter who you are, when you take a chelator, your urine levels go up, so it becomes this excuse to chelate everybody, not a look at where everybody really is with their metals levels.  But you can get the same results from just measuring the blood as long as you use the correct reference ranges, though mercury is an exception.

13:16  Nuclear factor erythroid 2-related factor 2 (NRF2) is a protein that regulates the expression of antioxidant proteins that protect against oxidative damage triggered by injury and inflammation.  When you turn NrF2 up, that’s a key pathway and a trigger in the body to dump toxins into the blood.  It also triggers the genes for glutathione synthesis, glutathione s-transferases, and transporters for removing toxins from the body. Turning up NRF2 is needed to get toxins out of the cells into the blood and then you need to turn up the filters, which are the liver, the kidneys, the GI tract, and the skin that take toxins out of the blood for excretion out of the body.

14:48  It doesn’t work well to just do serum metals testing through Quest or Labcorp even though it may be less expensive and it may be covered by the patient’s insurance, because they don’t speciate out the different forms of mercury into inorganic (from tooth amalgams) and methylmercury (from fish).  It is only measuring methylmercury, which is really a measure of how much fish you eat.  If you have inorganic mercury from dental amalgams you would only show a very small amount in the blood and the 95th percentile for inorganic mercury is below the detection limits for Quest and LabCorp.  The best way to test for mercury is with the Mercury Tritest from Quicksilver that measures blood, urine, and hair and compares the ratios.  Blood is the best way to measure organic mercury, while urine is a better measure of inorganic mercury and the urine:blood ratio provides information about the excretion of inorganic mercury. The excretion of methylmercury is seen in hair and the hair:blood ratio provides information about the excretion of methylmercury.

22:18  The most common symptoms of heavy metal toxicity include fatigue and anxiety.  Fatigue occurs because the metals diminish the antioxidant pool in the mitochondria. They suck down the glutathione and the thioredoxin in the mitochondria.  Metals also work at the thyroid level, which creates further fatigue. If you have normal or high T4 but low T3 that can be caused by mercury, cadmium, arsenic, or other metals. Metals can also affect the adrenals. And metals can accumulate in the kidneys and burn them out. Most metals are also glutamate receptor agonists, so they drive you into a neuroinflammatory state and this can lead to brain fog and depression and anxiety. You go into a state of hypersympathetic autonomic nervous system, which shuts down detoxification through prioritization pathways.  What engages with the mercury are endotoxins from leaky gut, chronic jaw infections, chronic UTIs, gingivitis, and periodontitis.

26:15  It would be great if our body just naturally got rid of all of our toxins or if we could simply do a juice fast, but it’s not true. Perhaps it would be true if “we were living in the mountains, and we were all chill, and we’re eating wild food and getting all the phytonutrients, yeah, we wouldn’t really have a problem, but we’re not.” We’re chronically in sympathetic mode, which downregulates detoxification.  We eat inflammatory foods, rather than phytonutrient rich foods.  We need to take specific nutrients to activate transcription factors like Nrf2 and activate cardiometabolic factors like AMPK and take things like glutathione to liberate metals from the cells to put them into the blood, so the liver will dump them into the bile and then into the GI tract.  And you need binders into the GI tract to make sure toxins don’t get reabsorbed.

27:57  At the cellular level the metals are conjugated onto glutathione and then transported out of the cells into the blood.  Then we want to pull from the blood into the liver, dump the liver into the bile, get it to the GI and then stick it on a binder.  If there are metals in a cell, the metals are always bound to some some protein. You have to take the metal off the protein its bound to and link it on to glutathione. This conjugation reaction occurs through an enzyme known as glutathione s-transferase, which is synthesized by the cell and if Nrf2 is upregulated, you will synthesize more glutathione s-transferase. Then there are transporters that escort the metal/glutathione conjugate out of the cell. This is phase three of detoxification.  These transporters use ATP and magnesium. 

29:57  Many of us are familiar with phase one, phase two, and phase three of liver detoxification. But these phases of detox occur in all the cells in all the organs of the body and not just in the liver.  Yes, detoxification occurs more in the liver, but if you’re a thyroid cell and you have a toxin in there, you can’t wait for the liver to walk into your thyroid, because it’s not going to happen.  So all three phases of detoxification occur in all cells.  Dr. Shade points out that when it comes to metals, there is no need for phase one detoxification, since metals are already reactive.  Phase one involves taking a toxin like PCB or a flame retardant chemical like a polybrominated diphenyl ether, to take you from being a nonreactive thing to being a reactive thing, and phase one chops into that molecule and makes it more reactive, so that phase two, you can link a glutathione onto it.  Most toxins start with phase one but metals pick up at phase two. 

32:01  After we attach glutathione to the metal, then it is in the blood and it ends up in the liver.  The liver transporters move both bile and toxins together, so you get this flow from the blood to the hepatocyte to the bile.  If your bile is not flowing smoothly (cholestatic), then you will have toxin buildup as well. Once the toxin, such as mercury, ends up in the GI tract, the glutathione will fall apart and you’ll be left with methylmercury bound to cysteine that will get reabsorbed in the gut unless you can stick it into a binder so it doesn’t reabsorb.  If there is endotoxin or fatty liver leading to inflammation, that can block the bile flow out of the liver.  Endotoxin is an inflammagen in that it generates inflammation.  Being stressed, being in sympathetic dominance can block the flow of bile and deprioritizes detoxification and digestion. Estrogen dominance, high estrogen levels, can also block bile flow via stimulating glutamate receptors in the brain.  Progesterone and herbal bitters open up the liver and facilitate bile flow.  There are a number of Nrf2 upregulators that are also AMPK activators, including quercetin, luteolin, berberine, resveratrol, green tea, and lipoic acid.  Lipoic acid is probably our best Nrf2 upregulator and it is also an AMPK activator.  Fatty and fibrotic liver can lead to leaky liver and AMPK can reverse this.  If you consistently eat a lot of carbohydrates, you will be building up fatty deposits in the liver and these fatty deposits are generators of inflammatory cytokines like NF Kappa beta and TNF alpha, which eventually activate hepatic stellate cells, which end up being myofibroblasts, resulting in fibrotic liver and blocking detoxification.

40:31  The best way to stimulate bile flow is with herbal bitters like gentium, dandelion, solidago, and myrrh, which are all contained in a formula from Quicksilver Scientific called Liver Sauce.  It also contains phospholipids, milk thistle, lipoic acid, DIM, quercetin, and luteolin. Milk thistle supports the liver and supports detoxification.  Most people think of DIM for estrogen metabolism, but DIM is an Nrf2 upregulator and its a Nrf2 epigenetic modifier. Mold can block your liver function and DIM can work against that.  DIM can also reverse immunological reactivity to food.  Quercetin and luteolin are included as mast cell stabilizers. 

47:05  CBD can be helpful if there is a lot of inflammation since CBD blocks inflammation at a brain level first and then cascades down. It helps reduce sympathetic dominance.  CBD stabilizes the glutamate receptors and stabilizes the activated microglia. It also helps with kids with autism.

48:23  Oral chelators can be a useful add on once you make sure the cells and liver are working well, the bile is flowing and glutatione system is upregulated using these protocols.  Once you have done all this, then you can add in a little DMPS or DMSA or EDTA in small doses to increase the amount of metal toxins being pushed from the blood into the urine and out through the kidneys.

49:28  One of the best binders for heavy metals is the IMD that Quicksilver developed, which is like putting DMPS on a little silica grain.  It has sulfhydryl groups, like you find on DMPS or glutathione, and they’re covalently bound on to a tiny silica gel particle with tons of surface area.  It is most specific for mercury, cadmium, arsenic, but also helps with lead and nickel. Oral EDTA can be added to help with lead because it is not absorbed in the GI tract.  Zeolite and charcoal are good for mold toxins and chitosan, which is a molecular mimic for wellchol, which is part of the Richie Shoemaker protocols for mold.  Acacia gum and aloe are added to the Ultrabinder to help with healing the GI tract. The best time to take binders is about 30-60 minutes after taking the Liver Sauce or glutathione.  Binders should be taken at least 30 minutes before or 2 hours after meals.

 



 

Dr. Chris Shade is a PhD researcher working in the field of nutritional supplements. He is the founder and CEO of Quicksilver Scientific, which is known for its heavy metal testing and detoxification products and its unique liposomal supplement delivery systems.   

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.

 



 

Podcast Transcript

Dr. Weitz:    Hello again. Dr. Ben Weitz here and I’m so excited to be able to speak to you today and I’m so happy that you decided to spend a little bit of your listening or viewing time with me to learn about another important topic in the world of Functional Medicine, in this case, what to do about heavy metals. How to test for them, how to get them out of our bodies with Dr. Chris Shade of Quicksilver Scientific. And today is going to be a broadcast of a Functional Medicine meeting that we did online with Functional Medicine practitioners and they were able to ask questions online, so I asked Dr. Shade their questions as well as my questions, but it is very similar to our regular podcast. I just wanted to point out to those of you listening today education people is a passion of mine, but the way I earn my living is by consulting with patients both in person and virtually Functional Medicine, Functional Nutrition, any sort of health care conditions that they want to address with a root cause approach. And I also see patients in my chiropractic office in my office in Santa Monica for chiropractic care. Anybody interested you can call my office at 310-395-3111. And for those of you who enjoy listening to the Rational Wellness podcast, it would be helpful if you went to Apple Podcasts and gave me a ratings and review. And I also wanted to remind everybody who’s perhaps listening on their phone through Apple Podcasts or Spotify or all the other areas that it is on that there is also a video version if you go to my YouTube page, weitzchiro. And if you go to my website, drweitz.com you can find detailed show notes and a complete transcript. So, let’s get into the podcast with Dr. Chris Shade about heavy metal detoxification.         

                                I want to thank very much, Quicksilver Scientific for sponsoring tonight’s event. For all of you listening in tonight, you will get 15% off your next order of Quicksilver Scientific products, if you use the discount code, Weitz, my last name, WEITZ 15 for products ordered from now until September 4th. If you are a practitioner, and you and you do not have a professional account with Quicksilver, you can email Katherine Sumner at Katherine, K-A-T-H-E-R-I-N-E.S-U-M-N-E-R@quicksilverscientific.com, and she can set you up with an account, so you can receive the discount. If you’re not aware, Quicksilver is Dr. Shade’s company that makes some of the most amazing products for detoxification that are widely used in functional medicine world.

                                Our topic for tonight is heavy metal detoxification with Dr. Chris Shade. We will cover how best to test for heavy metals. What are some of the most effective and safest ways to detoxify metals from our body? We all know that we live in a very toxic world, and many of us are exposed to various heavy metals in our everyday lives, including mercury, lead, arsenic, nickel, aluminum, and cadmium, which are pretty much always toxic. Then there are other metals that, in small quantities, are essential nutrients, but are toxic if at higher levels, like chromium, copper, zinc, and selenium. Now, there’s a lot of controversy over how to test these heavy metals, and even more controversy over how to reduce metals in our bodies. We’re going to try to clear up some of those controversies tonight.  For example, does it require doing intravenous curation to get rid of metals? Or can I just place my feet in an ionic foot bath? Or can I just brush my teeth with charcoal toothpaste? There are many products marketed to detox heavy metals, some of which have no proven effectiveness. We really need to hone in on what products have been scientifically proven to be effective, and what particular protocols are going to work for us and our patients.

Dr. Chris Shade is one of the most brilliant Ph.D. researchers working in the field of nutritional supplements. Dr. Chris Shade is the founder and CEO of Quicksilver Scientific. Quicksilver Scientific is known especially for it’s heavy metal testing and detoxification products, and its unique liposomal supplement delivery systems, among other things. Dr. Shade, thank you so much for joining us tonight.

Dr. Shade:           Ben, I’m happy to be here. Love to talk about this stuff. It’s second nature now.

Dr. Weitz:            I know you’ve been talking about heavy metal detox and other forms of detox for a very long time, but for those of us who are not familiar with your story, maybe you could tell us a little bit about your background in farming and how you became interested in heavy metals.

Dr. Shade:           Yeah. It’s really a story about how you get interested, not just in here’s why I detox metals. It’s a lot of people’s stories, like, “I was just shattered by metals, and then all I thought about was getting out from under metals.” When you do that, you get a little like … If it’s mercury, you get a little mercurial centric. But really, it was an education in becoming a holistic thinker. How does nature deal with things? How do people deal with things? How do fish, how do birds deal with things? I was in environmental chemistry as an undergraduate and I remembered learning these stories. Environmental chemistry, you just tend to test where the polluters are, and then you pollute some groundwater, you try to pump it out.  You never really get it out.  It’s just this kind of futility thing of running after industrial pollution and pretending you’re cleaning it up.  But then there’s a deeper understanding called biogeochemistry, which is about how elements cycle in the earth.  How they go into the atmosphere, down into the water. How they move through the food chain.  What happens in the sediments.  How they go into phytoplankton, zooplankton, fish and move on through.  That’s really where you understand the dynamics of elements cycling and the dynamics that we were studying with those of mercury.  At the time, all the money had gone out of studying mercury in people.  This is sort of post the first scare around vaccines and mercury.  All the money moved from the NIH and CDC, and moved over to the EPA.

                                All the studying was on mercury moving through the food chain and how it infected biota. We have very complex models of transitions of mercury forms in the atmosphere, in the rain, in the water, how they partition into different things that bind them in the cells. Key to that is that things like mercury are never present like sodium is in the water as a free ion. They’re always bound to something. It depends what kind of ions are present there, or what molecules are present to bind it. It was very sophisticated, and you know how much is bound on cysteine, how much is bound on glutathione in a cell, in the blood. When I came in over into … Well, I had developed this testing because to really test biomagnification, we had to separate different forms of mercury. That being nepo mercury from fish and inorganic mercury, the sort of primal form of mercury.

                                When I came over into looking at clinical, I realized nobody was respecting the different forms. Nobody was respecting how the metal is complexed, how it moves. Nobody was respecting the fact that the body has an innate system for detoxification, the glutathione system, and also the methionine system. I brought across these ideas and I said, “Look, you don’t need to just use chelators to do this. You can upregulate your natural system.” First, we should test better and separate the different forms of mercury, and look at how they excrete, and then we should up regulate aspects of our biochemistry, because they’re not only the ones that depurate it, meaning take it out of the system, get it out into excretion patterns, urine, fecal, sweat.  They’re also the ones, at the same time, that are making the cells resistant to whatever residual mercury is there. Let’s change the language from this one of, what’s your body burden and how does the chelator get it out, to what is your resistance to metals versus your susceptibility, versus how much is in there? We can work on these different things. We can turn up your resistance, and at the same time, turn up your depuration, how much comes out. In doing that, we found that we got people better, faster. There was less of this, “The chelator made me worse,” and much more of this, “My god, I started feeling better right away and then kept getting better, better, better. At the same time, my blood levels went down,” because we’re working to make the cell more resistant and get this stuff out at the same time. That doesn’t mean that there’s not a place where the two can play together, but the underlying thing is you must upregulate the glutathione system, the underlying detoxification system.

                                Then if you want to speed up depuration by putting some chelator in to get you to pee it out faster, you can do that, but only once you’ve corrected the system. I developed the testing. I moved in to starting Quicksilver Scientific, first doing environmental testing, and then moving on to doing clinical testing, and then moving on to developing the tools to detoxify. That was really my story of how I did that. Along the way, halfway through my PhD, I had 17 freaking amalgams in my mouth. I had come from Bethlehem, this hell place of Bethlehem Steel, the second biggest steel plant in the world. I was stinking full of metals, and I saw it. I felt it. Then when I went to get the stuff out, I used chelators and they got me sicker. That was really how I knew I was going the wrong way. Then when I went to fixing the system, I fixed myself and developed everything that we do now at Quicksilver Scientific.

Dr. Weitz:            Cool. Let’s start with testing. What’s the best way to test for heavy metals? The first part of that question I want to ask is if … I know the answer to this, and this gets asked a lot, but if metals are stored in our bones and organs, wouldn’t it make the most sense to take an oral chelator like DMSA to liberate those metals, and then measure urine before and after? If we’re just measuring the levels in the blood, then we’re not really going to get the levels in the tissues.

Dr. Shade:           Well, if that was true, it would be the best way, but it’s not true. It’s not that they’re not stored more in the tissue. There’s a dynamic equilibrium between what’s in the tissues and what’s in the blood, and there’s more in the tissues than is in the blood. But the lie is the idea that the chelators go and liberate this stuff from the tissue. They don’t. They don’t get into cellular. All they do is go into the blood, little plasma and get a little bit of the kidney burden, liver … well, they make that more kidney filterable and then you pee it out. You’re still working from the blood. Why not just measure the blood? Then that whole … and this has been all proved out, but the whole mythology around the chelation challenge was that these things go into the blood, and they go into the cells and give you a representative example of everything, but they don’t do that.   You’re working with what’s in the blood. You’re going to strip that off into the urine, and hopefully, you’re going to have a reference range in urine that’s from chelated urine, but it’s not. The reference range is from non chelated urine. No matter who you are, when you take a chelator, your urine levels go up. It becomes this excuse to chelate everybody, not a look at where everybody really is with their metals levels. Urine after chelation, if the kidneys are working, is a measure of what was in the blood. What’s in the blood is a measure of what was in the tissues. Fact, when you go and you turn up Nrf2, that’s a trigger in the body to dump things into the blood. When you turn that up, the blood levels will actually rise for a little bit and then come down. It’s showing you what you need to pump things out of the cells, into the blood. But the measurement [crosstalk 00:12:27]-

Dr. Weitz:            Now, can I stop you for a second?  I’ve heard you talk a lot about Nrf2 as being a key pathway.  Why is Nrf2 so important?

Dr. Shade:           Nrf2 is a trigger outside of the nucleus, in the cell, that is a stress response switch. It’s looking at chemical and oxidative stressors in the cell. If those oxidative stressors go up, or electrophilic stressors, that means something that pulls electrons out and oxidizes things like metals do, then this Nrf2 goes into the nucleus and it turns up the expression of the genes for all of the chemo protective system. That’s the genes for all of the glutathione synthesis, Glutathione S-transferases and transporters, all the defense mechanisms against those toxins. That’s what you need to elevate in order to throw things out of the cell, into the blood. Then once you’re out of the cell, into the blood, you need to turn up the filters. That’s the liver, the kidneys, the GI, the skin, even, that take it out of the blood into excretion.

Dr. Weitz:            Is it sufficient to just send out to Quest or LabCorp for heavy metal serum testing because this is, say, covered by the patient’s insurance and less costly?

Dr. Shade:           Good question. Quest and LabCorp are looking at whole blood mercury, and whole blood mercury, not speciated, not separated into inorganic and methylmercury, is really a measure of methylmercury.  If I took you, Ben, and I injected equal amounts.  Say you had no mercury, and we injected equal amounts of methyl from fish and inorganic mercury from amalgam, we fill up your blood, and then that would fill into the tissues.  Then, after a couple of days, it would come to this equilibrium, and we would see a small amount of inorganic mercury and a large amount of methylmercury, or maybe 10, 15 times more methylmercury.   It doesn’t mean it’s because you had more. It’s because of this equilibrium between the tissues and the blood, so it’s more to the tissues for inorganic, less to the tissues for methylmercury.  Then that means when you go and do blood mercury, whole mercury, it’s really a measure of how much methylmercury you have, which is a measure of how much fish you eat.  Inorganic mercury, if all your mercury was from dental amalgam, then you would … and you had no fish mercury, you’d have a very, very small amount in the blood.  In fact, the 95th percentile for inorganic mercury is below the detection limits for Quest and LabCorp.

                                If you don’t eat any fish, you have a ton of amalgams and you send in a blood sample, you’re not going to see anything.  You go, “But why don’t I have any mercury?” Then a good occupational toxicologist would say, “Inorganic mercury, that’s in the urine.  You have to run your urine.”  Your urine may be high, if your kidneys are working, but if they’re not working, then your urine will be low.  That’s a transport system in the proximal tubules that brings mercury from the blood into the urine.  If it’s not working, you’ll show low urine.  You can have high blood, low urine, that’s called retention toxicity.

Dr. Weitz:            Okay, so what’s the best way to test for mercury?

Dr. Shade:           Well, you got to send it to me.

Dr. Weitz:            I know that.

Dr. Shade:           The mercury TriTest. The blood, we will show you methyl and inorganic mercury independently with independent reference ranges. Then we’ll show the urine. Then we’ll take your blood inorganic mercury and compare it to the urine on a graph, which will show you as your blood goes up, your urine should go up.  Are you on that equilibrium line, or are you off?  If you’re not on the equilibrium line, and you’re below it, that means you’re retaining it.  The kidneys aren’t excreting it and it’s building up in your blood.  Hair to blood ratio, hair is all methylmercury.  Blood has both.  You compare hair mercury to blood methylmercury, it’s more of a liver proxy for how you mobilize methylmercury. There you’re getting excretion patterns and the relative ratios of methyl and inorganic mercury.

Dr. Weitz:            Now, why is hair a measure of how your liver mobilizes mercury?

Dr. Shade:           Yeah, I know. The urine, the blood is really, really direct. The hair in the blood, we did that based on some studies that were done by Boyd Haley looking at metals, and these are metals that are mostly detoxified by the liver.  They were looking at copper, mercury and I think cadmium, and they saw that in autistic kids, they knew relatively how much mercury should be in their body based on … they were pretty young, based on what their mother’s exposure was. They saw that the more of the sphere of the autism, the lower the mercury levels in the hair. They saw a dysfunction in the transport system going into the hair, so that’s where we picked that up.  The reason we relate it to liver, is liver is where all the methylmercury goes out.  It doesn’t go out through the kidneys.  You don’t get any methylmercury in the urine.  You only get inorganic mercury in the urine, and then through the bile, you get methylmercury and inorganic mercury.

Dr. Weitz:            What about using hair analysis for other metals as a general screen? Because it’s a easy to do and …

Dr. Shade:           There’s this whole cult movement around that and … Yeah, maybe I diminished it by saying cult movement, but all the data, if you look to Natural Resource Council, these big scientific groups, the relationship between mercury in the hair, and fish consumption is just well studied, really well studied. A lot of the others are just all over the map. They’re like, “It’s high. You’re screaming it.” “It’s low. You’re not excreting it.” The basic research on whether that’s relevant to the body is not really there. They’d like to call it hair tissue mineral analysis, and it’s as if it’s the same as taking a biopsy, but that’s not really true. It’s never really been proven out. Now, it doesn’t mean that there isn’t a relationship to it, and these guys haven’t built out systems that show things. It’s just not a direct way to do these.

Dr. Weitz:            Since we’re talking about the metals, I just want to make a suggestion. You might consider including additional metals besides the ones you include. For example, today I had a patient who had symptoms of metal toxicity, and we’re thinking it might have to do with this metal on metal hip plant implant he had, which is cobalt and chromium.

Dr. Shade:           Yeah, we actually have cobalt and chromium in our blood metals analysis, so those are in there.

Dr. Weitz:            Those are included? Okay.

Dr. Shade:           But really, we’ve got to change the reference ranges a lot. When the cobalt chromium comes up, it comes up really, really high, and then sometimes it’s localized. It’s a little bit difficult to track, but they’re both on the … so we have the Mercury Tri-Test, and then we have the blood metals panel, and the blood metals panel, in the nutrients, says chromium, but you just look for when it goes off the nutrient scale into too much. You got manganese. Do you have the right amount of manganese, or do you have this ridiculously high amount of manganese?

Dr. Weitz:            Right.

Dr. Shade:           Or copper. High copper is a real problem and it makes synergistic toxicities with all the rest of the metals.

Dr. Weitz:            Right. What are some-

Dr. Shade:           But there are some we do need to add, but they’re hard to do in blood, so we’re developing a urine panel, too, and that would be nickel, uranium, and one that’s a rat poison and the one that’s a radiotracer.

Dr. Weitz:            There’s beryllium. You’re going to add that one?

Dr. Shade:           Beryllium, not really. Beryllium, it’s not really toxic unless you get tons, and then you got ones that are toxic when they’re radioactive, but you can’t really tell the difference between the radioactive and the non radioactive ones-

Dr. Weitz:            I see.

Dr. Shade:           … like cesium. People want that.

Dr. Weitz:            Right. Okay, so what symptoms should alert us to the fact that somebody might have heavy metal toxicity?

Dr. Shade:           Well, the fatigue and anxiety are the most quintessential symptom. Fatigue, because all the metals are working at a mitochondrial level to diminish the antioxidant pool in the mitochondria. They’re sucking down all the glutathione and the thioredoxin in the mitochondria, and they’re creating free radical damage, which damages the membranes. Then the mitochondria can’t make ATP. They also work at a thyroid level. If you’re looking at thyroid labs, you look at the TH4, TH3 ratios, and what they do is they damage the ability of the deiodinase to take T4 to T3. You’ll have normal or high T4, but low T3. That’s usually a metal thing and it’s mercury, cadmium and arsenic dominantly, and also, to a second degree, the others. Then it works in an adrenal level.

                                I mean, the metals really accumulate in the kidneys, all aspects of the kidneys, and they burn those out. Plus the adrenals are trying to keep up with things all the time. Another thing that metals do, which is not … it’s sort of an unsung problem, is a disordered inflammatory response. When you have an inflammatory response, you have a little infection. You have a secretion of both inflammatory and pro inflammatory, and anti inflammatory cytokines. You’re trying to create a fire somewhere and a wall around it, so you’re not burning everything up. Metals are shown at physiological levels, the higher physiological levels, to block the secretion of the counter inflammatory cytokines, so you just have a pro inflammatory storm.

                                I mean, that’s what’s going on right now, that people get sick, have pro inflammatory and not counter inflammatory, and so the metals do that as well. They’re sucking down, then your adrenals are burned out trying to put out glucocorticosteroids all the time, trying to counter this inflammatory storm that’s coming out of the immune cells at a cytokine level. That’s the way that they burn out your adrenals. You’re burning out all your energy supply, then most of them, and the most notable of which is mercury are glutamate receptor agonists. They wind up the hyperfunctioning of the glutamate receptors, which of course, gets you anxiety, and eventually will drive you into a deeper neuro inflammatory state called neuro inflammation. That’s where you engage also the immune side of the brain, as well as the glutamate receptors, and when those really start going, you don’t just get anxiety.  Then you get these deeper brain fog, and these cycles of depression and anxiety, and your whole autonomics switch into a dysautonomia in which they are hyper sympathetic, all right?  Sympathetic autonomic nervous system tone shuts down detoxification through prioritization pathways.  Prioritization, meaning how are we going to use ATP? Now, if we’re parasympathetic, our ATP is going to be driven towards rest, digest, repair, regenerate, detoxify, all the rebuilding stuff, but if you’re in sympathetic, it’s just fight or flight. You’re going to deprioritize all the regenerative medicine. What really engages with the mercury to drive you into the deep neuro inflammation is endotoxin, which you’re getting from leaky gut, chronic jaw infections, chronic UTIs, gingivitis, and periodontitis, all drive endotoxin …

Dr. Weitz:            SIBO.

Dr. Shade:           Yeah, I mean SIBO for sure, but then we think it’s all in the gut, but your freaking mouth generates a ton of endotoxin, too.

Dr. Weitz:            Absolutely. What’s the best way to detox? Can I just do a juice fast? Or can I just do a water only fast? Can’t my body detoxify itself?

Dr. Shade:           You’re laying up these softballs for me, Ben. It would be nice, if only it were true. If everything else was good, and we were living in the mountains, and we were all chill, and we’re eating wild food and getting all the phytonutrients, yeah, we wouldn’t really have a problem, but we’re not. We’re chronically, sympathetically activated, meaning we’re chronically downregulating detoxification. We’re chronically eating inflammatory foods. We’re eating not enough real intense phytonutrient foods.   What we need to do is take all this stuff that activates all these nuclear transcription factors like Nrf2, activates cardio metabolic factors like AMPK, to liberate, to end taking things like glutathione, which are the necessary cofactors. That will liberate the metals from the cells, put them into the blood, the liver will jump them into the bile, into the GI. The kidneys of dumping into the urinary flow, and you’ll get them out. Then you just have to assist the process by putting binders into the GI tract that take the things that come out through the bile and make sure that they don’t get reabsorbed…

Dr. Weitz:            Well, hang on, hang on one second. I was trying to mute people and somehow … here, let me do this. Let me mute everybody, and then where are you?

Dr. Shade:           There we go.

Dr. Weitz:            Okay.

Dr. Shade:           Just to throw out this framework for detox, you’ve got a cellular level, I call the microcosmic level, and that’s the conjugation of the metals onto glutathione, and the transport out of the cell and into the blood.

Dr. Weitz:            Okay. Let me stop you there. What do we mean by conjugation of metals onto glutathione?

Dr. Shade:           All right. Well, let me give the framework. We want to push from the cells into the blood. We want to pull from the blood into the liver, dump from the liver into the bile, get it to the GI and stick it on a binder. Now, how do we get it out of the cell?  That’s back to the conjugation thing.  If there’s a metal in the cell … remember, the metals are never just free ions.  They’re always bound to something, and so you have to take it off of a protein it’s bound to, a membrane it’s bound to, and you want to link it on to glutathione.  You need this intermediary.  It’s called a phase two transferase.  It’s called glutathione S-transferase.  It’s going to kind of grab the edge of the metal and the edge of the glutathione, bring them close together, whisper sweet nothings in their ear, and boom, they’re a pair.  All right? They let go of the previous one and they go with the new one. All right?

Dr. Weitz:            Now, where does this glutathione S-transferase come from?

Dr. Shade:           Well, it’s synthesized. You’ve got genes to turn that on.  You’ve always got a little bit around.  Then when you have Nrf2 upregulation, you’ll synthesize more of it.  Then it’ll float around in the cell, and it’s sensing when there is a metal in a bad place. It’ll get the glutathione and it’ll pull those two together, and boom, then you have the conjugation reaction, and you have a metal glutathione conjugate in the cell. That’s floating around in the cell, but it doesn’t passively diffuse across the cell membranes. You have to get it out of the cell into the extracellular space, and then in the blood, and that’s the transporters. That’s phase three. Phase three is transmembrane transporters that use ATP and magnesium to push these things out of the cell.

Dr. Weitz:            Hang on one second. You’re referring to, we have phase one, phase two and phase three of liver detoxification, right?

Dr. Shade:           Yeah. Well, of all detoxification.

Dr. Weitz:            Of all detoxification.

Dr. Shade:           Well you call that liver detoxification, but what if you’re a thyroid cell and you have a toxin in there, and you need phase one, two and three. What are you going to do, wait for the liver to walk into your thyroid? It’s not going to happen.

Dr. Weitz:            But do you have a cytochrome P450 system in the thyroid?

Dr. Shade:           Yep.

Dr. Weitz:            Okay.

Dr. Shade:           You’ve got all that everywhere. You’ve got multiple copies of it in the liver because the liver has to handle so much. Maybe you got 10x more in the liver than you do in the thyroid, but the thyroid has to be able to do this.

Dr. Weitz:            Okay.

Dr. Shade:           Now we got to clear up the difference between glutathione … Well, I never talked about phase one with the metals, because metals don’t need phase one. All right? Really, if you’re a PCB or a flame retardant like a polybrominated diphenyl ether, you need a phase one to take you from being a nonreactive thing to being a reactive thing, and phase one chops into that molecule and makes it more reactive, so that phase two, you can link a glutathione onto it. Then phase three can move it out, but metals don’t need that because they’re already reactive.   We talk about, well, you need the glutathione, then you need to transferase, phase two, then you need to transport, phase three. Metals pick up at phase two, but most other molecules start at phase one, but not all. They all come into the pathways at different places, like a polyphenol. We don’t often think about, “Well, how am I going to detoxify resveratrol?” But you have to detoxify resveratrol, and you start also at phase two, so it’s more rapid than things that need phase one, two, and three.

Dr. Weitz:            Okay, so we attach glutathione to the metals, and then we have the transporters to get it out of the organ. Then what’s the next step?

Dr. Shade:           Then they’re in the blood. When they’re in the blood, then they got to get out, right? So, you have another transporter at the liver, at the basal lateral side of the liver. This is the blood side of the liver. Now you got to think about, make a little rectangular liver cell, a hepatocyte. You’ve got the basal lateral side that harvests toxins from the blood. Then on the other side, you got the canaliculi side. That’s the side that’s on the bile flow, on the bile canaliculus. Bile canaliculus is like … The bile tree is like an upside down root ball going down to a tree trunk, and the little rootlets, the little tiny hairs of roots are called the canaliculi, and they come together into bigger ducts. The bile canaliculus, your secreting bile salts out of your hepatocyte into the bile.  Same transport system that moves the bile salts moves the toxins. You’re moving toxins and bile together, and there’s two transporters that are sisters that live together in that membrane. They upregulate, down regulate together. Right there, you’re like, “Wait. What if I’m Cholestatic?” Well, then you’re toxostatic. You have to move bile and toxins together. They got to go together, or they don’t go. You’re setting up this flow from the blood to the hepatocyte, to the bile. The blood, you have transporters, phase three transporters called organic anion transport peptide, OATP, and it’ll pull that mercury glutathione conjugate into the hepatocyte. It’ll go over to the canaliculi membrane, and it’ll dump through MRP2 into the bile flow, and go into the GI tract.  Now, that’s all well and good.  It’s methylmercury, the kind from fish, the glutathione will fall apart and you’ll be left with methylmercury bound to cysteine, the amino acid with the sulfur on it from the glutathione.   That’s actually the same form that you absorbed from the fish, so you reabsorb it in the gut. When that gets down to the gut, you want to stick it onto a binder so it doesn’t come back in.  There’s a lot of toxins that have this reabsorption phenomenon, especially biotoxins like mold toxins, but then in the metals, it’s methylmercury and cadmium are the primary ones. We want to kick out from the cell, go to the blood, pull into the liver, dump into the bile, get to the GI and get a binder.  There’s all these ways that we can fuck up.  The cell might not be doing it, the liver might not be pulling in, the liver might not be dumping out, or you might be reabsorbing.  All that I call the directionality.  The baton race needs to be hand off one to one to one, to get all the way down there, stuck onto a binder and then you poop it out.

Dr. Weitz:            What are some of the sticking points in the liver that are going to keep us from being able to handle this?

Dr. Shade:           Inflammation. There’s a couple main ones. I want to hit inflammation and the prime inflammagen something that generates inflammation being endotoxin. Same thing we just talked about a second ago it stops at cellular level and it stops at the liver level.

Dr. Weitz:            What about in NAFLD, which is getting to be really common?

Dr. Shade:           Yes, we’ll wind that in, in just one second. Inflammation in the liver, and the inflammation can be from endotoxin, or the inflammation can be secondary to a fatty buildup in the liver, and we’ll talk about AMPK and how that winds into this whole thing. But then stress, just being sympathetically dominant, locks up that bile flow. That’s why when you’re parasympathetic, you get hungry. Why? Because your liver opens up and you secrete bile down into the GI, and you secrete other digestive enzymes. But one of the things that block all that, so I want to set up a connection between the glutamate receptors and sympathetic dominance, and the bile flow.  The other thing that can block the flow of the toxins out of the liver is estrogen dominance.  High estrogen, whether you’re just estrogen dominant, or whether it’s during pregnancy and it’s temporary, are going to block that bile flow. Now, what does estrogen do in the brain?  It makes you glutamate receptor hyperactive, which gives you glutamate dominance, which gives you what?  Irritability and anxiety, which is what estrogen dominance gives you, and what does that do on an autonomic level?  It puts you into a sympathetic autonomic tone, which is further deprioritizing detoxification, so that whole stress axis just locks you up.

                                We want to calm things down now on a hormone level.  What unlocks all that?  Progesterone, because progesterone is a GABA receptor agonist, or at least the metabolites are.  Progesterone, if you taste it, is hyper bitter, and bitters all open up the liver.  That’s why we use a lot of bitters in opening up the liver.  All that is open, close.  Fatty liver then, when ever we … That’s more of a AMPK switch. AMPK is what’s activated when you’re carb restricted and when you’re fasting, when you’re on a keto diet, when you exercise really heavily. All that draws down ATP temporarily, and activates the AMPK kinase, which activates burning of fuel.  What fuel do you burn?  You burn your stored glycogen, you burn your stored fat.  If you’re always carb loading, you’re always building up fatty deposits.  Fatty deposits are the generators of chronic inflammatory cytokines, like NF Kappa beta, and they build up in the liver, and they generate NF Kappa beta and TNF alpha highly in the liver, which eventually result in activating these hepatic stellate cells, which end up being myofibroblasts, which then start making fibrotic liver. All that is activating all these inflammatory processes which are blocking detoxification. Fatty liver brings with it toxicosis, or toxostasis. Then going the opposite way opens it all up. Now, it turns out, a lot of the things that I thought I was using as Nrf2 upregulators are also very strong AMPK activators. All your polyphenols, like quercetin and luteolin, berberine and resveratrol also do that. EGCG does that. They’re all very good for that. Turns out, lipoic acid is, too.

                                Now, lipoic acid is probably our best Nrf2 upregulator, and also an AMPK activator. We’ll use that … if we’re going more after clearing out liver, we’re going to use a different blend of things than if we’re going for cardio metabolic strength. We have a product called AMPK Charge. Used to be called Keto Before 6. Puts you right into ketosis. In like an hour, you’re making blood ketones, like nutritional ketosis from eating fries and drinking beer the night before, because it’s such a strong AMPK activator. Now, if we just want AMPK, we get more with the polyphenols.  If we want more Nrf2, then we’ll put in the lipoic acid as well, so that we can get the cellular response to detox. AMPK also brings with it a big amount of cytoskeletal organization around the liver.  I mean, people talk about leaky gut all the time. Who talks about leaky liver?  There is leaky liver.

Dr. Weitz:            Of course.

Dr. Shade:           There’s leaky liver, there’s leaky blood brain barrier, and as Grace Lou likes to talk about, there’s also leaky vagina.  There’s leaky everything, and adds all the integrity of the adherence in the tight junction. What brings them up?  AMPK activation.  In fatty liver and fibrotic liver, you have leaky liver. AMPK restores that cytoskeletal organization, and it’s also restoring the canalicular membrane, and the transport of the bile and the toxins out of the hepatocyte. It just brings all of that together, and including bringing up cell membrane polarization.

Dr. Weitz:            What’s the best way to get the bile stimulated?

Dr. Shade:           We use this stuff called liver sauce, and liver sauce, as the name implies, is something that is like A1 for your liver. It does everything. We use bitter compounds, classical bitters like gentium and dandelion, solidago, and then we use myrrh. We have all that in there and then we have phospholipids…

Dr. Weitz:            Let me stop you for a second. Those bitters have been a sort of naturopathic-

Dr. Shade:           Go to.

Dr. Weitz:            … go to for long period of time, but have they really been shown scientifically, to significantly affect bile flow?

Dr. Shade:           Yeah. I mean A4M made me put a bunch of slides in my presentation, and yeah, they’re cholagogues, they help regulate bile flow. Every one of them has been studied independently. The last 10, 15 years are ridiculous for how much primary research has come out of the universities looking at all these specific compounds and herbal extracts. They mostly like pure compounds, but they’ll do herbal extracts and stuff. All that shit works and … every part in the chain, sometimes we just know that it brings it up. We got bitters and then PC is part of the MDR, which is a transporter that keeps the bile flowing, that uses all phosphatidylcholine. We got all that in there. Then we got milk thistle and lipoic acid for Nrf2 and AMPK.  Milk thistle anchors … This is part of why it’s hepatoprotective, is it anchors those transport proteins in the canalicular membrane, so when the oxidative or chemical stress comes up, they don’t give up on their job, because you’ll see, often they just turn all that transport off.  Then what do they do?  When there’s too much free radical damage and toxin damage in the cell because you can’t get it up through the bile, it dumps all that stuff out of the cell back into the blood.  It’s the backwash of the liver, back into the blood when the liver can’t process. Because say it’s under too much autonomic sympathetic stress, hormone stress, inflammatory stress, it dumps it all back into the blood. That’s all the negative effects people get from detoxification, when they’re, “I’m herxing.”  You’re not herxing.  Herxing is a specific immunological reaction.   What you’re doing is dumping all these toxins from your liver back into your blood. They’re going to your kidneys. You have that lower back pain. They’re going to your skin and you’ve got rashes and itching and they’re going to your brain, and you feel like crap. All that’s because that anchoring through the liver into the bile isn’t happening.  Milk thistle helps anchor that as well as bring up phase one and phase two. It’s helping with all the different phases, and then we have an immunologic program in there that’s an AMPK activator, and a mast cell stabilizer, and that’s quercetin and luteolin, and DIM. Now, DIM, why do people use DIM? People use DIM for estrogen metabolites, but they miss the whole bigger picture of DIM. It’s an Nrf2 upregulator.  Good, it brings up all this detoxification stuff.  More importantly, it’s an Nrf2 epigenetic modifier.  When epigenetics block either Nrf2 or some of the mechanisms, some of the … well, just say when epigenetic processes block Nrf2, DIM can release them, and we see that mostly from mold. Mold isn’t always epigenetic. It’s what’s called post translational blockage, but DIM reverses all that. Mold blocks your liver function, and DIM can reverse that. DIM also reverses a lot of the immunological reactivity to foods.  The TH cells, you’ve got TH one polarization, then TH2, TH17. TH2 and TH17 are this runaway allergic inflammation, and then there’s T regulatory dominance, which is immuno passivity.  DIM pulls you into T regulatory dominance, and takes you away from TH2 to TH17, which are sort of autoimmune runaway reactions.  DIM is bringing down inflammation because inflammation blocks detox.  It’s unleashing Nrf2 from post translational and epigenetic effects-

Dr. Weitz:            You’re saying …

Dr. Shade:           … add it’s an AMPK activator and an Nrf2 activator. You want ingredients that hit a lot of targets all at once.

Dr. Weitz:            So DIM is something we could use if we have a patient who has a lot of food sensitivities?

Dr. Shade:           Yeah. I started using it because I was getting into hormones and I made a nano DIM. I just started taking it, like I do with everything. I’m like, “Oh my god, my food reactivities are going away.” Then all these different changes, I took it for like three months and it was like every week was like a new week. It was like, the sun is shining.

Dr. Weitz:            Wow.

Dr. Shade:           Then I gave it to other people and a lot of their food reactivities have gone away. It’s one of these unknown-

Dr. Weitz:            a clinical pearl.

Dr. Shade:           What’s that?

Dr. Weitz:            That’s a great clinical pearl right there.

Dr. Shade:           Wow. It’s a huge one.

Dr. Weitz:            Obviously, gut health is super important because what’s going to happen to the bile if you’re constipated and your gut’s not working right?

Dr. Shade:           Yeah. When the bile is not flowing, that will get you constipated. When you’re constipated, it’ll stop the bile from flowing. Those both are feeding against each other. SIBO, you have small intestinal bacterial overgrowth because your bile is not flowing enough, and bile is a detergent and an antimicrobial in the upper GI. The upper GI isn’t supposed to have all the probiotics. That’s the lower GI. Upper GI is pretty sterile.  It’s a chemical reactor.  When that stuff crawls up there, it’s because the bile is not pushing it down.  Whenever you’re trying to do a SIBO protocol, you should be encouraging bile flow.

Dr. Weitz:            It’s interesting because Dr. Rahbar, who I think is listening to this call tonight, he’s a integrative gastroenterologist, and he was telling me how he gets SIBO patients, and a lot of times they’ll have bile that flows backwards. He’ll see it in the upper intestine. He’ll see it in the stomach.

Dr. Shade:           Flows backwards. You mean, like they throw it up?

Dr. Weitz:            Yeah, exactly.

Dr. Shade:           Yeah. That’s a problem with the sphincter there, going into the GI and it’s coming back up there. That’s a directionality problem, and that needs to be corrected, and I don’t know necessarily how that’s done.

Dr. Weitz:            Right. Okay. I’ve heard you talk about using CBD as an important factor in this process.

Dr. Shade:           Yeah. Inflammation and detoxification are fundamental opposites. Inflammation blocks detoxification at a cellular level, at a liver level. It’s just doing it all over the place, and at a brain level. The inflammation is making you sympathetic dominant. CBD blocks inflammation at a brain level first, and then cascading down. It’s taking you from sympathetic dominance to a parasympathetic sympathetic balance. It’s cleaving the cycles of neuro inflammation by stabilizing glutamate receptors and stabilizing activated microglia.  I first saw this use in autism. The autistic kids, god, you’d have to … For the first two years, you just talk to them about detoxification. For the next three years, you show them the bottle, and the next 10 years, you start one year, every year you give them a drop more than you used to give them. It was a painfully slow process. Then you give them some CBD and you’re like, “Okay, here’s the adult dose.” I mean, it just created this beautiful window for detox. You do the CBD, you push in the liver sauce, you give them the binder and you’re like, “Whoa, you’re detoxifying like a pro.”

Dr. Weitz:            Now, is there a role for using chelators in this process?

Dr. Shade:           Yeah. First, restore the whole damn thing and make sure the cells are working, the liver’s working, everything else. Then if you want to poke in a little bit of DMPS or DMSA, I like DMPS, better, or EDTA for sure, and then just do small doses, and that’ll take more out of the blood and put it through the kidneys into the urine.  Now, first you want to do that testing, make sure that’s all right.  Then you can speed up the process. I remember Huggins used to use five to 25 milligrams of DMSA a day, along with using our metal binder and some glutathione, and a lot of the guys over at Ultra Wellness, Mark Hyman’s group, Todd Lapine  does this. He blends it, too. You’re going to do Chris’s glutathione system upregulation. I’m going to do DMPS. You don’t do the chelators without the other. When in doubt, you’re always going to do glutathione system upregulation. If they’re pretty stable and impatient, then you can put in some chelator, too.

Dr. Weitz:            Now, which are the best binders and does it depend on each metal? Is there an ideal binder for each metal?

Dr. Shade:           Well, we made IMD, which is like putting DMPS on a little silica grain.  That one’s super good for all metals.

Dr. Weitz:            What is that made out of?

Dr. Shade:           These are sulfhydryl groups, like you find on DMPS or glutathione, and they’re covalently bound on to a tiny silica gel particle with tons of surface area. It’s like a little particle with a million hairs that all have sulfhydryls, and any metal that gets near it just getting trapped into these hairs and get taken out the GI tract. Those are most specific for mercury, cadmium, arsenic, but those still do lead and nickel.  It’s interesting, oral EDTA is a binder for lead because EDTA is not absorbed through the GI tract, but I think you could just use IMD for all of the metals there.  Now, we added zeolite and charcoals, because zeolite and charcoals are going to work on your mold toxins and a lot of the … all the other environmental things, the pesticides, herbicides, the volatile organic chemicals.  We actually use a cocktail.  We use charcoal, zeolite, chitosan, which is a molecular mimic for wellchol, that’s using the Richie Shoemaker protocols for mold, and then we use IMD.  Then we put in some GI candy. It’s a acacia gum and aloe.

Dr. Weitz:            This is all included in your Ultra Binder product.

Dr. Shade:           Yeah, the Ultra Binder.

Dr. Weitz:            And then there’s-

Dr. Shade:           We do this combo, pair, push catch liver detox. You do the liver sauce, and then the Ultra Binder a half hour later. Push the toxins, catch them. Then you got all the add-ons. I got neuroinflammation, I add on CBD. I got metals, I’m going to add on glutathione, I got lead. I’m going to add on Liposomal EDTA. You take them all with all the liposoms at once and then go to the binder.

Dr. Weitz:            In terms of the binders, when’s the best time to take them?  You said a half an hour after you take the liver sauce or the glutathione?

Dr. Shade:           Yeah. A half hour’s a nice simple timing. It can be anywhere from a half hour to 45 minutes up to an hour. 45 might even be better but a half hour you feel it. You take this stuff and then a half hour later if you’re toxic you’re like, “There’s something happening.” You take the binder and you’re like, “Oh, perfect.” Binder then anytime you get into a detox and you feel funny, more binder almost always blocks the reaction.

Dr. Weitz:            Now of course binders will block all these nutrients from having any role either potentially, right?

Dr. Shade:           Yeah, if you take your nutrients and your binders at the same time, but that’s pretty stupid so why would you do that. Remember your GI is a tube, one thing in, then the next thing, then the next thing and they all go. It’s funny, they don’t actually mix, they actually go in a line.

Dr. Weitz:            They don’t exactly go that quick. Yeah.

Dr. Shade:           You take your binder in your wait a half hour, 45 minutes until you eat, and then the binder sooth, and then you can eat. You can take your supplements and stuff. If you want to be really careful, then your wait till lunch for your supplements. If you’re doing something like a serious medication, say you’re doing your thyroid or heart medication, give it an hour, two hours afterward, just to make sure that the binder wasn’t, didn’t have delayed gastric emptying, because it will bind that kind of stuff.

Dr. Weitz:            Right. Okay. Who wants to ask questions? We’ve got a few questions. I think I’ve been trying to blend them in. Somebody asked about at the beginning, you were mentioning about resistance and susceptibility. I guess some people can get exposed to toxins and not have any effect, and other people are super sensitive.

Dr. Shade:           Yeah, and that is how upregulated your cellular detoxification systems are and your systemic ones. It’s really more, how good is the cell. Because I’ve seen … If the cell’s pushing away really at a fast rate, the blood levels will actually be higher, but the cellular levels are lower, and so it comes down to that coding for those. When that is up, you’re keeping your cellular machinery free of the metals. When you keep inflammation down and you keep Nrf2 and AMPK up, you’ll have higher resistance.

Dr. Weitz:            In terms of when you get a complex patient, and this seems to be something that I see fairly commonly. You have a complex patient and maybe you do a bunch of testing and you find out, maybe they have some mycotoxins and they have some metals, and maybe they have a few gut issues. Where do we put metals in importance? Or do we try to … Let’s say you had a patient who had mycotoxins and metals, would you prioritize one and try to remove it, or would you try to do both of them at the same time?

Dr. Shade:           I do those both at the same time. The only really question … You might modify some of the things that you’re giving them. But you really want to get all the toxins at the same time, and you can’t pretend like you’re going to kick one out and not the other. Now, maybe Glutathione S-transferases is more important for metals, and make me glucuronosyltransferase is more important for molds. You can either do them both at the same time, or you can go back and forth but there’s no separating the two. You can’t activate one without activating the other, you can favor one, so that’s not really a big question. The big question is the infection versus the toxin.

Dr. Weitz:            Okay.

Dr. Shade:           Infections block detoxification. There was some schools that said well you … All right, infections block detox, but toxins diminish your immune system. A lot of people said, just get the toxins out, your immune system will pop back up. It’s not been my experience with a lot of other people have been like, “No, you got to clear an infection first.” But it doesn’t mean you do just one or just the other. We’re such a binary brain we think we do one or the other. It’s just relative importance. You’re going to be holding up detoxification but at a lower level, because as you kill things more toxins come out. You’ve got that going on, maybe you got that running at 30% out of 100. And you’re going to run antimicrobials at 70 to 100%.   Then as you get a little further into it and you’re wiping out the infections more, you’re going to switch and you’re always going to have both going on, so you don’t get a resurgence of the infection. I start antimicrobial dominant switch to detox dominant. When you know there’s creatures in there, you got to clear out.

Dr. Weitz:            I’ve heard some practitioners saying, “Look, you got to fix the gut first, because they’ve got a bunch of gut problems and leaky gut, and you were talking about endotoxins, that’s just going to make the process more difficult.

Dr. Shade:           Yeah, but sometimes the got problems or from the toxins, and so the toxins are locking the gut problems in place. You can never just do one damn thing. I mean, that’s just fricking psycho. You’ve got to be blending things. Yeah, you’re working … But when you’re using Ultra Binder you’re working on gut. So to me you’d be doing push, catch, maybe not hitting it so hard, but you got gut problems, so you’re going to put a lot of other gut things in there. You’ll be using the programs just for the gut, you’ll be fasting them more, you’ll be keeping them away from bad foods, but you can’t just ignore detoxification.

Dr. Weitz:            One of the questions came in, if you’re using your liver push catch protocol, does drinking coffee affect it?

Dr. Shade:           It helps it.

Dr. Weitz:            Okay.

Dr. Shade:           At least in my espresso centric lifestyle. Yeah, I mean, coffee actually has AMPK activating activity, it has niacin in it. It’s got a lot of different things. People are like, “Oh, caffeine, it’s a toxin.” If you do too much coffee, you’re going to make yourself sympathetically … If you’re wired, you’re going to be sympathetically dominant and you’re not going to do that. But a little bit of coffee … What was the what was the Arrested Development song? Coffee makes you go to the bathroom. I don’t have a cafe but my cousin does. It was in a song. Everybody knows it makes you go to the bathroom, which means it’s a bioflow stimulant. You can do an enema of it, and everybody knows that works, but just a little bit of coffee does that too.   The right amount of coffee, good. Too much coffee, you’ll lock up the system.

Dr. Weitz:            Right. Somebody asked if you have a really high viral burden and metal toxicity at the same time, but I think we just covered that.

Dr. Shade:           Well, yeah. But what do you want to use for that? There’s a lot of different things, but I want to do that always at the same time. Low glutathione makes high viral burden, and so you’ve got to bring glutathione into the system, and the metals are draining out the glutathione. A cat’s claw was the thing that I use the best for high viral burden. A cat’s claw along with push catch and glutathione was how I dealt with high viral burden. But sometimes [crosstalk 00:58:17].

Dr. Weitz:            How does cat’s claw-

Dr. Shade:           … the other ones that are better.

Dr. Weitz:            How does cat’s claw work? That’s an immune stimulant?

Dr. Shade:           Yeah, it’s poorly researched, but clinically people show it. It’s an immune stimulant, and it’s immune modulators, so the immune system doesn’t get so hijacked by the viruses. Things like Epstein–Barr and cytomegalovirus I’ve seen the best results with. They have things that block your ability to take the virus and digest it through autophagy, and then mountain immune response to it. The best I can see it’s blocking the blocking of the digestion of the virus to mount the immune attack, but that one’s worked really well for us in the past.

Dr. Weitz:            It’s interesting how some of these pathways like the AMPK pathway and Nrf2, are some of the same pathways that are really beneficial for antiaging as well.

Dr. Shade:           Oh, yeah, totally. Because, if there’s anything we know longer live people have higher glutathione. I did a glutathione study for LifeWay patches we were trying to … Way back before it was even making glutathione. We’re measuring serum glutathione in people are whole blood glutathione in people and seeing if this product raised the glutathione. But the thing that was so obvious is these people who came in and look super good for their age, all had the highest glutathione. The people that look very dry and [inaudible 00:59:53] burned out for their age, they’re the lowest glutathione. Glutathione, why is that? Because it controls telomerase activity for one.  Goes into the nucleus and controls cell division, controls the immune system, it controls detox. It does all these different things. Glutathione is a major antioxidant thing, and so Nrf2 activation as part of that. It just turns up all the antioxidant system. The only down with it is in cancer that system gets hijacked for immortalization of the cell. Everything that’s good for antiaging people worry about for cancer.

Dr. Weitz:            Serum glutathione, is that a good measure of glutathione levels?

Dr. Shade:           Whole blood.

Dr. Weitz:            Whole blood glutathione?

Dr. Shade:           Yeah.

Dr. Weitz:            Okay. [crosstalk 01:00:40].

Dr. Shade:           If the lab can match it right. It’s very tricky, it’s very labile, it breaks down a lot.

Dr. Weitz:            I see. It’s interesting. I wonder if anybody’s looked at whether whole blood glutathione levels are a marker for outcome with SARS-CoV-2.

Dr. Shade:           Well, there’s all these anecdotal responses of giving people glutathione and blocking the runaway inflammation of SARS. All the anecdotes we got from people using … As soon as they went on liposomal glutathione, it was like, “ah.” It went from being really bad to being, “Oh, this isn’t so bad.” That’s a definite one.

Dr. Weitz:            That was after they had breathing problems or what’s [crosstalk 01:01:31]?

Dr. Shade:           They were already sick. These were going through some of the doctors that work for us, so I wasn’t direct on all of them. But they had that whole hyper fluishness, and yeah, there was breathing problems. They weren’t in ICU, but they were having problems. Then over in New York, there were some cases where people were hyper sick and they took glutathione and started getting better right away.

Dr. Weitz:            Somebody asked can you measure pyroglutamate, which is a glutathione metabolite instead of whole blood glutathione?

Dr. Shade:           Yeah, I can’t really speak to that, whether that’s a good measure.

Dr. Weitz:            Right. Okay. I think people are still coming, but I think those are the questions. I have any final thoughts you want to leave us with Chris? [crosstalk 01:02:20] you want to talk about?

Dr. Shade:           No, we’ve said a lot there. I think the importance of the of the autonomic system is the thing that’s missed the most often, and how do you get yourself to an autonomic balance, meaning you’ve got good parasympathetic balance. It’s not just things like CBD, GABA also works for that. But it’s getting into breathing, getting into mindfulness. Taking more time for your time for yourself. Yoga, tai chi is my favorite. All of those lifestyle factors are going to be a big X Factor [crosstalk 01:02:50] from getting you into proper detoxification.

Dr. Weitz:            Do you recommend sauna and things like that to stimulate detox as well?

Dr. Shade:           Sauna is excellent. That’ll take out some of the excess burden while you’re moving a lot of toxins around, the sauna will relieve some out through the skin make that a little bit easier. Foot baths are actually not taking toxins to the skin. They’re an autonomic measure. I’ve had people do foot baths and measured their blood metals before and after the foot bath 30 minute thing, their blood metals go up. That means the tissues dumped into the blood, but the next day they’re back down. The foot baths are relieving the autonomic block. Saunas are working on autonomics if they’re nice, calm saunas, and they’re also relieving toxic burden through the sweat.

Dr. Weitz:            What about any these electrical modalities like PEMF?

Dr. Shade:           Those all definitely work on autonomic levels. I haven’t measured them. I felt them. I know they do work. You have to set the biochemistry in place, and then what are your different technical modalities, and what are your life’s style modalities. These are all things that add into it.

Dr. Weitz:            You recommend infrared sauna for sauna?

Dr. Shade:           Infrared is the best yeah.

Dr. Weitz:            Okay. Well, thank you, Chris. Thank you for-

Dr. Shade:           Thank you.

Dr. Weitz:            … spending this time with us. It was fascinating. We all learned a lot, great clinical pearls. Just want to remind everybody that everybody who listened in on this call, get a 15% discount on your next order if they order before September 4th I think, and use the code Weitz W-E-I-T-Z, my last name 15. Thank you, everybody, and we’ll see you next month.

Dr. Shade:           Great. Thank you so much Ben. Take care.

Dr. Weitz:            Okay.

 

,

Autoimmune Disease with Palmer Kippola: Rational Wellness Podcast 171

Palmer Kippola speaks about Autoimmune Diseases with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

4:28  Palmer reports that when she was 19 years old she woke up one day and had tingling in the soles of her feet. This tingling progressed and crept up her legs like a vine. Her parents took her to a neurologist who did a cursory exam and then told her that she has multiple sclerosis and there is nothing that she can do except go home and wait and eventually she would be destined for a life in a wheelchair.  She essentially laid on the couch for 6 weeks since it was difficult to walk, but eventually, with the encouragement of her father, who told her “Honey you’re going to beat this thing,” so she decided to fight it and overcome her health challenge.  But her Dad was also verbally abusive to both her and her mom and she recalls her dad yelling at her mom when they were age 3 or 4 for being overweight. She developed insomnia at around age 11 or 12.  So she lived with chronic stress and this may have been the trigger for her autoimmune disease.  The Adverse Childhood Experiences (ACE) Study shows that traumatic events in childhood can trigger autoimmune diseases later in life. Palmer considers herself cured of her multiple sclerosis and she pointed out that in the dictionary, the word cure means to restore to balance. She recognizes that she still has the genes for MS but she has altered the epigenetic expression of those genes.

13:52  Some of the keys to Palmer improving were developing a yoga and a meditation practice that enabled her to deal with stress better. Prior to that she would get symptoms whenever she felt stress building up. She tried following a low fat, vegetarian diet since this is part of the Roy Swank diet that was recommended for multiple sclerosis, but it did not work for her. She found that she did not do well eating gluten and she also found that it was important for her to include some humanely raised, grass fed, grass finished beef and wild fish and that such animal proteins and amino acids were helpful in her body being able to repair and heal.

19:12  Most patients with autoimmune diseases should give up eating gluten since Dr. Alessio Fasano in 2015 discovered that gluten creates leaky gut and leaky gut (aka intestinal hyperpermeability) is the pathway to autoimmune disorders.  And 70% of the people sensitive to gluten are also sensitive to dairy.  The casein protein in diary is inflammatory, esp. from A1 cows. Palmer recommends her clients do a 30 or 60 or 90 day food elimination diet in which they avoid gluten and all grains, dairy except for ghee, sugar, eggs, soy, corn, night shades (tomatoes, white potatoes, peppers, eggplant, goji berries), legumes, nuts and seeds, coffee, and alcohol. They essentially do an autoimmune paleo diet until their symptoms resolve and then they test these foods back in one at a time to see if they create a reaction or are tolerated.   

29:25  Gut health is a big factor in autoimmune diseases and if you have leaky gut then large protein molecules like gluten and casein will more likely get into your bloodstream and get attacked by the immune system.  If you have leaky gut, you have genes that predispose you for it, and you have environmental toxins and other factors that create inflammation and cause the immune system to overreact, then you are more likely to end up with an autoimmune disease. In order to stop an autoimmune attack we need to remove the stuff that is breeching the lining of our gut, heal it, and seal it, so that we can arrest that process. Palmer said she likes look at a good stool test like GI Map or a stool test from Genova or Doctor’s Data to assess the gut health and then she will use the 4 R program (Remove, Replace, Reinoculate, and Repair) first pioneered by Dr. Jeffrey Bland, the Father of Functional Medicine, in her treatment approach.

 



 

Palmer Kippola is a Functional Medicine Certified Health Coach who specializes in helping people prevent and reverse autoimmune conditions.  Palmer is the author of the best selling book, Beat Autoimmune: The 6 Keys to Reverse Your Condition and Reclaim Your Health. Her website is PalmerKippola.com.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.

 



 

Podcast Transcript

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

                                Hello Rational Wellness podcasters. Today our topic is autoimmune diseases with Palmer Kippola. Autoimmune diseases are increasingly common causes of sickness and death in the United States. Autoimmune diseases have been on the rise for at least the last four decades. The immune system which we’ve all been learning a lot more about in recent times, it’s designed to protect us from viruses, sure. Bacteria and parasites and to repair our tissues from damage. Autoimmune diseases are diseases when the immune system, instead of attacking those pathogens, attack our own cells and organs and what this means is that the immune system is out of balance. This is often referred to as immune dysregulation. So there are at least 100 different autoimmune diseases and the list is growing and quite a number of other diseases that are suspected to have an autoimmune base. So if we include diseases that have an autoimmune basis, then autoimmune diseases are now the third leading cause of death in the United States, since most of these diseases are chronic and are often life threatening. So a little more common autoimmune diseases include Alzheimer’s Disease, Parkinson’s, Rheumatoid, Hashimoto’s Hypothyroid, Celiac Disease, Type one diabetes, multiple sclerosis, Crohn’s Disease and what we have recently learned from Dr. Pimentel that Irritable Bowel Disease, the most common GI condition, also has an autoimmune origin in many patients. Conventional medical doctors treat autoimmune diseases either by controlling the symptoms, such as providing thyroid hormone in the case of Hashimoto’s Hypothyroid or by using medications that suppress the immune system such as corticosteroid, chemotherapeutic agents or the newer injectable TNF alpha blocking agents like Humira and Remicade. These drugs block the immune system and unfortunately this is a problem because we do need a properly functioning immune system and they have potential side effects like infections and cancer.

                                But functional medicine treats autoimmune diseases by looking at some of the underlying factors that lead to this immune system getting dysregulated such as leaky gut, food sensitivities, toxins, mold, heavy metals, infections, nutritional deficiency, stress, et cetera. This is very important. If I have a patient with Hashimoto’s Hyperthyroid and most women in the U.S. with Hypothyroid have autoimmune Hashimoto’s and all this patient is treated with is thyroid medication, it doesn’t do anything for the smoldering fire of the autoimmune disease that’s been attacking the thyroid gland and chances are will continue. So this patient may need higher dosages of thyroid or they may end up with another autoimmune disease. So not just regulating the thyroid, but also putting out that smoldering fire of autoimmunity is crucial for this patient’s long term health.

                                Palmer Kippola wrote an awesome book, “Beat Autoimmune The Six Keys to Reverse Your Condition And Reclaim Your Health.” She is a functional medicine certified health coach and she specializes in helping patients reverse and prevent autoimmune diseases and she’s here to bring some clarity to this topic and give us some more detailed ideas about what we can do about preventing and reversing autoimmune diseases. Palmer thank you so much for joining me today.

Palmer:                It’s an honor and a pleasure Dr. Weitz. Thank you so much for having me.

Dr. Weitz:            Absolutely. So, maybe we can start by introducing you to our audience by having you tell us a little bit about your life story, beginning when you were diagnosed with MS at age 19.

Palmer:                Yeah, well I have to take you back a few years in time for that. In fact, I grew up in where you’re practicing right now in Southern California and I was home for the summer after my freshman year of college. I was your average 19 year old hardworking, hard playing young woman. I was home from school and I didn’t have any of the precursor symptoms. So this hit me quite out of the blue. I was working a summer job and one morning I woke up and the soles of my feet were all tingling. That feeling, that pins and needles feeling like when you sit on a limb too long. I shook my feet, but as hard as I shook my feet I couldn’t get the blood flow back to my feet. I headed off to work thinking this will just pass.   But over the course of the morning the tingling progressed and it crept up my legs like a vine. By the time it got to my knees I knew something was wrong. So, I called my parents who called the family doctor who said, “Get her over to the neurologist at UCLA today.” So that afternoon we sat in the neurologist office and it was a woman who had me do the cursory exam which you know heel toe, heel toe. Touch your finger to your nose. That was really about it. Tested my reflexes and after about five minutes she said with what I consider to be a spectacular lack of sensitivity, “I am 99% certain that you have MS, multiple sclerosis.” My family and I had never heard of this. So this is in the mid-80s. I have to take you back a little bit. We didn’t have an internet, but like you said in the introduction, these are on the rise. These autoimmune conditions and when I was growing up and in the mid-80s nobody had heard of MS or multiple sclerosis.    So the doctor continued if I’m right, “There’s nothing you can do except go home and wait. We have these immunosuppressive drugs. These steroids, which you could take and we have something called an NMR, a nuclear magnetic resonance image machine” which was the precursor to the MRI. “But other than that there’s nothing you can do.” So later I would learn that she actually pulled my parents aside and said, “You better get ready because she destined for her life in a wheelchair.”

Dr. Weitz:            Wow.

Palmer:                “So you need to really prepare for that.” I’m telling you like a mack truck just simply quite out of the blue and that day we went home just devastated. We had no idea what to expect. That feeling of uncertainty and the earth has shifted beneath your feet. That was what we felt and that night we got into bed, my mom crawled in with me and all the areas that had been tingling had crept up right underneath my chin, but now every part of my body had gone numb. My body would stay completely numb for a full six weeks that summer, 1984.

Dr. Weitz:            Wow.

Palmer:                A terrifying time. Yeah, so I’ll leap into, I won’t leave you hanging here. We started when I wasn’t despairing about the future, my parents were really rocks. They were really there for me and my dad, who really encouraged my can do attitude, would say to me, “Honey you’re going to beat this thing” which is how I got the title of the book was my dad’s encouragement, “You can beat this thing.”  My mom started to plan for my future in a wheelchair.  Could I got to school? Could I attend UCLA in a wheelchair for example?

Dr. Weitz:            Wow.

Palmer:                That was what we were feeling. So I lay on the couch because there was nothing else I could do that summer. When you’re numb, you can walk, but you don’t have any of that proprioception where you can feel your limbs in space. So it’s this really gangli walk. I would install myself on the couch everyday for six weeks. Friends who weren’t too scared off by this mysterious disease, would come and visit and some friends brought, what do 19 year old friends bring you? Cookies, books, movies, they hand out with you. This one family friend came to visit. She was into things metaphysical. She said, “Palmer why do you think you got this MS? Why do you think you got this?” I was literally stunned. I was really taken aback. I got mad. “Are you insinuating that I brought this on? Do you think that I did something to do this or deserve this?”   She left, but the question wouldn’t leave me. So I sat there on the couch chewing on that question like a dog with a bone. I just lay there, “How did I bring this on?” So I need to take you back a little bit more in time. So I had been adopted as a baby and my parents were very loving. But my dad had been a fighter pilot and his way was invariably the right way. We used to butt heads quite a bit. It was this dichotomy because on the one hand super motivational, encourage my can do attitude all the time. But on the other hand, he was a yeller and he was really judgmental and really critical and he verbally abused my mom and me.

Dr. Weitz:            Wow.

Palmer:                I have to tell you Dr. Weitz that my earliest memory and this is unfortunate, but true.  I’m maybe age three, maybe four my dad’s yelling at my mom who is overweight.  She struggled with her weight perpetually.  So she shut herself behind the bedroom door and she’s crying and my dad is yelling at her.  I am standing up to my dad in the hallway with my little dukes up, “You call my mom names? I’ll sock your lights out” or some words to that effect, right?  I had become a child warrior.  I was going to protect my mom no matter what.  I had become hyper vigilant.  I developed insomnia maybe around age 11 or 12.  I was always scanning my environment for safety, right?  In that moment as I’m lying on the couch at age 19 I had no idea how this came to me.  But I figured that if I didn’t have a real battle to fight my immune system, the concept of Don Quixote?  I came up with that idea years later.  But he didn’t really have a battle.  He was fighting windmills. He was lunging at windmills right?

Dr. Weitz:            Right. Yes.

Palmer:                So there was nothing really to fight. But if I didn’t have a real battle to wage, I would turn those warriors, that immune system, that attack on myself. So that hypothesis, that initial hypothesis at age 19 that it was chronic stress from growing up in that environment where I didn’t feel safe. That still rings true for me today even though I know there’s vastly more to the story. But that was my initial hypothesis and now we have tons of research from the ACES study, the Adverse Childhood Experiences Studies powerful connecting what happens in childhood does not stay in childhood, but is profoundly linked to the advent of autoimmunity even decades later. So just to put a nice period on the story, I had the type of MS which is called relapsing, remitting. Meaning symptoms come and symptoms go.   So that summer just in the nick of time for me to go back to college for my sophomore year, the numbness started to retreat. That would take a full two years for the numbness to completely dissipate, but I got off the couch and went back to school for my sophomore year and there I went off on my 26 year course of relapsing, remitting MS.

Dr. Weitz:            So along this journey what have been some of the biggest keys to helping put your condition in, would you say it’s in remission now?

Palmer:                I don’t like to use that word because remission makes you think that something is lurking in the background, ready to pounce forth.

Dr. Weitz:            Okay.

Palmer:                Okay. So let me step out boldly here and say that the word cure if you look it up in the dictionary, means to restore to balance.

Dr. Weitz:            Okay.

Palmer:                Okay, I believe that the larger forces like the pharmaceutical industry and I’m not a doctor so I’m not constrained by some of those American Medical Association rules that say you cannot say cure. So I believe that I am cured and I will say very, very clearly that I will always have the genes for MS. That’s not what we’re talking about here. We’re talking about the expression of our genes and that is some of the most profound science that I discovered was the science of epigenetics which allows us to control the expression of our genes. That is what’s super empowering and ultimately how I healed.

Dr. Weitz:            So what were some of the real keys that allowed you to overcome the expression of your genes?

Palmer:                So, it just follows that because I intuited that chronic stress was my big root cause, then I needed to address stress head on.

Dr. Weitz:            Right.

Palmer:                I didn’t immediately do this. In fact, I went back to college and I was in denial for quite some time. Let’s call it for the next couple of years and probably for the next three or four years I just went on with my life. When I started having symptoms again I started to realize maybe there was something in fact, that I could do about this. Maybe my dad was right, I could beat this thing. So I noticed that when I was stressed out when I had exams at school or something that I was particularly stressed out about, I would develop symptoms, almost immediately within a day or a week of that stressful event. Conversely, when I started to relax more I noticed a dissipating of symptoms. I mean it really became clear. So in 1987 I started doing yoga and I found that that was a practice that I could actually do and become present. I wasn’t focused on the past. I wasn’t worrying about the future. I was just on the mat and I learned how to breathe in through my nose and man that shavasana of just lying there and letting things go, that was huge for me.  So that practice was the first thing I did and subsequent to that I discovered meditation in the early to mid-90s and as long as I did those practices I noticed a reduction in symptoms. I mean it really became this little experiment that I was doing, not realizing that I was really doing it. But I could tell this cause and effect pretty early on that stress equals symptoms, relaxation equals a diminishment of symptoms. That was certainly number one and that is still true today. That was one of the biggies.

Dr. Weitz:            Great. So if that’s number one, what were number two and three on your journey to health?

Palmer:                So there was a lot of experimentation that went on. Since I had more than two decades with MS and I was really trying to do this and remember there was no internet at the time. So I was just doing things by going to the public library in Santa Monica or intuiting things and following that intuition. I tried diet for awhile. I just want to touch on this because I think it’s also important to pay attention. We try things, right? Our life is a series of experiments. Not all of them are going to work.

Dr. Weitz:            Yeah, so let’s talk about diet. What’s the best diet for somebody with an autoimmune disease?

Palmer:                Yeah, well-

Dr. Weitz:            Or does it depend on the person?

Palmer:                I think it depends. I will say what didn’t work for me was a low fat veterinarian diet. So it became very clear there was this book that was in the mid-80s called the Roy Swank Diet. Multiple sclerosis diet, something like that.

Dr. Weitz:            Yes.

Palmer:                He professed that you got to get rid of fat, that’s your enemy. So we were a super low fat house. Tried that. The advent of the inclusion of more healthy whole grains in my diet, not only didn’t make the MS symptoms better, it actually made things worse and I started experiencing more tummy troubles.  So that for me was a failed experiment and it wasn’t until much later until 2010 that I discovered my biggest root cause or I would call it the linchpin root cause for me happened to be gluten.  So, I have what’s considered to be non-celiac gluten sensitivity meaning I don’t have Celiac Disease, but I am sensitive to the protein in wheat called gluten.

Dr. Weitz:            By the way do you think that that’s the case for most people? Can some people get positive results following a vegetarian diet with an autoimmune disease?

Palmer:                It’s an interesting question and again I need to just convey not only my personal experience, but I’ve done a lot of research since as you’ve seen I have a very large book.

Dr. Weitz:            Right and what have you found?

Palmer:                I have found that not a single person that I have found or interviewed including Dr. Terry Walls, including Linda Clark who is a health educator, including lots of people that I include in my book, Michelle Corey, people who had been vegetarian or vegan could not heal from autoimmune disorders until they began to incorporate meat. We’re not talking about tons of meat, but I found from my studies that what I’ll call a paleo template diet appears to be the best for people with autoimmune disorders. Now that’s not to say that a short term vegetarian or vegan diet is not powerful in helping you to detoxify from things. I think as a cancer healing mechanism that can be helpful for a short term. But when it comes to building and repairing the proteins that we have in our bodies every single cell, we need those amino acids from animal based protein. I would certainly only advise and advocate for humanely raised, grass fed, grass finished, so 100% grass fed animals and wild fish.

Dr. Weitz:            So, in terms of you mentioned gluten, so gluten is a food that you said you were sensitive with. You didn’t necessarily have Celiac Disease and so are there a set of foods that all patients with autoimmune disease should avoid, or should we be testing for food sensitivities or doing an elimination diet? How should we approach that?

Palmer:                So this is huge and I didn’t answer one of your questions which was does everybody need to give up gluten? I want to really address this.

Dr. Weitz:            Okay, yes.

Palmer:                Because this is the elephant in the room. In 2015 Dr. Alessio Fasano who is now at Harvard Medical School, he and his team of researchers discovered that gluten creates a leaky gut in anyone who eats it. I want to be really clear because that sounds like a really big and bold statement and it is. Because we’ve also discovered that a leaky gut that is intestinal hyperpermeability is the pathway to autoimmune disorders. So if you are doing something that is causing your gut to be leaky and you’re continuing to do that thing and you have the proclivity, the genetic predisposition to autoimmune disorders, then you are setting yourself up for a bad path. So, I would say from my research, from the science, if you have an autoimmune condition or if you have the proclivity because you have the genes in your family which we know genes are a part of it. May only be five to 10% of the equation. Your lifestyle matters way more. But gluten happens to be the biggest baddie that I have seen in my practice, in my experience, in my research.

                                To add to that, it turns out that people who are sensitive to gluten, it turns out 70% of the people sensitive to gluten are also sensitive to dairy. So that goes hand in hand. We see a lot of people sensitive to gluten have the same sensitivity to dairy and it’s not the lactose. It’s the casein, especially in these inflammatory cows like A1 cows, these Holsteins. So there are varying degrees of this, but in my research and experience and work with people, the gold standard as they say in functional medicine and in my experience is to do that elimination diet. I call it a 30 day food vacation to make it a little more palatable in the book. But it’s really the same thing. Take the usual suspect foods out for a period of time and when we remove those inflammatory proteins it gives our immune system a chance to calm down so that when you add them back in slowly and one at a time you can really tell if you are reacting to something. That’s super empowering because my-

Dr. Weitz:            So you’re saying essentially anybody with autoimmune disease, you should automatically give up all gluten and all dairy?

Palmer:                I am saying that gluten needs to go for good and I’m saying that dairy most people need to get rid of it, now with the exception of ghee.

Dr. Weitz:            Right, what if they say what about this one form of dairy? What about just yogurt? What about just non-A1 casein?

Palmer:                That might be just fine.

Dr. Weitz:            Right.

Palmer:                So this is where experimentation comes in. I’m not dogmatic about my approach.  You’re asking me for … I’m giving you the 80-20 rule.

Dr. Weitz:            I know. These are some of the controversial areas.

Palmer:                Right, right, right. But gluten isn’t controversial.

Dr. Weitz:            We get really clear about it, you know?

Palmer:                Right, people want clarity. But nothing tastes as good as feeling healthy feels. I like to say that to remind people that look, I can do this. I have been completely gluten free since 2010. So just about 10 years. I have not experienced a single MS symptom, not a tingling baby toe, not anything and we didn’t get into all of the ups and downs that I had over the years. But I had searing pain of optic neuritis. I really felt terrible MS symptoms for a very, very long period of time. So by removing some of these things, it can be a eureka moment for some people, but it’s not the only thing. That’s why I go into a great bit of detail about what the other categories are that we have to address.

Dr. Weitz:            Okay, so when you put somebody on an elimination diet, what are the six, eight or 10 foods that you have them eliminate?

Palmer:                Yeah, so we take out grains. I mean that’s really a starting point. Gluten is a grain, but many grains contain a form of gluten that is highly inflammatory. So we take out all grains. We take out all dairy with the exception with organic, grass fed ghee. We take out sugar. We take out soy. We take out corn, which happens to be a grain. We take out for a period of time night shade vegetables. People with pain or aches often are sensitive to night shades which include tomatoes, white potatoes, eggplants, even goji berries. So those have to go for a period of time. Let’s see what else is on that list? I don’t have them all.

Dr. Weitz:            You take out nuts and seeds?

Palmer:                Take out nuts and seeds and coffee and alcohol.

Dr. Weitz:            You take out legumes?

Palmer:                Yes.

Dr. Weitz:            So essentially you’re saying follow an autoimmune paleo diet?

Palmer:                That’s right. That’s right.

Dr. Weitz:            Okay.

Palmer:                I would say it sounds so restrictive and people are like, “What do I eat? What’s left?” I have that optimal food guide which we can share with people. They can go to my website and get this free download because I really want people to know there is a ton of stuff that you can eat. But the best you can do for this period of time, it might be 30 days, could be 60, might be 90. Some people never want to go back to eating these things. Eggs, oh, we forgot eggs. That’s a big one. It might actually be number three on the list and what people will notice across all of these foods, it’s the protein. These are protein molecules that can often be inflammatory in people with autoimmune susceptibilities, but not everybody is intolerant to eggs for example. So that’s why we call it a paleo template because sometimes there’s variability. You asked about dairy. Could you come back to goat yogurt for example or sheep cheese. I mean there is a world of things that you could try to experiment with. But we know enough now. There is enough data, there is enough research, you don’t have to go and do all this research on your own. I did it because it wasn’t out there. There was no Terry Walls when I was healing from MS, right?

Dr. Weitz:            So they follow this autoimmune paleo very strict diet.

Palmer:                Yep.

Dr. Weitz:            How do you determine if it’s 30 days or 60 days? You’re waiting for a [inaudible 00:26:09] of symptoms?

Palmer:                That’s right. that’s right. So people typically and I see and other practitioners and integrative and functional doctors agree that people can reverse symptoms of autoimmune conditions between 60 and 100% just by addressing food which is why it’s chapter one in my book, start with food because it’s such a high leverage category.

Dr. Weitz:            Okay so you do that. Let’s say you do it for 30 days, your symptoms go away. Now they start putting foods back in one at a time. What if they put all the foods back in and they don’t notice any difference?

Palmer:                Oh. I have to share with you that this was a story of one practitioner who is a friend of mine who overcame, completely reversed lupus and hashimoto thyroiditis. She had a hefty dose of traumatic stress in childhood. She had a ton of food sensitivities. She developed these autoimmune conditions. She finally discovered that food might be the path out. So she did this elimination phase, but she was so eager to go back to her favorite foods, guess what she had for her first meal after all this? She had a burrito. A burrito. So it’s got flour, there’s gluten in the tortilla. There’s cheese, so we’ve got dairy. There’s beans, so there’s beans and legumes, right? There’s tomatoes for the night shades or other people. Then she developed the symptoms, they came flooding back. So she had lost all this weight, that inflammatory water weight when she was doing the elimination phase, she had the burrito and everything swelled back up again. So she had to go through the whole process again.

                                So that’s one thing that can happen if you decide to introduce things, like you’re going to go have a pizza as your first meal. One at a time. There are other people that try this elimination, they go through it, they put things back in slowly. They do everything right and they still can’t tell their symptoms. This is when as you mentioned, doing food sensitivity testing can be helpful, although I’ve seen it go both ways in my own personal experience and with clients who get these tests done and it turns out that they’re sensitive to cooked pineapple and red dye number 32. Crazy things that they don’t even eat. So it’s less empowering when you get a test done and you don’t resonate with what I find.

Dr. Weitz:            Or the test comes back and says they have no food sensitivities and they spend 800 bucks for it.

Palmer:                That’s right. That’s right. So there’s more than just food and we need to talk about that because there are a number of root causes. I mean even stress can create a leaky gut. So I’m not sure that people are really aware of that. But, you can do everything right. You can get your pristine diet, you can exercise. You can get up in the morning and meditate. But if you’re still wrangling with a lot of stress, I would submit that you can have a really hard time healing or if you decide you’re not going to address that traumatic stressful childhood, it’s a tough road to get fully better.

Dr. Weitz:            So let’s go into gut health next. Gut health is one of the chapters in your book. It’s obviously one of the big factors in autoimmune diseases and you mentioned leaky gut and there’s the term gut dysbiosis. How do we figure out what’s going on and how do we figure out how do address these issues?

Palmer:                Great question. So we know that and I don’t know what your experience is in working with autoimmune patients, but I can say that if you have symptoms, mysterious symptoms or an autoimmune condition, there is almost a one for one correlation with a leaky gut. We can assume that your gut is leaking these large protein particles.  Why?  Because if you have symptoms that means that your immune system is attacking something in your body and it could be dysregulated.  Sometimes it’s called molecular mimicry or mistaken identity.  That gluten fragment if we want to use that inflames the lining of the gut, actually breeches the cut barrier, gets into the bloodstream where it doesn’t belong and that’s what sets off the immune system.  So let’s start there, right? So it gets through the lining of the gut. Then your immune system doing what it does, what it’s supposed to do develops antibodies which are missiles. They’re actually bullets you can think of them to attack the invaders. That’s what the immune system is supposed to do. So it views gluten or that protein, that casing from dairy as an invader. Tags them, begins to shoot at them, right? But it develops so many antibodies in the process of trying to destroy that invader that it’s going around the bloodstream looking for a fight. Your human tissue and I don’t know how in the world this is possible, but our human tissue at a molecular level can resemble that gluten fragment. That gluten molecule looks like the thyroid tissue or in the case of MS, as the myelin sheath, okay? So that’s where the bullets are mistaken. They’re doing their job, but your thyroid or your mile in chief just gets in the way.  So it’s not that your immune system has turned on you in some evil or malicious way. It’s just doing its job. So, in order to stop that autoimmune attack, we therefore need to remove the stuff that is breeching the lining of our gut, heal it and seal it, so that we can arrest that process.  That’s central to the autoimmune equation that Dr. Fasano and his team discovered.  We have an autoimmune equation which are, you have to have the genes for it, right?  So it turns out that my birth father has MS.  So I know that there’s a genetic connection.  Number two, we have to have these inflammatory environmental factors that are either coming from the environment or within us that are toxic and causing our immune system to overreact and then we have the advent of this leaky gut.  So the exciting thing about this autoimmune equation is that if you flip the equation, we can reverse the condition.  Meaning, you find and remove your environmental triggers, remove them and heal and seal the lining of your gut and that is central to arresting that process.  So, I wanted to share that mechanism of how autoimmunity happens so that people can really visualize every time you’re putting something into your gut that is irritating it, inflaming it, there’s a possibility that that autoimmune attack could start or it could be perpetuated until you stop that process of introducing those proteins.

Dr. Weitz:            So how do we assess that’s going on in the gut? Do we assume they have leaky gut? Do we test for leaky gut? Do we do a stool sample? Do we do a SIBO breath test. What is your normal procedure with a patient to figure out what’s going on in the gut?

Palmer:                So typically we can assume that leaky gut is going on and so people don’t necessarily need to spend money to figure this out. They can just do their own experimentation of just taking stuff out. We know what the biggest baddy culprits are for harming our guts and we’ve talked about food.  I will also add that part of the food problem is how it has grown and how it is sprayed with lyphosate and that is one of and commonly known as RoundUp. This is something we know harms the lining of the gut. So people can take this stuff out and do their own experimentation. We know that antibiotics-

Dr. Weitz:            But the container of RoundUp at the store has nice pictures of animals and butterflies and plants.

Palmer:                Don’t be fooled people. Don’t be fooled. This is where it is incumbent upon us as consumers to really become the CEO of our own health and wellbeing. We have to do our job, our research to protect ourselves. The Europeans have or follow what’s called the precautionary principle and in their I forget the name of the body that tests for chemicals and whatnot. But they won’t let chemicals get introduced into the environment until they’re proven safe. Whereas in this country, we release the chemicals and then they’re only taken off the shelf when they’re proven guilty.

Dr. Weitz:            Well because the goal is protection of the profits of big corporations. People’s health? Oh, well.

Palmer:                Right. So I’m somebody, I’m a product of cheerios. I ate gluten with every meal, okay? I have peanut butter and jelly sandwiches for every day of my life growing up. I had pasta or pizza or beer throughout my life. I did not realize, I did not put this together that I was inflaming and harming my gut and perpetuating the MS for more than two decades until I did that experimentation and removed it and voila. Again not to say that that’s going to be the standard that happens for people, you take one thing out and your good. No, no, no there’s a lot more than that. But-

Dr. Weitz:            Okay, assume they have leaky gut. We assume they’ve gotten exposed to pesticides and other chemicals. Do you do a stool analysis? Do you put them through a gut healing protocol 4R, 5R, what’s your normal protocol?

Palmer:                Yes. Yes, I’m a big fan of getting the data. We’ve got fantastic modern lab work that’s getting better all the time and even though nothing is perfect, we do have some good tests that we do and a couple of the tests that I like are the GI map test is fantastic. GI Effects from Genova has been around it’s probably the gold standard gut test. Doctor’s Data, all of these labs have comprehensive stool tests and we can tell not only what’s the state of somebody’s microbiome, but are there any infections present? Because it’s not just foods, they’re infections that could be at play here. They offer I think it’s called a zonulin add on. Zonulin is the marker.

Dr. Weitz:            That’s for leaky gut, yeah.

Palmer:                For the leaky gut, right? So, when you have that it monitors and manages the tight junctions in our gut in that lining. So our gut is supposed to be selectively leaky to let in nutrients, right? But when the doors are left open, that means there’s excess zonulin at play and zonulin gets into the blood stream and so forth. So we can test for leaky gut and I think that’s now considered to be more of a gold standard than the former-

Dr. Weitz:            Lactulose mannitol test.

Palmer:                Yeah, yeah, yeah.

Dr. Weitz:            Yeah. Okay. So, what protocol do you put everybody on besides you’ve already put them through a diet program, right?

Palmer:                Right.

Dr. Weitz:            Do you change their diet again? do you put them on a specialized diet? Do you put everybody on probiotics? Do you use the four or 5R program?

Palmer:                I really like that 5R program. I mean this has been around for decades now.

Dr. Weitz:            Since Dr. Jeffrey Bland.

Palmer:                Yes, yes. There were a lot of people-

Dr. Weitz:            The father of functional medicine.

Palmer:                Right, right. There were a lot of people involved with that and you’ll have to remind me of all the R’s, but the biggest one in a 5R program is the remove. A lot of people are they get a little miffed that, “Well why aren’t we talking about putting more stuff in? I just want to take probiotics and heal.” Well, the best thing, the biggest bang for your buck is taking the stuff out that’s harming you. So the first R of remove is what we’re already doing when we’re in the food phase. So these are often overlapping categories right? The next thing we want to do is maybe oh, my goodness. It’s not replenish, reinoculate. A lot of us are missing digestive enzymes.

Dr. Weitz:            Replace, yeah.

Palmer:                Replace. Thank you. So, we need to replace our digestive secretions and often people feel like if they have an acid tummy or acid reflux that they are experiencing too much acid when in fact it’s often a sign that they’re not producing enough acid. So by supplementing with hydrochloric acid when eating meals can be a game changer for people to be able to actually digest and absorb their food better. Maybe their enzymes that we want to include and a lot of people don’t have a gallbladder. A lot of people are having sluggish bile. So whatever you can do to improve your bile flow by maybe taking digestive bitters before eating, we definitely start to add those. So people can digest and absorb what they’re already eating and that is that phase, replacing those digestive secretions.

Dr. Weitz:            Okay.

Palmer:                Then and only when we address if there’s an infection present, like candida, we want to get rid of it, right? So we’re going to work to get rid of that with as natural a process as possible and other infections that might be present, H. Pylori and so forth.

Dr. Weitz:            So you’re going to use natural antimicrobials in that case?

Palmer:                Exactly. Exactly.

Dr. Weitz:            Okay.

Palmer:                And there are some helpful anti-yeast and anti-mold things that people can do.

Dr. Weitz:            Right, combinations.

Palmer:                Combination therapy is often very, very helpful and-

Dr. Weitz:            How long does that usually take? Two weeks? A month? A few months? Many months?

Palmer:                It can take three to four weeks. Excuse me, three to four months.

Dr. Weitz:            Okay.

Palmer:                I’m doing wishful thinking there. Because sometimes we find parasites too and if people find that on their stool test that parasites are present, there’s actually another test that I really like from Parawellness Research that can be much more specific about the types of parasites that are in there. So oftentimes we got to get that stuff out. I mean this is … We were designed to cohabitate with a lot of these critters that are in us. But I think what happens is that when we have all of these inflammatory foods and the sugar we’re eating and the simple diet, we start to feed those microbes of the pathogenic stuff and it starts to overgrow like the candida, like the parasites. So when we start with a diet, remove stuff, we address those parasites in yeast. It might take three to four months. People need to be patient with the process, right?

Dr. Weitz:            Yep.

Palmer:                And it’s only when we remove all of those pathogens that we want to start replacing with the, and reseeding with probiotics and prebiotics because we don’t want to be feeding the microbes that are out of balance. We want to be introducing probiotics at the right time.

Dr. Weitz:            Right. So, the next chapter in your book is infections and so this is not somebody who currently has a cold or a fever. These are stealth, chronic infections that they often don’t know they have.

Palmer:                That’s right. That’s right. Again, you’ll see the overlap here because a lot of the gut infections that I just talked about are the infections that are driving autoimmune conditions. But people here about Epstein-Barr and they want to point every finger at Epstein-Barr at being the problem. Well I’ll tell you, 96% of us in the United States have Esptein-Barr. So, we have coexisted with viruses for I don’t know how long. As long as we’ve been on earth. It’s when things get reactivated and when things get way out of balance that these things become problematic. So, infections could include viruses. It could include bacteria. We’re seeing much more Lyme Disease. What’s now called Persistent Lyme, I found out only in 2017 that I have Persistent Lyme and in fact, I might have gotten it when I was age 18 when I was romping around in the hills of Vermont. That may have preceded the MS. But I only learned about it recently. So, getting tested for Lyme and there are more and more good tests for Lyme Disease.

Dr. Weitz:            Yeah, yeah.

Palmer:                And many more doctors are recognizing that. I don’t know if you see Lyme frequently in your practice.

Dr. Weitz:            There is a fair amount of Lyme. It’s not necessarily one of my specialties, but we’re learning how common it is. In fact, we have Dr. Darin Ingels speaking at our functional medicine meeting on Thursday who is a Lyme expert. He feels like a large percentage of patients with MS actually are undiscovered Lyme patients.

Palmer:                That’s right. That’s right and not just MS. I mean this is why I didn’t call the book, “Beat MS” because what we’re talking about these healing principles-

Dr. Weitz:            Goes to all autoimmune.

Palmer:                All of them. It’s wholistic. Mind, body, spirit, but you got to look at food. You got to look at infections. You got to fix your gut health. You got to look at toxins in your environment. And you got to balance your hormones and last, but not least is that S for stress that we are all facing and that makes everything worse.

Dr. Weitz:            Right.

Palmer:                So all of it is part in partial of what we do. I’m not collaborating with a naturopathy doctor who specializes in infections and toxins. The other thing that we’re seeing much more of is mold. Mold and mycotoxins are just amplifying the problem. So it’s not just one thing. It’s I call it a toxin bucket. We all have one, right? We carry a certain amount of toxins and if we’re not excreting properly, if we’re not able to handle and let go of the toxins that come into us and it’s all of those things, then things start to build up until finally the leaky gut spills over and you start to have symptoms. Because autoimmunity happens on a spectrum. It goes from silent where you start to build those antibodies, right? That’s happening silently. So when I was 19 and the MS struck, I had been silently building antibodies to my own tissue and the gluten and other things. Not even knowing it and then the next phase is autoimmune expression where you start to feel symptoms. That is exactly where you want to … Well you want, ideally you want to prevent things. But most people are going to pay attention when they start having symptoms.

                                What you don’t want to do is get to the next phase of things which is full blown autoimmune disease where tissue damage starts to happen, right? So you have this window of it could be decades from the first silent autoimmunity all the way to full blown autoimmune disease. But the opportunity to address it is now. It is now.

Dr. Weitz:            So for practitioners who are listening and maybe even patients who are trying to sort through some of this stuff themselves and they are saying to themselves, “Wow, look at all the things that could be affecting my potential autoimmune disease or the autoimmune disease of this patient sitting here in front of me and we could have food. We could have stress. We could have nutritional deficiencies. We talked about infections. We’re talking about gut problems. There’s hormonal problems. Oh, my God where do I start? Then where do I go next and how do I decide what to do?”

Palmer:                Yeah I think the first thing to do is take a big, deep breath. I mean I really do and I’m not being facetious. I mean in through the nose, in the belly a big deep breath. Autoimmune problems did not happen overnight and they’re not going to go away overnight. This is a process and a practice. But now we have people that have gone through this that have a framework or a protocol. Follow people who have healed themselves or who have cured themselves. I mean that would be a really good place to start. There are books out there, not just mine. There are a lot of really good books on the subject. Educate yourself. Empower yourself. I would submit that the very first thing to do is to understand that these are reversible conditions. This is not a death sentence. This is not something that you should take what a conventional doctor tells you that all you can do is manage your disease. That is simply false. There is so much hope and it’s real, find people who have reversed their condition. I profiled 12 of them in my book. I didn’t want to write a memoir, because people would just pat me on the head, “Oh, look at you. You had a spontaneous remission.”

                                No, no, no. This is not a spontaneous remission. This is learning to control what we can control and you let go of the rest. But the people that I profile in there, Dr. Mark Hyman, Terry Walls, Susan Bloom, I mean there are a wealth of practitioners who used to be medical doctors who themselves had some debilitating autoimmune disease or condition. They did the work and then the wounded healer themselves, now they’re helping hundreds, thousands of people. So this is an exponential good news story. It’s not just my story. So my aim is to really help people to know this is possible. So the first step, understand that it’s possible, decide you’re going to reverse your condition and reclaim your life because you can. Then the next step is to get whatever book you’re going to get and then educate yourself. There’s lots of … My website is palmerkippola.com. I have got lots of free information on there. I’ve got this book which is about ten bucks on Amazon. People ask me, “I need more help than a book. I want help implementing this.” Because there’s a lot. As you said, it’s not just one thing, it’s wholistic. So I created this membership called Beat Autoimmune Academy. I’ve got a bunch of people in there who we’re taking step by step because it can be overwhelming. People get overwhelmed.

Dr. Weitz:            I would say to the practitioner out there, the first thing you want to do is take a detailed history like they teach in the Institute of Functional Medicine courses and then you’ll start once you really go deep into someone’s history from birth and find out about their life story, you can start to figure out what direction, “Oh, this person had a lot of early life stress. This person took lots of antibiotics and had multiple ear infections and maybe more liable to have gut and chronic infections.” You’ll get a sense of what direction to go first. If nothing jumps out at you, always consider starting with the gut and then also doing some testing can give you an idea of what direction to go to as well.

Palmer:                Perfectly said. That was beautiful. That history when you’re sitting with somebody and they’re sharing with you how they grew up. Were they breastfed? Were they delivered as a C-section. What kind of home life did they have growing up? What was that like? If they started to develop let’s call it juvenile rheumatoid arthritis, what happened before age seven that you developed rheumatoid arthritis at age eight? What happened when you were 11 years old and you developed lupus when you were 15? We really need to have other people tell us the story so that they can see how powerful it is that when I was asked that question, “Why do you think you got the MS?” I took it as an affront, right? But that question has become my north star for me and for the people that I work with. We always want to find out why. If you haven’t healed, if you’re still experiencing symptoms, those are just messages from your body letting you know that you haven’t dug deeply enough into root causes. You need to keep going.

Dr. Weitz:            That’s great. So, any … I think we should wrap because we both have appointments coming up. Obviously there’s a lot more stuff we could talk about. We really didn’t get to toxins or hormones, but this is a huge topic and we could spend hours talking about it. So for now do you have any final thoughts for our audience?

Palmer:                I do. I do. I want to help you shortcut the suffering because there’s an expression that pain is real, but suffering is optional. I think the faster that you can view what’s happening in your life as a gift, the faster that you can realize that this is happening for you and not happening to you. You move from a victim mode to an empowered mode. The faster you can get to the other side of this. So when I was 19 I didn’t have a crystal ball into the future. I don’t know that I would have had the where with all to think, “Oh, thank goodness this is happening to me.” I’m not trying to be [inaudible 00:52:01]. Of course you’re going to have grief and there’s going to be stress and so forth. But the faster you can realize that these things are actually happening for you to take a more close look at your life mind, body, spirit, the faster you’re going to get to the other side of this. I find it such a privilege to work with people when I do my one on one consulting and they tell me, “I want to get to that side too. I want to work with people who have autoimmune conditions. I want to help people. I know I can reverse my condition and I’m still working on it, but I can see that I’m going to view this as an opportunity and as a gift.”

                                So that’s what I would invite people to consider this as happening for you and not to you.

Dr. Weitz:            That’s a great message, absolutely. It’s easy to play the victim or feel the victim and not see it as an opportunity.

Palmer:                Yeah. I think every moment of every day we all have an opportunity. Health is not static. So I didn’t just beat an autoimmune condition and everything is roses. It takes daily work and practice. That’s why health is a practice. But when we view it in a certain way it can take a lot of that angst and deep level of stress away and when we remove the stress and we get into that relaxation response that’s where healing happens. So, it’s powerful.

Dr. Weitz:            That’s great and you have a special gift for our listeners?

Palmer:                Yes. So I mentioned when we were talking about food that it can be very, very frustrating and difficult to figure this out. So I have a gift. If you go to my website palmerkippola.com/gift, I have created an optimal food guide E-book and you can find out what your optimal foods are by following this process of what I call a 30 day food vacation and that’s just a little 12 page E-book that can be very helpful for people to see that there are a lot of things that you can eat. It’s not just, “Oh, I can’t have any of the foods I love.” No there’s a world of foods for you to explore and maybe many vegetables that you’ve never heard of or tried. So I invite people to take that step.

Dr. Weitz:            And what’s the best place for people to get ahold of you?

Palmer:                Palmerkippola.com is my blog and website and so I have a lot of information there. That would be a great first place to start. I lead people in Beat Autoimmune Academy, so it’s on website beatautoimmuneacademy. People can check out what’s in there. Those are two great places to find me and so thank you.

Dr. Weitz:            That’s great, excellent. Thank you Palmer.

Palmer:                It’s been a pleasure. Thank you so much for having me Dr. Weitz.

 

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Reducing Food Cravings with Dr. Elena Zinkov: Rational Wellness Podcast 170

Dr. Elena Zinkov speaks about Reducing Food Cravings with Dr. Ben Weitz.

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Podcast Highlights

3:47  Many of us, esp. women, have food cravings such as for sugar or chocolate or for salty, crunchy foods and they can be overpowering.  There are numerous reasons why they may exist, including genetic predisposition, skipping meals, hormones, etc.  If a woman is nearing her cycle and her progesterone is tanked that can trigger food cravings.

5:20  There are various genetic variations including if there is a MTHFR mutation, which controls how our body utilizes vitamin B12 and folate.  This can trigger neurochemical imbalances and mood disorders that can lead to food cravings.  We often need to prescribe methylated B12 and methyl folate to such patients but if you see skin breakouts or feeling a bit more irritable than you were before are signs that you could be over-methylating.

15:28  There is a dopamine receptor gene that can play a role in neurotransmitter balance and in food cravings.  If you are genetically programmed to have fewer dopamine receptors, you need more stimulus to gain the same effect and you may be reaching for more pleasurable things and you need dopamine to reinforce that behavior.  It can be helpful to do urinary neurotransmitter testing.  It can be beneficial to use amino acids therapeutically, like 5-HTP or L-Tyrosine or to use some adrenal support or thyroid support or some B vitamins. GABA, pregnenolone, or progesterone supplementation can also be helpful for the right patient to help with issues with the GABA receptors.

19:45  Dr. Zinkow has found that some patients do really well with pregnenolone, which is one of the main precursors for all of the other female hormones, like estrogen and progesterone and it can have a positive effect on the GABA receptors and can be very soothing to the nervous system.  Similarly, for some women giving DHEA may work better than prescribing testosterone, since it is like a back door way of boosting both estrogen and testosterone levels.

22:58  Diet can be very helpful in controlling food cravings but we should be cautious if we have been eating the standard American diet that if can be too drastic to just jump into intermittent fasting right away and this can trigger more food cravings and they may get irritable, angry, and fall off the track completely.  It is probably better for them to clean up the diet first, get your emotions under control, and then later jump into some time restricted eating. Start by cutting out the crap and processed foods and find healthier ways to satisfy food cravings like having a couple of dates with some almond butter instead of a candy bar.  Getting enough protein and healthy fats is important and getting carbs from starchy vegetables or sweet potato and limiting fruits to one or two per day rather than eating pastas and breads.

27:32  Nutritional deficiencies can promote food cravings, such as a lack of magnesium can lead to more chocolate cravings.  A lack of iron can lead to carving more red meat.  A lack of B vitamins can stimulate sugar cravings.  Or we may have an inability for our mitochondria to produce enough ATP, so we may need mitochondrial support, like CoQ10, L-Carnitine, B vitamins, and magnesium.

29:48  The microbiome can play a role in food cravings.  For example, if you eat more sugar, you are more likely to grow more yeast and then you’re going to crave more sugar, which is going to cause more yeast overgrowth.

31:44  If we eat a higher fat, higher protein diet it is still important to get enough fiber to feed the microbiome, but we just need to avoid foods that we have sensitivities to. Dr. Zinkow said that she tends to stay away from food allergy testing because she does not find it to be very accurate and the gold standard is to do an elimination diet.

 

    



 

Dr. Elena Zinkow is a Naturopathic Doctor in Seattle, Washington who specializes in women’s health, hormones, and gut health utilizing a Functional Medicine approach.  She is also the best selling author of Crave Reset: A breakthrough guide for mastering the psychology and physiology of carvings.  Her website is ProactiveHealthND.com.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.

 



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the rational wellness podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast. Hello, Rational Wellness podcasters. Those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple Podcasts and give us a ratings and review. If you’d like to see a video version of this podcast, go to my YouTube page, and if you’d like to see detailed show notes and a complete transcript, go to my website, drweitz.com.

                                Today, we will be discussing how to reduce food cravings, which we all have, with Dr. Elena Zincov. How do we reduce food cravings? Is it just by not giving into them? Is it by learning to stop hating our father? No. Food cravings actually have some physiological relationship to various things going on in our physiology, our genetics, our hormones, our microbiome, et cetera, and today we have Dr. Elena Zincov here to discuss those with us. She is a naturopathic doctor in Seattle, Washington. She specializes in women’s health, hormones, and gut health utilizing a functional medicine integrative approach, and she’s also the bestselling author of Crave Reset, a breakthrough guide for mastering the psychology and physiology of cravings. Dr. Zincov, thank you so much for joining me today.

Dr. Zincov:           Hey, thanks for having me. It’s a pleasure.

Dr. Weitz:            Good. So, we can get to know you a little bit. Perhaps you can tell us how you decided to become a naturopathic physician, and for the few who are new to this podcast, what exactly is a naturopathic physician?

Dr. Zincov:           That’s a great question. So, I grew up as a competitive athlete. I played competitive tennis for many years, I played in Voluntary Academy down in Florida, and I got exposed to a healthy lifestyle early on as a teenager, and so having struggled with my own cravings and acne and bloating and gut issues and hormone imbalances, I found my way to naturopathic medicine, and in fact, my mom was actually a medical doctor and I was exposed to naturopathic medicine when I was about 16 years old and I felt great, and so after competitive sports, I wanted to help others, I wanted to help myself, and I found myself at the Steer University applying for the naturopathic doctorate program, and naturopathic medicine, it looks at the whole person.

                                We don’t want to just treat the symptoms, we want to see how all things are interconnected and how they’re working synergistically, and even nowadays when patients come see me and they want to know what’s at the root cause, I always say there could be multiple root causes, right? We sometimes don’t know what came first, the chicken or the egg, and it ends up being this orchestra of things. It’s hormones, it’s gut, it’s brain, it’s inflammation, it’s immunity. So, naturopathic medicine really looks at the whole person, and not just the person, at the the environment, at mental state, at the work situation. So, it’s a total mind-body approach.

Dr. Weitz:            Cool. So, what are food cravings and how should we think about them? It’s a general thought.

Dr. Zincov:           Yeah. Yeah, we need to willpower away through food cravings, no. Food cravings are really interesting. I personally struggle with food cravings, sugar in particular, I’m sure a lot of people-

Dr. Weitz:            Does everybody have food cravings?

Dr. Zincov:           Not necessarily, actually.

Dr. Weitz:            Okay.

Dr. Zincov:           So, from personal professional experience, I feel like, as someone who sees both men and women in my private practice, men tend to have fewer food cravings, from just my observation. I find that women, and this is where I get, even in my book, I go a lot into hormones, women, due to just natural fluctuations in our hormones throughout the month, tend to be a little bit more impulsive around food, tend to have more of the sweet, that salty, crunchy, savory-like cravings, and they can be very overpowering.  But the thing with cravings is that they are multifaceted.  It’s not just, “Oh, I’m craving chocolates because I’m just craving chocolate.” There’s usually many more biochemical things that are happening behind it. You could have a genetic predisposition of why you’re craving sweets. You could be skipping meals and just not eating right, and you’re craving those things, right? For a women, she could be nearing her cycle and her progesterone is tanked, and that’s why she’s craving those things. So, cravings can be multifaceted, we all experienced them differently and there needs to be a unique approach when you’re addressing them.

Dr. Weitz:            Cool. So, in your book, you go through various concepts, and one of the concepts you talk about is genetics. So, perhaps you could talk about some of the genetic factors that might affect our craving for sweet foods or bitter or different types of foods.

Dr. Zincov:           Yeah. That was actually really interesting just in my research, and frequently, I won’t go into too much of scientific detail, but many people have heard of MTHFR mutation, and it’s how our body utilizes B12, well, and B12 is a really important nutrient that if it’s not metabolized properly or used correctly by the body.  And MTHFR prevents us from getting methylated B12 in our system that we can have a lot of neurochemical imbalances, mood disorders that can actually predispose us to craving more junk food, can predispose us to feeling more irritable and really not understand why we’re feeling the way that we do, and of course, Dr. [crosstalk 00:06:23]-

Dr. Weitz:            It’s interesting that you describe MTHFR as primarily about B12 when most people think of it as primarily about folate.

Dr. Zincov:           Yes. Yeah, and I think it’s a fine balance between the two, but predominantly from my experience, I really see B12 being an issue from just clinical or professional background, but I think it needs to be both, right?   Just like we need to talk about methylated B12, we also need to take methylated folate into consideration in this case.  So, that’s a really common one, right?  And that’s the low hanging fruit as far as genetics go. It’s easy to test, it’s easy to address, sometimes supplemental form.

Dr. Weitz:            The tricky part is how much. How do I know how much methyl B12, folate, methyl B vitamins do we need to take, should we take, can we over methylate?

Dr. Zincov:           Yes.

Dr. Weitz:            How do we measure levels?

Dr. Zincov:           Right. Yeah, and you actually bring up a really good point, and I had this conversation with one of my colleagues that I think we’re over methylating people to some extent, because a lot of providers are not testing for MTHFR and they’re just prescribing, let’s say methylated B12, right?    And so I get that many people are actually deficient or they have this mutation, but some of the things that I tell my listeners and my viewers and followers is that if you take methylated B12 and things like skin breakouts or feeling a bit more irritable than you were before, are signs that you could be over methylating.

Dr. Weitz:            What about testing? Because we do a fair amount of testing and I often find serum B12 is high, maybe serum folate is high, but then they could have sky high homocysteine levels, so obviously they don’t have enough folated B12, so testing is tricky and I think it can easily get confused if we run the wrong test.

Dr. Zincov:           Yeah, absolutely. I don’t know what your perspective is. I personally like more white blood cell testing than red blood cell testing, especially for B12. So, this is something when we do like a micronutrient test, I think that can show, I would say, not more optimal levels, but more accurate levels of nutrients.

Dr. Weitz:            Are you still using SpectraCell?

Dr. Zincov:           Every once in a while, I do, but for me, I’m at the point where I am seeing more of how my patients are feeling.  If I see somebody’s B12 are through the roof, but they’re presenting that they’re deficient in B12 and folates, I’m not just going to go for the labs, right?  I think that there’s something more involved, and I’m a conservative lab prescriber just because I’m sensitive sometimes to, when patients come in and they have like a 10 year history of not feeling well, and they’ve had all sorts of lab testing done, functional and nonfunctional, I’m more interested in talking to the patients and hearing how they’re feeling rather than maybe ordering another lab test, right?  Because I do cost-benefit analysis, pros and cons.  What is this lab test really they going to show us? Right? Are labs always 100% accurate? And do they always show the full picture? And so I’m really just sometimes more interested in seeing and hearing what the patient is all about. There’s so many times where we’ll do a serum B12 test and it’s like 2000, right? Whatever. It’s through the roof, but we still supplement, or we do a nutrient shot like a hydroxocobalamin, methylated B12 combination and they feel great. So, who’s to say that they have too much, quote unquote, air quotes-

Dr. Weitz:            So, my argument would be because that’s the wrong test, that serum B12 levels are not indicative of tissue levels, that doing a methylmalonic acid or homocysteine is a more functional test, so my argument would be, you got to run the right test.

Dr. Zincov:           Right. Yeah. No, I agree with you. Mm-hmm (affirmative).

Dr. Weitz:            Okay. So, talk about more, some of these genes that affect our cravings.

Dr. Zincov:           So, there’s definitely a few genes. For example, I talked about MTHFR and the reason why I call it the low hanging fruit, because it’s easier to address. There are-

Dr. Weitz:            So, what cravings does a MTHFR, if somebody… So, MTHFR they could have, there’s at least several different versions of this gene, and then they could have one or two copies of it. So, how many copies of one or both of these variations, and actually there’s 10 more that most people don’t measure, would affect food cravings? And in what particular food cravings would we tend to see with that?

Dr. Zincov:           So, I think just focusing on the MTHFR mutation can actually not be very beneficial because what I don’t want is for people to get hyper-focused that if they have even one or two genetic mutations of this gene, that all of a sudden they’re going to blame all of their life’s problems on MTHFR mutation.  So, I definitely don’t want people to walk away from this thinking, it’s like, “Oh my gosh, well, I have this one mutation, I have two mutations, therefore, all the things that I’m craving or all the things that I’m experiencing are based on this, because-

Dr. Weitz:            You don’t want them walking into your office saying “Dr. Zincov, my life is ruined. I have MTHFR.”

Dr. Zincov:           Exactly. I want to approach this a little bit more from a holistic approach, which is where, when you have just one mutation compared to two, chances are, yes, you could possibly be experiencing fewer food cravings, and particularly sugar, and the reason for that is we need B12 for serotonin synthesis, and serotonin is a really important neurotransmitter that regulates our cravings, regulates our habits.  It’s a desirable, right? Neurotransmitter, and so it causes us to feel pleasure, and food is just such an easy thing. It’s a quick fix these days, and so when someone has one or two mutations, chances are that they’re not producing optimal levels of serotonin, which can lead them to binge more, right? Because they got to get that pleasure from somewhere else.

                                So, the tricky part with the other genes is, some people like bitter foods, some people don’t like bitter foods, some people like fatty foods, some people don’t like fatty foods as much, right? When you talk to your clients, people have different food preferences, and those folks who are genetically predisposed to avoid bitter foods are not going to be eating as many leafy greens because the bitter and the leafy greens is going to be a deterrent for them, but that is to say, right?   I don’t want people to say, “Well, I’m not going to eat my leafy greens because I’m genetically predisposed not to eat them.” Right? One of the things that I talk about in my book is that there are different ways that if you don’t like bitter greens, guess what? There’s an area of other greens that are non bitter, that are neutral to taste that you can have, right? So, let’s not just blame our genes for our poor dietary decisions.

Dr. Weitz:            In fact, maybe if you don’t like bitter greens, maybe that’s a reason why you need them.

Dr. Zincov:           Exactly, right?

Dr. Weitz:            I know chiropractic, right? We get patients all the time, and they spend hours and hours stretching and they can put their leg behind their head and twist it around three times, and they think that taking more yoga classes is going to help them with their back pain, but they love doing things they’re really good at, and that person really needs strength training and is not going to benefit from more yoga classes, whereas the person who is super tight and only does strength training and hates stretching probably needs, or definitely needs stretching more.

Dr. Zincov:           Right. Exactly. So, that’s so funny because I’m actually, I’m a yoga practitioner myself, and I’ve been doing yoga for 20 years, but I learned early on that more stretching is not actually a good thing, and my perspective is that we need to strengthen more than we need to stretch.

Dr. Weitz:            Yes.

Dr. Zincov:           But that’s-

Dr. Weitz:            Let’s talk about some of the other genes. I’m sorry. I’m throwing you off track.

Dr. Zincov:           No, that’s okay. So, I think those are the main ones that I would talk about, not to get lost too much in the weeds. I really think-

Dr. Weitz:            You mentioned a dopamine receptor gene also in your book.

Dr. Zincov:           Yeah. The dopamine receptor gene. So, this is really interesting because serotonin and dopamine are partners in crime. So, if someone has, we talked about MTHFR, we talked about serotonin synthesis and how someone who has, let’s say, deficiency in serotonin just naturally biologically, for whatever reasons, will seek pleasure in other ways.

                                What would happen, so let’s say you do an activity or you eat a food that causes you pleasure, right? Then dopamine comes around and reinforces that behavior, right? Because this is where I always talk about how we live in very urban environments, but we’re very primal in certain ways, and so if there is a dopamine receptor issue, for example, maybe you have fewer dopamine receptors, right?

                                Genetically you’re predisposed to have fewer dopamine receptors, your body’s going to need more stimulus to gain the same effect, right? So, now you’re reaching for more pleasurable things and then you need more dopamine to reinforce that behavior. So, it’s a vicious cycle that people find themselves in, and then, God forbid, then you share that something was pleasurable, then you produce oxytocin, and that reinforces that behavior. So, it ends up being a hot mess.

Dr. Weitz:            So, neurotransmitters, you have a whole chapter devoted to neurotransmitters, like serotonin, dopamine, GABA, and so these are crucial for food cravings?

Dr. Zincov:           Yeah, absolutely. So, a lot of times-

Dr. Weitz:            Do you ever measure neurotransmitter levels? Have you done the urinary neurotransmitter testings?

Dr. Zincov:           Yeah. Yeah, and I find that to be really interesting. There’s simple quiz that people can take online, and maybe I can forward the one that I like, if somebody doesn’t have access to testing, but I think urinary metabolites, really, the breakdown products of a lot of these neurotransmitters can be a good indication of our natural production.  In fact, I think it should be more mainstream to test for this, right? Before we even prescribe something like a SSRI or an antidepressant or anything like that. It’s like, why don’t we test these things first? Right? And spare people a lot of pain and agony.

Dr. Weitz:            Absolutely. Because otherwise we’re just guessing at what we’re doing with neurotransmitters.

Dr. Zincov:           Yeah. Yeah, exactly, and so when it comes to craving-

Dr. Weitz:            In fact, very few studies really directly link low serotonin levels with depression, it’s much more complex than that.

Dr. Zincov:           Right. Right. Absolutely, and so it ends up being like a cocktail of neurotransmitters that are involved in regulating our emotions, our mood, and then in turn, our food cravings, right? It’s not uncommon for someone to say like, “I’m irritable.”   Or let’s say depressed, right? Since we’re talking about serotonin and SSRIs, “I feel depressed, I feel anxious, I’m going to have something sweet.” Right? Because it just provides that immediate release of serotonin to patch that pain for a short term.

Dr. Weitz:            So, can a therapeutic use of amino acids be beneficial in helping to support neurotransmitter production?

Dr. Zincov:           Yeah. Absolutely, and this is one of the things, even in my research and trying this with my patients as well, I’m not the first provider in the history of medicine, right? Who’s saying, hey, how about even just a little bit of supplementation of 5-HTP or L-Tyrosine, or how about a little bit of adrenal support, a little bit of thyroid support?   How about some B vitamins? Like we talked about some precursors for some of these neurotransmitters. I talk about GABA, pregnenolone, progesterone, all those things play with the GABA receptors, right? How about we try those things, right? And see if we can manipulate our physiology or optimize our physiology in that way.

Dr. Weitz:            So, how often do you prescribe pregnenolone?

Dr. Zincov:           I would say actually more nowadays than ever before.

Dr. Weitz:            So, give us an example of when you might prescribe pregnenolone.

Dr. Zincov:           Yeah. I have a couple of women that I’m working with right now where it’s actually made quite a big difference and I actually didn’t really believe in pregnenolone for some time. I just-

Dr. Weitz:            Going back and forth on it?

Dr. Zincov:           Yeah. Yeah. I was like, “Oh, does it really work?” And then I’ll go through phases where I’ll research something a little bit more and then I’ll dose it, and then I’ll just see how my patients react.

Dr. Weitz:            By the way, for people listening to this podcast, if you’re not familiar with pregnenolone, maybe you could just explain what pregnenolone is.

Dr. Zincov:           Yeah. Pregnenolone is one of the main hormones which then gives birth to all the other hormones, right? So, it’s higher up in the chain of command as far as hormones go, and we can’t really test for it because it has a super, super short lifespan in the bloodstream, so it’s not like you can… I don’t like it when I see providers testing for pregnenolone, because I’m like, “What does it give us?” Right? I mean, it doesn’t really give us a lot of information, but anyways, but what can happen, so I’ll give you an example. I have a postmenopausal woman who continues to have really poor sleep and we’ve tested her cortisol, we’ve tested her nutrient levels, we’ve worked on her thyroid, worked on all of the sex hormones.

                                She does exceptionally well with bioidentical progesterone, but terrible with any sort of estrogen, right? And so, one of the things that I wanted to explore with her is because I know pregnenolone has a really positive impact on GABA receptor. So, one of the pregnenolone metabolites can affect GABA receptors and can be very soothing to the nervous system, right? And so I added, I think, like 25 milligrams of pregnenolone to her nighttime routine, because technically, you can take it in the morning. For someone who tends to be anxious, pregnenolone can be really good to dose first thing during the day, but for her, I used it at nighttime and that really did the trick.

                                However, I should also add that I also added DHEA to her routine, and for someone, let’s say, there’s a lot of women who are sensitive to hormones, right? And so we have to go through the back door, and the reason why I like pregnenolone, the reason why I like DHEA is because I’m not giving you exactly estrogen, I’m not giving you exactly testosterone, but those guys get converted, right? DHEA, some of it gets converted to estrogen, some of it gets converted to testosterone, and that could be the back door to boosting someone’s, even estrogen levels. So, that’s one way that I’ve used it in my practice.

Dr. Weitz:            Cool. What is the best diet for controlling food craving? Should we follow a low carb program? What about intermittent fasting?

Dr. Zincov:           Oh, the million dollar question. I get this asked a lot, and I actually, this is where medicine becomes really individual because some people who have a really hard time controlling food cravings, sometimes intermittent fasting or time restricted eating may not be the best thing, right? Because it can cause… Yes, it can help balance blood sugar longterm, but you almost have to clean up the diet first, get your emotions under control, and then later jump into some time restricted eating, right? What happens sometime is somebody eats the SAD diet, the standard American diet, they’re have uncontrollable sugar cravings, and they’re like, “Intermittent fasting or time restricted eating is going to fix all of my dietary problems.” Right?

                                And so they go from doing 0 to 100, and they find themselves really overwhelmed, really irritable, angry, and falling off track really quickly, and so in terms of what’s the most optimal diet, you’ve got to start with the basics, right? Let’s cut out the crap, all the processed food, all the processed junk. I’m okay with people, even initially when they’re battling food cravings, and having gone through this personal experience myself, it’s like, it’s okay to have alternatives, right? But have them healthy. Instead of having a chocolate bar, having a couple of dates with maybe some peanut butter or almond butter, right? So, still satisfying that sweet craving, but in a really more holistic and functional way.

                                And then later, once you have your bearings under you, right? You can start playing with time restricted eating. The other thing I should say is that a lot of times people experience cravings because they didn’t eat enough protein. They didn’t eat enough fat during the day, or they skip meals, not unintentionally. So, it’s different if you’re fasting, right? And you know that you’re skipping meals, versus, I’ll have breakfast, and then six hour later, I have a snack, and then I find myself staring at a refrigerator at six o’clock at night eating everything in sight. That’s, I call, the non-intentional fasting where you lose track of your day, versus time restricted eating, which is intentional fasting.

Dr. Weitz:            So, if not getting enough protein and not getting enough fat is important, should we follow a high protein, high fat, low carb diet?

Dr. Zincov:           I’m a huge proponent of a lower carb diet, but not necessarily keto. I think that I’m not a carbophobe, I think carbs are important. I think, obviously, a lot of carbs are not created equal. When I talk about carbs, I want people to get most of their carbs from vegetables, from starchy vegetables, maybe like squash, right? Or sweet potato. Maybe just limiting fruit to one to two servings per day. When I say carbs, I really am talking about the vegetable group of carbs, right? Not necessarily the pastas and the breads. I want people to avoid those things.

Dr. Weitz:            What about legumes?

Dr. Zincov:           Sensitive topic.

Dr. Weitz:            Watch out for the deadly lectins.

Dr. Zincov:           I know. Oh my gosh, I am fine with legumes. I think that they have lots of good nutrients, they can actually help people balance their blood sugar, they can be-

Dr. Weitz:            Lots of fiber to feed your microbiome.

Dr. Zincov:           Absolutely. The whole thing with-

Dr. Weitz:            Low in the glycemic index.

Dr. Zincov:           Yeah. There’s just so many benefits to legumes, and it’s more about the source, how you prepare them. I mean, there’s so many ways that you can optimize their digestion and breakdown and absorption. I’m just not 100% in the whole lectin theory that that’s at the root problem of our diets, like what do we eat? Just meat and kale? I mean, I’m all about moderation when it comes to diet.

Dr. Weitz:            It could be the new diet, the meat and kale diet.

Dr. Zincov:           God forbid.

Dr. Weitz:            The Carni-Kale diet.

Dr. Zincov:           Yeah, exactly. You never know, right?

Dr. Weitz:            So, how do nutrient deficiencies promote food cravings?

Dr. Zincov:           Yeah, absolutely. So, a key example, like we talked about B12, right? And MTHFR deficiency, and that can predispose people to have more sugar cravings. Magnesium is a really common example. It’s like the poster child for food deficiencies or nutrient deficiencies that can lead to food cravings, so if someone, let’s say, is low in magnesium, they can have more chocolate cravings, and so that’s the poster child for that.  If you have low iron levels, that can cause, especially a lot of women, it can cause them to crave more red meat, right? We just run into a problem. Do you really need to eat more red meat? So, that’s where we need to individualize our medicine a bit more. So, those are really the common examples. The thing is that, what I’ve seen is a lot of deficiencies in B vitamins. Deficiency-

Dr. Weitz:            So, if I had a sugar craving right now, if I popped a couple of mag citrate caps, that would take care of it?

Dr. Zincov:           No. I think in that situation, when someone is like, “Oh, I really need sugar right now.” Chances are, maybe they didn’t get enough B vitamins, right? Because here’s the situation, is that, how do we get our energy? ATP? When we talk about, “I need more energy.” We need more ATP. That’s the unit of energy, right? Where’s your energy produced? In the mitochondria. What does your mitochondria need?  It needs, for the electron transport chain, right? How do we get the ATPs? We need CoQ10, we need, L-Carnitine, lots and lots of B vitamins, we need magnesium, we need B12, which is part of the B-vitamin family. So, there’s all of these nutrients that are involved in energy production, that if we’re deficient in those things, guess what? We’re going to crave more sugar because we can’t make those ATPs. Now, we’re getting into mitochondrial dysfunction.

Dr. Weitz:            Absolutely.

Dr. Zincov:           Yeah.

Dr. Weitz:            Functional medicine discussion without mentioning the mitochondria.

Dr. Zincov:           Or MTHFR.

Dr. Weitz:            What part does the microbiome play in food cravings?

Dr. Zincov:           Well, we’ve got more bacteria in our gut than we have the total amount of cells, right? In our body, and people talk about the microbiome as something like super cozy, working for us, but the reality is that the microbiome is there to serve itself, right? So, it’s us versus the microbiome, and the more certain foods you eat, let’s say you eat more meat. You’re going to create more microbiome that’s going to thrive on meat, right?   So, you’re going to produce that type of bacteria that’s going to make you crave more of those foods. Same thing with carbohydrates. I don’t remember off the top of my head, there are certain bacteria that when you do eat a higher starch diet, higher carb diet, those are the things that you’re going to crave, right? So, you create the microbiome by what you eat. The cool thing is that there’s a lot of research that shows that we can simply turn that around 24, 48 hours, right?  Which is pretty cool, and so I tell people, if you slip off your diet, don’t worry about it. You have the next day, or even the next moment to start making the change. So, certainly there’s a link between what we eat and the type of microbiome that we shape, and when I talk about microbiome, even I used to think that microbiome just talks about bacteria. Microbiome is viruses, microbiome is bacteria, it’s yeast, it’s parasites.  So, it’s a whole ecology that we’re dealing with. If you eat more sugar, chances are you’re going to grow more yeast, right? You’re going to crave more sugar, which is going to cause more yeast overgrowth, and it’s not just candida, right? There’s like 20 plus, some sort of yeast species that we can get exposed to or create.

Dr. Weitz:            Now, if we have a higher fat, higher protein diet, lower carbs, are we going to risk not having the fiber that a lot of the bacteria that are in a microbiome need?

Dr. Zincov:           Yeah. Well, and this is going back to what you were talking about, even legumes, right? I have no problem with people eating legumes or whole grains, things that they’re not sensitive to.  It’s really, the only foods that I want people to avoid are the ones that they’re sensitive to, right? Or that can be inflammatory, or that possibly can cause allergies or blood sugar dysregulation-

Dr. Weitz:            How do you determine which foods those are?

Dr. Zincov:           Ah, another sensitive topic. So really, I stay away from food allergy testing because I don’t think that it’s very accurate. Really, the gold standard of food allergy testing is, take a food out for an extended period of time, bring it back in to see if that’s something that you get a reaction to, and-

Dr. Weitz:            The elimination diet?

Dr. Zincov:           Elimination diet, exactly, is really the gold standard. There’s just way too many false positives and false negatives with food allergy testing, and don’t get me wrong. I’ve seen great success with those tests, right? But I think there’s few individuals who really benefit from it, and I think that it can be useful when we’ve exhausted all our options, and we have no clue where to begin, right? I’ve seen something like asparagus being a really big sensitivity for someone, and we didn’t know that until we did the food allergy testing. So, it’s not-

Dr. Weitz:            And there’s better and worse food sensitivity testing too.

Dr. Zincov:           Yeah, exactly. But when it comes to, going back to the question of, are we risking people eating lower fiber diets by choosing higher protein, higher fats? Yeah. We are. And that’s why I’m not afraid to prescribe, right?   Legumes and squash and the tubers, right? I’m not afraid to prescribe those things, and I encourage those things because fiber is super important and prevents against colon cancer and it supports the microbiome growth, and so it’s-

Dr. Weitz:            Yeah. I interviewed Kiran Krishnan a few weeks ago, he spoke at our functional medicine meeting and he was talking about how, if you have a higher meat diet, you have a higher level of Prevotella, and you throw off your Prevotella to Bacteroides ratio.

Dr. Zincov:           Yeah, yeah. And-

Dr. Weitz:            Yeah. And how that’s a negative and that affects blood sugar, so that could play into this whole thing too.

Dr. Zincov:           Yeah. And I’ve studied Bacteroidedes and Firmicutes species and some of those other proteobacterium like E. coli pretty extensively, and that can affect your estrogen, especially for women. This is really important.  Actually for men too, because sometimes when people think about estrogen, it’s like, “Oh, that’s a woman’s hormone.” Well, guess what guys? You don’t want your estrogen to be through the roof, right? And when I-

Dr. Weitz:            And you don’t want it to be too low either. Men need a certain amount of estrogen also.

Dr. Zincov:           Absolutely. Yeah, absolutely, and so when I look, let’s say I do somebody’s hormone panel and I see that their estrogen is through the roof-

Dr. Weitz:            What’s your favorite hormone panel?

Dr. Zincov:           So, I do a combination. I like urine testing, and I also like blood testing.

Dr. Weitz:            You like Dutch?

Dr. Zincov:           I like Meridian.

Dr. Weitz:            Oh. I don’t know them.

Dr. Zincov:           Yeah. Yeah. I-

Dr. Weitz:            Just like a 24 hour urine?

Dr. Zincov:           It is. So, it’s actually both Dutch and Meridian and I’m pretty vocal about my preference between the two.  I’m a Meridian fan for my reasons, but they’re similar in the technology-

Dr. Weitz:            You got to carry around the jug of urine, though.

Dr. Zincov:           No, that one, so it’s different. So, they’ve moved away from doing the jug of urine test, which is really inconvenient for people, to doing the dry urine strip testing.

Dr. Weitz:            Oh, okay.

Dr. Zincov:           So, a bit more convenient. I’m sure it’s not as maybe accurate as doing an actual jug of urine, but it’s a lot more convenience, the compliance rate is obviously a lot higher, and it gives us great data. I mean, everything from estrogens to estrogen metabolites to, right?  Progesterone, to androgen breakdown, cortisol curve, super essential to know, and so there’s just minor differences that I like in Meridian compared to Dutch. I don’t think we should go off of just urine testing alone, I think it’s important to also do blood testing, get a snapshot of the, actually, bioavailable levels, but when it comes to once someone is doing-

Dr. Weitz:            You often see discrepancies between serum and urine on hormones?

Dr. Zincov:           It’s not comparing apples to apples. So, there is, every once in a while, and I’ll tell you what it is. I’ll give you an example of testosterone, for example, right? So, someone can test really high on testosterone in the morning when they go get their blood drawn, right? But the benefit of doing something like a 24 hour hormone test is that-

Dr. Weitz:            It could drop later in the day.

Dr. Zincov:           Precisely, and I’ve had women who would say, “Well, my testosterone is high. Why do I need more testosterone?” And then I show them their test on the 24 hour, and I’m like, “Yeah. You could have been high at 8:00 AM, but then starting at 10:00 AM, it could significantly or exponentially drop, for whatever reason.   Maybe there’s an adrenal dysfunction, right? And so for whatever reason, and then they ended up feeling better, right? Once they’re in a little bit of testosterone, for example, or MOC or whatever we decide what the route of treatment is going to be, but that’s the benefit of using both tests, urine and blood, because the blood is great if we just get a snapshot, right?    And if you’re low, well, then you’re low, right? But someone could be low at one point and super high at another point, and this is where even the thing with estrogens we want to be really careful with, is that we want to make sure that we are understanding what are the total levels of hormones? I think that’s really the point, that, what are the total levels of hormones, given that they can cycle throughout the day, not just a month?

Dr. Weitz:            And also, how does your body process those hormones?

Dr. Zincov:           Oh, man.

Dr. Weitz:            Are you clearing your estrogens? Are you clearing them in a way that puts you at less risk of breast cancer?

Dr. Zincov:           I work with so many women who are post breast cancer, who have a high risk of breast cancer, I have a lot of women who don’t have breast cancer, but their mom, their aunt, their sister have all had had breast cancer, and so I’m such an advocate for women getting their estrogen metabolites tested, getting their estrogen tested.  I think there’s a misconception that when women hit, let’s say, perimenopause or menopause, that our estrogen declines. It does, but actually some women are still estrogen dominant even in menopause, and that’s a scary thing, giving what estrogen can do in terms of cancer.

Dr. Weitz:            So, what do you do about that?

Dr. Zincov:           So, we definitely want to offset estrogen. Estrogen, I see it more as a bully hormone. It’s an important hormone, but it can be nasty, right? When it’s I high amounts.

Dr. Weitz:            So, you give them progesterone?

Dr. Zincov:           We give them progesterone. That’s one of the best ways to offset estrogen. The other thing we can is-

Dr. Weitz:            And you like oral or cream for progesterone?

Dr. Zincov:           I like oral. Yeah. I like oral. Again, lots of benefits, especially if we’re dealing with estrogen dominance, I say, just go for the oral form. Every once in a while, and literature is really mixed on this as phytoestrogens, right? Phytoestrogens much more mild in terms of binding estrogen receptor sites, bu you got to be careful.

Dr. Weitz:            Like soy, black cohosh, things like that?

Dr. Zincov:           Yeah. Black cohosh, dong quai, all those things are great. Flaxseeds, ground flaxseeds are actually natural phytoestrogens, and of course soy, just making sure that it’s organic soy, but it’s really, again, it’s like people are so scared of soy. Well, it’s actually just maybe a couple of times a week as a phytoestrogen source, it might not be a bad option. Yeah. So, those are the two ways that I would offset estrogen, and of course we can get into some liver optimization, right?  Like DIM and NAC and glutathione and dandelion root and burdock root. Anytime there’s estrogen dominance, you actually got to work on the liver, but then you actually, like we were talking about, gut health and Bacteroidede species, it’s really interesting. I started my own case study research in my clinic, because I’m like, if someone is estrogen dominant, I bet if I test their stool, they’re going to be dominant in certain types of bacteria, and sure enough, right? And they’ll be high in Bacteroidedes, they’ll be high sometimes on Firmicutes or even E. coli, and people are scared E. coli.

                                It’s like, well, we have certain strains E. coli in us, right? It’s just, it’s when they outgrow their welcome, then it becomes a problem, and so when it comes to even estrogen dominance and people are like, “Well, how’s this related to food cravings? Well, if you’re estrogen dominant, you’re going to be an irritable mess, which is going to force you to make really poor food decisions, in a nutshell.

Dr. Weitz:            What’s your favorite stool test?

Dr. Zincov:           I liked Genova. The GI Effects. And again, some people prefer the GI-MAP. I really like Genova, I think they do a really great job of breaking down the different categories. It’s visually more pleasant to look at, it’s easier to explain, wrap your mind around it. I think they do a great job of showing the protein breakdown, the fat breakdown, if there’s missing short chain fatty acids, right? Which are important for the microbiome as fuel. So, I think they do a really great job of just putting things in their place.

Dr. Weitz:            So, you mentioned estrogen and progesterone and testosterone. What about adrenal hormones and thyroid?

Dr. Zincov:           Yeah. Yeah, absolutely, and I think those are the ones that people think about more frequently than the other hormones, the sex hormones. The thing is that, especially in times of stress, and a lot of people are under a lot of stress right now, right? Times of uncertainty. That’s an understatement. “What stress?”

Dr. Weitz:            “What stress? There’s no problem.”

Dr. Zincov:           “I don’t know what you’re talking about.”

Dr. Weitz:            “I don’t know what you’re talking about. Everything’s great.”

Dr. Zincov:           I know. Yeah, right? A little bit of denial can’t hurt us, right?

Dr. Weitz:            Just another pandemic. No big deal.

Dr. Zincov:           Yeah. Exactly.

Dr. Weitz:            “Our economy’s locked down.”

Dr. Zincov:           Oh, man. Don’t even get me started on that. So, the two really main organs, or not organs, glands that are really taking a beating is our thyroid and our adrenals. We’re not sleeping enough, we’re eating bad food, we’re angry, we’re frustrated, we’re stressed. We are dealing with things that are out of our control, right? And so your thyroid and your adrenal gland, the things that really keep your metabolism going, the things that keep your adrenaline pumping like your adrenal glands, they’re stressed. They’re also stressed.

                                And so what happens is that when your thyroid tanks, people tend to crave more sugar, and one of the reasons is because your thyroid regulates your insulin, it regulates your blood sugar, and when that system is broken, you’re going to get your sugar from elsewhere, right? Not from your innate reserves, for example. And then because your adrenal gland, which is actually located right on top of your kidneys, it helps your kidney. It helps your kidneys function, right?

                                It keeps your pH, keeps your concentration of your blood at a certain level and people crave salt. And it’s a synergistic relationship, right? Between the thyroid and adrenals and people are like, “Well, what if I create both sugar and salt?” Well, that’s a double whammy. We gotta address both, but that’s, again, from a functional medicine perspective, a lot of people are walking around with under functioning thyroid glands, and I just don’t understand, given the research that TSH is not the most optimal marker to test the thyroid gland, we’re still not feeling well.

Dr. Weitz:            So, what do you look at? What’s the most important thing to look at, and what are the key ranges?

Dr. Zincov:           Yeah. Yeah. So, I hope people have a piece of paper and a pen or their notes on their iPhone ready. So, I still like to test for TSH, but I like to test for total T4, total T3, free T4, free T3, always fired antibodies, sometimes reverse T3, mostly used for cancer monitoring or inflammation, but not really relevant, at least from my… I have not seen it professionally or in research that it’s relevant in terms of diagnosing thyroid dysfunction.  So, you want to test all of those thyroid markers and what’s the optimal range? There’s a lot of even research that shows that TSH below 2.2 has linked to less depression and fewer mood disorders. So, I like the TSH to be at least closer to 1. 1 is that optimal range. I like to look at free T4 and free T3 because those are the more bioavailable active hormones.   For free T4, I like for it to be at least between 1.2, 1.4, and a lot of people are walking around with like 0.9, 0.8, right? “Just because it’s not tanked doesn’t mean that I need to treat it.” And four free T3, some providers just look at free T3, what it’s doing, because that’s really the most active of thyroid hormones. Free T3, I like for it to be at least 3.3.

Dr. Weitz:            Oh, wow.

Dr. Zincov:           3.3, 3.5. Men actually do really well with at least like a 3.7.

Dr. Weitz:            Wow.

Dr. Zincov:           Yeah.

Dr. Weitz:            That’s that’s a high level.

Dr. Zincov:           Yeah. Well, I mean-

Dr. Weitz:            I mean, compared to the normal range, right?

Dr. Zincov:           Oh, yeah. Well, it’s really frequent that someone will, like during my initial consult with a patient, people will say, “Well, my thyroid is normal.” And I’m like, “Well, what is normal?” Because they’re coming to me from, let’s say conventional medicine, or even a naturopath, right?   I do a lot of second opinions on hormone testing and they’ll say, “Well, my thyroid is normal and they’re free T3.” So, the free T3 range, let’s say, is 2.0 to 4.4, and they’ll say, “Well, my free T3… let’s say, “… is 2.4.” “Wow, you’re low.” Right?

Dr. Weitz:            Yeah.

Dr. Zincov:           And so-

Dr. Weitz:            Oh, even though it’s in that range, because it’s at the lower end of that range, that’s something to look at, so don’t just pay attention to the things that come up in red, you’re saying?

Dr. Zincov:           Exactly, exactly, and my patients, they’ve become really educated about that. They know that I’m not just looking for something in the middle, right? I’m really looking at what’s the upper ends, but even though, we talked about B12, doesn’t matter. If you’re through the roof on B12, but you are feeling crappy, chances are, it’s either the wrong test, right? Or something else.

Dr. Weitz:            Now, some of the functional medicine labs will include the free T3 and a free T4, but not the total T3 and a total T4, so a lot of times I don’t do those. Am I really missing something?

Dr. Zincov:           I don’t think so.

Dr. Weitz:            Okay.

Dr. Zincov:           I think it’s really more essential to understand what the free T4 and the free T3.

Dr. Weitz:            Okay. Because those are the active forms?

Dr. Zincov:           Exactly, and that’s where you’re getting the real benefit, and the real result.

Dr. Weitz:            Yeah. Okay. Great. Any final thoughts for our listeners and viewers?

Dr. Zincov:           I think one of the things I’d want them to know is just pay attention to how you feel. So much we’re in a reactive mode, right? We just don’t take the time to pause and check in with ourselves, and whether it’s food cravings, whether it’s fatigue, whatever you’re feeling, we go from feeling something, to reaction, and so nowadays, I think it’s just really important to just take pause, right? You’re going to get a lot out of that 10 second pause. That’s where the change happens. That’s where the magic happens. That’s where you change your behavior and your habits for the best.

Dr. Weitz:            Cool. How can listeners get a hold of you and find out about your book and seeing you for a consult?

Dr. Zincov:           Yeah. People can go to my website, proactivehealthnd.com. There’s a lot of information there on the programs, on some educational things that we’re doing, and then I’m big on the Instagram. It’s Dr. Elena Zincov, really easy to find me. Try to basically share the knowledge of health with everyone.

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

Dr. Zincov:           Thanks for having me.

 

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Gut Parasites with Dr Jason Hawrelak: Rational Wellness Podcast 169

Dr. Jason Hawrelak speaks about Parasites with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

6:49  Gut parasites used to be considered a more common cause of gut infections 20 years ago, whereas in the last 5 or 10 years in Functional Medicine circles we have come to focus more on conditions like Small Intestinal Bacterial Overgrowth, H. pylori, dysbiosis and fungal overgrowth. What should make us suspect that a patient with digestive symptoms might have a parasite?  The symptoms do overlap with symptoms from conditions like IBS, SIBO, functional dyspepsia, and inflammatory bowel disease.  We have to distinguish between parasites like Giardia and Entamoeba Histolytica that clearly cause serious gut infections from more debatable ones like Blastocystis Hominis and Dientomoeba Fragilis. You might get some history like they have recently travelled overseas and then got a case of traveler’s diarrhea.  We have to do some testing to see what is causing the symptoms and not just stool testing for parasites. If you find Giardia, you can be fairly confident that this is responsible for that patient’s symptoms. But if it is Blastocystis Hominis or Dientomoeba Fragilis we can’t make that assumption, because of the prevalence of these microbes in healthy populations.  Dr. Hawrelak recommends doing a suite of tests to determine what causes these symptoms including not only a PCR stool test but a microbiome analysis stool test, fecal calprotectin or lactoferrin for inflammatory bowel diseases, a fecal occult blood, and SIBO breath testing.

12:00  If you have a patient who has digestive symptoms like gas, bloating, diarrhea or constipation, and they have a positive SIBO breath test and they also have a protozoan organism like Blastocystis and/or Dientomoeba that shows up on a stool test, you should treat the SIBO.  Such protozoans are extremely common and are generally irrelevant to that person’s symptoms.  15-20 years ago SIBO wasn’t that well known and we used to treat such patients for Blastocystis and we would get some results but it would generally not resolve completely. He talked about one patient who he treated for Blastocystis and got somewhat better and then 12 months later was diagnosed with fructose intolerance and went on a low fructose diet and all her symptoms completely resolved and Dr. Hawrelak was upset that he missed that diagnosis.

15:15  It is interesting to consider whether there could be SIPO or Small Intestinal Protozoan Overgrowth as a cause of IBS.  We should probably think of certain protozoans like Blastocystis and Dientomoeba as commensal, as a normal part of a healthy gut.  In fact, Dr. Hawrelak noted that he personally has elevated levels of Blastocystis Hominis on a stool test and no gut symptoms.  Perhaps we’ll be taking protozoan probiotic supplements one day.  On the other hand, taking certain antibiotics like Metronidazole, Flagyl, the most common antibiotic used to kill protozoal organisms, it tends to awaken the pathogenic potential of Blastocystis and increases its capacity to actually cause gut damage and to interact negatively with precancerous cells and become much more virulent. 

20:54  There are 17 different subtypes of Blastocystis Hominis but only 9 have been found in humans and the rest in other animals, like chickens, pigs, cows, etc..  For humans the most common subtypes are 1, 2, 3, and 4, esp. 1 and 3. There is no consistency in the data around which of these subtypes may be more pathological than the others.  Dr. Hawrelak wants to emphasize that when he has a patient who shows elevated Blastocystis or Dientomoeba he used to think that these were primary parasites that needed to be killed to help his patients feel better and now he generally regards these as a normal part of the microbiome in healthy patients. There have been a lot of good studies done in western Europe that have found that 7 out of 10 healthy kids have Dientomoeba in their guts and kids with functional abdominal pain are less likely to have Dientomoeba in their guts than those who are actually healthy.

25:33  In rare cases where he has a patient with significant GI symptoms and who has elevated Blastocystis and no other findings on gut testing, Dr. Hawrelak will treat the protozoan.  Blastocystis Hominis flourishes in an alkaline environment, so he will have patients eat more fiber, prebiotics, and a more plant based whole food diet.  More fiber will lead to more production of short chain fatty acids like butyrate and acetate, which will lower the colonic pH.  That in itself can lower Blastocystis levels.  Dr. Hawrelak will use agents like pomegranate husks and garlic along with saccharomyces cerevisiae boulardii probiotic.

29:57  Of the more clearly pathological parasites, Giardia is the one that Dr. Hawrelak sees most commonly, though less common than when he was practicing in a more rural area of Australia. He said that Giardia will often resolve without the need for specific treatment, but when it is required, he will use raw garlic and have patients press a couple of cloves into capsules or a glass of water and consume it twice per day. One study in Eqypt showed 100% erradication in only 3 days with raw garlic. He will also use pomegranate husk and plantago major ribwort. Dr. Hawrelak used to use berberine containing herbs like coptis, but he is concerned that berberine may have a damaging effect on the microbiome since it reduces bifidobacteria levels.  He will also give saccharomyces cerevisiae boulardii again as a probiotic, since it has been shown to help erradicate Giardia.  The Giardia is an amazing protozoal organism that forms a cyst and when you get one or two of them in the gut, they can cover the entire small bowel with the Giardia trophozote and they can damage the intestinal villi so necessary for absorbing nutrients from our food and damage the brush border and affect the brush border enzymes that are necessary to absorb foods like fructose and lactose.  Saccharomyces boulardii are wonderful for helping to regrow those villi and the brush border and you might do that during, then for at least six to 12 weeks afterwards to speed up healing. 

36:18  When treating worms, especially bigger worms like pinworms, it may be necessary to treat for 10 days, wait 10 days and then treat again for 10 days since eggs laid by the worms will not germinate until the antibiotics or antimicrobials are stopped. But this approach is not necessary with Giardia, which has a short treatment period and does not require using some of the stronger antimicrobial herbs.  For pinworms, Dr. Hawrelak used to use various herbs, including megadoses of wormwood and pomegranate husks and mix some garlic and peppermint essential oil with Vaseline and inserting it around or up the anus. Now he tends to use the prescription anti-parasitic taken once and then again in 10 days and that turns out to be both effective and cost effective and less labor intensive, esp. if it occurs in an entire family. 

41:02  H. Pylori is another type of infection that has been famously shown to be the cause of gastric ulcers in a percentage of patients.  What should Functional Medicine practitioners think about seeing an elevation of H. pylori show up on a stool test?  Dr. Hawrelak said that if he had a patients with GI symptoms and H. Pylori showed up on a stool test, he would look to see if there are any virulence factors and then he would follow up with an antibody blood test and a breath test.  If the antibodies and breath test were negative and a small amount of H. pylori showing on a PCR stool test, then its probably benign and not there in large enough amounts to cause any issues. If there are antibody levels and they have symptoms consistent with ulcers or gastritis, then it is important to treat H. pylori.  We know that certain strains of H. Pylori can cause peptic ulcer disease, we know they can cause increased risk of stomach cancer.  But there is also concern about eradicating H. pylori, since if you wipe out this species, what other microbe might start growing there that might be more virulent. Also there are quite benign strains of H. Pylori that might even have some healthful effects for us over time.  We should be especially concerned it we are considering using a triple or quadruple antibiotic cocktail that can cause permanent damage to the microbiome.  On the other hand, we can use some common nutritional products that have very little risk of harm and that can be very effective, like a mixture of the following natural agents: cranberry juice, broccoli sprouts, Lactobacillis reuteri DSM17938 probiotic strain, green tea extract, turkey rhubarb, and pomegranate husks have about a 90-95% eradication rate.  Dr. Harwelak noted that he rarely uses potent antimicrobial herbs like high dose berberine or eregano, clove, or thyme oil, since these can cause damage to the microbiome. 

                               



 

Dr. Jason Hawrelak is a Naturopathic Doctor, a PhD, and a master herbalist. He has been in practice in Australia for more than 20 years. Dr. Hawrelak is one of the leading experts in the treatment of gastrointestinal conditions with natural medicines and he has written extensively in Australia and International textbooks and journals on digestive topics. He continues to see patients in person and remotely. Dr. Hawrelak has developed an incredible subscription based resource to keep track of all the research on probiotics, called ProbioticAdvisor.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.

 



 

Podcast Transcript

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

Today, I’m very happy to be speaking with Doctor Jason Hawrelak all the way from Australia about parasites. Parasites is a topic in gut health that seems to have fallen out of favor among functional medicine practitioners who deal with patients with gastrointestinal symptoms in the last five or 10 years. The focus seems to have shifted towards focusing for patients who are negative for having Crohn’s and ulcerative colitis, the focus seems to be towards SIBO and IBS.   Certain parasites are referred to as protozoans. Protozoans are actually single cell microorganisms and they include a large variety including amoeba, flagellates, ciliates, protozoans. Protozoans are common in fresh, brackish, or salt water. As well as in other moist environments including in an extreme environments like hot springs, hypersaline lakes. The protozoans can also form cysts to survive in dry environments in a dormant state. Some protozoans live in our guts without causing harm and may even provide some benefits while other protozoans may be a significant cause of disease such as [inaudible 00:01:54], malaria, giardiasis, et cetera. Protozoans are not infrequently found in the stool of patients when undergoing stool testing, especially some of the very sensitive molecular PCR tests. Parasites can take the form of worms or protozoans, of which, Blastocystis Hominis, dientamoeba fragilis, and Giardia are some of the more common parasites. Blastocystis Hominis is often considered by Functional Medicine practitioners to be a particularly difficult microorganism to eradicate and is often associated with a host of gastrointestinal symptoms including diarrhea and it’s also sometimes thought to be associated with Hashimoto’s hypothyroid disease. Some of these protozoans may not always be pathological as many of us think, as Doctor Hawrelak will explain today. One other topic I would like to ask Doctor Hawrelak about is H. Pylori infection, which at one time was considered an obvious problem when discovered on a stool panel, but is now understood to have a much more complex relationship with our gut.

                                                Doctor Jason Hawrelak is a naturopathic doctor. He’s a PhD, he’s a master herbalist, and he’s been in practice for more than 20 years in Australia. He’s one of the leading experts in the treatment of gastrointestinal conditions with natural medicines. He’s written extensively in Australia and international textbooks and journals on digestive topics. He both sees patients in person and remotely, he also teachers other healthcare practitioners. He’s currently coordinates and teaches the evidence based complimentary medicine program in the School of Medicine at the University of Tasmania. He’s the gastrointestinal imbalances lecturer in the master of science and human nutrition, and functional medicine program at the University of Western States in Portland, Oregon. Doctor Hawrelak started and runs an incredible resource to keep track of all the research on the latest probiotic strains called Probiotic Advisor, which I have used and is an extremely valuable resource. Doctor Hawrelak, thank you so much for joining me today.

Dr. Hawrelak:                     You’re very welcome, Ben. Nice to speak to you again. It’s been a while.

Dr. Weitz:                            Absolutely. Before we get started, I don’t know if you saw 60 minutes on Sunday, but I have bad news for you. You’ll have to close down your Probiotic Advisor because 60 minutes reported that there’s absolutely no benefit to any probiotic.

Dr. Hawrelak:                     Great. What can I tell my patients for the last 20 years? I can say it was all placebo perhaps. I haven’t seen that actually. I should put it on my agenda as something to watch to see what the mainstream media is actually reporting there. I think that comes from really misunderstanding some of the nuances around probiotics. Rather than taking them to change the ecosystem or to repopulate, which I think is the more popular idea, with knowing that they actually have specific effects and actions when ingested which creates physiological change, so we can use it for helping to eradicate H. Pylori for example, for decreasing obesity, or for moderating mood. There’s a whole bunch of positive clinical trials that it’s I think pretty mind blowing to come to that viewpoint that probiotics don’t work for anything based on what data has been published for the last 30, 40 years, particularly the last 20 years.

Dr. Weitz:                            Amazing amount of studies. Of course, that was one of their complaints. We’re not going to spend the whole time talking about 60 minutes, but that was one of their complaints that the probiotics that you ingest don’t actually find themselves to populate the gut. We know that.

Dr. Hawrelak:                     That’s not surprising, that’s now why we should be taking them. At least, what the research has shown us is that if that’s why you’re doing it, you’re not really taking it for the right reasons because you’re not really going to achieve that with the current generation that we have. It’s pretty rare to have any sort of longterm colonization, but that’s not to say that won’t be something we generate with future probiotics if we start making probiotics from things like Akkermansia, [inaudible 00:06:24]. Novel species that might actually have that capacity to stick around for longer periods of time or if not permanently. Reality is that they have therapeutic effects when we take them, some of them do anyway if we select them well and make sure they’ve got the right traits and qualities. When we stop taking them, that will stop having that effect just like any pharmacological agent whether that be pharmaceutical or herbal medicine that they’ve got an action while you take it. You cease taking it, it stops having that action.

Dr. Weitz:                            One of the reasons I really have been looking forward to this discussion is that I really wanted to dive into some information about parasites. When I first got into Functional Medicine 20, 30 years ago, it was a lot of talk about parasites. In the last five or 10 years, we’ve lost that focus, but I think it’s an important topic to talk about. When you’re consulting with a patient, are there any particular symptoms that come up during a consultation that will make you suspect this could be somebody who’s having a problem with parasites?

Dr. Hawrelak:                     I mean, the challenge with most symptoms that we’d associate with gut parasites like Giardia, which is undoubtedly a cause of gut infections, gut damage, Entamoeba Histolytica for example that are in that camp, versus ones that are much more debatable like Blastocystis and Dientomoeba is that the symptoms overlap with irritable bowel syndrome in some degrees with inflammatory bowel disease, functional dyspepsia, post infectious IBS with SIBO. It’s a whole cluster. If someone presents with these symptoms, you really need to do testing to ascertain what’s going on. You might get some clues from history in that they’ve just traveled overseas. They went to developing nations and they got a case of traveler’s diarrhea. That to me is a red flag that there may well be something staying in their gut from that.  That time of ingestion and that acute flair.  Sometimes, your body will fight that off.  Most of the time, it’s a bacterial agent anyway that causes traveler’s diarrhea, but we do get protozoa as part of components of or as contributors to that overall traveler’s diarrhea load.

                                                We might get that flag on the history, but we really need to do testing to ascertain what’s going on. For me, that wouldn’t mean just doing stool testing for parasites because I think we all get the potential of getting quite lost and missing what’s going on if that’s all that we do just because some microbes like Blastocystis and Dientomoeba are so common in healthy everyday people that if they’ve got some runny stool and some abdominal pain, you do one test, you do a stool test. It shows that, I think there’s a decent chance you’re going to miss what’s really causing that person’s issue in that instance. If it happens to be Giardia, fair enough, that’s a different scenario. If it’s Dientomoeba or Blastocystis, we can’t make that assumption that this is the cause of their symptoms because of the prevalence of these microbes in healthy populations. Essentially, to me it means we’ve got to do a suite of tests that if they present with that symptom picture that overlaps with so many other conditions, we actually have to test to rule out those conditions.   That would be things like fecal Calprotectin or Lactoferrin for inflammatory bowel diseases, a fecal occult blood for example also looking for more pathological changes and damage to the small or large bowel. For me, it would mean SIBO breath testing would be a component of that.  As well as doing a stool PCR looking for the presence of potential bacterial and protozoal parasites that may have been picked up from overseas.

Dr. Weitz:                            What is your favorite stool test these days?

Dr. Hawrelak:                     I would actually use a number in practice. I’m based in Australia, so we have the conventional pathology labs that do a stool based multiplex PCR that looks for the most common protozoal parasites, the most common bacterial causes of diarrhea. I might run that, but then also do a microbiome assessment as well that tells about the bacterial ecosystem, as well as doing breath testing. Then, the other tests looking for inflammatory markers.  In the colon, that might indicate that it’s more likely to be inflammatory bowel disease.  Even some of the more rare ones like lymphocytic colitis or collagenous colitis for example.

Dr. Weitz:                            Which microbiome tests will you use?

Dr. Hawrelak:                     Good question. These days, I’m using one of mostly between two different labs. One lab here in Australia called Microbiome that does metagenomic sequencing, which means we get very good detail and data from a species level perspective as well as from genus and higher up the hierarchy up to phylum. It also gives us the markers around levels of LPS production, levels of hydrogen sulfite gas production for example that I find can be clinically useful. Then, I’m also using Thrive as well particularly for my US patients where we get that nice snapshot of the bacterial components of the ecosystem.

Dr. Weitz:                            Yes, you might check out this biome FX test that Microbiome Labs is promoting now that Kiran Krishnan helped fine tune. It looks pretty interesting.

Dr. Hawrelak:                     I haven’t had a chance to look at that yet.

Dr. Weitz:                            Yes, check that out. If you had a patient who came in your office and they’re having some of these symptoms like gas, bloating, maybe diarrhea or constipation, they had a positive SIBO breath test, and you also saw a parasite, which would you treat first?

Dr. Hawrelak:                     For me if it showed up a very clear positive on SIBO breath testing and it had Blastocystis and/or Dientomoeba in the stool, I would treat the SIBO. I do this all the time. The presence of Blastocystis and Dientomoeba is generally completely irrelevant to that person’s symptoms. That’s something I’ve come to from 20 years of practice and reading more the recent literature around the prevalence of these parasites or in parasites. Protozoal and protozoal like organisms in people’s guts is extremely common. What I found is that most patients who present to me with, they go I’ve got a positive stool test for Blasto or Dientomoeba and they haven’t done a breath test yet, we’ll do a breath test for SIBO and it will actually show up positive. We treat the SIBO, their symptoms get better, they still have Blasto in their gut afterwards. That is so common. For me, it really showed clearly … I go back to how I treated patients 15, 20 years ago. If they showed up with a positive Blasto or Dientomoeba, I was like let’s try to kill this. Let’s focus in on that.

                                                Sometimes, you’d get symptomatic improvement for sure, but I think at least temporarily. I still think we were often inadvertently treating the SIBO in these patients, which was the cause of their symptoms because I wasn’t really aware of SIBO 15, 20 years ago. It wasn’t well known as a diagnostic label. Testing wasn’t really promoted, discussed, and talked about very much. I think I’ve seen that major shift in focus. I mean, one patient also illustrated to me very clearly that they came to see me. Classic symptoms of bloating, distention, some runnier stools.  Positive stool test for Blastocystis. I just made the assumption that was the cause. I said let’s treat that. Yes, there was symptomatic improvement while they were taking the herbs. Then, I hadn’t seen them for a while. Then, she came back. I think it was probably 12 months later. She said, “I was actually diagnosed with fructose intolerance. I reduced my level fructose and all my symptoms went away.” I just really was like, how could I miss that? I really let this patient down by not doing a proper diagnostic workup.

                                                I got fixated on this thing and that wasn’t the cause of her symptoms, she still has Blastocystis in her gut, but no symptoms if she goes on a low fructose diet. That patient really taught me a major lesson that we can’t … We’re often guilty of this premature diagnostic closure. I try to be less guilty of that now than I was in the past where we wouldn’t do a proper suite of tests to really see what’s going on. We’d get really fixated on that one and actually miss it. I’ve had other patients that I’d subsequently diagnosed with celiac disease that were by other practitioners diagnosed with Blastocystis and not followed up. You think, what’s the consequence of that missed celiac disease because we got so fixated on that Blastocystis on a stool test? Huge.

Dr. Weitz:                            Right. I want to go into some more detail on those two protozoans. I wonder if it’s possible that we have SIBO, which is bacterial overgrowth in the small intestine, I wonder if there’s a SIPO, if there could be a protozoan overgrowth in the small intestine that could be creating some of these problems. I asked Doctor Pimentel that when he was speaking at our meeting last month. He said, “We’re still going through all the samples. We’re going to look at that as a possibility.”

Dr. Hawrelak:                     Yes, because I think really with the evolution of technology I’ve used in metagenomics, we can actually take samples and see things that exist that we didn’t know existed before. It is interesting. I think because we’ve changed that technology or evolved into using technology that is far more accurate in its capacity to tell us what’s there, we’re seeing now that we all have protozoal organisms in our gut. That’s totally normal for humans. If you go back 20 years ago, people weren’t thinking that.  We were thinking if there’s a protozoal there, we must need to kill it because it shouldn’t be there.  It’s like, no.  We’re supposed to have fungi in our guts, we’re supposed to have bacteria, and we’re supposed to have protozoal.  They live in this usually beautiful harmonious ecosystem where they’re all interacting in ways that ensure our state of health until we upset that balance in different ways.

Dr. Weitz:                            Are you proposing that we should really think of protozoans in some cases as commensal?

Dr. Hawrelak:                     Definitely. I think certainly in the camp with microbes like Blastocystis and Dientomoeba, I will generally put them into the commensal camp in vast majority of my patients. Personally, I had a stool test done just because I was testing a bunch of different labs. It turns out I’ve got Blastocystis and Dientomoeba in my gut and I’ve got no gut symptoms. Managed to work 60 plus hours a week for the last 10, 15 years. No fatigue issues like the things that people see as symptomatic with these things, I don’t have. Here’s this one clear example of a case of a healthy person that has these microbes there, no symptoms whatsoever. You look at the literature, we find that’s actually fairly common with Blastocystis and Dientomoeba. They are extremely common in healthy people. The more recent research for the last few years have suggested particularly for microbes like Blastocystis that they actually play a pivotal role in keeping our ecosystem healthier verses the loss of our protozoal species that we’ve evolved with over millions of years some scientists and researchers are suggesting is having negative repercussions on our state of health that we see around us. Just like we’ve had that loss of bacterial diversity and loss of arguable fungal diversity that we are just finding out about now, but the repercussions of which I think we see all around us with the Western disease states that we see in practice all the time.

Dr. Weitz:                           Yes. Maybe we’ll be taking protozoan supplements at some point.

Dr. Hawrelak:                     It’s possible, I reckon. Yes.

Dr. Weitz:                           Maybe, it’s a question of balance. Maybe, it’s a question of you’re supposed to have a certain amount, but maybe if the Blastocystis is too high, it’s not a question of it shouldn’t be there, but it shouldn’t be there at that level.

Dr. Hawrelak:                     Yes. I mean, I do think there might be a part of that. Part of that is around environment. I always go back to that, the train is really immensely important for most organisms whether they can be infectious or not. The train is important and I’d dare say it’s similar with some of these microbes too that if we’re eating the right things and living the right lifestyle, then their presence is probably fairly irrelevant. You throw those things way out of balance and you throw other things in the gut out of balance, then maybe their populations or their behaviors change. I think that’s something we can see with microbes. There is some research around that with Blastocystis for example, research published very recently showing that exposure to Metronidazole, Flagyl, the most common antibiotic used to kill protozoal organisms. Well when it doesn’t kill Blastocystis it seems to actually awaken it’s more pathogenic potential that was lying dormant beforehand, exposed to antibiotics, and it increases capacity to actually cause gut damage to interact negatively with precancerous cells and become much more virulent. I think that there is an argument around how we eat, what our lifestyles are like, and potential functionality and behavior of these organisms within our gut that can be different if we ate a completely different diet, different lifestyles, exposed to low levels of antibiotics in our food chain. Maybe we’re bringing up more of the pathogenic potential.

Dr. Weitz:                            I was listening to an interview that Michael Ruscio did with Ilana Gurevich. She was talking about a study that found that species like Blasto and Dientomoeba fragilis, what they do is they change the microbiome enough to make the bacterial neighborhood more pathogenic and predisposed to negative changes either in the small or large bowels. Therefore, they’re maybe setting up things like SIBO.

Dr. Hawrelak:                     Interesting. I haven’t seen any research around that. I’d be happy to be posted some so I can read it. There is certainly some data. There was one study done in 2019 in vitro data getting a subtype seven from a symptomatic isolate subtype seven Blastocystis and giving it to mice. Finding that in in vitro, that it was able to shift the ecosystem. Maybe that’s what she’s referring to. She might be referring to some other study that I’m unaware of. That was interesting in that it did seem to increase levels of more pro inflammatory bacteria like E coli and [inaudible 00:20:51] for example, and decrease levels of bifidobacteria.

Dr. Weitz:                            We need to discuss the subtypes. There’s 17 different subtypes of Blastocystis, right?

Dr. Hawrelak:                     There is and there’s nine that are found in humans. The rest are found in other animals. That said, it’s not like these are only exclusively found in humans. The ones we find in humans, we also find in chickens, primates, pigs, cows, horses, rhinoceroses, zebras, and any animal you can name generally has a Blastocystis that can be in its gut or a number of them. For humans, the most common subtypes are one, two, three, and four. Prominently, types one and three. Extremely common.

Dr. Weitz:                            Is one of those subtypes more pathological potentially than the other?

Dr. Hawrelak:                     Well, there’s been a lot of research trying to tease that out and I would say the research has been generally … has not shown any clarity around that at all. The only small pivot I’d say there is subtype seven is very rare in humans. It’s mostly found in animals, birds. Chickens particularly, they sometimes carry seven. That study that looked at those shifts in bacterial ecosystems was associated with symptomatic type seven isolates. If I had a patient and it did show up a subtype seven Blasto and all the other tests came up negative as in normal, then I might be inclined to go let’s see about eradicating this organism because it could likely be a cause of their symptoms in your case. I certainly don’t think the data is consistent enough because you’ll find one study that goes subtype three is more common with IBS patients. Another study will go subtype three was totally not and it’s subtype one. Another study will show subtype four. There’s no consistency around the findings.

Dr. Weitz:                            Right. I just want to highlight the fact that what you’re discussing is that Blastocystis Hominis, which I still think a lot of functional medicine practitioners if they see that on a stool test are going to say you’ve got this parasite and this parasite is pathological. This is probably the cause of your symptoms. You’re saying that in a majority of cases, it’s probably not the cause of their symptoms and you may be missing another important underlying cause of their symptoms and you may be going up the wrong path focusing on eradicating the Blastocystis Hominis.

Dr. Hawrelak:                     Yes, that is definitely my viewpoint for sure.

Dr. Weitz:                            I just want to make sure that everybody understands that.

Dr. Hawrelak:                     Fair enough, yes. It’s something that for me has evolved over 20 years of practice, of dealing with patients who present with gut symptoms and Blastocystis on stool test from what I used to do, to what the research is saying, and to what I do now and the results you actually see. I generally will see something else. When we do a suite of tests and make sure we don’t stop our diagnostic procedures so early, we’ll find something else that actually explains it. You treat that something else, their symptoms go away, Blastocystis or Dientomoeba are still there. There’s that component of it, but it’s also just the fact it’s so common. I mean, Dientomoeba in Western Europe where a lot of good studies have been done, it’s found in up to seven out of 10 healthy kids have got Dientomoeba in their guts. What’s normal, what’s not normal? Kids with functional abdominal pain are less likely to have Dientomoeba in their guts than those who are actually healthy.  I still have practitioners here, integrated practitioners who wanted to use antibiotics or a suite of antibiotics to try to kill that Dientamoeba because it shows up on the stool test. Yet, the data tells us that it’s actually immensely common in kids. It’s more common in healthier guts and it’s unlikely to be a common cause of the gut symptoms when you look at the research in totality. Yes, if you’re going to be selective and not look at the broader literature, find a study going look we gave them antibiotics and the case study’s showing they improved, will quote that study rather than looking at the totality of data or looking at only one to date, randomized placebo controlled trial that looked at kids with chronic gut symptoms and had Dientamoeba present and that seemed to be the only … everything else had been essentially ruled out. They said they’ve got these kids with chronic gut pain, they’ve got Dientomoeba, let’s give them antibiotics or placebo. Let’s see the response.   Do you know what the response was? Placebo was equally effective as antibiotics for reducing these kids’ symptoms. There was no difference between them. There was no correlation between eradication in Dientomoeba and any change in symptoms. I think the really good quality data is not suggesting that particularly things like Dientomoeba when we’re talking about now is a cause in symptoms in kids and that it is immensely common in health population.

Dr. Weitz:                           In those rare cases when you have a patient with elevated levels of Blastocystis Hominis and you don’t find any other pathology, what natural treatments have you found to be the most effective?

Dr. Hawrelak:                     It’s been years since I’ve found a patient like that, Ben.

Dr. Weitz:                           Really? Okay.

Dr. Hawrelak:                     I can tell you it’s actually really rare that I don’t find something else that’s going on. The biggest challenge can be teasing out the post infectious IBS from a case of Blastocystis induced infection, gut symptoms because you’ll have a similar picture where someone will travel overseas, they’ll get traveler’s diarrhea, their gut’s never well since. You do a stool test, only thing that shows up is Blastocystis. Now, that Blastocystis could have been present in their gut for the last 10 years, 20 years, or 30 years and not be remotely relevant to what’s going on because we know that post infectious IBS happens where two things once post infectious SIBO develops, that’s pretty common. Then, you have more the colonic inflammation that persists after the infection is gone. You might have traveler’s diarrhea caused by E Coli.  It causes colonic inflammation and visceral hypersensitivity that persists for weeks, to months, to years after that infection.  There’s no more infecting agent present, you just have this residual inflammation that impacts.  Causes bloating, distension, may alter transit time a wee bit. Certainly, holds a sensation in the gut, so you feel a small amount of gas being produced. We know that’s common in literature. Yet if you do a stool test and you found Blasto in that case, you might go I want to kill the Blasto. That’s the cause, but it may not be because it may just be post infectious IBS. That’s I think the area that can be the most tricky to navigate because you’ll have normal tests come back. They may not have SIBO, but they can still have post infectious IBS and there’s no test for that. It’s based on history and their symptom pattern.

Dr. Weitz:                           Not to kick a dead horse, but one more attempt.  What if the stool test shows a really high level of Blasto? Does that raise any suspicions or not?

Dr. Hawrelak:                     I think …

Dr. Weitz:                           No.

Dr. Hawrelak:                     It would depend on the overall path from the history side.  It wouldn’t rely solely on that.  Looking at their symptom picture, looking at their history.  Let’s assume if there was someone, now it’s been years since I’ve had one of those patients that I think Blastocystis is the cause of their symptoms. Then, there are certainly some herbal preparations, et cetera, that I would use to try to help reduce levels, but you’re also focusing on trying to optimize the microbiome as well, heal up inflammation in the gut, and improve their overall vitality and health anyway.  I think for me those are always the core aspects.  What can I do to improve this person’s state of health?  What can I do to make the ecosystem a more healthy environment that’s less conducive to bringing out the bad behavior in things like Blastocystis?

                                                We know that Blastocystis likes living at a more neutral or alkaline PH. It doesn’t like living in an acidic environment in the colon or levels can be certainly reduced that way. The focus is on having a lot more fiber, using prebiotics, eating predominantly plant based whole food diet as ways of actually shifting the ecosystem in the colon, so it’s actually one more healthy, but two there’s more production of short chain fatty acids like butyrate acetate for example that then will lower the PH. That in itself can be effective in decreasing levels of Blastocystis just by changing the environment. Then, I might compliment that with some herbs. These days because of my concerns of causing collateral damage to the colonic ecosystem, I try to avoid as much as I can when I can. I’ll use agents like pomegranate husks and garlic, which we know that can be effective against Blastocystis. The best data that we really have at this juncture of time is in vitro studies or animal studies for example. Mostly, in vitro. I do use that alongside saccharomyces cerevisiae boulardii, which we know has got the positive research for eradicating Blastocystis in the human trial alongside the other agents I talked about that they’re focusing on improving the ecosystem balance in the colon. That will generally one sometimes eradicate the Blastocystis, but two certainly improve their symptoms and importantly their overall state of health and well being.

Dr. Weitz:                            Let’s go on to some of the more pathological parasites. Which ones do you see most commonly?

Dr. Hawrelak:                     I would say Giardia would definitely be top of my list. I work in an inner city environment that is a colder climate, so I don’t see Giardia as often as I once did. My first number of years in practice, I was living in the subtropics where people drank creek water and rain water for most of their … it was rural and people were often bush walking, hiking and drinking the water from creeks, et cetera. Giardia was much more common back then, so I had a lot of chance to hone my practice on Giardia treatment over the years. Now, I tend to see it more in the odd returning traveler or I see the odd person who’s got a chronic infection of Giardia that they weren’t able to get rid of with their previous course of antibiotics.

Dr. Weitz:                            What is some of your favorite natural agents for treating Giardia? Also, do you cycle your use of these?

Dr. Hawrelak:                     Generally, there’s no need. My experience with Giardia is it’s immensely responsible to the right treatments and target treatment with natural medicines. I would use raw garlic ideally and if they’re very sensitive, we might use an allicin based product, but most of my patients have tolerated raw garlic. A couple cloves pressed into either little capsules or a little glass of water and swig it down a couple times a day. There’s one study out of Egypt that showed I think a hundred percent eradication rate by day three on having essentially blended raw garlic.

Dr. Weitz:                            Wow, three days.

Dr. Hawrelak:                     That’s impressive. A hundred percent reduction of symptoms or essentially elimination of symptoms by 36 hours into the treatment protocol. That’s very quick. Garlic’s definitely on my list. These days, I would be using pomegranate husk and usually plantain, plantago major ribwort, which is one of those herbs that grows as a weed almost everywhere in North America and here in Australia.  It’s got some lovely potent anti-Giardia activity, but it actually has some healing anti-inflammatory effects on the gut as well. It doesn’t taste too bad and it doesn’t have that broad killing effect that I might get with something that was more berberine containing herbs.  Years ago when I first started practicing, I used more berberine containing herbs and it’s certainly effective for Giardia, no doubt.  I would be using coptis chinensis, which contains more berberine than goldenseal or other berberine containing herbs like Mahonia aquifolium or Berberis vulgaris a lot more. It’s undoubtedly effective, but I also know from research I did as part of my PhD that it reduces levels of bifidobacteria. It’s not such a big deal for 10 days, which is a usual treatment period for Giardia, but given I can get the same results without having to worry about any collateral damage to my bifidobacteria populations in patients if I use pomegranate husk, ribwort, and garlic, I’ll choose that.  Then, I would give saccharomyces cerevisiae boulardii again as my probiotic of choice because there’s good data on that in Giardia both for helping to eradicate, but I think this is the important aspect too. A number of people have symptoms that persist long term post Giardia. It’s because Giardia, amazing little protozoal organism that when it exits from it’s little cyst, you often get one or two little guys that come out of that, but they can cover up every single little bit of your proximal small bowel, every little millimeter of space will be covered with Giardia trophozoite. They can actually cause a lot of damage as part of that. They can cause nutritional issues in the short term in that most things you eat are going to be malabsorbed because they’re just covering that entire area, they’re going to eat those foods, you don’t get much if any. They’ll also cause a fair bit of damage to the small bowel. This can sometimes mean that there’s a bunch of symptoms that persist even after eradications.  You might kill off the Giardia with antibiotics or with herbal medicines in my case in probiotics and nutritional supplements, but they might still have some persistent diarrhea, persistent lactose intolerance, persistent fructose intolerance that comes from afterwards because when you flatten those villi and you damage the brush border, you don’t have lactates on those brush enzymes anymore. The fructose transporter is very much impacted by inflammation. If we inflame the small bowel, we really limit the capacity of that fructose transported to pull up the fructose and take it in. We can often get this secondary lactose and fructose intolerance. The saccharomyces boulardii is wonderful for helping to regrow those villi and the brush border. You might do that during, then for at least six to 12 weeks afterwards to speed up healing.

Dr. Weitz:                            Interesting. The villi are damaged by the parasite.

Dr. Hawrelak:                     Yes, by the Giardia because they’ve got this little ventral disc that sucks onto it and actually causes tissue damage, inflammation. It’s a crazy little guy.

Dr. Weitz:                            Do you have to have Giardia for a long time for that to happen?

Dr. Hawrelak:                     One would say the longer you’ve got it, the more severe the level of inflammation would be. There’s a caveat there because we know that most people will throw off Giardia in three weeks with no treatment at all. I think from memory, it’s around 90 percent of people who get Giardia, you do nothing. In three weeks, it’ll be gone in 90 percent of people. It’s going to be an uncomfortable three weeks. There’ll be lots of diarrhea, lots of bloating, lots of nausea. I don’t recommend it, but we know that the immune system can generally deal with it, except for people that have IgA insufficiencies tend to be the biggest issue where they will have it … it’s impossible for them to throw off Giardia if they don’t produce enough secretory IGA in the gut. There’s some people that it tends to be a chronic infection. Even a week to two weeks is still enough to actually cause a degree of malabsorption. Depending on how severe the infection was and how much of the small bowel was covered will dictate how much of that post infectious symptomatology we have to deal with and post infectious damage we need to heal up to get patients’ function back to a good level and absorbing food again the way that they should be.

Dr. Weitz:                            Interesting. Have you heard this concept that when trying to kill a parasite because parasites are laying eggs, that you want to use the antimicrobials for 10 days, then wait 10 days because supposedly in the presence of the antimicrobials, the eggs won’t germinate, they’ll wait until the antimicrobials are gone, then the eggs will germinate and you’ll have more Giardia or other parasite? Then, you’ll have a reinfection, so therefore there’s this thought that you treat for 10 days, you wait 10 days, and then you treat again for 10 days.

Dr. Hawrelak:                     Yes. I mean, I certainly will do that with helminth, actual bigger worms, pinworms, et cetera. I will follow that approach. I don’t with Giardia and I haven’t seen any cases where that particular approach has been problematic in that instance. I think if we’re choosing agents that are not going to cause collateral damage to the ecosystem, then I got no qualms with that approach at all to err on the safety side. I’ve never seen it necessary with Giardia. That’s by far the most common one I would be treating in practice.

Dr. Weitz:                            What’s your protocol for pinworms?

Dr. Hawrelak:                     It’s a tricky one. I’ve tried lots of different things. To be honest these days, I actually recommend the pharmaceutical ones from the pharmacy because they work. Yes, I can give you herbs that taste absolutely ghastly, garlic [inaudible 00:37:55], and essential oil put in a little bit of Vaseline around the anus at night, you can do all that for weeks at a time and will get okay results, or I can give one little dose of that chocolate, 10 days later another dose of that thing, and they’re gone. It’s far less costly. You’re often treating a whole family. I’ve trialed and error-ed lots of different things. Maybe some people have got much better results with herbs than I ever had, but we’re using megadoses of wormwood and pomegranate husks which has got anti worming activity too. Listen, it’s certainly brought worms down. Oiling up a tiny a tiny clove of garlic that’s been peeled and inserting up the anus, that helps break the cycle of bit.

                                                Same way with putting some peppermint essential oil around, a little Vaseline around the anus. The worms come out to lay their eggs and are like I don’t like that oil, so they go back in and it’ll help break the cycle. It’s labor intensive. To do herbs for a family of four for a month, that whole process, is costly. I still don’t find the results as effective as just doing the pharmaceutical twice. In this case, I’m not worried about the collateral damage to the gut ecosystem because the data to date doesn’t suggest this much in the way of collateral damage because worms are actually more related to us than they are to bacteria. The agents that are targeting those worms actually have more capacity to cause us side effects than they do kill bacteria directly. I’m not so concerned and that’s my approach now, which is not so exciting as you got to use this fantastic herb, but I just didn’t find the result with the herbs as what I’ve got with the pharmaceutical. The cost differential didn’t make it worthwhile.

Dr. Weitz:                            Speaking of worms, have you looked into helminth therapy, the therapeutic use of worms? A couple of worms that are used is the pig whipworm or the human hookworm. I’ve read some articles where they’re being used for allergies, autoimmune conditions, inflammatory gut disorders like Crohn’s and ulcerative colitis.

Dr. Hawrelak:                     I’m not super familiar with the literature around that. I’m a little bit around the uses of [inaudible 00:40:05] for celiac disease.

Dr. Weitz:                            Yes, that’s the hookworm.

Dr. Hawrelak:                     That’s right. When I looked at the results, they were very underwhelming in terms of [inaudible 00:40:18]. It was like, okay. They gave them these worms, they had a bought of severe enteritis, and they got a lot of pain from the worms. Then, it slightly diminished the degree of inflammation caused by subsequent gluten exposure. To me, that was underwhelming. Okay. Yes, you made the gluten, you got less gut damage than if you didn’t, but it still didn’t completely stop the gut damage and it didn’t completely stop the pain from ingesting the gluten. Plus, you had the pain and discomfort from ingesting the hookworm in the first place. I thought the worm results were very underwhelming for celiac disease. That doesn’t mean that they might be more useful for inflammatory bowel disease and other conditions. I’m not so familiar with the literature there, not enough to make any judgment calls on their efficacy or not.

Dr. Weitz:                            I like to ask you about one more topic about H. Pylori. H. Pylori is another infection in the gut. Often, occurs in the stomach. There’s a whole story everybody’s probably familiar with that it could be related to ulcers and we have that whole story about Doctor Marshal giving himself H. Pylori causing ulcers. Anyway, H. Pylori is another thing that comes up on stool tests a lot. We’ve learned more and more how H. Pylori’s an important part of the gut. It may not necessarily be pathological.  What’s your take on H. Pylori?  When is it pathological?  How do we know?

Dr. Hawrelak:                     That’s another great thread of questions. I think we’ll answer this question differently in five years’ time than what we can now.

Dr. Weitz:                            I mean, we do have the virulence factors that give us an idea of whether we’re reacting or not.

Dr. Hawrelak:                     That’s right, we’ve got some of them. I think that’s a step in the right direction. For me if I had H. Pylori show up on the stool test for example, I would look at the presence of the virulence factors. That’s the first thing I would do because that’s usually in that same test that might pick up the H. Pylori and tell me those things are present. I would always follow that up with doing a antibody test like a blood test or a breath test because for me I want to see, is the body reacting to that H. Pylori? Is it increasing antibodies to the H. Pylori? Is it high enough of a count that it’s actually showing up on a more conventional test rather than using these genetic markers? Those to me really tell me the data that I’m after as well as, do they have symptoms that coincide with gastritis, gastric ulcer or peptic ulcers? If they do, then I would go H. Pylori’s probably related to what’s going on there.  If I have a patient where they have it negative, no antibodies in the blood, nothing on the breath test, and a small amount in the stool that showed up on a PCR based test that didn’t show any markers of virulence, then I wouldn’t worry about its presence at all because I would be thinking it’s probably benign, it’s probably there in tiny amounts, not enough to cause any issues. Conversely if it actually showed up with antibody levels, they’ve got symptoms that are consistent with peptic ulcers or gastritis, then I would generally treat H. Pylori in that case. For me, it’s always this balance. We know that certain strains of H. Pylori can cause peptic ulcer disease, we know they can cause increased risk of stomach cancer. That is clear. There’s also some concerns about the eradication of that species. One, leaving an ecological vacuum and what will grow in there. What’s next if we take that species out? Some other microbe might start growing in there. That might be more virulent than that. Second point is there are quite benign strains of H. Pylori that might even have some healthful effects for us over time.

                                                It’s just we don’t necessarily have the technology yet and this is where I would say five or 10 years’ time where we know a good chunk of virulence factors now, but we’re still discovering new things. We might discover more, we might be able to get down to strain subtype. [inaudible 00:44:30], look at the genes of this specific strain. Beyond that, and yes. There’s a greater risk of it being a problem, let’s get rid of it. For me if I’m using natural agents that don’t have the capacity to cause widespread damage to the colon ecosystem, I’m not that worried. If I’m going let’s eat some broccoli sprouts for two weeks, have some cranberry concentrate, and take this herb, et cetera, that can be in my experience very effective at getting rid of H. Pylori. I’m not worried about treatment so much. If there’s patients taking triple or quadruple antibiotic cocktail, then we’re talking about big life … essentially, it’s life altering in the respect that colonic ecosystem that will inadvertently be smashed by that antibiotic cocktail will be permanently changed. It will never go back to the way it was before. When we’re talking about those bigger interventions, then I think we need to consider much more about the risk/benefit ratio that are different when we’re looking at using natural medicines to treat the H. Pylori. That the risk is far less, so it’s quite a different way of considering it.

Dr. Weitz:                            The natural agents you would use would be mastic gum and maybe something else?

Dr. Hawrelak:                     I would usually use a combination of things. You look at the data about natural medicine, there’ll be ones today showing a 16 percent eradication with cranberry juice. 16 percent, not fantastic, but it’s better than none. There’s one study that used the Lactobacillis reuteri DSM17938 strain. I think it had over 50 percent eradication rate just with that single strain. You combine that and I might combine broccoli sprouts, which I think at a 78 percent eradication rate from memory.  You’re going let’s add a few of these things together and nigellis sativa, so black seed again had over 60 percent eradication rate on its own. You’re doing a few of those things together. Then, I might use some herbs like green tea, rhubarb, pomegranate husks for example, turkey rhubarb, and in my experience we follow a protocol that’s for most of my patients around six weeks. It’s around a 90 percent eradication rate, which is really I would argue better than what we’re getting with antibiotics these days. At the first time they started using antibiotic cocktails like triple therapy, they were looking at 90, 95 percent eradication rate. Now, some of the recent studies are like 50, 60, 40 percent eradication rate because of antibiotic resistance.

                                                I’ve been impressed at how well a combination of herbal agents and natural supplements work versus using them just on their own, much more [inaudible 00:47:14] to get the occasional time just getting one of those things to work for a patient. My experience has been again through a fair bit of trial and error with patients, it actually makes more sense and I get the best results with doing a much more intense protocol for a six week stint. Then, do follow up testing, and go, yes. It’s gone. Generally, that combination of things works well. You get synergy between those agents.

Dr. Weitz:                            You think natural agents like oregano, berberine, and maybe some of these other antimicrobials could potentially have negative effects on the microbiome.

Dr. Hawrelak:                     I would say from both of some of the in vitro research I did as part of my PhD and from clinical work with patients doing pre and post testing, yes. That berberine I think clearly can diminish overall diversity of an ecosystem and reduce levels of bifidobacteria specifically. Some of those species may be fine with it. I’ve even seen one patient who managed to essentially result in the extinction of bifidobacteria population from taking high dose berberine for longer periods of times, so I’ve got some caution around that. Again, some plant essential oils, so oregano essential oil, thyme essential oil, clove essential oil that are potent antibacterial agents. They totally are, anti protozoal, and anti fungal agents. They’ve got a wide set of actions, but I do think they have come collateral damaging effects in the gut too. I think there can be times and places for more potent agents. I try to follow that, the naturopathic therapeutic order where we use the agents that are less likely to cause harm first. Then, we move along that order to those that have greater capacity of causing harm if the other ones don’t do the job. I’ll rarely use berberine when I’m treating Giardia these days, I’ll rarely use berberine or oregano essential oil for treating SIBO these days because I think there are other herbs that are effective that don’t have the collateral damaging effect that those herbs have.

Dr. Weitz:                            That’s interesting because I haven’t seen that sort of negative effect on a microbiome from berberine. I also treat diabetics. We very regularly use a pretty decent dosage of berberine on a regular basis. I have seen no increased gut problems coming from that.

Dr. Hawrelak:                     I wouldn’t say [inaudible 00:49:36]. Obviously, it’s got issues. Although, sometimes longer term I think that can manifest. In terms of populations of bifidobacteria, I would suggest if you haven’t yet, using the test that uses either [inaudible 00:49:48] looking at proportions of bifidobacteria or metagenomic sequencing for bifidobacteria pre and post, you might get a slightly different picture with that rather than some of the previous tests that use two plus four ways of measuring things, which are far less clear what’s going on. You may see that.

Dr. Weitz:                            We’ve been using the GI map with quantitative PCR.

Dr. Hawrelak:                     Okay.

Dr. Weitz:                            Good. Excellent. Thank you for sharing some fascinating information with us.

Dr. Hawrelak:                     You’re very welcome. I’m glad I could come back and chat to you, Ben. It was good.

Dr. Weitz:                            Good. I’m glad we could make this happen across the world even in the midst of the coronavirus pandemic. How can listeners and viewers get ahold of you and find out about some of your … I know you have a number of courses that are available?

Dr. Hawrelak:                     Yes, we’ve got one on Dientomoeba and Blastocystis because I’m trying to get that information out there about that. That change in conception that research has actually made manifest. Also, ones on Giardia too as it turns out. The microbiome, probably more broadly lactose intolerance, fructose intolerance, we’ve got a few different lecture out there on the Probiotic Advisor site. My passion is really around the gut microbiome, probiotics, and prebiotics. I’ve been in this area for 20 years when I first started my honors and my PhD research, so I love this area and I love being a clinician still so you get a chance to actually work with patients and see what works. Sometimes, what works in research doesn’t always manifest in clinical change in any beneficial way or it just doesn’t work in reality. It’s been nice to go, what does? What doesn’t? Over years of working with patients too.

Dr. Weitz:                            What’s the website for the Probiotic Advisor? That’s where they can find new courses, right?

Dr. Hawrelak:                     Yes. Www.ProbioticAdvisor.com. Then, we’ve got a teachable courses page too. I think we’ve got 12 or 13 courses up there now around microbiome and gut health more broadly.

Dr. Weitz:                            Great. Thank you so much.

Dr. Hawrelak:                     You’re welcome, Ben. Nice chatting again.

Dr. Weitz:                            Nice chatting with you too. I’ll talk to you soon.

 

 

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Preventing Cognitive Decline with Dr. Tom O’Bryan: Rational Wellness Podcast 168

Dr. Tom O’Bryan discusses Preventing Cognitive Decline with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

17:28  When a patient presents with Mild Cognitive Impairment (MCI), such as forgetting where their keys are, where they parked their car, etc.  Dr. O’Bryan explained that his website, TheDr.com is a platform that provides the roadmap that helps to make it easy to take the journey back to health.  Brain deterioration is a condition of inflammation.

22:15   While we can use questionaires to assess the level of cognitive function, the first thing to recognize is that brain deterioration is a state of brain inflammation.  Then we can run some testing to help us identify some of the triggers for this inflammation, including the Neural Zoomer Plus from Vibrant Labs that looks at 48 different antibodies in your brain.  The second test Dr. O’Bryan recommends is the Wheat Zoomer, which is the most sensitive marker for intestinal permeability.  The intestinal microbiome modulates your brain function, so having good balance in the microbiome is important for brain health. 

29:41  Dr. O’Bryan likes using the BiomeFx stool test to assess the microbiome health.  So the basics of reducing mild cognitive impairment is to heal leaky gut, create intestinal microbiome balance, and avoid environmental toxins.

 

                         



 

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

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.

 



 

Podcast Transcript

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

Today, we have a very special discussion with Dr. Tom O’Bryan, and we’re going to be talking about how we can prevent and reverse cognitive decline which as we know is a precursor to some of the degenerative brain diseases like Alzheimer’s.  Alzheimer’s disease is the most common form of dementia and we currently have close to six million Americans age 65 and older living with dementia, and 80% of these patients are age 75 or older. 1 in 10 people over the age of 65 has Alzheimer’s and dementia and almost two-thirds of those with Alzheimer’s are women. We predict by the year 2050, we’ll have 13.8 million with Alzheimer’s.  So, this is now one of the leading causes of death for seniors and a major burden on our healthcare system. And of course, the best time for intervention is prevention and during the beginning stages of when you start to see what we call mild cognitive decline. The current medical model provides very few treatment approaches that can help and not even any of that help with symptoms, never mind preventing the disease progression.

                                                Dr. Tom O’Bryan is going to be discussing with us an approach using a functional medicine model that has been pioneered by Dr. Dale Bredesen that looks at a number of underlying risk factors, triggers, and causes using a network-based approach that looks at functional and lifestyle factors, looks at metabolic parameters, everything from hormones to food sensitivities, to infections, to toxins, to sleep, to insulin sensitivities and a bunch of other factors that we can reasonably intervene on and get some improvement.  Dr. Tom O’Bryan is a doctor of chiropractic, a best-selling author, a professor for the Institute of Functional Medicine. Dr. Tom is an internationally recognized speaker focusing on gluten and other food sensitivities, environmental toxins and its development of autoimmune diseases. His 2016 book, The Autoimmune Fix, won the National Book Award and the docuseries released the same year, Betrayal: The Autoimmune Disease Solution They’re Not Telling You, has been seen by over 500,000 people worldwide.  He’s also organized the highly successful, The Gluten Summit: A Grain of Truth. His website, TheDr.com, is a very popularly visited website and his second book, You Can Fix Your Brain: One Hour a Week to the Best Memory, Productivity, and Sleep You’ve Ever Had, was released in 2018 and it’s another huge hit. Thank you so much for joining me, Dr. O’Bryan.

Dr. O’Bryan:                        Thanks, Dr. Weitz. Always a pleasure to be with you.

Dr. Weitz:                            So, before we get into the topic at hand, how are you feeling about life in the midst of the continuing coronavirus pandemic? And you can take that question whatever direction you want.

Dr. O’Bryan:                        Oh, man. It’s really difficult in this world of polar opposites that we’re in now for the last 10 years. Democrats and Republicans don’t agree on anything. They’ll fight to the death on every topic. You’re either red or you’re white. You’re black or you’re white, and not only in that race-wise but in terms of opinions. There’s-

Dr. Weitz:                            And unfortunately all these health factors like wearing a mask or whether or not hydroxychloroquine works is now political and it should just be scientific.

Dr. O’Bryan:                        A paper came out just last week, one of my mentors is Professor Yehuda Shoenfeld from Tel Aviv, Israel. And when I interviewed him for Betrayal, at that time, 28 of the PhD students who received their PhDs in immunology under him, there are many more, but at that time, 28 of them shared Departments of Immunology in med schools and hospitals around the world. This guy is the godfather.   And he just published a paper last week with nine other world famous immunologists. Six of them shared Departments of Immunology somewhere in the world. So, these are the cream of the crop in terms of experts on your immune system, cream of the crop, very best. And in the first paragraph of the paper, they say about this current viral epidemic, pandemic, is that worldwide the death rate is between 0.02% and 2% of the population depending on whether you’re an elder, do you have high blood pressure, do you have diabetes.

                                                But the top end is 2%, and that’s not what we’re hearing in the news, that the numbers are being manipulated. I’m not going to go into why. I don’t know why I have some ideas. But if somebody dies in a motorcycle accident and a family member said, “Well, they had some sniffles.” The death certificate said trauma and SARS-COV2, COVID-19, that they’re manipulating the numbers.   And if somebody gets an antibody test to see if they developed immunity for this thing, they inflate the numbers to say, “Oh, he’s got the virus.” And so, millions of people have, “Well, if you’ve got the antibodies, you’ve got immunity. That’s a good thing,” but they’re representing it as more people are sick with this thing. So, there’s a whole world of things going on and it’s really difficult to understand what to do. It’s really difficult.

                                                And my wife has been so patient with me over the last few years to understand this whole thing about news, and news broadcast because she’s from Poland. And she told me early on in our relationship, US news stations and newspapers don’t say the whole story. And I’m like, “What? You’re challenging The New York Times? Oh, my gosh, I think you’re a pretty cool lady but don’t challenge The Times,” because I read the Sunday times. Every Sunday, I have some coffee, relaxed and just update.   Now, I see because I started … First, I’d read The New York Times, then I’d read the London Telegraph. Then I’d read the French Le Monde in English and I’d see and then I’d read something from Argentina about world events and the whole world is consistent on reporting an event except in the US, that the US story was consistently different. And I was just startled.  I was born and raised in Detroit, raised my family in Chicago, I’m red, white and blue. I just was startled by this. And it was hard to hold. It was hard to accept. I mean, wait a minute … And that’s what’s going on now for people with this whole viral pandemic. It’s when you look, when you really look and say, “Wait a minute. That keeps happening again and again, because it doesn’t make sense.”

Dr. Weitz:                            I think there’s one thing that we should take from this whole pandemic is when they talk about the risk factors, I was talking to somebody and they say, “Well, it’s only people who are high risk are really a problem.” “Oh, really, just a few people?” Well, let’s see. What are the risk factors? One of them is being overweight, 70% of Americans. You got people with hypertension, people with cholesterol. You got people with fatty liver. You got people … You started listing all these chronic conditions and you think, “Wait a minute, maybe in some other country, there’s a small amount in a population.”    But this is like 80% of our population. This should be a wake-up call for us to get more healthy because if we were, we wouldn’t have to worry about having the worst outcome with situations like this.

Dr. O’Bryan:                        Well, you’re exactly right, Dr. Weitz. That’s why it’s important for people to realize that this pandemic is a lifestyle disease, meaning how we’ve lived our lives up to now determines whether or not we get sick, period. No discussion, that every single person that they looked at who has a reaction here, lifestyle, and whether they’ve got deficiencies of vitamin D which over 96% of the people or 5,700 people in New York who died in the hospital from this, 97% of them had low vitamin D levels.

Dr. Weitz:                            Absolutely.

Dr. O’Bryan:                        So in the words of Roseanne Roseannadanna, you think? You just want to check your vitamin D to make sure you’ve got adequate levels. Now, I’m not saying vitamin D cures viral infections, but I’m saying when you have low vitamin D levels, your immune system can’t work the way it’s designed to work.

Dr. Weitz:                            There was another huge study in New York City where they had two groups that both took hydroxychloroquine and azithromycin and one group also took 100 milligrams of zinc. The group that just took the hydroxychloroquine and azithromycin, they got really no benefit. The group that took the zinc in addition had a 49% reduced risk of death.

Dr. O’Bryan:                        Well, I’ll tell you why that is-

Dr. Weitz:                            And so this is the reason why some of the hydroxychloroquine studies have shown a huge benefit is because it’s the zinc transporter.

Dr. O’Bryan:                        That’s exactly right. I’ve done the research on that one. It came from India, the fever tree, the cinchona tree. They take the bark of that tree and they extract quinine from it. And quinine has been an antimalarial drug in India for a couple of hundred years. And what they found was that what the quinine does and that’s where hydroxychloroquine came from was to make a drug that copied what quinine did.  And hydroxychloroquine has been around for over 60 years, really relatively safe as drugs go. Well, what happens is the quinine, it’s called an ionophore and that’s a geek word, but it means as you said, a zinc carrier that if you have enough zinc inside your cells, the only way this virus can grow is it sheds. It’s kind of like dandruff. Viruses have dandruff inside your cells. It’s called shedding. And then that dandruff gets inside some of your DNA and then more virus grows from that.   So, the virus doesn’t reproduce, it sheds. But it only sheds inside your cell. A virus in your lung or in your bloodstream won’t shed. It won’t develop more. It has to get inside your cell to do that. Well, when you enough zinc inside your cell, it can’t shed. That’s why zinc is so important. Zinc of the bloodstream, it doesn’t help very much. It’s necessary to have adequate levels in your bloodstream, but you got to get it inside the cell.   So, to get it inside the cell, you need a carrier, and in the natural world, the most prevalent carrier, number five of all ionophores is called quercetin, which is part of vitamin C.  That’s why quercetin is good to take.  It helps to get zinc inside your cell.  So, when you’re exposed to viruses, the viruses can’t shed. There’s no dandruff.

Dr. Weitz:                            Exactly.

Dr. O’Bryan:                        … the viruses inside your cell. Well, quinine is a zinc ionophore. It carries zinc inside the cell. And in the late 1800s, it was the British who were occupying India and their soldiers were given quinine to prevent malaria but that stuff is really bitter. I mean, it is bad news taste.   And so, they took a little fruit water and added sugar to it with their quinine. That’s where the song came from just a little bit of sugar helps the medicine go down. It came from the Brits from the late 1890s. And the British soldiers and that was the formation of tonic water, which is quinine, a little bit of fruit, a little bit of water, a little bit of sugar.      The British soldiers got permission to put a spoonful of gin with it. Thus was born the gin and tonic. That’s where the gin and tonic came from. It was a medicine.

Dr. Weitz:                            Who knows what you’re going to learn when you talk to Dr. Tom O’Bryan?

Dr. O’Bryan:                        Well, I really like that kind of geek stuff. So, once I learned that, my wife and I started drinking a little bit of tonic water every day. I don’t know that it’s going to help but it sure is not going to hurt. But you just have to make sure of two things if you do this, that there’s commercial tonic waters that are chemical copies and don’t have quinine in them.   So, you have to look on the label and make sure there’s quinine. That’s the first thing. And the second thing is most of the companies add a whole lot of sugar to that bottle of bitter-tasting quinine tonic water. But there’s one–the company’s called Fever Tree, like the tree in India where quinine comes from. And they have five different tonic waters, one of them is India Light.   And so there’s an India tonic water but the India Light has, I think it’s six grams of sugar in the bottle. So, it’s not much at all. So, what we do is we do about a … They’re small bottles so we do like half a bottle and then put sparkling water in there and then a little slice of lime. And it’s a nice pleasant little afternoon drink, but I’m taking a zinc ionophore to help carry the zinc inside the cell.   It may help. It’s not going to hurt. It doesn’t cure viral infections, but it may help a little bit.

 



 

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.

Among other things, one of the great things about Pure Encapsulations is not just the quality products but the fact that they often provide a range of different dosages and sizes, which makes it easy to find the right product for the right patient, especially since we do a lot of testing and we figure out exactly what the patients need. For example, with DHEA, they offer five, 10 and 25-milligram dosages in both 60 and 180 capsules per bottle size, which is extremely convenient.

                                                Now, back to our discussion.

 



 

Dr. Weitz:                            Now, let’s get into our topic. This one got off topic, my fault. So, how would you … Now, your brain book I know was kind of a self-help book but in this discussion, I’d like you to play the role of the clinician and let’s say you have a patient who comes in your office with symptoms of mild cognitive impairment, how would you assess the patient? How would you set up your consultation and then how would you work that patient up and go about making some recommendations?

Dr. O’Bryan:                        Really good, really good question, thank you. And it’s a really tough topic and I’m going to explain why. When someone is suffering from mild cognitive impairment, which means they’re forgetting where their keys are, where did I park the car in the parking lot, things like that. They’re forgetting things that happened yesterday. “What did you have for breakfast yesterday?” “I don’t know.”  When people notice that kind of thing, it scares the hell out of people. And when we get scared, we tend to avoid the topic. That’s human nature especially in the US. We like everything to be convenient and easy. What pill can I take so that this doesn’t happen anymore? So, one of the platforms at TheDr.com, my website, is that our goal is to make it easy to do the right thing. So, what does that mean?   Well, in order to do the right thing, you have to understand what’s going on and what the goal is of every step you take, so the journey to health. When your body is not functioning the way you want it to, it’s a journey to get back to health again. And if you can take a journey to go from New York to Miami, you need a map. And so we have to teach you how to read the map of your journey to health. But people often don’t want to hear that. What they want to hear is what pill do I take that gets rid of this?

                                                So, the first thing is it’s a wake-up call. And the geek term is you have to change your paradigm. You have to be receptive to thinking a different way, obviously, and I don’t mean that in a pun but you have to think differently. So, first, reality check. The Alzheimer’s Association of America which is the number one group. They have hundreds of thousands of people. They get lots of good education programs they have and all of that.  They told us last year, one out of three elders dies with Alzheimer’s or another dementia, one out of three. We’re hearing numbers all the time. You started the show with some numbers about Alzheimer’s. People don’t know how to hold the numbers. So, here’s how you hold that number from the Alzheimer’s Association. Dr. Ben, you’re interviewing me right now, and then there’s that person listening. So, between you Dr. Ben, you the listener and me, one of the three of us will die with dementia and it sure as hell ain’t going to be me.

                                                That’s the goal here. But that’s the reality check. That’s how common this thing is now. And people don’t get it. It’s not going to happen, because everybody knows someone that had a heart attack and survived and changed their diets, started exercising, they looked better than they’ve looked at years. Most of us know someone diagnosed with cancer that went through the protocols, whatever they were, who’s in remission and they feel great.  No one knows anyone diagnosed with a brain deterioration, mild cognitive impairment that’s doing great.  It scares the hell out of us.  So, we avoid the topic. You can’t avoid this topic that you have to learn how to read the map.  And it’s a day by day journey to learn how to read the map. Critically important, or else people are going to feel a little bit better for a while but they continue to go downhill.  And as a doctor, you say, “Well, we told him what to eat and then told him what to take, and they did it most of the time.  But that really didn’t help very much.” So-

Dr. Weitz:                            How do you … Let’s say the patient comes in your office and maybe they recognize their memory is off or maybe their spouse, how do you assess what their level of cognitive impairment is?

Dr. O’Bryan:                        Yeah. Well, so you’re saying let’s get to the meat of the matter?

Dr. Weitz:                            Yeah. Do you use a questionnaire or-

Dr. O’Bryan:                        I understand. Well, the first thing to understand is-

Dr. Weitz:                            I didn’t mean to cut you off.

Dr. O’Bryan:                        It’s all right. I understand. It’s your podcast. The first thing to understand is that your brain deterioration condition is a condition of inflammation. It’s always inflammation without exception and I’ll challenge anyone to show me that it’s not inflammation because there are so many studies that show your brain is on fire. And when your brain is on fire, you’re killing off brain cells.  So, the question is, is it the frontal lobes or the occipital lobes in your brain that’s on fire? Is it gasoline or kerosene? Where is the fire coming from?  But your brain is on fire. And you say, “Well, I feel fine. I don’t have a problem going on.” You don’t feel when you lose a hundred or a thousand brain cells because you got so many.  But every time you pump gas, every time you pump gas, you fill your gas tank, if you can smell the gas, you’re smelling benzene.  And benzene goes right up to your brain, killing brain cells. It causes inflammation killing brain cells every single time you smell gas.   “Well, I have to pump gas.” I understand.  But when you put it on there, if you’re smelling gas, you’re downwind.  Walk around to the other side of the hose, now you’re upwind.  We just have to start thinking differently about this. We need a paradigm shift, and that’s really difficult for people because they want the magic fix right now.  So, what type of test do you do to identify?

Dr. Weitz:                            Do you use a questionnaire to assess cognitive function? I know there are some good online ones.

Dr. O’Bryan:                        There are some really good questionnaires and I don’t, because if someone comes to me and said, “I’ve got mild cognitive … Doc, I’m not remembering the way I used to. There’s something going on.” I don’t need to document it. I get it already. But they’re very valuable to do and you can compare them six months later. We do multiple symptom questionnaires, so we have a number of questionnaires we use specific memory questions.   I think it’s a good idea to use it, and I just don’t in my practice.

Dr. Weitz:                            And then how do you conduct your consultation to get an idea of what some of the underlying triggers might be for this particular person?

Dr. O’Bryan:                        We have to read the map. So, in order to read the map, you have to have a map. So, to have a map, you have to do some testing to identify where is this coming from? What are the triggers setting it off? So, the number one test … There are two tests we do on every single person, two tests that come in with these complaints. The first one is called the Neural Zoomer Plus.  The Neural Zoomer Plus is a blood test that looks at 48 different antibodies in your brain. If you have elevated antibodies, you’re killing off brain cells. And so, it’s the most comprehensive test I’ve ever seen on this. And we use this at the beginning to see how many different tissues are on fire right now, how many are there?

And the second test is the Wheat Zoomer.  And we do the Wheat Zoomer for two reasons. The first is that it’s the most sensitive marker for intestinal permeability or leaky gut. And when you read the science out there, inflammatory diseases whether it’s brain inflammation diseases, kidney inflammation diseases, skin inflammation diseases; inflammatory chronic, inflammatory diseases, there are five factors required or five pillars as Professor Fasano talks about, the five pillars in a development of chronic inflammatory disease.

                                                The first one is you’ve got the gene that says you’re vulnerable to that. It doesn’t mean you’re going to get it. It just means you’ve got the vulnerability. The second one is an environmental trigger that sets it off. And that can be benzene you’re breathing when you pump gas, or wheat if you have a sensitivity to wheat. The third one is the environmental trigger alters your microbiome, the intestinal microbiome which the geek word is modulates your brain function.   Now, what does that mean? It means it had its hands on the steering wheel, that the bacteria in your gut have their hands on the steering wheel of how your brain functions. For every one message from the brain going down telling the gut what to do, there are nine messages in the gut going up telling the brain what to do. So, when your gut is out of balance, the term is dysbiosis. But when your gut is out of balance, you’re sending the wrong messages to your brain.   So, just imagine you’re driving down the road, if the bacteria has got its hands on the steering wheel of your brain function and you just turn the steering wheel 10 degrees to the right, a hundred yards down the road, you’re off the road. And in your brain that means the hormones that your brain makes called neurotransmitters that they’re way out of balance when your gut is out of balance. And that sets up brain dysfunction. So, that’s the third one, is the microbiome in the gut.   The fourth pillar is intestinal permeability or leaky gut. And when you come back positive for leaky gut, you’ve got leaky brain and we’ll talk about that in a minute. And the fifth one is chronic inflammatory immune response. Whether it’s going into your brain or into your kidneys or your joints or your skin or your heart, but this chronic inflammation is determined by your genes where it’s going to manifest.

                                                So, there are five different parts to this, but the ones that we got complete control over without exception, we’ve got our hands on the steering wheel ourselves is the environment that you expose yourself to, what’s on the end of your fork is the most common environmental trigger, changing the microbiome to a healthier more balanced microbiome, and focusing on healing intestinal permeability. And those three, you’ve got complete control over.  So the baseline, the very baseline of dealing with mild cognitive decline is those three, what’s on the end of your fork, what foods are you sensitive to, what’s your microbiome like, let’s rebuild the healthier microbiome which helps to heal the inflamed gut causing the leaky gut or intestinal permeability. That’s the key, those three.

Dr. Weitz:                            So, how are you going to assess the microbiome?

Dr. O’Bryan:                        There’s a number of gut tests, stool tests that you can do that look at the microbiome. Currently, we’re working with one called BiomeFX that I’m seeing as the most sophisticated one out there right now. But there’s a number of good ones that different doctors will use. And some focus on one piece of information, some focus on others.

Dr. Weitz:                            The BiomeFX is the one that Microbiome Labs is involved with, right?

Dr. O’Bryan:                        That’s correct.

Dr. Weitz:                            Yeah. We just had Kiran Krishnan on our monthly meeting, talking through Zoom. And he was talking about the microbiome and gave us some information about that full molecular analysis stool test.

Dr. O’Bryan:                        Right. It’s a great test. I’m really impressed by it. But that’s the three. That’s the three things that everybody has control over. Now, you don’t fix them in a day. You have to first be able to read the map and then start heading in the direction from New York to Miami. You have to be on the right road to eventually get to health, to better health.

Dr. Weitz:                            What are some of the things that you might see on that Neural Zoomer panel?

Dr. O’Bryan:                        Oh, man, we’ve never had one come back negative yet. Of all the ones we do, every … And I tell people. I tell them this when they first come. And I say, “Mrs. Patient, my favorite patients are the ones that have been to Mayo Clinic and they’re told that they don’t know what’s wrong.” I said, “That’s great. That’s really great.” And they looked at me like I’m a little weird which I am.  But I say, “That means that you don’t have a disease because if you had a disease, Mayo Clinic would find it. You’ve got dysfunction. Something is not functioning right, so the tests we’re going to do are going to look at functional problems, not disease markers.” And they’d say, “Oh, okay. That kind of made sense.”    Then they come back in the next visit, everybody is nervous with test results. They always are. And I look at the test results and I say, “Well, this is really good news. You’re a mess. Look at all these problems on here. These are great because this one will take two months to fix. This one might be six months. This one, somewhere of six months to a year. But every single one of these markers can be turned around and we’ll show you how to turn them around. But this is what we have to focus on, is get the inflammation down in your brain.” So, what’s it going to take? Whatever it takes to get the inflammation down.

                                                I’ll give you an example. The number one type of Alzheimer’s, you mentioned Dr. Bredesen, the real pioneer here. And Dale says that of the five types of Alzheimer’s, the number one most common type is inhalation Alzheimer’s. It’s what you’re breathing that goes right up to your brain. That’s the gasoline on the fire causing the inflammation, killing off brain cells.   And you learn that indoor air pollution is much worse than outdoor air pollution. Molds are huge problem in our country today, huge. “Well, there’s just a little bit of mold on the shower curtain. It’s not too bad.” Yes, it is. If you see it, it’s way too much. It’s way too much, right?   And NASA came out with a study and they showed these common houseplants. You put two six-inch houseplants in every room and you suck up formaldehyde, trichloroethylenes, molds, spores by depending on the chemical for anywhere from 42% to 76% of what’s in the air. The plants suck it in, take it down into the roots of the plant. The microbiome in the dirt converts that stuff, breaks it down and then the plant produces more oxygen in the air.   So, it’s really simple things. You get houseplants in every room. “Well, I don’t have a green thumb.” So if they die, you buy more. You don’t have to have a green thumb, and you’ll learn how often to water them and when not to water them. But the idea is-

Dr. Weitz:                            What about air purifier or plants that are-

Dr. O’Bryan:                        Exactly, much better if you can’t afford an air purifier or in addition to an air purifier, houseplants in every room. And people don’t know that your air … If you can see the sunshine coming through the window, sometimes the rays of the sun and you see kind of the dust in the air, you’re sucking all that stuff in all day every day. And what’s in that dust? Formaldehydes from pressboard, cabinets like your kitchen cabinets or your bathroom cabinets. They outgas formaldehyde into the air. You just can’t smell it.

                                                Scotchgard on your sofas outgases into you and this stuff causes cancer. These chemicals cause cancer. Now, there is no evidence that the amount of Scotchgard that reaches out into the air is toxic to humans. And that’s true, there is no evidence because it’s a minor amount. But this stuff accumulates in the body over years and years and years. Now, you got a problem. And that’s how the chemical industry got away with this crap, excuse me, but they had the legislation passed that you have to prove the amount of toxic stuff in the air is dangerous to humans. It’s not.

Dr. Weitz:                            Yeah, it turns out they actually stopped regulating PFOS and PFO recently. They said, “No, we’re not going to regulate it.”

Dr. O’Bryan:                        Yeah. And when Trump came to the office, I’m not getting political here, but in his first month in office, he removed the regulations for filters on coal burning power plants to filter the mercury, so that mercury doesn’t spew into the air. For the last seven years, there’s been a whole lot more mercury spewing into the air because of our government regulations or lack of regulations.

Dr. Weitz:                            Actually when they remove the controls on the PFOS, it was right after two scientists from his own organization published some studies showing that these chemicals and these are like the chemicals that are found in Scotchgard and Teflon pans and stuff that they’re actually way more toxic at much lower levels. And we’ve already got reports that they’re in the drinking water throughout most of the country including in California.

Dr. O’Bryan:                        Right. See, that’s why all these stuff is overwhelming.

Dr. Weitz:                            And all these chemicals build up in the body like you’re saying.

Dr. O’Bryan:                        Exactly. That’s the danger, is the accumulative aspect. That’s why part of the roadmap to better brain health is teaching people how important it is to detox and that we have to be thinking a little bit every day about helping our detoxification pathways, break down these chemicals we’re exposed to.

Dr. Weitz:                            How do we detox? That word is thrown around a lot.

Dr. O’Bryan:                        Yeah. The first and most important thing is the highway of detox needs to be open and clear. If you’ve got a four-lane highway that’s narrowed down to one lane, everything backs up. You back your car into a snow bank, the exhaust pipe is full of snow, the exhaust comes back into the engine. What does all that mean? You have to drink a half ounce of water per pound body weight.  A half ounce per pound body weight. You just have to have the highway available to flush this stuff out.  “Oh, my god. Well, let’s see, I weigh 140 pounds, that’s 70 ounces. So that’s a half a gallon of water. Oh, my god. I’ll be peeing all day.” That’s the idea. You got to get this stuff out of you. I mean if your brain is on fire, where are the triggers coming from? And there are many, many triggers. And once again, it’s an overwhelming thing to deal with. That’s why you have to understand the paradigm, I’m learning how to read the map to get to Miami.

Dr. Weitz:                            What else can we do to promote detox of chemicals?

Dr. O’Bryan:                        Number one most important is be well-hydrated with the purest water that you can get your hands on.

Dr. Weitz:                            Is there a particular type of water you like?

Dr. O’Bryan:                        Yeah, tap water through a really good filtration system.

Dr. Weitz:                            Okay.

Dr. O’Bryan:                        Yeah. That’s the only time you’re safe. If you can afford it, to spend 400 to a thousand dollars and get a really good water filter … The best one would be a couple of thousand dollars for the water coming into the house [crosstalk 00:38:36] to the kitchen sink because you brush your teeth in the bathroom. You take a shower and you get water in your mouth in the shower. So, having a whole house water filtration system is the best.  But if you can’t afford that, whatever you can afford is better than nothing. Even if it’s just a little countertop Brita that you put the tap water into and it goes through a little filter in the top and it drips down into the container. That’s better than nothing.

Dr. Weitz:                            You can get one of those systems that goes onto the sink that does reverse osmosis and a bunch of filters. And there’s a number of companies that will actually do it for a monthly rental fee. You pay 30, 40 bucks a month or something like that.

Dr. O’Bryan:                        So, that’s the important component on the map of getting to Miami, of getting to better brain function. You have to understand you’ve got lots of cities to drive through, lots of states to drive through to get from New York to Miami.   So, with detox, what else is critically important after water, the next in my opinion most important thing is what’s on the end of your fork. That is the most common trigger, fueling inflammation in the body. And so, the first concept is always get organic whenever you can. And when you go shopping at your local supermarket and they don’t have organic potatoes or sweet potatoes, you ask for the produce manager. There’s always some guy putting out more fruit or something. And say, “Hi, is the produce manager in?” “Yeah.” “Could you get him please?”

                                                And the guy comes out and he’s really happy, he’s the produce manager. Say, “Hi. I’m wondering how come you guys don’t have organic sweet potatoes?” “Oh, well, there’s really not … We just … There’s not that much to manage.” “Oh, my friends and I, we know how important organic is and if you carry organic, we’ll buy it. I promise.”   And then he walks away, “Oh, okay.” he walks away and he might blow you off. But what if 20 people a week do that? It won’t take long before he goes to the store manager and says, “I’m having people every day asking for more organic produce.” That’s the only way you’re going to get a change in the supermarket, is that everybody takes five minutes and ask for the produce manager and does your own due diligence to tell them you want organic carrots. You want organic apples.

                                                And you tell him and a hundred people a month do that, you think they’re not going to get organic? Of course, they’ll get it. They’ll start with a little bit and you say, “Oh, it’s there.” And you ask for the produce manager again six months later and say, “Hey, I see you got some organic rhubarb here. That’s really great. Thanks so much. Now, what about avocados?” And then they’ll have regular avocados and the organic ones that are a little bit more usually. And you just start building it up.

                                                But anyway, when you go shopping, always think of the rainbow diet. Most important concept in your food selection is the rainbow diet. The deeper the colors of the rainbow, the more polyphenols and antioxidants in the fruits and vegetables – blueberries, purple cabbage, red tomatoes, green broccoli, chard. The list goes on and on.   But you think of the colors of the rainbow, critically important. Because the more of the polyphenols you get in your diet every day, every meal, even breakfast, every meal … The more polyphenols you get, the more you support your detoxification pathways so that your liver is better at breaking down the chemicals you’re exposed to. Your lungs are better at breaking down the chemicals you’re exposed to. Your microbiome is better at breaking down the chemicals you’re exposed to.

                                                So, of course you want to reduce exposures of the bad stuff but you can’t in our world today. So you want to enhance your detoxification pathways. One is water, two is food. It’s critically important. And then your doctors can check you for compromised detox pathways and there are some geek terms like methylation, others that you may need more extra support and certain vitamins to help. But your doctor can find that out for you.

                                                But the simple things, you can do it every day and it should be just your new paradigm, is always a rainbow diet and always hydrating really well. You want to be at the point just from those two things, just from that where you wake up in the morning and your spouse wakes up. And you say, “Honey, I just had the best bowel movement I’ve had in three weeks. Holy cow, I feel great.” We think that intimacy and sex is great, but I’ll tell you what man, good bowel movements, you’re a happy man.  And we don’t talk about that stuff, but those functional abilities are critically important to get your brain working better because the ratio is nine to one. The message is coming from your gut nine times more of them going up to your brain. You want a gut that’s working really well.

Dr. Weitz:                            And most of the toxins are being put into the stool and pooped out. So, that’s a major route for detoxification.

Dr. O’Bryan:                        Right. And I could talk about vitamins and take this one or take that one. And those are valuable. Those are really valuable. But if you don’t do the basics, if you don’t learn how to read the math, you can temporarily feel a little better because you’re taking vitamin and caffeine. You’re taking things that jack up your brain to work better, so it’s going to work better for a little while but you keep throwing gasoline on the fire, what do you think is going to happen?

Dr. Weitz:                            So, you’re saying even if you use a specialized detox program, take a detox powder, certain capsules, glutathione, binders, things like that, all those things need to be added on top of having a healthy diet, drinking a lot of water, getting sleep. You’ve got to have those fundamentals first before those specialized detox protocols are going to be beneficial.

Dr. O’Bryan:                        That’s exactly right. When you get out of New York, you need to get … You have to go through the city of New York to get on the highway to get down to Florida. And now, it’s a straight shot on the highway once you’re there. But you’ve got to do all those maneuvering to get on the highway. And the maneuvering … What people have to understand, and people don’t like to hear this. But what they need to understand is that if you have cognitive decline, if you’re forgetting things, if your memory is not working very well, what you’re doing, the way you’re living your life ain’t working. If you’re lucky, you’re going to be one out of the three, you’re at risk of that. So, what you’re doing ain’t working, period.  And you have to understand first because if you keep doing those same lifestyle, you got mold in your house but now you’re going to take some smoothie combination and put this brain powder in there and with 18 different ingredients for your brain and you take the smoothie and your brain is working really good and you’re fired up for a while but you’re still sucking the mold air into your brain, killing off your brain cells, what do you think is going to happen?

                                                It’s like we have to change our paradigm first. I never talk to people about a bunch of supplements to start with ever because you have to change the way … You have to realize the way you’ve been living your life has created the problems you got right now.   So, the definition of crazy is doing the same thing and expecting different results. “So, I’m going to do the same thing but now I’m going to take some brain powder with my smoothie. Oh, I feel better. My brain is working better,” for a short period of time but your lifestyle is the same. You’re breathing the same air. You’re eating the same foods that you’re sensitive to. “Well, I don’t get gut pain when I eat wheat. I don’t have a problem with wheat.” Really? Just do the Wheat Zoomer test and find out.

Dr. Weitz:                            Should everybody stop eating wheat?

Dr. O’Bryan:                        Say it again.

Dr. Weitz:                            Should everybody stop eating wheat?

Dr. O’Bryan:                        I never say that, ever. I’ve never ever said that. But I’m misinterpreted that way because what I do say is that if your immune system is fighting wheat, you can’t eat wheat, period. So, you just have to have an accurate test to see, is my body fighting wheat right now? Because the ratio is eight to one, for every one person that get gut complaints from eating wheat, eight people don’t have gut complaints. They’ve got brain complaints or joint complaints or skin complaints. They don’t have gut complaints.

                                                So, you think I eat wheat, I feel fine, it doesn’t matter how you feel if your brain is fried because it may be your genetics the wheat is causing gasoline on the fire in your brain. So, what I always say, if you’re not happy with your current health and how your body is functioning, do the test to see, does my immune system say I have a problem with wheat? If it says yes, you do, you don’t eat wheat anymore, period. So that’s what I always say.

Dr. Weitz:                            Right. What about just doing an elimination diet and taking wheat out and see if you feel better?

Dr. O’Bryan:                        The concept of … I have to plug my power in here on my phone, there we go … The concept of an elimination diet, the danger of that, it’s a good concept but the danger of that is that you’re looking for how you feel to determine whether or not wheat is a problem. And quite honestly, most people that eliminate wheat, they feel better pretty quickly. But some don’t or they feel better, and if they have a little wheat once in a while, they’d still feel fine. They can’t tell.

                                                So, by the time you’ve got symptoms, it’s the end stage of that organ or that tissue and its ability to function normally. You can’t function normally anymore? You got symptoms. So, there’s a long degenerative process that goes on before you ever have a symptom. That’s the whole world of predictive autoimmunity. That’s what my book The Autoimmune Fix is about.

                                                So, it’s a good idea to do an elimination diet but it’s not comprehensive. Let me see if I can come up with the analogy for that. It’s kind of like saying if you’re driving on the highway through the city and everything is fine, you’re just driving along, everything is fine. You may not know there’s a riot going on four blocks over and there’s lots of chaos and lots of police and maybe the National Guard has been called out. But you’re on the highway and everything is fine.   So, you eat a little wheat once in a while and you can’t tell your brain is on fire. You can’t tell. Sometimes you can, but most of the time you can’t.

Dr. Weitz:                            Your immune system could be reacting to wheat. You could be having some clinical inflammatory reaction that hasn’t created symptoms yet and it could be a period of time before symptoms occur and by then you may be risking organ damage, so better to know early.

Dr. O’Bryan:                        That’s exactly right. You say it much clearer. And there’s only one test, though there are two tests that are really good tests now compared to the ones that almost every doctor does. The ones that most doctors do, the tests have been around for 25, 30 years and they’re good tests but they’re not comprehensive. Then in 2010, a laboratory opened up called Cyrex Labs and they looked at 10 different components of wheat instead of just one. So that’s better. But then a lab opened in 2015 called Vibrant Wellness that looks at 26 different components of wheat, and not just one. Most doctors look at one or maybe two components.

                                                So, if you test for that one component, gluten, and it comes back negative, your doctor says, “Oh, wheat is fine for you. See, the test is negative.” But you may not be reacting to gluten, you may be reacting to what’s called the wheat amylase trypsin inhibitors, that’s in wheat, and that’s causing your brain inflammation or that’s causing the thrombosis, the clots that you’re forming in your blood stream. And wheat does that a lot and you don’t feel any of that. So, you have to test comprehensively. So, those two labs are the only labs that are in the ballpark of being comprehensive.

Dr. Weitz:                            Great. So, I think we have to wrap because I have a patient coming up. As usual, it’s always fun to talk to you.

Dr. O’Bryan:                        I’d like to say one more thing if I may.

Dr. Weitz:                            Oh, yeah, absolutely. I was going to give you an opportunity to give some final thoughts.

Dr. O’Bryan:                        The subtitle of this book, You Can Fix Your Brain, the subtitle is Just 1 Hour a Week to the Best Memory, Productivity, and Sleep You’ve Ever Had. And it’s not a cutesy subtitle. It’s the only way to be successful with mild cognitive impairment, is that you don’t think you’re going to do it all immediately today. You just allocate a little bit of time if you have impairment every day one hour a day or one hour every two days, every Tuesday night after dinner or every Tuesday and Thursday or every night after dinner, I’m going to spend one hour. And I’m just going to review a little bit more.

                                                So, what’s the name of those plants that I need to buy? You go back to the book and you write down the name of the plants or you write down the URLs to look for glass storage containers to get rid of the Tupperware. The only thing Tupperware should be used for is out in the garage for your husband to store nails or for your kids to store crayons, but not around food. But you have to order glass storage containers, that’s going to take an hour, you’re done for the day. But you do this regularly, consistently.  And that’s how you start to change your lifestyle, is a little bit every day, a little bit every week, depending on how severe your symptoms are. In the book, I said one hour a week. But if you’ve got mild cognitive impairments, one hour a day.

Dr. Weitz:                            Yeah, absolutely. We all need to take steps to get as healthy as possible and mild cognitive impairment is one of the more important conditions that we want to do all these things, optimize our lifestyle and once again using a functional medicine approach. This is something that could be prevented and reversed. And just relying on the blockbuster drug that’s going to fix that is not the way to go. And that drug doesn’t exist with this condition anyway.

Dr. O’Bryan:                        Well, you know I know of two, there may be more, pharmaceutical companies that closed down their Alzheimer’s research departments. They closed them down and laid off the scientist after spending literally billions of dollars over the years trying to find the drug because they now know there is no drug and Dr. Bredesen taught us there’s 36 different things that have to be looked at and fixed. It’s a step by step progression. You have to fix this, fix this, fix this, and fix this.   That means there’s a map. To get from here to there, there’s a map and you have to learn how to read the map, which is every step along the way. That’s where the one hour a day or one hour a week comes into play. Be patient, be consistent and you will make it to Miami.

Dr. Weitz:                            Excellent. On that thought, we’ll bid adieu and listeners can find out more about you through TheDr.com website, correct?

Dr. O’Bryan:                        Yes. That’s TheDr.com. Don’t spell the word “doctor” out, TheDr.com.

Dr. Weitz:                            Okay, excellent. Thank you Dr. O’Bryan.

Dr. O’Bryan:                        Thank you, Dr. Weitz.

 

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Lyme Disease with Dr. Darin Ingels: Rational Wellness Podcast 167

Dr. Darin Ingels discusses Lyme Disease with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

6:35  Dr. Darin Ingels contracted Lyme Disease, so he learned first hand about the condition and it took him three years to get his life back.  Lyme is a bacterial infection caused by the Borrelia species with Borrelia burgdorferi being one of the more dominant species and it’s transmitted primarily through the bite of a deer tick.

8:20  In the early 70s there was a mysterious group of cases of Rheumatoid Arthritis in children in Lyme, Connecticut. They thought that it was a Rickettsial infection, which is a different type of infection, so they started sending samples to a doctor named Wille Burgdorfer, who was a Rickettsia expert who worked for the government in Colorado. It took him about 6 or 7 years to isolate that this was not Rickettsia, but an infection caused by a spirochete, which was named Borrelia Burgdorferi, after Willie Burgdorfer.  There are at least five different subspecies of Borrelia burgdorferi and at least 100 different strains of Borrelia in the U.S. alone, and more than 300 strains worldwide.  However if we run a Lyme test through a conventional lab like LabCorp or Quest, they are only looking for one species, one strain, Borrelia burgdorferi, so if your patient happened to be exposed to a different strain, there is a high probability it will miss it on that test.

9:47  Some doctors mistakenly think that Lyme Disease only exists in New England, buy Lyme does exist in Southern California as well as in Northern California and California is the 5th fast growing state for the number of Lyme cases in the US. In Southern California we do have hills, mountains, trees, and we have areas where ticks live. In fact, Lyme disease has been reported in all 50 states, including Alaska and Hawaii and there’s more than 300,000 new cases of Lyme disease each year in the U.S. And Lyme is the number one spreading vector-borne epidemic worldwide. Here is a picture of the Ioxodes tick that causes Lyme disease:

                              

13:00  Lyme is a spirochete, which has a corkscrew shape, so it can penetrate other tissues and cells a bit different than other bacteria, and this results in many different kinds of symptoms.  In fact, there are over 100 different symptoms, so Lyme is known as the great imitator, since it resembles so many other diseases.  Borrelia is a shape shifter, since it can ball itself up like a slinky called a cyst form and there is a cell wall deficient form which looks like a long, straight line. Borrelia’s ability to shape shift allows it to evade the immune system.

14:12  Another interesting thing about Borrelia is that it has a very slow replication cycle. Most bacteria replicate every 10-20 minutes and Borrelia replicates every one to 16 days, which is one reason why Lyme often requires many months of treatment.

15:40  Most of us are unlikely to see patients with acute Lyme disease since this is when the patient is first bitten with the tick and 20-40% end up with a bulls eye rash and Dr. Ingels noted that in California he hardly ever sees a bulls eye rash.  Symptoms can occur anywhere within 3 to 30 days following the tick bite, though many patients have no recollection of being bit by a tick.  Symptoms of acute Lyme include headaches, neck pain, fever, swollen joints or spine pain, fatigue, heart palpitations, and others.

19:37  Chronic or persistent Lyme disease occurs after the acute infection, though the CDC refuses to acknowledge that chronic Lyme exists, even though there’s multiple studies out of Johns Hopkins University showing otherwise, and millions of patients living with chronic Lyme.  Symptoms of chronic Lyme include fatigue, GO symptoms, memory loss, cognitive impairment, neuropathy tends to get worse and spread, burning sensations, feeling of creepy crawlies under the skin, wandering joint pain, light and sound sensitivity, dizziness, vertigo, sleep problems, Lyme carditis, (which can cause mitral-valve prolapse, heart block, heart palpitations, chest pain), balance, coordination problems, newly acquired dyslexia due to a type of brain inflammation, and endocrine disruptions (including hypothyroid, adrenal issues, and menstrual problems).

22:02  Lyme is the great imitator, so it may resemble autism, multiple sclerosis, ALS, chronic fatigue, fibromyalgia, mono, herpes 6, parvovirus, RA, lupus, and pretty much any autoimmune disease.  So if you have been diagnosed with any of the above, you should consider if Lyme could be an underlying root cause.  An autoimmune disease that is triggered by Lyme often looks different and CRP, rheumatoid factor, and ANA may all be normal, whereas we would expect them to be elevated. Some of these patients when they get tested, they will show evidence of Lyme and then you treat them and they get better.

24:07  While we are focusing on Lyme, there are a quite a number of other tick borne infections, including Babesia, which is a blood parasite and a cousin of malaria, Bartonella (aka cat scratch fever), Anaplasma, Ehrlichia, Mycoplasma, Rickettsia, Rocky Mountain spotted fever, Powassan virus, Colorado tick fever, Heartland virus, Tularemia, and Brucella.

25:16  The reason there is a rise in Lyme is because of climate change, which is also leading to an increase in other insect-borne illnesses, including Dengue virus, Zika virus, and Chikungunya virus.  The World Health Organization published a paper and here is a similar paper with the same conclusion: “Ticking Bomb”: The Impact of Climate Change on the Incidence of Lyme Disease.

26:37  The diagnosis of Lyme disease is complicated. The CDC criteria is that you run an elisa antibody test for IgG and IgM antibodies and if it’s positive, then you should run a western blot, also looking at IgG and IgM antibodies. For a test to be positive, you have to have 5 out of 10 IgG bands or 2 out of 3 IgM bands. But sometimes Lyme patients don’t produce antibodies or don’t make an adequate response and for those that do, over time, immunity tends to wane, so it depends upon then their exposure was.  There is no test that measures Borrelia directly in the body. Dr. Ingels prefers to use Medical Diagnostic Labs, because they do very comprehensive tick-borne testing and they bill insurance. IGeneX up in Palo Alto, California is also a great lab, its very expensive and outside of Medicare they don’t bill insurance. Dr. Richard Horowitz has developed a questionaire for Lyme called the MSIDS, Multiple Systemic Infectious Disease Syndrome questionaire: MSIDS.

32:42  Treatment for Lyme should start with diet and Dr. Ingels prefers to have patients follow a nutrient dense, alkaline diet.  Darin points out that with the exception of the skin, the stomach, the bladder, and for women, the vaginal area, which are very acidic, to protect against outside invaders, by and large, the rest of your body is mostly alkaline.  The enzyme systems work best and cell repair work best in an alkaline state. It’s not about the pH of the food, but how the food breaks down in your body. This has nothing to do with blood pH.  Urine pH should be above 7.2  Dr. Ingels breaks down his dietary recommendations into three categories:

1. Foods that can be consumed as often as possible, including vegetables, avocados, citrus fruits, sweet potatoes, some nuts and seeds (almonds, brazil nuts, coconut, flax seeds, pumpkin seeds, sesame, chia, sunflower seeds), some grains, legumes, some oils (avocado, olive, coconut, flax, safflower), and some beverages. 

2. Foods that should be restricted to 20-25% of the dietary intake, including some fruits, some nuts (pecans, hazelnuts) some grains (rice, oats, organic soy, rye, hemp), animal proteins like meat, eggs, fish, and some oils (sunflower, grapeseed). 

3. Foods that you should avoid, like dairy, dried fruits, certain nuts (macadamia, peanuts, pistachios), junk food, artificial foods, processed foods, sugar, condiments (honey, jelly, mustard, soy sauce, vinegar), oils (corn, cottonseed, soybean, vegetable, hydrogenated fats), and beverages like coffee, which is very acidic, alcohol, black tea, and fruit juice.  Then you need to get your gut healthy, which can be adversely affected by the long term used of antibiotics. 

39:14  After getting the diet and the gut in order, the next step is targeting the Lyme and the coinfections.  Antibiotics can be very effective following an acute infection, but the longer you are away from the initial exposure, the odds of antibiotics being effective go down. Antibiotics can disrupt your microbiome and can damage your mitochondria and Dr. Ingels has seen patients that come to see him who have been on antibiotics for many years. Dr. Ingels prefers using herbal protocols, which tend to be more effective than antibiotics, can kill Lyme in multiple forms, and they don’t damage your microbiome, are anti-inflammatory, and can also boost your immune system.  The first botanical protocol that Darin likes is the Cowden Protocol, developed by Dr. Lee Cowden, a cardiologist.  Here are some of the botanicals that may be included in the 5 to 9 month protocol that involves changing the herbs each month, that are designed to kill the microbes, support detoxification, and clear heavy metals:

  • Amantilla
  • Banderol-microbial defense
  • Burbur-detox
  • Cumanda
  • Enula
  • Magnesium Malate
  • Mora
  • Parsley-detox
  • Pinella-brain/nerve cleanse
  • Samento-microbial defense
  • Sealantro-metal detox
  • Serrapeptase
  • Sparga-sulphur detox

These herbs are liquid extracts and can be used easily in kids and you can easily titrate the dosages.  The herbs that Dr. Ingels uses most often are Samento, Banderol, and Cumanda and he will recommend 15-30 drops in 1 oz of water twice per day for at least 6 weeks. If the patient has a herxheimer reaction, he may add Burbur.  He may have patients start with 2-4 drops in 1 oz of water twice per day and slowly increase dosage by 1 drop every 3-4 days till they get up to 30 drops per day.  If a patient has a herx reaction, then leave the dosage the same. For severe herxheimer reactions you can give 10 drops of Burbur every 10 minutes. 

45:51  Zhang herbal protocol.  The clinical protocol that Dr. Ingels took to help himself when he was suffering with Lyme disease after being on antibiotics for 9 months that were not helping and he has found to be the most effective for his patients with Lyme is the herbal protocol that was developed by Dr. Qincao Zhang, LAc and it includes the following herbs:

1. Artemisiae
2. Houttuynia (HH Caps)
3. Circulation P
4. Coptis
5. Cordyceps
6. Pueraria
7. R-5081
8. AI-M
9. Allicin

The downside to this protocol is that it is fairly expensive, since some patients are on at 5-6 products and this involves taking 15-20 capsules.  The patient cost is at least $500 per month with Dr. Zhang’s herbs.  Dr. Zhang’s protocol helps eradicate the infections, improves circulation, reduces inflammation and improves detoxification. It is one of the most comprehensive herbal protocols to address each aspect of Lyme Disease.  Dr. Ingels pointed out that he tends to use Coptis for acute Lyme but not as much for chronic Lyme because it contains berberine, which might potentially disrupt the microbiome during long term usage.

49:56  There are other herbal protocols, like Byron White’s. His formulas are based on what you know your patient has. If your patient has Lyme, you use AL-Complex.  If your patient has babesia they get A-Bab and if they have Bartonella they get A-Bart, etc..  These herbs are extremely strong and herxing reactions are very common.  These are tinctures, so you should start with a low dosage, say 1 drop and slowly increase. Stephen Buhner is a well known herbalist who has a very good protocol for Lyme that includes Japanese knotwood, Cat’s Claw, Andrographis, Wireweed, and Yellow Dye Root.

53:30  Breaking down biofilms is another important aspect of treating Lyme.  There are specific enzymes that can help to break down biofilms, including serrapeptase, nattokinase, and lumbrokinase.   Interface Plus is a product from Klaire Labs that has EDTA and serrapeptase in it that works pretty well. Coconut oil contains monolaurin, which can break up biofilms. N-Acetyl Cysteine is an amino acid that breaks up mucus and has been shown to break up biofilms. Long term use of NAC can deplete zinc and copper, so you should also supplement with these.

56:12  Low Dose Immunotherapy can also be helpful for patients with chronic Lyme disease. It was developed by Dr. Ty Vincent and it helps to down-regulate the TH2 dominant immune response.  It’s based on the concept of molecular mimicry. The goal is to promote tolerance to the offending antigen, using homeopathic doses of nosodes.   The antigen we select is really depending on what we think is triggering the symptoms. If we think Lyme is the trigger, that’s what we use. If you’ve got someone, based on stool testing or organic acid testing, if it’s an overgrowth of candida or yeast, maybe you want to do the candida antigen. Maybe you want to do the strep antigen. We probably have about 40 different antigens we use right now, and I know Dr. Vincent keeps expanding that in experiments with different things, and every year it grows a little bit, based on what he and other doctors around the world have been finding.  This is given as a sublingual administration every seven to eight weeks, depending on patient response.

                            

                                                         



 

Dr. Darin Ingels is a Naturopathic Doctor licensed in both the state of California and the state of Connecticut. His practice in Irvine, California, focuses on environmental medicine with an emphasis on Lyme disease, Pediatric Acute-onset Neuropsychiatric Syndrome (PANDAS) and chronic immune dysfunction.  Dr. Ingels has published three books, including his most recent book, The Lyme Solution: A 5-Part Plan to Fight the Inflammatory Autoimmune Response and Beat Lyme Disease, and his websites are Wellness Integrative and DarinIngelsND.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.

 



 

Podcast Transcript

Dr. Weitz:            Thank you for joining us this evening for our Functional Medicine group meeting on Lyme disease with Dr. Darin Ingels. I’m Dr. Ben Weitz, and I’m so happy that you’ve taken the time out from your busy schedule to join us, and hopefully to participate in our discussion tonight. If you’d like to ask a question, please type it into the chat bar, and we’ll get to it once Darin has finished his presentation. He’s going to speak for about 45 to 60 minutes, and after that, we’ve allotted approximately 30 minutes to Q and A.  Please consider attending some of our future Functional Medicine discussion group meetings, which are going to continue to be virtual through Zoom at least through the end of this year, and probably the beginning of next year. Dr. August 27th, Dr. Chris Shade of Quicksilver Scientific will be speaking about heavy metal detoxification, and he’s an awesome speaker, so that should really be good.  September 24th, please mark your calendar, another incredible speaker, Dr. Isaac Elias, on the survival paradox. October 22nd, we will do a deep dive into how to understand a GI map stool test, with Tom Fabian of Diagnostic Solutions. And November 19th, Dr. Steven Stanford Lewis will be speaking to us about some GI-related topic, yet to be decided. December we’ll be off, and then we’ll start up again in January of 2021.

                                Please join our closed Facebook page, Functional Medicine Discussion Group of Santa Monica, so we can continue the discussion beyond this meeting. Please check out my rational wellness podcast, which is dedicated to all things functional medicine. You can listen to it on your phone through Apple Podcast or Spotify, or you could watch it on YouTube and video recordings of most of our Functional Medicine meetings for the last three years can also be found on my Weitz Chiro YouTube page.  I’ve now posted over 166 episodes on my podcast, and there’s some amazing information contained in these interviews with many of the top names in functional medicine, including this week’s interview with Dr. Joel Khan on Lipoprotein (a). So, please subscribe and give me a positive review on Apple podcasts. Metagenics is our sponsor this evening, so Kailey Oogaard, my Metagenics rep, is going to tell us about a few Metagenics products, after which I will introduce our speaker, Darin Ingels, and we’ll get started. So, Kailey, let’s see.

Kailey:                 Can you hear me?

Dr. Weitz:            Yep.

Kailey:                 Hi everyone. Thanks Dr. Weitz. As Dr. Weitz said, I’m one of the local Metagenics reps in Southern California. There are about seven of us down here, from LA to San Diego, and I’m happy to put you in touch with your local rep if you would like to learn more about Metagenics, but I’d like to take this time to discuss one of our newer products, which is Hemp Advantage Plus. Hemp Advantage Plus features organic, broad-spectrum hemp extract, and a natural occurring bio-lipid, called palmitoylethanolamide, also know as PEA. PEA is an endocannabinoid-like molecule that interacts with the endocannabinoid systems, and PEA has been the subject of numerous clinical trials and studies, with results that support its clinical potential for safety and for patients with chronic pain and inflammation.

                                Studies have been conducted on chronic sciatic pain, fibromyalgia, osteoarthritis, and many other inflammatory conditions. If you’d like additional research about PEA, you can log on to the Metagenics Institute website, at www.metagenicsinstitute.com. There are lots of podcasts, research articles, and just hot topics out in the functional medicine world there. You can also contact your local rep to learn more, and if you don’t know your local rep, you can go ahead and shoot me a text. And my number is 310-321-8785. I hope that you all are doing well and I hope I get to see you all in person soon. Thanks Dr. Weitz.

Dr. Weitz:            Absolutely. Thank you Kailey. So, our special guest for this evening is Dr. Darin Ingels, and he will be joining us for a discussion on Lyme disease. He’s got a presentation for us. Dr. Ingels is a licensed naturopathic doctor in both the State of California and the State of Connecticut. His practice focuses on environmental medicine, with an emphasis on Lyme disease, pediatric acute onset neuropsychiatric syndrome and chronic immune disfunction. Dr. Ingels has published three books, including his most recent, A Lyme Solution: A five-part plan to fight the inflammatory auto-immune response and beat Lyme disease. So, without further ado, Dr. Darin Ingels.

Dr. Ingels:            Thanks Ben. All right, I’m excited to join you guys tonight. I wish we were all doing this in person, but this is the way life goes, so if you guys have questions, I think it would be best, if you go ahead and just go into the chat box and put your questions. When I get to the end of the presentation, we’ll just answer them all then. It will be easier than trying to disrupt the presentation. So, let me share my screen. Ben, you need to enable me to share my screen.

Dr. Weitz:            Let’s see. What do I do?

Dr. Ingels:           Go into the Zoom preferences.

Dr. Weitz:            Multiple participants can share simultaneously, is that right?

Dr. Ingels:           That should work.

Dr. Weitz:            Okay. Did that work?

Dr. Ingels:           There we go.

Dr. Weitz:            Okay. Couple people reminded me to record.

Dr. Ingels:            Okay, here we go. Hopefully you guys can see my screen. If there’s a problem, I can’t see the chat box, so just post it and Ben will let me know. Today, we’re going to talk about Lyme disease and co-infections, diagnosis and treatment options. I’ve got about 45 minutes plus of material, and then we’ll do some Q and A afterwards.   Lyme disease is near and dear to my heart. I’m a Lyme patient. I contracted Lyme disease in 2002 and spent three years trying to get my life back, so I know what it’s like for so many of these patients to really have to struggle with what can be sometimes a very debilitating illness. So, to start off, just a little background on what is Lyme disease? Many of you already know this, but it’s a bacterial infection, primarily caused by Borrelia species, Borrelia burgdorferi being really one of the more dominant species, and it’s transmitted primarily through the bite of a tick, specifically the Ixodes ticks, which are the deer ticks.    There are a lot of different ticks out in the world, deer ticks, dog ticks, wood ticks. The overwhelming majority of these cases are transmitted by deer ticks. Dog ticks, wood ticks and other ticks have really not been shown to be major carriers of Lyme disease. They carry a lot of other disease that can infect people and cause problems, but Lyme disease specifically is really more around the deer ticks. There is some evidence that perhaps other insects, such as mosquitoes and fleas, may transmit Lyme as well. To be honest, it’s really speculative. There’s literally just a few studies done in Europe on it. So, again the consensus is that the overwhelming majority of these cases are coming from tick bites.

Dr. Weitz:            Isn’t there a study about a mouse being involved in this too? That the tick bites a mouse, a certain type of mouse?

Dr. Ingels:            Well, ticks can bite any number of animal vectors. Mice are probably the primary carriers, more than the deer itself. We call it the deer tick, but mouse, rabbits, raccoons, any of these furry little creatures can potentially carry these ticks and potentially be reservoirs for Lyme.  So, in the early seventies, there was a mysterious group of cases of RA in children in Lyme, Connecticut. So, if you didn’t know, Lyme disease is named after Lyme, Connecticut. And juvenile rheumatoid arthritis is a pretty unusual condition. There were also several adults in Lyme, Connecticut that were also having this arthritic flare-up. So, it took actually several years. They originally thought it was a Rickettsial infection, which is a different kind of bacteria. And then they started sending samples to a guy named Dr. Willie Burgdorfer, who was a Rickettsia expert. He worked for the government in Colorado, and it took him about six or seven years to isolate that it was a spirochete, and the rule is, when you discover the organism you get to name it after yourself. So, that’s why it’s Borrelia burgdorferi, named after Willie Burgdorfer.

                                We know there’s at least five different subspecies of Borrelia burgdorferi and at least 100 different strains of Borrelia in the U.S. alone, and really more than 300 strains worldwide. This becomes relevant, because when we talk about testing, we are generally testing for one species, one strain, Borrelia burgdorferi, that’s pretty much it. So, if you’ve ever run a test through LabCorps or Quest or your conventional reference lab, they are only looking at that one specific strain. So, if your patient happened to be exposed elsewhere and they have a different strain, there is a high probability it will miss it on that test and you’ll get a negative test. Which doesn’t exclude the possibility of Lyme disease, and I’ll talk a little bit more about that when we get to the testing section.

                                And for those of us in California, which is all of us, when I first moved here, I grew up in Southern California and moved away and lived in Connecticut for almost 20 years, and moved back about two years ago full-time, I’ve been shocked at the number of healthcare practitioners, doctors that tell patients, “Oh no, we don’t have Lyme disease in California.” That is the most ignorant statement, uninformed, and if you look at, even according to the CDC, they’ve identified California for the fifth fastest growing state for the number of Lyme cases in the country.  The northern area, the Bay Area, is more endemic than Southern California, but again, we have hills, we have mountains, we have trees, we have areas where ticks do live, and we do see cases here. So, if your patient gets dismissed by another doctor, please be the one to do the diligent work and help identify it. Most of the cases, more than 95 percent, still come from New England and the central part of the U.S. However, Lyme disease has been reported in all 50 states, including Alaska and Hawaii. People travel, so even if you’re in a state like Arizona, that we don’t think about having really a lot of deer ticks, people in Arizona like to leave the heat, they travel, and they may have acquired it elsewhere, outside of the state they reside.

                                We know according to the statistics, that there’s more than 300,000 new cases of Lyme disease each year in the U.S. Remember that’s new cases. That’s not existing. That’s new, every year, so we are literally talking about millions and millions of people in the United States living with Lyme disease, many of which who don’t realize it. And in Europe, it’s about 65,000 cases a year. As you move to different parts around the world, some governments are very cognizant and recognize it. We find most governments are really blind to it and it’s overlooked. But we’ve got cases in Asia, Africa, and other continents outside of Europe and North America.

                                This is just a picture of the Ixodes tick. Out on the East Coast, Ixodes scapularis. Out here on the West Coast, it’s mostly Ixodes pacificus. Honestly, I’ve looked at pictures of both. I can’t tell the difference. They look kind of the same to me. They very much have this tear drop shape to them, with the sort of black back and sort of reddish orange lining. They look significantly different than dog ticks and wood ticks, which have a much rounder body and kind of a hard shell. If you push on a deer tick, their outside is as little softer.  Part of the reason that Lyme disease is so difficult to pick up is these ticks are teeny, weeny tiny, about the size of a poppy seed. Maybe when it’s fully engorged, it’s as little bit bigger. I can remember seeing a tick on my arm, actually when I actually had Lyme disease, I thought it was just a fleck of dirt, and I went to flick it off and it started walking, so small I couldn’t see the little legs. So, it’s a good idea to keep a magnifying glass in your office. It’s rare that you’re actually going to be able to find a tick on someone, but if you do, having something to magnify to really help identify if that’s a deer tick can be really helpful.

                                It is the number one spreading vector-borne epidemic worldwide. So, we see this all over the world. We see more cases in terms of rate than … I mean there’s still more cases of malaria and things like that, but in terms of the rate of infection, Lyme disease is still the fastest growing. And because Lyme is a spirochete, the nature of these corkscrew shaped organisms is that they can penetrate other tissues and cells a little bit different than other regular rods or other types of bacteria. And as a result of that, it can cause many different kinds of symptoms. In fact, there’s over 100 different symptoms that are associated with Lyme disease.  So, we call Lyme the great imitator, the great mimic, because it looks like so many other things. And I think that’s why it gets overlooked so often, because people think it’s an autoimmune disease. They think you have mono. They think you have a bad flu. It’s very easy to overlook it, but when you start to see these symptoms go on and on and on for a much larger period of time than what you would expect for some of these other infections, that’s where the red flag goes up that maybe it’s Lyme or some other tick-borne illness.  So, Lyme itself, Borrelia, is a shape shifter. If you see these pictures, it’s always that long corkscrew shape form. It can literally ball itself up like a slinky, and that’s called a cyst form or round body form. There’s also the cell wall deficient form and what they call an uncoiled filaments form, which just looks like kind of a long straight line. And it’s ability to shape shift allows it to evade the immune system, it allows it to penetrate other cells and tissues, and again, that’s what makes it a little bit more unique than other types of bacteria out there.

                                And the other thing about Borrelia that’s really interesting is that it has a very slow replication cycle. Most bacteria replicate about every 10 to 20 minutes, and to put it in perspective, if you get tuberculosis, microbacteria tuberculosis replicates every 15 to 20 hours, so that is much slower than every 10 to 20 minutes. And if you get TB, you go on a triple antibiotic cocktail for nine to 12 months. Well, if you look at the research on Borrelia, it replicates every one to 16 days. So, for the life of me, I can’t figure out why the recommendation has always been two to three weeks of antibiotics for an organism that may replicate once during that life cycle.  And considering the standard treatment is doxycycline, which actually is bacteria static, it’s not bactericidal, all it’s doing is stopping the organism from replicating, which means it needs to be in a replication phase to work. So, there’s a little bit of madness here that I can’t really get my head around. I don’t understand it, but this is sort of the politics of medicine and the politics of Lyme disease. But just understand that you’ve got an extremely slow-growing organism. So, as we start talking about treatment, that becomes relevant, because these courses of treatment do tend to go long term, often for many months, where it’s not like a sinus infection that you treat for seven to 10 days. Most Lyme patients are looking at many months of treatment.

                                So, I kind of break Lyme down into what I’ll call acute Lyme disease and chronic Lyme disease. This is just for simplification. In reality, there’s a lot of overlap. But your acute Lyme people, you’re probably not going to see very often unless you do primary care medicine, because these people are generally acutely ill. They’re sick. They’ve got headaches, stiff neck, fever, arthritis, neuropathy, muscle pain, fatigue, chills, lymphadenopathy, heart palpitations, shortness of breath, sometimes Bell’s palsy. The hallmark of Lyme disease is that classic erythema migrans or bullseye rash.  The CDC says up to 70 to 80 percent of people who get Lyme disease get that rash. If you look at the literature, the literature suggests it’s probably closer to 40 percent, and those of us in clinical practice, who work with a lot of Lyme patients, it’s probably less than 20 percent. So, if you have a patient who has a bullseye rash, do not pass go, do not collect $200. It’s absolutely Lyme. There’s nothing else in the world that causes that classic rash.  The absence of a rash, though, doesn’t exclude the possibility of Lyme disease. Whatever you learned in medical school, don’t let that be your guide about if someone does or does not have Lyme. The rash itself is not a reliable marker, and at this point, since I’ve been in California, I pretty much hardly ever see a bullseye rash. Now there are other rashes associated with Lyme that are not the bullseye rash.   So, when you see a flat rash that’s red and spreading, that would still make me nervous, even if you don’t see the central clearing. I get a lot of messages from people, especially on social media. They take pictures of, is this a bullseye rash? They freak out. Remember when you get bit by a mosquito, you will get a histamine reaction, and histamine reactions do not always cause a uniform redness spreading away from the puncta, so people will often mistake it, because they see a little bit of clearing, thinking it’s a bullseye rash.   Your biggest thing is when you get a typical insect bite, it usually goes away with 24 to 48 hours. At least the redness goes down, the swelling goes down. Mosquito bites, specifically, get raised. Tick bites are generally flat. They don’t get raised. You can usually feel another insect bite, if you get stung by a bee, you get bit by a mosquito, usually you will feel it. Ticks have a little bit of anesthetic in their saliva, so when they bite you, you don’t feel it.

                                So, that’s just a couple of quick, little ticks to differentiate, is it just another insect bite, like a spider bite or a mosquito bite, versus a tick bite? Most erythema migrans rashes are flat, they will spread. When I got bit, my rash spread for almost eight weeks before it started to dissipate. So, that is pretty common.  So, here’s a picture of the classic bullseye rash, red in the middle, central clearing, another red ring. And again, if you were to see it early, it might be small, but it will continue to spread. And again, mine got to be almost 18 inches by the time it was done spreading.

                                Symptoms can occur anywhere within three to 30 days following a tick bite. CDC, again, says up to 70 percent of people get the EM rash; as I just mentioned, that’s not always the case. Most people have no recollection of being bit by a tick. These ticks actually like the dark, warm, moist areas of the body. So, behind the knees, under the armpit, the belt line, under the butt cheeks, hairline behind the ears. So, often they go to places that people don’t necessarily see. So, if you’re out hiking in the woods, you like camping, you like outdoor activities, make sure that you do thorough tick checks, particularly if you’ve got kids. It’s very easy to overlook, and remember they’re small, so just make sure you’ve got a place that has good light and you can really do a thorough inspection.  So, I tell parents, if they go camping, strip your kids naked, go through every crack and crevice. They don’t like it, but it’s the safest way to ensure that they don’t get exposed. As I mentioned again, the symptoms are vague, look like a lot of other things, and misdiagnosis is very, very common.

                                So, if people miss that window of getting diagnosed to acute Lyme, it can progress more into what I’ll call chronic or persistent Lyme. As a political note, the government refuses to acknowledge that chronic Lyme exists, even though there’s multiple studies out of Johns Hopkins University showing otherwise, and millions of patients living with chronic Lyme. But their feeling is, three weeks of antibiotics and regardless of how you feel, you’re done. Whatever you’re dealing with, they now call it post-Lyme syndrome, but they don’t think it’s Lyme disease. They think it’s just something else, so kind of odd.

                                So, again, you can get the fatigue, but then you’re going to start getting more gastrointestinal problems, more neurological problems, memory loss, cognitive impairment, neuropathy tends to get worse and spread, sensory distortions, which is really a type of neuropathy, but burning sensations is a very common complaint, or this feeling of creepy crawlies under the skin, and wandering joint pain. Wandering joint pain is another hallmark of Lyme disease specifically. There’s nothing else we know in recorded literature that causes wandering joint pain.  What that means is, one day it’s my left shoulder, then it’s my right knee, then it’s my right shoulder, then it’s my left ankle, and it just seems to keep moving. If you’ve got rheumatoid arthritis or other types of autoimmune arthritis, they tend to be the same joints. Now they can come and go in terms of their intensity, but they tend to be pretty consistent. But with Lyme, it can be completely different joints altogether.  Light and sound sensitivity, dizziness, vertigo, sleep problems, general rheumatism. There is a thing called Lyme carditis, which can cause mitral-valve prolapse, heart block, heart palpitations, chest pain. So, I always send someone I’m suspicious has Lyme or if I know they have Lyme, we’ve already diagnosed it, if they’re complaining of chest problems, I always send them to the cardiologist, get a cardiac workup and make sure they don’t have Lyme carditis, because that can become very serious.  Balance, coordination problems, people say, all of a sudden, I’m clumsy, I trip a lot, I drop things. What I call newly acquired dyslexia, where all of a sudden people start transposing their numbers, their letters, whether they’re writing or typing. The brain has an element of inflammation. I think it is a type of encephalitis that ensues, and that’s what triggers a lot of these neurological problems.  And finally, we’ll see a lot of endocrine disruption, particularly underactive thyroid, hypothyroidism following Lyme is a pretty common occurrence, well documented in the literature. And sometimes we’ll see women having menstrual problems, adrenal issues and so forth.

                                So, as I mentioned, it’s the great imitator, looks like a lot of these things; autism, multiple sclerosis, ALS, chronic fatigue, fibromyalgia, mono, herpes 6, parvovirus, RA, lupus, name any autoimmune disease pretty much, and there is some association with Lyme. And if you look at this list, a lot of these things are descriptions. They don’t really tell you why. Rheumatologists, to their credit or to their fault, can help identify that there’s an inflammatory process going on in the body, but I don’t think they’re terribly good at telling you the why. And these people who get these labels, and say, “Well, I’ve got a diagnosis of MS.” You say to the neurologist, “Well why?” “Well, I don’t know. That’s just the way it is.”

                                Well, it makes a lot of sense, and again, we’ve got as lot of ample literature showing that microbes are major triggers for autoimmune disease, not just MS in particular, but Klebsiella’s a major autoimmune trigger, strep is a major autoimmune trigger, so we have a lot of microbes that can do that, and Lyme just happens to be really effective at triggering autoimmune problems.  And a lot of these autoimmune issues don’t fit the bill of what you typically think of with lupus and rheumatoid arthritis.  Often, the CRP is normal, rheumatoid factor is normal, ANA is normal.  I often do see the ANA will come in and out of being positive with people if you measure it over time. That’s pretty common with Lyme, but it’s always very low titer, and you do all the follow-up tests and everything comes back negative. So, it doesn’t really point to any one autoimmune problem, but again you will see that with Lyme.    So, again when you see these patients that have these chronic labels without an understanding of really why, it should be probably at least part of your differential diagnosis to test appropriately and just make sure that tick-borne illness is at least part of the underlying cause.  We all practice root medicine, we want to get to the cause of these things, and I’ve been shocked at the number of people I’ve seen who have been to 50 doctors, and nobody ever bothered to test them for tick-borne illness, and then we test and it lights up like a Christmas tree and you treat them and they feel tremendously better.

                                We’re focusing really on Lyme on this talk, but I at least want to mention that a lot of these ticks that carry Lyme do carry other infections. So, here’s just a short list of things that are pretty common. Babesia, which is a blood parasite, it’s a cousin of malaria. Bartonella, which we typically think of cat scratch fever, but it can be transmitted through a tick bite. Anaplasma, Ehrlichia, Mycoplasma, Rickettsia, Rocky Mountain spotted fever. Powassan virus, which has shown up in the last handful of years as a very deadly virus, unfortunately. We’ve seen most of those cases out in New England. Colorado tick fever, Heartland virus, Tularemia, Brucella. Every time I go to a Lyme conference, I swear this list of things that ticks transmit gets longer and longer, and it’s exhausting when you’re trying to do as workup with patients.  So, just keep in the back of your mind that if you’re suspicious of a tick-borne illness, you probably want to test for the gamut. I will tell you I test for the things I see most commonly first. We see what happens, and then I do a second-tier testing. Instead of doing 50 tests at once, let’s take the top 10, the top 12, because those are the most likely ones anyway, and then if we run into a wall, then we can go back and look at all the other ones.

                                So, why is there a rise in Lyme disease? Well again, worldwide, we’re seeing an increase, not just in Lyme, but other insect-borne illnesses. We’ve had more Dengue virus. Remember Zika virus? That freaked everybody out for a long time, and it kind of just magically disappeared. Chikungunya virus in Central South America. Of course now, SARS-COV2. So, we’ve got these different infectious agents, particularly viruses that have been emerging for a number of different reasons, and really the World Health Organization attributes it to climate change.  I didn’t put the list, or the reference here, and I apologize, but if you want to message me and I’ll send it to you. But the World Health Organization published a paper. It was actually pretty good, and basically because we’ve got a warmer climate, that allows, ticks in particular need the cold to get killed off, and New England, the central part of the U.S. has been warmer overall. They’re not getting those cold, cold winters to really kill off the ticks, and therefore the tick population continues to explode. Birds are migrating further away than they used to before, so they can carry these ticks to other places.  [Here is a paper with this conclusion: “Ticking Bomb”: The Impact of Climate Change on the Incidence of Lyme Disease]

                                There was one study, it was done in Canada, where they found that birds in the U.S. can get as high as the Yukon, and so they can go pretty faraway, and therefore, these birds have the ticks on them, they go somewhere else, carry the tick. Now the tick is implanted somewhere else and it just starts a new tick population. So really, climate change is to partially blame for all of this.

                                So, the diagnosis of Lyme, I will tell you this is extremely controversial. The CDC has a very hard line on it, and understand that, when we talk about testing, the testing that is available out there through commercial labs was never designed to be diagnostic, ever. It was designed to monitor people that had known Lyme disease. So, once we discovered Lyme back in the early eighties, they developed a test not long after, and again, they wanted to monitor people who had the bullseye rash, the high fever, all the classic symptoms, and they wanted away to kind of monitor and see how their progress was going.  So, if you go to the CDC’s website, they will tell you today that Lyme is a clinical diagnosis. It’s based on signs and symptoms and particularly people that live in endemic areas, and you kind of have to rule out everything else. You’ve got to rule out autoimmune disease. You’ve got to rule out other neurological issues, if they’ve got neuro symptoms. So, there’s a whole process of trying to pinpoint, is it Lyme? And as best, what these tests tell you is, has your patient been exposed. It does not tell you if they have Lyme disease.

                                I can promise you if we tested everybody in this country, we would find a huge number of people show evidence of exposure who have never had a single symptom. So, it’s kind of like SARS-COV2 right? We’re testing all these people that have no symptoms. I think there’s an analogy between Lyme disease that’s kind of scary, but very, very close, and it’s true for the Lyme testing.  So, as I go through this, I will explain a little bit why that’s so. The typical CDC criteria is you run a screening test, which is an elisa test. It’s just an antibody test, IGG and IGM antibodies. If that test is positive it flexes over to a western blot, also looking at IGG and IGM antibodies. So, to call a test positive, you’ve got to have five out of 10 IGG bands or two out of three IGM bands. And that’s what they call a positive test.

                                And in 40 years of research and understanding more about these antibodies, some being very specific to Lyme, some of them being non-specific, I don’t know why we’ve never changed that criteria, and really just focused on the Lyme-specific antibodies. And the way I think of it, if you’ve got a Lyme-specific antibody, and it’s there and it’s strong, it’s kind of like being a little pregnant. I mean you are or you aren’t. What difference does it make if it’s one or two or three or four? Having evidence you’ve had exposure when you’ve got clinical symptoms is hugely important and relevant. So again, keep that in mind.

                                Some of the pitfalls of this test is a lot of Lyme patients are [inaudible 00:29:06] negative, which means they just don’t produce antibodies. Now, is it because they have an immune deficiency? Is it because they’re so far away from their initial exposure that their immunity has naturally waned with time? There’s any number of reasons that people don’t make antibodies or don’t make an adequate response, and as a result of that, this test might look negative.  We don’t have good technology to date that measures Borrelia directly in the body. There was a lab in Pennsylvania that was doing a Lyme culture for a while. They got shut down by the FDA, so we don’t really have any direct Borrelia testing in the body. And for an antibody to be considered positive, it has to be at least 60 percent of the control. And I was a former microbiologist, medical technologist before I was a doctor. I used to do these western blots for a living, and then one thing that is very odd is that when you run pretty much any lab test out there, if you’re running a CBC or a chem panel, there’s always a low, a medium and high control to represent that there’s a gradation of what represents normal.

                                And with a western blot, there’s not. It’s black-white, yes-no. So, they set this threshold at 60 percent. What that means is that, the CDC’s perspective is that if you’ve got Lyme, you make a ton of antibody. You make a lot of it, and if you were to do this test within maybe a few weeks to maybe a month and a half or so of someone being exposed, you might expect that there would be a decent antibody response. But if you learn in immunology, over time, it’s that immunity wanes. If your exposure was a year ago, three years ago, 10 years ago, I wouldn’t expect to have the same level.   So, it doesn’t reflect the nature of how antibody levels can change, and that’s why I said earlier, if you’ve got Lyme-specific antibodies, I think that’s relevant, in conjunction with a patient in front of you that actually has the clinical symptoms.  So, most conventional labs don’t test for the breadth of antibodies associated with Lyme, so you can also miss people. There was a Lyme vaccine that was available, back in, I think, the nineties. It went off the market. It was out for maybe three years. Anybody who would have gotten that vaccine would test positive for the 31 antibody. So reference labs intentionally leave it off, because anyone who might have had the vaccine, they don’t want to call the false positive. But we now know that A) there’s not that many people who got the vaccine, particularly now, and that 31 antibody can be very specific to Lyme.

                                So, that’s where if you’re using labs that specialize in Lyme testing. I use specifically a lab out of New Jersey called Medical Diagnostic Labs. I like them because they do very comprehensive tick-borne testing, and the best thing is they bill insurance. IGeneX up in Palo Alto, California is also a great lab. They do fantastic testing. The only down side is outside of Medicare they don’t bill insurance, so it just gets to be another out-of-pocket expense for your patients.   It can also take up to six weeks for people to produce antibodies, so depending on when you do the testing, if someone truly, you thought, had acute Lyme, if you test too early, it may just be that you missed that window yet. They haven’t made enough antibodies to show up as positive. So, I generally, if someone has a suspicious tick bite, I will wait at least three or four weeks before I do a blood test, just to make sure we hit the right window of actually picking up a positive.

                                ILADS has a different criteria. I don’t know if you guys know, the International Lyme and Associated Disease Society, they have their own criteria, where again, it’s more of kind of I explained, looking at these Lyme-specific antibodies and not really following the hard line five our of 10 IGG or two out of three IGM antibodies that the CDC sets. And again, really based more on clinical symptoms, but again, you do have to rule out other inflammatory, other autoimmune conditions as part of your process.

                                So, let’s jump in a little bit to talk about treatment. You’ve gone through this whole process. You’ve got this patient who’s got clinical symptoms. And I didn’t put a slide, but I should mention it, Dr. Horowitz, Richard Horowitz is kind of a Lyme guru in the U.S. He has a questionnaire called the MSIDS questionnaire. He has actually validated this questionnaire in clinical studies and found it is a reliable marker on the probability your patient has Lyme.  So, if you have a patient that just can’t afford the testing, or for any reason, maybe that’s not available to them, you can always have them, it’s a free download online, they can take the questionnaire, and if they score high on it and they have the clinical symptoms, you can probably feel pretty good and I think you’ve got some teeth in justifying your treatment, because again, this questionnaire actually has been validated in clinical studies. So, there is evidence that this is a reliable way of identifying those people that have been exposed to a tick-borne illness.  [Here is the Multiple Systemic Infectious Disease Syndrome questionaire: MSIDS.]

Dr. Weitz:            One more time, the name of that questionnaire.

Dr. Ingels:            It’s the MSIDS.

Dr. Weitz:            Okay, thanks.

Dr. Ingels:            So, first and foremost, I think diet plays a huge role. I know we’re hearing this again with SARS-COV2, that people who are overweight, obese, diabetic, they are some of the highest risk people of getting SARS-COV2. I think these are also the highest risk people of getting Lyme disease. So, getting people to start eating healthy, nutritious, nutrient-dense foods is important. However, we know from the research that eating what I call an alkaline diet, I mean I didn’t start that. There’s plenty of books written about an alkaline diet, but it’s not really a diet, in terms it’s not calorie-restricted. It’s not a diet to lose weight. This is a way of people learning how to eat.  And what I like about it is that it doesn’t restrict calories. It’s not really that restrictive. So, people can actually follow this. Some of the diets out there, like Keto for a lot of people, is really challenging. They can’t stick with it. This is a diet I find people will actually stick with, and the alkaline diet is based on the premise that as you eat certain foods and they break down in your body, they become alkaline-forming. So it’s really about shifting your tissues, your cells to be more alkaline.

                                I mean, with the exception of the skin, the stomach, the bladder, and for women, the vaginal area, which are very acidic, to protect against outside invaders, by and large, the rest of your body is mostly alkaline. So, we know that the enzymes systems work best, cell repair works best in really an alkaline state. So, it’s not about the pH of the food. It’s how the food breaks down in your body.  So, for example, lemons, if you squeeze lemon juice on pH paper, it’s very acidic. However, when you drink lemon juice, it actually breaks down and makes your body very alkaline. We’re not taking about blood pH by the way. I get this from time to time, “Well blood pH is very tight.” That’s stupid. We’re not talking about blood pH. Yes, you’re right, blood pH is 7.2 to 7.4, up or down you’re dead. So, this has nothing to do with changing blood pH at all. This is really about changing cellular pH, and again there’s a lot of studies out there that validate this.

                                So, what I recommend for people when they’re transitioning their diet, just go ahead and buy that pH paper at the pharmacy. It’s really cheap, and 30 minutes after they eat, you have them go pee on the strip, and we really want to see their urine pH above 7.2. Some people like doing saliva pH. I find salivary pH is a bit more variable, because of all the other microbes in the mouth, but if that’s easier for people, that’s another way. But I do like the idea of doing urine pH better.

                                Just talking about some of the diets, I’ve really broken this down to three categories for people. The first category are foods that can be consumed as often as people like. I won’t go through all of these. I’ll let you read through it, but basically it’s mostly vegetables. Most vegetables, thank goodness, and seaweeds, are very alkaline forming. Avocados, the citrus fruits, by and large, sweet potatoes and so forth.

                                Some nuts and seeds, there are some grains, legumes, some oils, some beverages. I deviate a little bit away from the Gundry work about lectins. My personal opinion, I don’t think lectins are as pro-inflammatory as suggested, considering most of the world they’re staple food are high-lectin foods, and yet autoimmune disease allergies are extremely low in these countries. My clinical experience with Lyme patients is that they eat legumes, and outside of the normal farting, they actually do pretty well. So, I think that’s okay.

                                Category two are foods that I like to restrict to about 20, 25 percent of their dietary intake for the week, and you’ll see this is a lot of fruits, some grains, like rice and so forth. It’s all the animal proteins, meat, eggs, fish, some of the oils. And the reason is, when these foods break down is they’re either neutral to even slightly acidic. So, that’s why it’s not that they can’t have it. We just don’t want it to be the bulk of their diet. So, I think if you kind of go back to our true paleo forefathers, we didn’t kill every day. We killed when we could, so we still foraged off the land, ate mostly plant-based foods, and then had some mixed in animal protein, and I think this kind of reflects that a little bit better.

                                And people might say, “Well do I have to do 20 percent? What if I do 30 or 40?” And look, check your urine pH, and if you can maintain your pH in an alkaline state, then it’s fine. This gives you the opportunity for each of your patients to play around with what works best for them. There is no hard and fast rules here. Again, this is just my experience in working with Lyme patients that this works very well. It’s sustainable. It’s nutrient-dense, and it gives them all the things they need to heal.

                                And the last part here is really just foods to avoid. So, these are dairy products. There’s probably a million reasons we could talk about why to avoid dairy products, dried fruits, some of the nuts listed there, any junk food, artificial foods, processed foods, condiments, oils and beverages. The next one that gets a lot of my Lyme patients it coffee. Coffee is very acid-forming. Again, the pH of coffee itself is like two or three right? It’s very acidic.

                                So, I do have some people that will drink a little bit of coffee every now and then. And again, if they’re eating so well with the rest of their diet to balance it, then it’s fine. So, for your heavy coffee drinkers, maybe have them scale back. Someone told me that there is a low pH coffee. I have yet to find it yet. If it exists, great. Again, the easy way is just check urine pH and make sure everything is okay.

                                Beyond getting the diet, get the gut in good working order, the next step is really start targeting the Lyme itself, or some of these co-infections. So, I want to just talk through some of the herbal protocols that I use. I didn’t really talk about it, but I’ll just give you a quick synopsis. Antibiotics early on in Lyme disease can be very effective, and I’m certainly not opposed to it. However, when you get further and further away from your exposure, the odds of antibiotics being effective go down.

                                And I’ve seen patients literally have been on antibiotics for six years, eight years, 10 years, 12 years continuously to treat Lyme disease, and they have not improved. And you have to draw a line in the sand of when do you get to that point when the treatment is worse than the condition? And when you’re on long-term antibiotics, I guess depending on which ones you’re on, obviously you’re disrupting your normal gut microbiome, which you need to have a healthy immune system, and there’s also a greater potential to damage your mitochondria. And we know that Lyme itself can damage mitochondria.

                                So, for your Lyme patients that are tired, have problems with wound repair or tissue repair, if the mitochondria don’t work well, it’s going to be really, really hard to get over that hump, if they’re on hardcore antibiotics. With antibiotics, you’re really just targeting killing the bug or at least stopping the bug from replicating.

                                With herbs, herbs have so many other components in it, that they’re anti-inflammatory, they help promote better circulation, they help boost your immune system. So, we get multiple functions out of herbs that we just don’t get with antibiotics. So, a lot of potential upside, and there’s this myth out there. Let me dispel it very quickly. “Well, they’re not as strong as antibiotics,” and that’s not true at all. There is actually a handful of studies out there looking at herbs compared to antibiotics, albeit in vitro, and across the board, the herbs tend to be more effective than the antibiotics, and can kill Lyme in multiple forms, where antibiotics typically only address Lyme when it’s its uncoiled normal spirochete form.

                                So, the first protocol I want to talk about was developed by a Dr. Lee Cowden. Dr. Cowden here is a cardiologist out of Dallas, and he started working with a company called NutriMedics. They’re based out of Jupiter, Florida, and these herbs are all wild crafted out of Peru, down in South America and the Amazon jungle. So, I like these herbs for a lot of reasons. Again, clinically, they can be very effective. If you guys want to do a little bit more research. There’s a doctor named Eva Sapi. It’s S-A-P-I. She’s at the University of New Haven and she’s published a handful of studies looking at these herbs, specifically in vitro with Lyme against different antibiotics, doxycycline, rifampin, a couple of others, and again, she found that the herbs were actually more effective.

                                So, there’s some evidence that these are effective. Clinically, I’ve been using these for almost 20 years. I find they work really well for patients. These are liquid tinctures, so the other nice thing for your really sensitive people is you can do drop doses, and titrate up to a point where you start to see clinical benefit, without getting any kind of die-off reaction, Herxheimer reaction, or other side effect.

                                Dr. Cowden’s protocol himself, the way that he has it structured is that every month he kind of changes the protocol, the concept being, if we keep confusing the bug, maybe it won’t adapt. We don’t actually have any evidence that this organism can become resistant to herbs. It’s a little bit different than antibiotics, because herbs aren’t used nearly with the frequency of antibiotics. So, that has not been my clinical experience, and when I looked at Dr. Sapi’s work, there was really just a few of these herbs that were doing the heavy lifting in the whole protocol.  So, what I have listed here are all the herbs that he includes in his protocol, and then the ones in bold are really the ones that I use most often.  The combination is designed to, again, kill the microbes, support detox pathways, clear metals, basically make the terrain a more hospitable environment to do what you want to do. It’s a five to nine-month protocol, again of constantly changing herbs and again, they’re liquid extracts, so drop doses are possible. I use this with a lot of my kids, just because they don’t taste horrible, they’re drop doses, you can mix in water or a little bit of dilute juice, and again, it gives us a lot of flexibility to adapt it.

                                This is just my protocol on treating acute Lyme disease. I’ll let you read through the slide, but there is a difference between, if you’ve got someone who’s been exposed fairly recently, versus someone you think has more persistent Lyme. With acute Lyme disease, we basically go in at a fairly high dose to try and hit it hard right off the bat, and we’ll typically do a treatment for at least six weeks. Six weeks is the minimum. Because it’s a slow-growing organism, we don’t want to short ourselves. So, at least six weeks, and at six weeks we re-evaluate, how are you feeling. Sometimes we’re on longer, but really no less than six weeks.

                                For persistent Lyme disease, I just start at smaller doses and titrate up slowly. When people have had it longer, they’re disposition to Herxing or getting that die-off reaction goes up. So, if you just start slow and work your way up, drop by drop, again, it just minimizes that impact. Herxing with this particular protocol is not that common. Maybe 10 to 15 percent of people, where with antibiotics it’s much, much higher. Again, it’s a much more tolerable treatment.   And again, I just have them titrate up one drop twice a day every three or four days. If there’s really no improvement in the way they feel, up to really 30 drops twice a day. They do have one formula here called Burbur or Burbur pinella. This is to help mitigate the detox reaction. If people start to Herx, this particular formula, they can take 10 drops every 10 minutes every hour, as frequently as they need to. There’s nothing toxic about it. It really is to help open up those detox pathways, and sometimes it really helps curtail that die-off reaction.

                                So, the advantages of this protocol, it’s really easy to administer, clinically it works and it’s pretty cost-effective. Those four tinctures I mentioned, for most people, at max dose, 30 drops twice a day will last them about a month. It will cost about $135 for their cost on all that, so it’s not terrible.

                                The disadvantages, again, you can get Herx reactions. As I said, they’re not really that common, but they’re more common than with some of the other protocols. It is a long, potentially long-term treatment. It does require multiple bottles and dosing schedules, so it’s a bit more labor-intensive, especially when people get to the higher doses. They pour their glass of water, and then they grab the one bottle and they count out 30 drops, grab the next bottle, count out 30 drops, and so forth. So, for people who hate counting drops, they don’t like it. But aside from that, it’s actually pretty simple.

                                The other protocol I want to talk about is developed by Dr. Zhang. He is a Chinese medical doctor and licensed acupuncturist in New York. When I had Lyme disease myself, after having been on antibiotics for nine months, I went and saw him, and after being on his herbs for three to four weeks, I was 80, 85 percent improved. So, the proof was definitely in the pudding with me, and I’ve since used his protocol. In fact, it is my primary protocol for Lyme patients, and I’ll talk about, again, the advantages and disadvantages. There is one major disadvantage to this protocol, and that’s cost, but it is the most clinically effective protocol that I use with my Lyme patients.

                                In Chinese medicine, they don’t use herbs singly. These are all formulas, so each one I’ve listed here, even though I’ve listed an herb, like artemisia, it’s actually a formula with artemisia, a formula with houttuynia and so forth. Artemisia is a well-established antimicrobial, as is houttuynia. Circulation P, as the name suggests, helps promote better circulation, breaks up immune complexes. Coptis is an herb they’ve used in Chinese medicine for years, as an antimicrobial. Cordyceps is a medicinal mushroom to help boost the immune system and adrenals. Pueraria is an herb they use a lot, actually, for a lot of sinus infections, but it also helps open up the blood vessels. It’s great for brain fog.  R5081 is to help boost the immune system. BAIM is an anti-inflammatory formula, so that’s for inflammation. And allicin, which is a garlic extract, is also a very potent antimicrobial. I don’t really use the allicin much anymore, only because of the social issue that it makes people reek and smell like garlic all day, and they hate it. So, I used to take allicin and my patient would just look at me like, “Dude, did you just have a pizza in here?” So, there is this social issue around it. If people don’t mind it, it’s very effective, but I don’t use it as much, because most people are still functioning in the world and they don’t like smelling like pizza.

                                The goal of the protocol, again, treat the infection, improve circulation, reduce inflammation, improve detoxification, boost the immune system. I will use actually all of these protocols. All my protocols, I actually give a minimum of two months, especially if it’s chronic. Six weeks if it’s acute, two months if it’s chronic. At two months, if we haven’t seen the needle move at all, then it’s time to move on and try something else. But I tell all my Lyme patients that have had it for a long time, anywhere from three months to a year is normal treatment. Sometimes it’s longer, so just kind of prepare them mentally that they’re in for the long game in most cases.

                                Here’s my protocol for acute, for Dr. Zhang. Again, I’ll let you read through that. And by the way, if you guys want copies of these slides, just message me and I’m happy to send you a .pdf of all these slides.  And then for persistent Lyme disease, with the Zhang protocol, there’s not as drastic of a difference. There’s just a little bit of a difference in the the types of herbs I use. I use coptis initially for acute Lyme disease. I don’t use coptis as much for chronic Lyme disease, because if they’re on it longer, it has a greater disposition to disrupt the gut microbe biome, so that’s really the big difference between the two.

                                Advantages, again, clinically beneficial, Herx reactions are actually not that common. I think those combination of herbs actually work well to offset any potential side effects. The disadvantage is it’s kind of of difficult to administer, because you’ve got to take a lot of capsules. Each formula is one capsule three times a day. Some people are taking five or six of his formula, so 15 to 20 capsules a day. And when they’re already taking a lot of other supplements, it just starts to add up.  So, a lot of people like the Cowden stuff, because at least it’s not capsules, they can drink it. In this case, these are capsules and some people prefer it. So, you can just talk about your patients, and gain, as I mentioned earlier, the biggest downside is just cost.  Patient cost on these herbs run about $500 or more a month. So, for people who might be on a budget, this may not be the best option, but if money is not the limiting factor and they don’t mind swallowing capsules, this is really my go-to protocol.

                                There are other herbal companies out there. Byron White is an herbalist. He’s developed different formulas. The biggest difference is that his formulas are really based on what you know your patient has. So, if they have Lyme disease they get AL Complex. If they’ve got Babesia, they get A-BAB. If they have Bartonella, they get A-BART. So, each one of his formulas are really targeted towards the bug. He also does have formulas for detox and so forth, so that one is not so much a protocol as you the practitioner picking and choosing what you think is appropriate for that patient. These herbs are very strong. Herxing is extremely common with these herbs, so we use teeny, tiny doses of these herbs. They are liquids; they’re tinctures.  So, again, if you’re going to use these, have them start really small, one drop a day, one drop twice a day. Go up very slowly. Most patients don’t tolerate more than six to eight drops twice a day. So again, it’s very concentrated herbs and they pack in quite a punch. Again, these therapies are really targeted towards the organism and just a little bit different than the Cowden stuff.  Advantages again, clinically it works for some people, very easy to administer, because usually there’s less product, less drops. Disadvantages is Herxing is pretty common. Again, it’s still long-term treatment. And each bottle is pretty expensive. Each bottle to the patient is around $100, so if they are getting multiple bottles, that can add up pretty quickly.

                                Other herbs that I at least want to mention. Steven Buhner has written two excellent books on treating Lyme with herbs. He’s an herbalist. I highly recommend picking up his books if you’re interested in using herbal medicine in your practice and you already don’t. He uses Japanese knotweed, Cat’s claw, andrographis, wireweed, yellow dye root. Hopkins actually published a study earlier this year looking at, I think, it was 17 or 19 different herbal extracts, and just looked to see which ones were most effective in treating Lyme. And Japanese knotweed and cryptolepis were actually at the top of that list. So, good evidence that these herbs work well as well.  The problem with the Buhner protocol I had at least early on is that he never had one company that made all the different herbs, so you, as the doctor and the patient, had to go find different companies that made each individual one and put it all together. So, it was just kind of labor-intensive to get it put together, but now I think there’s a couple companies that make everything. I think Research Nutritionals makes a lot of these herbs and so forth.

                                Beyond Balance is another great company. I use a lot of their herbs. It’s a little bit more akin to some of the Byron White stuff, that there are herbs that are developed by Susan McCamish, who is an herbalist, and there’s one for Bartonella. Actually, there’s I think three for Bartonella, two for Borrelia, three for Babesia. So, there’s a couple of different formulas. A lot of herbs for detox and those kind of things, so I like them a lot. The other big thing with their herbs, to be aware of, is that all of their extracts are in glycerine. Most other companies when they make tinctures, they put them in alcohol. If any of your patients are using disulfiram to treat Lyme, they have to stay away from alcohol. They get really sick, so you don’t want to use any of these tinctures that contain alcohol, if your patients are on disulfiram, but you can use Beyond Balance, because they’re in glycerine and it’s perfectly safe.

                                And there’s a lot of other herbs out there, again, to help support the immune system, have antimicrobial effects. They’re anti-inflammatory, help improve circulation, reduce pain. So again, if you look at the fundamental aspect of what these herbs are doing, there’s a lot of overlap between these different protocols.

                                Breaking down biofilms, another important aspect of treating Lyme, a lot of bacteria in your body make biofilm. That, by itself, is not abnormal. In fact, it’s essential for these bacteria to survive. It so happens that Lyme is exceptional, or Borrelia is exceptional at making biofilm. So by breaking down that biofilm, it’s easier for us to, whatever we’re using as our therapy, plus your own immune system, to actually get to the microbe. And if you look at some of the studies on biofilm, you have to use up to 250 percent the amount of drug to get the same effect when biofilm is in place versus when it’s not in place.   So again, biofilm itself is not abnormal, but we do want to help break it down to make our treatment more effective. There’s a lot of enzymes on the market that break down biofilm. I use a lot of serrapeptase. I use nattokinase. I use lumbrokinase. I know they have different price points. I think if you look at the research on cardiovascular disease and the fibrinolytic effect of enzymes, lumbrokinase is the most effective by about tenfold over nattokinase. Serrapeptase is probably somewhere in between. But lumbrokinase is an excellent biofilm disruptor, and when we think about biofilm, it’s not like popping a balloon. It’s really dissolving, so it’s a different process. When they say biofilm busters, again, we’re not just popping it. It’s just really breaking it down.  I kind of have a discussion with patients about what they feel comfortable with, a bottle of nattokinase is probably $20 and change. Serrapeptase is probably around $40. Lumbrokinase is about $100. So again, if it’s a cost factor, lumbrokinase may not be the best option, but it does work quite well. Interface Plus is a product from Klaire Labs that has EDTA and serrapeptase in it. I’ve used that quite a bit and it works pretty well for people too.  The trick to [inaudible 00:55:24] all these biofilm disruptors is you do want to get these enzymes between meals, so we don’t want them to become digestive enzymes for their food. We do want them to break down their … to get absorbed into the bloodstream without food.

                                Coconut oil itself is actually a natural biofilm disruptor. I don’t ever really give it as a supplement. I just tell them, just use coconut oil in your cooking and use it on your food, and most people can get a decent amount of coconut oil in that case.

                                N-acetyl cysteine, NAC, this is an amino acid that we use a lot to break up mucus in the body. It does help break up biofilm. 200 to 600 milligrams TID. Just be aware if you’re going to use NAC long term, it can deplete zinc and copper, so make sure they’re supplementing with those. And also make sure you don’t ever give NAC to anyone who’s got a stomach ulcer. It will make them significantly worse.

                                Low-dose immunotherapy, this was developed by Dr. Ty Vincent. If you guys haven’t been exposed to LDI, I know there’s a handful of us here in Southern California, I know Dr. [inaudible 00:56:23] has been using LDI. We use LDI, and the concept behind this is that, if your immune system starts treating the organism as an antigen, sorry as an allergen instead of a pathogen, that changes the part of the immune system that gets engaged. And that’s what really triggers these autoimmune reactions, so we want to alter the way the immune system is reacting to these bug. We want to down-regulate, really that TH2 dominant response that drives allergy and autoimmunity. So, we don’t wasn’t to interfere with TH1 that’s going to go right after the organism and eradicate it. And we find that that’s exactly what this does, is it seems to modulate that reactivity.

                                It’s based on the concept of molecular mimicry. There’s something in the molecule that’s similar to our own tissue, so in the immune systems effort to get rid of, in this case Lyme disease, it actually starts cross-reacting with your joints, your brain, your nerves. When I was writing my book, I came across all these references showing how Borrelia targets these different human cell tissues, and it just makes a lot of sense of why we get this broad scope of different systems, because again, it does target those different tissues.

                                So, again, this is a way to try and help modulate that immune response. The goal really is to promote tolerance to the offending antigen, using homeopathic doses of nosodes. So, if you guys aren’t familiar with homeopathy, a nosode is basically a homeopathic microbe. They take strep, they stake staph, they take whatever it is, it’s been irradiated, it’s killed, it can’t reproduce, it can’t cause disease, and then you just dilute it out in homeopathic dilutions. And then we mix it with an enzyme called Beta-glucuronidase, and this enzyme was found actually kind of by mistake, that whatever you mix it with would actually help build immune tolerance to it.

                                LDI stems out of another therapy called LDA or low-dose allergy therapy. It used to be called before that enzyme potentiated desensitization, and it was a way of treating allergies, like food allergies, mold allergy, pollen allergy, dust, dog and so forth. And so, Dr. Vincent had been doing LDA, kind of said, well it makes sense that what’s happening with microbes is very similar to what’s happening with these other allergens. So, he just started experimenting with different nosodes, and found clinically it was working really well, and we’ve now been doing it for six or seven years, and there’s maybe a couple hundred doctors around the country that have trained with him on doing it.

                                Clinically, I have found for a lot of my patients it has been a game changer in their Lyme treatment. If you’re ever interested in learning this, I can get you the information to contact Dr. Vincent. He’s got some online YouTube videos you can watch for free. He does have a training course coming up in September that’s going to be virtual. It was supposed to be in Hawaii, but travel right now is almost impossible, so it’s going to be virtual, and you can go through and get all the details on how to do this in your practice. It’s a fairly easy thing to utilize. There is an art to it, where you’ve got to learn how to figure out where to start people with their doses. Generally, kind of like, if you’ve got a sensitive person, you’re starting them on a drug, you start them on a low dose and then incrementally go up in small amounts until you hit that target dose.

                                The antigen we select is really depending on what we think is triggering the symptoms. If we think Lyme is the trigger, that’s what we use. If you’ve got someone, based on stool testing or organic acid testing, if it’s an overgrowth of candida or yeast, maybe you want to do the candida antigen. Maybe you want to do the strep antigen. We probably have about 40 different antigens we use right now, and I know Dr. Vincent keeps expanding that in experiments with different things, and every year it grows a little bit, based on what he and other doctors around the world have been finding.

                                This is given as a sublingual administration every seven to eight weeks, depending on patient response. So, the nice thing about this too is, they’re doing all these things every day, this is something they don’t have to do every day. It’s really about every two months. And when you hit the nail on the head, often we’ll see changes within 24 to 48 hours. Although it may take longer, in some cases, to see the full benefit, it doesn’t usually take that long to see if we’ve really hit the right dose.

                                Pulse electromagnetic frequencies, I just want to mention. PEMF, we actually utilize this in the office. This is basically a device that helps put a resonant energy that matches your normal human cell vibration, and if you think about pushing a child on a swing, every time you keep pushing the same direction, it moves them further and further. It’s kind of the same thing. So, our bodies get exposed to so many frequencies that are against us, WiFi and cell phones and things of that nature that probably inhibit our own natural frequency. This is a way of kind of restoring that.

                                We’ve got over one million receptors on any given cell, and applying the right EMF can really help stimulate these receptors to alter cell function. The goal is really to find the right frequency that stimulates the body towards better health. We always talk about the chemistry of the body, and we pretty much ignore the physics of the body. I think getting down at that level of intervention, it’s nice, because it’s safe, it’s easy. You don’t have to worry about side effects. It’s a very gentle way to try and help facilitate tissue repair in a very easy way. There are professional devices. There are devices they make for people’s homes that they can do at home.

                                The professional devices obviously give you more options and different ways to treat people, but again, for people who like the therapy, there are plenty of companies out there that make devices you can use at home. The benefits is improved circulation, decrease pain, reduce inflammation, faster recovery after injury, faster healing of skin wounds, and acceleration of nerve regeneration. So much of this is important for our Lyme patients, that again, I’ve found some people do remarkably well with this therapy.

                                Like physical therapy, they do need to do it somewhats frequently. We recommend doing two sessions a week when they come to our office. If they’ve got a machine at home, they can probably do it every other day, but you don’t necessarily need to do it every single day to get the benefits.

                                Germans have published a ton of research on this. There’s literally over 1,600 studies on the use of PMF. These devices are FDA approved in the U.S. So, again, this is something that can be very beneficial for people who have access to it. And in your own practice, may be something worth adding in too, as another tool to put in your tool chest for your patients.

                                Low-dose naltrexone, I like. I’ve been using it for a long time. I’m actually a part of the LDN Trust, which publishes a book and several research studies on their website. And the naltrexone is an opioid antagonist, but at low doses it actually enhances and dodges opioid production. So, basically gets your brain to make its own natural opioids. The short-term block in these receptors for four to six hours leads to an increased level of endogenous opioids for up to 20 hours.

                                So, we typically give this at bedtime for that very reason, so by the time daytime rolls around, those endogenous opioids are already circulating. This is all off-label use. There’s actually over 40 studies using it off-label for cancer, MS, fibromyalgia, autism. Unfortunately, there’s no studies on Lyme disease specifically, but a lot of us in the Lyme world do use this for our patients, particularly those who have pain issues, sleep issues, muscle issues. Here’s just a list of some of the studies that have been published. Again, you can read through that.

                                But again, what I like about it is that the side effect profile is excellent. The biggest side effects you typically see, tend to circle around sleep. Some people will talk about getting wild, vivid dreams, but outside of that, it’s very well tolerated. I’m a naturopathic doctor. I’m supposed to tell you drugs are bad, and I’m telling you, I use a lot of this medication. I think it’s great.

                                The other thing is it’s very cost-effective. We have a compounding pharmacy here in [inaudible 01:04:25] that makes a three-month supply for about $45. So, even for people that are on a tight budget, this is doable. It takes about three months to get the full benefits once you start people on it. So, just tell them, if you’re going to use it, to give it a little bit of time, and we’ll typically start with one milligram at bedtime, and every two weeks go up by one milligram. You can go as high as six milligrams. I find most people, somewhere between three and four and a half milligrams where they hit their sweet spot.

                                If you start to get up to five or six milligrams and they don’t feel any different after two weeks, you’re barking up the wrong tree, and at that point I would ditch it.

                                Just to summarize, our treatment approach, obviously we want to treat the organism if it’s acute. We want to treat these other immune distractors, if they’ve got food allergies, environmental allergies, because it drives that TH2 pathway. We want to promote better detoxification, fix these endocrine problems that get disrupted, make sure they’re sleeping well, get their inflammation under control, get their diet and nutrition under control, help their mitochondrial function if you think it’s been disrupted, get their circulation moving, boost their immune system. These are the fundamental things I think about when I’m dealing with Lyme patients.

                                It’s sort of naturopathic medicine 101, functional medicine 101. A lot of these things you’re already doing in your practice are very easy to apply. But hopefully the things we’ve talked about tonight will give you just a few more tools to add to the tricks. This is the book I wrote called The Lyme Solution. If you guys are interested, please feel free to pick up a copy. The information in it, I think, as a … it was written for patients, but I think as a practitioner, there’s a lot of great information. It goes into a lot more detail about the things we talked tonight, especially the herbs, what they do, why we use them, their chemical action.

                                All the references are in there. It’s a very well-referenced book. I have almost 300 references in there, so it’s not just my professional experience. It’s backed up by research as well. And just conclusion, here’s my information if you need to … if you want to follow me, in my information I talk a lot about Lyme and tick-borne illness. If you’ve got follow-up questions, there’s my e-mail address and phone number. And I think that concludes the talk tonight, so I’m open to any questions.

Dr. Weitz:            That was a lot of information Darin.

Dr. Ingels:            Let me stop sharing my screen here and we’ll turn it back over to the video.

Dr. Weitz:            So, let’s see. Some of the questions that have come in about sharing the slides with me, and I can send it out in an e-mail. Something about weaponized ticks released by the Department of Defense.

Dr. Ingels:            Well, you know, that’s been hearsay. The thing with that is that there’s a little place called Plum Island off the coast of Connecticut, which is a government research facility, so the theory has always been, is that, something got off the island, got to Connecticut, because Lyme, Connecticut is sort of across the pond, the Lond Island Sound from Plum Island. It’s all hearsay, and then Kris Newby came out with a book, last year maybe or the year before, where she interviewed Willie Burgdorfer, seems to suggest that ticks were being weaponized.

                                It’s hearsay. Maybe it was, maybe it wasn’t. At the end of the day, at this point it doesn’t matter. For people who have been infected, that’s what we have to deal with, so we don’t really know. There’s no concrete evidence that that’s a fact at all. She took some of Willie Burdorfer’s words and I think twisted it a little bit to make it sound like it was fact. Look, we know our government does things to weaponize viruses and bacteria. I’m not sure the benefit of weaponizing a tick. Again, that’s not my area of expertise, but to date, we have yet to really see any hard evidence that that’s true, unfortunately.

Dr. Weitz:            Which PEMF device do you use?

Dr. Ingels:            We have one from a company called Lenyosys. They’re based out of Ford Lauderdale, Florida. There’s a lot of good companies. There is another company based out here in Southern California. If you guys are interested, off the top of my head I forget the name of the company, but if you message me I’ll send you their information, a contact with their rep.

Dr. Weitz:            So, is the type of PEMF device you have the one where you lay on a mat, or is it the coils that you put on-

Dr. Ingels:            Yeah, so the one that we have, there is a big mat that you put behind your back. We do it in a recliner chair, and then depending on the protocol we’re using, there’s different leads that’s you connect to their wrists, their chest, their ankles, and so each protocol tells us where you need to connect each lead. What that one is doing is it’s basically getting the feedback through the skin during the protocol, so that one is a little bit different. Some of the coils, you put around your body or on your body. Yeah, so there’s a lot of different variations of PMF devices. Talk with different reps and again, the price ranges are enormous. I had been talking with Lenyosys for years before we actually bought our machine.

                                We bought their professional machine. It’s called the Cellcom. It’s $18,000. A lot of these good ones are about that price range, and then we charge, I think, $75 a session when people come in. Because it’s a set it and forget it. Once you get them set up, you set it and then you walk out of the room. You don’t have to stay in there with them, so our tech, our MA sets them up and then leaves.

Dr. Weitz:            And what’s the main benefit that patients notice?

Dr. Ingels:            With the PMF? Well, it depends what their primary symptoms are. Sometimes it’s improved energy, better mental clarity, better sleep, less anxiety, they feel less stressed. We put an adrenal protocol in all of our Lyme patients, because they’re all stressed. They’re sick, they don’t feel well, and yeah, sometimes circulation. I had a woman who came in, she was a new patients, she came in in a wheelchair. She could walk, but it was very hard for her. She did one session of PMF for about an hour and a half, and she stood from the table, she pushed her wheelchair out. She didn’t get in it. She’s like no, I’m fine, and then she walked out. I’m like, oh, well that was amazing for one session.  So, that’s my N of one, and the asterisk, the result is not typical, but again, for people who are sensitive, that may be enough.

Dr. Weitz:            So, you use your Lyme protocol to try to treat the Lyme. When do you start looking at things like heavy metals and mold and some of these other things? Is that something you tend to look at once the original protocol is not getting the results you want, or is it based on history, or …?

Dr. Ingels:            Well, in reality, we’re talking about Lyme disease. In clinical practice, we’re always looking at everything. If I have someone who, based on their history, has occupational exposure, I may test for heavy metals at the same time. If I know that they’ve been in a mold-damaged building or I’m suspicious, I’ll test them for mycotoxins. We’ll do mold allergy testing. It’s not like we’re only looking at Lyme. We’re looking at the whole person, so I’m doing all this simultaneously.

Dr. Weitz:            But let’s say you find mold and mycotoxins or Lyme and heavy metals, do you treat one and then the other? Is there a certain order? Do you treat them all at the same time?

Dr. Ingels:            I treat simultaneously. If they’re both problems for patients, I have heard other practitioners say, well you have to treat the mold before you treat the Lyme. That makes no biological sense. It’s never the way that I practice. I treat them simultaneously and I find that works perfectly fine. If we’re giving people glutathione to mobilize, which his good for their nervous system and Lyme anyway, and then we’re still using a binder to help pull out mycotoxins, it’s perfectly fine to do in conjunction with a Lyme treatment.  It gets to be kind of a pain, because sometimes people are taking more stuff than I would prefer, but I don’t think it’s fair to patients to make them wait if they’ve got a problem that you’re not specifically addressing. My approach is really just to try and cover as many bases without overwhelming them.

Dr. Weitz:            And how often do you have to work on gut health?

Dr. Ingels:            Always. Yeah, I mean, gut health is an ongoing thing. My feeling is, depending on the nature of what their gut was prior to us working together, I want them to have one to two healthy bowel movements a day, no indigestive food, blood, mucus, easy to pass, they’re not straining. So, if we can get to that point, then I kind of feel like our work with the gut is good. And at that point, they’re maintaining it through their diet and lifestyle. They’re eating good nutrient-dense foods. They’re getting good sleep to promote better peristalsis. They move their body. So, as long as they can maintain it with their lifestyle, then I don’t think we have to keep giving them tons of stuff to keep healing the gut.

Dr. Weitz:            And since Lyme is a chronic disease, do you find that after six months or a year, patients need refreshers or is there sometimes maintenance dose of herbs that people take long-term?

Dr. Ingels:            Well, not unless they’re having symptoms again. Now, I’ve had plenty of patients that get to a point where they’re pretty much symptom-free, they’re doing great, and then some big stressor hits their life, whether it’s a death of a family member, a divorce, whatever it is, and then we’ll see relapse of symptoms. So, I think stress is that one trigger for a lot of Lyme patients that can make them slide back very quickly, even if they’ve been doing well for a very long time.    The patients I’ve seen who really take to task their ability to maintain their diet and lifestyle, even when those stressful events happen, they are less prone to the effects of it. The people who let themselves go a little bit and get kind of lacks on that stuff, are more prone to it. So, yeah, my goal is to get people to the point where they’re functioning at a high level and hopefully symptom-free. It’s challenging, but it does happen. I also tell my Lyme patients, “Don’t ever go on social media.” It’s the worst place for a Lyme patient. Especially these Facebook groups that are Lyme groups. They’re allowed to come to mine, because I monitor it, and if there’s stuff that’s really negative or really misinformed, I either comment on it or I just flat out delete it. So, I think people need to be very wary, because they’re getting so much information off the internet and Facebook, and in the Lyme world, there’s a lot of misleading information.

Dr. Weitz:            Now, it looks like you find a protocol of herbs and then keep the patients on that for quite a period of time, but it’s kind of a naturopathic principle that I hear a lot of practitioners talk about, and I’ve gone back and forth on this myself, but is that, you need to constantly rotate the herbs, because otherwise you stop getting response if you continue to use the same herb?

Dr. Ingels:            Yeah, and as I mentioned, that I’ve never really seen. The reason for me to change a protocol is it’s just not working, or if someone’s having a side effect. They’re just not tolerating it well. But as I said, I give it that two month mark. Again, we’re trying to find what works best for each patient, and that’s a function of what they tolerate, and that’s, of course, factors of their genetics, how well their liver detoxifies, all these other external factors.

                                So, it’s a constant fine-tuning of whatever. We need a place to start, and once we start on that path, as I said, with herbs, we give it two months to give it its full time to really see how it works. Because sometimes, as I said, people will start the first month, there’s not a lot of progress, and people get very discouraged, and then they get to week five, week six and then they turn a corner. I don’t want to keep switching so quick that we can’t say that it really didn’t work. We may not have given enough time, but I kind of feel like I have a good sense of how long each thing should take to get the kind of results we want to see, and if we’re not seeing that, we need to change.

                                What makes me crazy is when I see practitioners that start people on a protocol, they’re not six months into it, there’s no improvement at all, and they want to keep waiting for the corner to turn. At that point, it ain’t going to happen. Give yourself a reasonable timeframe. Make sure you’re clear with your patients that this is what I expect, and if we don’t see the kind of improvement we’d like to see, then we’ll switch gears.

Dr. Weitz:            Is there part of your protocol that’s particularly designed to strengthen immune function or specific supplements that are out there that are specifically to strengthen parts of the immune system?

Dr. Ingels:            Yeah, and some of that is accomplished through the herbs, but I still, it’s really patient-specific. Most of our Lyme patients are Vitamin D deficient, so most of my patients are getting Vitamin D as supplements, and of course, encouraged to be out in the sun. There’s a lot of them taking Vitamin C, some of them take Vitamin A. A lot of them take zinc, so yeah, we’re still doing a lot of things nutritionally to help support their immune system. So, yeah.

Dr. Weitz:            Do you use things like colostrum or bovine serum?

Dr. Ingels:            Yeah, I don’t really use a lot of colostrum, for no really particular reason. It’s just something I’ve never really used in my practice. I tend to use more of the nutrients for those things. Alan Gaby was my nutrition teacher when I was a med student, and he literally wrote the textbook on nutritional medicine, so mine tends to be probably more nutrition-oriented.

Dr. Weitz:            Right. Somebody asked, do we need to retest to know that we successfully are-[crosstalk 01:17:52]

Dr. Ingels:            That is a great question. I don’t know who asked it, but thank you for asking that. No, don’t ever retest them again. Honestly, and this is why, I’m not being facetious. The problem is, we know from the research that Lyme antibodies can stay elevated for 20 years after you’ve treated someone, and it will not change your treatment. And what it’s going to do is it’s going to make you and your patient crazy.   I used to test every couple of months, and we’d see antibody levels go up and down, even if the patient was improving or not improving. So, you always feel like you’re chasing these antibodies. The likelihood of getting someone completely antibody free, it’s not zero, but it’s pretty close to it. They will probably have IGG antibodies their whole life and they will come, potentially, in and out of being IGM positive.    I was exposed 18 years ago. I actually did my Lyme test, just for fun, about a month ago, and it looks like I have acute Lyme disease.

Dr. Weitz:            Wow.

Dr. Ingels:            So, don’t use it as a marker. Unfortunately, there’s not a single, reliable blood marker that we can use to tell whether somebody is better or not. Now, if you do your standard chemistries, someone did have a high CRP, maybe we will see it come down. But outside of that, CD57, a lot of doctors like to tout it as being a reliable marker for Lyme. It’s not. And I have yet to see a single person that ever had their CD57 checked before they had Lyme. So, they come in and say, [inaudible 01:19:12], you’ve got chronic Lyme because you have a low CD57. So, yeah, I mean I have not found a single marker that we can reliably use to monitor people’s progress.  This is the slippery part of managing Lyme patients, is that you’ve just got to go with their symptoms. I think having them take that questionnaire periodically is a good way to see how they’re progressing. In my book, I have an abbreviated version of the MSIDS questionnaire. If people want, you can photocopy it if you like and hand it out to your patients, but that’s a really easy way to monitor in between, without doing more complicated testing. Just where are you at?

                                And it’s good for patients too, because they live with themselves. It’s like watching grass grow sometimes. Day to day, they don’t necessarily see the progress, but over the course of weeks and months, you start asking about, well what about your neuropathy? “Oh yeah, I forgot I had that. Oh yeah, I guess that’s gone, because I still have joint pain.”   So, it’s a good way to keep tabs, and it’s also for documentation standpoint. It’s good to have them fill out that questionnaire periodically and just put in your chart as a way of monitoring their progress.

Dr. Weitz:            Is that questionnaire in place of an MSQ or you use an MSQ as well?

Dr. Ingels:            No, it’s different than the MSQ.

Dr. Weitz:            Okay. Couple people asked about Rife, and somebody asked about Magnawave.

Dr. Ingels:            I don’t know what Magnawave is. I think the Magnawave, correct me , I think it’s a thing you put on your wrist. I think that’s what it is. You can chime in if that’s what it is.  

                                Rife, I’ve had patients who have used Rife, who have actually reported they feel a lot better. I had one patient I worked with for a long time in New York, and she got marginally better, but not 100 percent. And then she kind of disappeared from my practice, and she popped up in California five years later. And when I first saw her, she was very feeble, she walked with a cane, very disabled. And she walks in next time, no cane, strong, I didn’t even recognize her. And I said, “Well what did you do?” And she said, “Well I stopped doing everything and I did Rife every day for two years.”

Dr. Weitz:            Wow.

Dr. Ingels:            So, again, N of one. Take it for what it’s worth. I have several other patients around here in Southern California who have Rife machines. Again, I think it’s a tool. I don’t think I would rely completely on Rife, but it’s another tool. I think the concept behind it makes sense. The whole thing is you’re putting a frequency in the body to disrupt the organism, much like an opera singer breaking a glass with their voice. It’s the same kind of concept. There’s a practitioner here in Orange County who has been doing Rife for 40 years very successfully.  So, again, it’s not the first thing I go for, but if you’ve got patients asking about it, if they’re interested, I don’t see really a lot of harm to it, and you can buy some of these Rife machines for under $1,000. They’re not super expensive. They’ve just got to learn how to dial in the right frequency.  The FDA doesn’t like it at all. They think it’s nonsense, but I never argue when people tell me they do something and they get better. And I’ve had enough people over a 21-year career telling me that they did it and they felt better, and I’ve rarely ever had someone tell me that they tried it and it made them worse.

Dr. Weitz:            Somebody asked about CellCore, it’s another line-

Dr. Ingels:            Yeah, it’s another company. I’ve not used their products, in particular, but if you look at the ingredients, again, there’s a lot of similar concepts behind the products in there. Again, I don’t have any experience using their particular products. I’ve got about eight other companies I work with and they all work well, so I’ve never had to deviate to try something new. But yeah, if you’ve used it and it works, then I think they’re fine.

Dr. Weitz:            Okay. So, I think that’s a wrap.

Dr. Ingels:            That’s a wrap. Well, thank you guys very much for joining us tonight, and as I said, if you guys are interested in getting a copy of the slides, just e-mail me and I’ll be happy to send those to you. Absolutely.

Dr. Weitz:            And if we want to contact you, what’s your website?

Dr. Ingels:            All that is on the last slide. Well, my website is just DarinIngelsnd.com. And all of my information is there if you’re interested.

Dr. Weitz:            Okay. And your book is available through Barnes and Noble and Amazon.

Dr. Ingels:            The book, Amazon, Barnes and Noble, not that you can go anywhere to buy a book anymore.

Dr. Weitz:            Thank you Darin.

Dr. Ingels:            All right. Great. Thanks Ben.

 

 

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Lipoprotein (a) with Dr. Joel Kahn: Rational Wellness Podcast 166

Dr. Joel Kahn speaks about Lipoprotein (a) with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

4:18  Lipoprotein (a) is a particular type of cholesterol particle that can be measured on a blood test.  We know that only 50% of those people who have a heart attack have elevated conventional cholesterol levels, so there must be some other risk factors and elevated levels of Lipoprotein (a) is one reason in some of those cases.  Lipoprotein (a) has at least three dangerous properties: 1. It is called the sticky cholesterol because it promotes blood clotting. 2. Lipoprotein (a) causes atherosclerosis and it may be found in the plaque that closes your carotid artery, your heart arteries, your sexual organs or your kidney arteries. 3. Lipoprotein (a) causes inflammation. All three of these properties promote heart disease and Lipoprotein (a) is found in one out of every four Americans.  A celebrity case is Bob Harper, the trainer from The Biggest Loser television show, who was in tremendous shape and yet suffered a major heart attack. It turns out that Lipoprotein (a) was his main risk factor.  In fact, elevated levels of lipoprotein (a) increases the risk for coronary artery disease, heart attack, stroke, thickening of the aortic valve, and even heart failure.  If you have elevated lipoprotein (a), you are 2 to 4 times more likely to have a stroke, heart attack, or scarring of the aortic valve. It causes inflammation and foam cells and plaque.

12:04  Since we are in the midst of the COVID-19 pandemic, having elevated levels of Lipoprotein (a) is liable to increase the likelihood of a more severe case if you get infected.  It would be interesting to know if actor Nick Cordero, who had severe blood clotting and who died from COVID-19, had elevated Lipoprotein (a).

13:31  The clotting associated with Lipoprotein (a) seems to be an evolutionary disadvantage, so why would it be there?  There must be some evolutionary advantage for it to be present in so many people, which was hypothesized by the late, great Dr. Linus Pauling.  It turns out that 40 million years ago we developed the ability to produce Lipoprotein (a) at about the same time we lost the ability to make vitamin C.  Most animals can make vitamin C, except humans. Perhaps we were eating so many leafy greens and fruits that we just didn’t need that enzyme to make vitamin C. If you are deficient of vitamin C, you can develop scurvy.  And you’re going to bleed in your skin and your gums because your collagen and your tissues are super weak, including your arteries. Well, it turns out that lipoprotein (a) tries to prevent breaking down clots. So if you had weak arteries 40 million years ago from scurvy or something close to scurvy, it might be an advantage to have lipoprotein (a) when you have a baby or when you got cut chasing a saber tooth tiger because this would keep you from bleeding to death.  Lipoprotein (a) is considered elevated when it is over 30 mg/dL, though some labs measure it in nm/L where the normal range is less than 75.

18:57  If a patient has elevated Lipoprotein (a), you should listen to their heart with a stethoscope to hear if there is a murmur from the aortic valve.  You might want to get a heart calcium CT scan (Coronary Calcium Scan) to see if there is any calcified plaque in their cardiac arteries.

22:55  What can you do if you have an elevated Lp(a)?  For one thing, statin medications do not lower Lp(a) and they may even raise it.  CoQ10 and ground flaxseed can both help to lower Lp(a) 5-10%.  L-carnitine might drop Lipoprotein (a) 20-25%. (Impact of L-carnitine on plasma lipoprotein (a): A systemic review and meta-analysis of randomized controlled trials.)  If a woman goes on hormone replacement therapy after menopause, that can lower Lipoprotein (a). The most significant supplement is Niacin, vitamin B3, which can lower Lipoprotein (a)  by 20-80%.  Niacin will lower overall LDL cholesterol, raise HDL, and also lower triglycerides.  The downsides are the patient may get flushing. It could elevate blood sugar.  It could raise liver enzymes. It could increase risk of gout. The recommended dosage is to start with 500 mg twice per day and you can slowly up the levels if needed, up to 3,000 mg per day.  But these patients should be monitored carefully.  If you take the niacin with applesauce, it will lower the flushing due to the quercetin in the apples.

26:27  The average Primary Care Physician or Cardiologist is often skeptical of using niacin because of two questionable studies that showed no benefit with niacin. The AIM-HIGH Study tried to raise HDL in patients with almost normal lipids and another study that used an odd combination of niacin and a drug that blocked the flushing, so it did not test niacin alone.  Unfortunately, since niacin is an over the counter, inexpensive vitamin, nobody is going to come up with $80 million to do a three year study looking at its effect on the carotid arteries.  So the large, long term studies with it have not been done.

29:17  There’s a study that showed that a whole food, plant based diet can modestly lower Lipoprotein (a)  (Consumption of a defined, plant‐based diet reduces lipoprotein(a), inflammation, and other atherogenic lipoproteins and particles within 4 weeksDrinking coffee can also slightly lower Lipoprotein (a) levels.  A small company called Akcea Therapeutics has developed something called antisense oligonucleotide, which can drop Lipoprotein (a) by about 80% with a once per week injection. One study in patients with existing heart disease was published in the beginning of 2020 and a five year study will be started soon. (Lipoprotein (a) reduction in persons with cardiovascular disease.)  The injectible cholesterol drug Rapatha does help to lower Lipoprotein (a) but at a cost of $6000 per year. There is also a treatment called lipopheresis, where your blood is removed and filtered and then placed back after about 3 hours and this must be repeated every few weeks.  It definitely removes Lipoprotein (a) and it decreases your risk of heart attack, stroke, and all the important measures.

33:27  Dr. Linus Pauling hypothesized that since Lipoprotein (a) helps your body when your collagen is deficient, then by supplementing with vitamin C and Lysine, the two essential components to make strong collagen, then Lipoprotein (a) would be neutralized. This was shown in a mouse study conducted by his protege, Dr. Matthias Rath published in the American Journal of Cardiovascular Disease in 2015:  Hypoascorbemia induces atherosclerosis and vascular deposition of lipoprotein(a) in transgenic miceSupplementing with 2-5000 mg of vitamin C per day along with 1500 mg per day of lysine will keep the Lipoprotein (a) from causing harm to your arteries, though the level of Lipoprotein (a) will not go down and there is really no way presently to know if this strategy is working.

35:07  Low dose aspirin or natural anti-clotting agents like Nattokinase or Lumbrokinase might be beneficial due to the increased tendency for clotting that is associated with elevated levels of Lipoprotein (a).

 



 

Dr. Joel Kahn is an Integrative Cardiologist, internationally known speaker, and best selling author.  He has a weekly podcast, Heart Doc VIP and he’s written 7 books, including Your Whole Heart Solution, Dead Execs Don’t Get Bonuses, The No BS Diet, The Plant Based Solution, and Lipoprotein (a): The Heart’s Quiet Killer. Dr. Kahn’s goal is to prevent heart disease by promoting a plant based diet, exercise, and a healthy lifestyle. His website is  DrJoelKahn.com   

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.

 



 

Podcast Transcript

Dr. Weitz:            Hey, This is Dr. Ben Weitz host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me. And let’s jump into the podcast. Hello Rational Wellness Podcasters, Dr. Ben Weitz here. Thank you so much for joining me again today. For those of you who enjoy listening to the podcast, please go to Apple Podcasts, give us the ratings and review. If you’d like to see a video version, go to my YouTube page. And if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript. So today our topic is lipoprotein(a) with Dr. Joel Kahn. So we are going to talk with integrative cardiologist Dr. Joel Khan, about a very specialized factor that increases your risk of heart disease. This is a specialized lipid particle that is not often measured but, can be seen on a specific blood test.

                                We’ve all heard about cholesterol as a major risk factor for heart disease. Most of us have also heard about LDL, the so called bad cholesterol, and HDL the so called good cholesterol. And you may have even heard about triglycerides, but you likely have not heard about this specific particle. And it’s unlikely that your primary medical doctor or cardiologist has even measured it. The conventional medical way to think about lipoprotein (a) is that it’s determined by genetics and there’s no prescription drug that can lower it.  So what’s the point of measuring it.  At least that’s what I’ve been told by some primary care doctors and conventional cardiologists but, from a functional medicine perspective, from an integrative perspective, there are some natural strategies that can lower lipoprotein(a). And it’s very important to know if you have this respect, we’ve known for years that a sizable percentage of patients who have heart attacks actually have normal cholesterol.  So there must be some other factors that account for why they have this heart attack. And lipoprotein (a) is one such factor.  There’s a famous example that’s been in the news a few years ago.  One of the trainers from The Biggest Loser, Bob Harper, who was in incredible shape, and yet he had a massive heart attack and almost died.  And he had essentially normal risk factors, normal cholesterol but, he had very high LP little a lipoprotein levels.  And so elevated levels of lipoprotein (a) increases the risk for coronary artery disease, heart attack, stroke, thickening of the aortic valve and even heart failure.

                                Dr. Joel Kahn is an integrative holistic cardiologist, internationally known speaker and best selling author. He has a very popular weekly podcast Heart Doc VIP, that I listen to regularly. And he’s written six books. At least six including; Your Whole Heart Solution, Dead Execs Don’t Get Bonuses, The No B.S, The Plant-Based Solution, Young at Heart by Design. And his newest book, an Amazon best seller, Lipoprotein(a) The Heart’s Quiet Killer. Dr. Kahn, thank you so much for joining me today.

Dr. Kahn:             You need an ice cold water for all that incredible, kind both very appropriate introduction. And then the kind words. I was at a podcast recently as a guest and I did write a book called Dead Execs Don’t Get Bonuses, how to survive your career without the arc. I was introduced as the author of Dead Exes Don’t Get Bonuses which, if I write a divorce book would also be a… So, you nailed it buddy. 

Dr. Weitz:            I remember the golfer, John Daley wrote a song called All My Exes Have Rolexes.

Dr. Kahn:             That’s very funny, a little play on Willie Nelson there.

Dr. Weitz:            So what is lipoprotein (a)?

Dr. Kahn:             And this is authentically. I’m so happy to share this with your audience. Nothing about me, it’s about their health, your health, our ability to make a dent in the number one killer of men and women in the United States. That rolls off your tongue; number one killer of men and women. That means 39 year olds die of heart attacks. And 44 year olds have bypassed and 51 year olds have stroke. And we’re also going to talk about a valve in the heart called the aortic valve, which doesn’t get as much press but, creates a couple 100,000 procedures that some people make it through ad some people have complications. So it’s just what you said. We learned way back in the 1960s. Why would I go there? If you smoke, do you have diabetes? Do you have high blood pressure? Do you have a high cholesterol?  Do you have a mother, father, sister, brother with an early heart attack, early death from heart disease? These so-called Framingham risk factors. Your doctor sits down with you and might pull out a little app on the phone, on their laptop. “Hey, you’re in really good shape. Your numbers, your history, you’re at low risk.” That does help us define a one-to-one patient. Are you a really high risk patient or low risk patient?  Do you need medications?  Do you need lifestyle?  If you do your best job at that, it’s still missing about 40% of the people that go on to have heart attack, strokes, drop dead or in this case also aortic valve surgery. That is called residual risk. Just as you said, we should care about identifying 50% to 60% of the explanation. You’re a root cause guy, I’m a root cause guy.

                                Your cholesterol, your blood pressure, your blood sugars up. It’s not just a prescription.  It’s diet, fitness, stress environment, chronic infection, toxicity and all the rest. We should be searching why don’t we reach more than 50%, 60% of explaining heart disease.  Lo and behold, 57 years ago, 1963, a Scandinavian researcher found a new cholesterol particle in the blood. And now there’s several thousand research papers. And we know which gene and we know what RNA. We’ve characterized it completely. It got the name, It’s not a good name. That’s the biggest problem. It’s like the Pinto. If you go back long enough for a Ford car, it never was a good name; name a car after a bean. This was named Lipoprotein-little-a. Some people call it the sticky cholesterol. Can you imagine if all the research called it the sticky cholesterol? That has Madison Avenue attraction, because we just got to get it unstuck.  But, what we’ve learned, I’ll be brief, is you go to your doctor, you have your annual physical. You go to a wellness fair. You go to a corporate wellness fair at your business. You get your finger poked or a full blood draw. And your doctor says cholesterol, HDL, LDL, triglycerides, blood sugar, blood pressure, all those things. They’re great to know but, they did not measure this cholesterol particle that was found 57 years ago. Although it is simply a blood test, you can’t do it as far as I know from a finger prick.  Any lab; Quest lab, LabCorp, any hospital in LA, anywhere for about $30. So what have we learned? We have learned that this cholesterol particle does three things that are just awful.  It causes atherosclerosis. It actually may be found in the plaque that closes your carotid artery, your heart artery, your sexual organs, your kidney arteries, leg arteries. It may be found in the plaque more than the one we talked about a lot, LDL cholesterol. There’s a reason, I’ll tell you in a minute. So it causes plaque. That’s bad. Plaque causes people to lose quality of life and quantity. Number two, it causes inflammation. It has some really unusual attachments called oxidized phospholipids. You teach your patients about inflammation as a root cause of many chronic diseases. This particle is pro-inflammatory. And the third thing so unique is it actually promotes clotting of the blood, is prothrombotic.  Even LDL cholesterol doesn’t do all that. Some people have said, imagine LDL cholesterol, has cholesterol in the middle, has some things called phospholipids on the outside.  And then it has, it’s called apolipoprotein B.  It’s something you can measure in the blood. I don’t want to get too technical. People say LDL is like a baseball and apolipoprotein B as the stitching holding it all together. So it can float through the blood either back to the liver on its way to tissues on its way to your arteries. Lipoprotein(a) has the LDL, then it has a little, it’s called two sulfurs, a little bridge. And then it’s got this unique tail and people say, imagine a baseball, the pitcher is throwing at you with huge spikes all over the place. God forbid you get hit by that sucker. You’re going to have a lot of damage. That’s just an analogy. But, that’s the difference between LDL, which is already a problem if you have it in excess.  Potentially, getting under your arteries, responding, it’s called the retention of the cholesterol in your arteries to drive the plaque.  And now we’ve got these spikes all over the place. So lipoprotein (a) is a nasty little beast. And this is the magic. You said the word genetic. Okay. I learned when I was a cardiology fellow in Dallas where a Nobel prize in medicine was awarded to two of my professors. When I was there about LDL cholesterol in the pathways, one in 500 people, maybe one in 250 from their parents inherit a high LDL cholesterol purely on genetic. Eat sprouts, go to the gym. Be thin, still got a cholesterol of 400 that’s genetic. It turns out this lipoprotein (a) is the new kid on the block in terms of what most people know about it. One out of every four people, not one out of every 250, or one out of every 500. That means right now how many people are listening to this very valuable podcast?

                                One out of every four, you got it. You got it. You got it. You got it. It’s a lot of people. That’s 90 million Americans and those 90 million Americans from the time they’re one years old have this triple threat particle in the blood and slowly, slowly, they might, It’s not inevitable. Like these risk factors, you can have a high cholesterol and not end up with a heart attack but, you’re at risk. You end up about two to four times more likely stroke, heart attack, valve scarring; the aortic valve gets scarred. And need heart valve procedure.  And Doctors scratch their head and say, “Bob, Sue, why did you have a heart attack? You’re numbers look so good; your lifestyle, your diet.” You know, “Mr. Jones, you just said your heart valve up. We have no idea why you developed this problem but, we’ve taken care of it.”  Well, it turns out very frequently. It’s lipoprotein-little-a that drives all this. That’s the broad picture. Would you want to know that you inherited one out of every four people? It could be one pair. You could get the double jeopardy of both parents on chromosome 6, there is a gene in one out of every four people. And there’s a whole lot of discussion, why do we have it? When did we get it? What can we do about it? But, it will become in the next five years routine. You’re hearing it now early, five years. So now there’ll be an expensive drug that the pharmaceutical industry will be sure every healthcare provider in America knows to check lipoprotein (a). They do it in Europe but, God bless America, great country, or sometimes a little slow to adapt new science, like 57 years a little slow.

Dr. Weitz:            How about adding this to the risk factors.  Here we are in the midst of the coronavirus pandemic, which causes clotting.  What’s the likelihood that somebody with elevated lipoprotein (a) if they get coronavirus is liable to have a worse prognosis?

Dr. Kahn:             You are like a visionary.  That is a theory.  There’s very few people in the country that are studying lipoprotein-little-a.  There’s not a lot.  And some of them have brought up this question.  Could it be if you’re at UCLA or you’re at USC, and you’re sick in the ICU. Like Broadway actor Nick Codero has been in the news in Los Angeles. So 39 years old, and he’s still 90 days later, clotting has taken one of his legs. And I hope that God doesn’t take his life.  Could it be since it’s one out of every four, that ICU bed, that one, that one, no clotting, clotting here. It’s been hypothesized that it could be somebody needs to draw the blood and run the numbers and see if it correlates. And tries to explain this monster problem in COVID-19 of apparently blood vessel damage and clotting which is a real deal. It’s become even more in the focus of the media to some degree, the science community to some degree. We got to get the word out and then we can play with it. Let me talk to you about the clotting for a minute, because it’s a question. Why do we have things in the blood that seem to be all a disadvantage? What is the reason?

Dr. Weitz:            Right. It’s got to be an evolutionary advantage if it’s there.

Dr. Kahn:             And so it turns out the only species on the planet that have the ability to make lipoprotein (a) in the liver. It’s not made like LDL. That is made in the liver. This is a whole different factory. Now, GM and Ford, totally different. About 40 million years ago, we may have developed the ability, one out of every four people to produce lipoprotein (a). Well, why would we do that? This is a little complex but, it’s really interesting. And it’s going to fit with your emphasis on nutrition for sure. That, also about 40 million years ago, humans lost the ability to make vitamin C and very few people know that your dog and your cat make vitamin C whatever amount they need from glucose. Actually glucose can be converted to vitamin C. Humans lost the enzyme. It’s believed maybe we were in the jungle and eating so many leafy greens and fruits and such that we just didn’t need an enzyme pathway anymore. And maybe there was an advantage that whoever lost that gene had some super power that evolutionary, favored their survival.

                                Dr. Linus Pauling, who wanted to know about prizes into some people, they immediately would say the vitamin C guy, yes, he’s passed away. But he was the vitamin C guy.  He hypothesized when we lost the ability to make vitamin C, if you have the gene for lipoprotein (a), you had an advantage.  Let me just run you through this.  If you are deficient of vitamin C, you can develop scurvy.  And you’re going to bleed in your skin and your gums because your collagen and your tissues are super weak, including your arteries. Well, it turns out lipoprotein (a) tries to prevent breaking down clots. So if you have weak arteries 40 million years ago from scurvy or something close to scurvy, might be an advantage to have lipoprotein (a) when you have a baby. When you got cut, chasing a saber tooth tiger, if that’s the right term. I haven’t said that word in a while.  It might’ve been an advantage in terms of excess bleeding by favoring clotting. It is similar to something in our body called plasminogen.  Plasminogen breaks down clots.  Here’s a competitor that interrupts that process.  Very complex idea to think about it but, it’s interesting and when you talk COVID-19 all of a sudden, it might just be the factor that’s a disadvantage by promoting clotting and not allowing breakdown of clots. Interesting theory, more traditionally it’s an issue with just clogging your arteries. And if you have carotid surgery and you take the plaque and look at it under a microscope, you can find a ton of lipoprotein-little-a structures in the plaque.  Same with if you have bypass surgery and they take out some of the tissue of the heart arteries and look at a very dense concentration. So it’s in the plaque. It’s not some window dressing. It gets under the endothelium. It gets retained. It causes inflammation and foam cells and plaque. And it does it on the heart valve too, which is really unusual. One out of every seven aortic valve surgeries in the United Sates are believed to be due to the constant from the time your one year old irritation, inflammation and a thickening of the valve from lipoprotein-little-a. So it’s just a monster to deal with clinically that we haven’t even addressed really.

Dr. Weitz:            So when you see it on a lab, what level do you consider significant? A couple of the labs that we typically use, usually say anything over 30 milligrams per deciliter. Some people say 50, I’ve heard other people say, “Well, it should be as low as possible.”

Dr. Kahn:             So it turns out, and I want to stress as again, this is just a lab test. This is $30. We’re not talking about needing to have a bone marrow biopsy to determine this. Tomorrow at your doctor you can have your blood drawn for this or at any lab. There’s two ways unfortunately like pounds and kilograms. They both describe your weight. There is a unit milligrams per deciliter, less than 30 is normal. And over 50, just an arbitrary cutoff is felt to be the higher risk group. But, that can go 50 milligrams, a hundred milligrams per deciliter, 200, 300, 400, 500. I’ve got patients who I practice that are 400, 500 plus.  Not much more than that. You’re not going to see a thousand. And again, one out of four is over 30 but, a substantial number is over 50, 60, 70, 80, I think. But, two or 3% of people are over 100. There is another unit called nanomoles per liter. Quest Lab now reports in nanomoles per liter. Other labs report… It doesn’t really matter. They’re the normal range there is less than 75 is normal. Over 125 is considered high risk. They’re pretty similar. I think pretty soon we’ll stop doing the milligrams per deciliter. But again, there’s no real issue about one more accurate than the other, or ignore one. Pay attention either way it’s measured. Simple, simple lab tests.

Dr. Weitz:            So, if a patient has an elevated LP little a, how do you work them up to see if they’re having any negative effects from it?

Dr. Kahn:             So for the past 10 years, if you do find lipoprotein-little-a mentioned in the guideline, the American Heart Association might come out with somebody about prevention, the National Lipid Association. A group that really deals with complex pharmacology and pathophysiology. They might tell you if your family history is strong for early heart attack, early stroke, early valve problems, calcified aortic valve, ask your doctor if it’s reasonable to measure the lipoprotein-little-a. Again, blood tests has been available for over a couple of decades but, not a routine test has been recommended. That’s starting to change in November 2019 pretty recently. In Europe, it’s called the European Society of Cardiology. They’re equivalent. They came out with a new guideline that said, “We not believe it’s prime time.” Everybody once, should have the level measure. If you’re normal, you don’t need it again. You don’t have the genes that are actively reducing lipoprotein-little-a. And if you’re elevated, well, it fits in the risk factor profile.

                                It may explain some of the risks that your standard approach hasn’t identified. So the workup is take out a stethoscope if you have one as a healthcare provider, make sure there’s no murmur from the aortic valve. Make sure there’s no noise. And then that [inaudible 00:20:27]. And make sure they’re not describing anything that suggests blockage like shortness of breath or chest tightness or chest pressure. Look at the other numbers; blood pressure, blood sugar, weight, waist circumference, inflammation, maybe homocysteine and the other cholesterol panel. My approach, I think it’s consistent with the general approaches. If you’re 40, 45 and you’re really a health seeking individual, and now you’ve checked your lipoprotein-little-a and it’s abnormal, you might want to get a heart calcium CT scan. You have no symptoms.

                                That’s a quick five seconds CT scan. It costs about a hundred dollars at UCLA, at Cedar Sinai, at Good Sam. Some of the best places in America where they’re done. No injection, no IV. And it takes a quick look at your heart arteries. And if it comes back really good and your blood pressure’s good and your other numbers are good, okay, you’ve got no risk factor. Eat a little better exercise a little more and do the whole program of heart disease prevention with maybe a little more incentive to really do it well because you identified it. If you knew you were prone to kidney cancer, if you knew you’re prone to breast cancer. There’s some measures, you might not be going to Arby’s and McDonald’s every day.

                                So lipoprotein (a) to me is a good platform just to get people on a good place. But, if there is known disease, “Doc, I had a stent last year and nobody checked my lipoprotein-little-a. And now you’re telling me it’s 300 milligrams per deciliter.” Or if they’re silent but, by calcium scoring or a murmur, you identify there’s a disease process that isn’t yet overt. There’s room to consider what do you do about it? And before we dive into that, you always treat all the other stuff.  You want your blood pressure to be at its best, use all the approaches, standard and natural from yoga to acupuncture, to breathing, to sleep. And the whole thing that your audience knows so well from your good work. Now you want your cholesterol to be in range and do it with diet, you watch your blood sugar. But, do you specifically address the lipoprotein (a)? And in 2020, there’s a divergence of opinion. And to tell you the standard opinion is, use it as a risk factor but, there’s no way to deal with it just as you said at the beginning of the podcast, I disagree with that but, that’s the standard approach.

Dr. Weitz:            So, why don’t we start with the nutritional supplement approach?

Dr. Kahn:             Sure. And thank you. Let me just say what doesn’t work right off the table; Lipitor Zocor, Crestor, the statins. What’s your doctor’s going to ask you to consider taking if your cholesterol is very high and certainly if you’ve had an event like a stent, they do not lower… Again, the production of lipoprotein (a) in the liver is totally different than LDL cholesterol. Your LDL cholesterol will fall with a statin almost always. But, it actually doesn’t address lipoprotein (a) and it’s sometimes raises it. That’s the disconcerting part. “Doc, my lipoprotein (a) was 180 milligrams per deciliter. We went on Crestor and you just told me it’s up to 207.” I’ve seen that dozens of times. Now, some would say don’t reject it. The reason you started Crestor was to lower the LDL, lower the C-reactive protein, be consistent with a lot of studies in somebody with known heart disease. But, don’t expect your lipoprotein (a) to go down.  That’s the main prescription drug. Back to natural. There’s been an adequate number of studies to look at some issues, Coenzyme Q10, a great heart supplement, it goes down a little; ground flaxseed, might go down a little [inaudible 00:24:17], 5%, 10%, nothing substantial and nothing in the range that’s really felt to really move the needle a lot in terms of better outcome. There are no large long term studies. There is the supplement your well aware of, L-Carnitine. That isn’t a lot of energy drinks. Even it’s in Red Bull or Monster but, that’s not where I’d prefer a patient to be getting their L-Carnitine. It’s obviously comes from red meat. So the carni of carnitine but, you can take a capsule or a powder with L-Carnitine. You might drop your lipoprotein(a) 20, 25%. A little more substantial. If a woman’s perimenopausal and chooses to go on hormone replacement therapy, lipoprotein(a) tends to go up a little at menopause and it’ll come back down maybe substantially with hormone replacement therapy if they find a practitioner that does that.

                                The big one though is niacin. Niacin, plain old $10 a month. Get a big red hot flush face from taking vitamin B3 will lower LDL cholesterol. Nice. We’ll raise HDL cholesterol often. We think that’s good. We don’t know. Will lower triglycerides. Nice. Will lower overall cholesterol but, it actually can lower lipoprotein (a) pretty predictably and variably 20% to 80%. So you can sometimes, if you choose to use niacin, you got to tell a patient about the flushing, about rash, about watching your blood sugar, your blood enzymes, gout. But, it’s been around for 50, 60 years. You can buy a big bottle of good natural niacin for $30 to last three, four, five months.  So it’s not been studied though. I mean the big drawback from the academics, like if you go 90 miles south where you live, and UCSD has the leading academic physician. And he won’t publicly blast out use niacin, because where’s the thousand patient 10 year study that identifies you just drop that person’s risk of heart attack or stroke. Privately, and in certain publications he uses niacin too, because we know it’s on a limited range of therapeutics. It works. And now there’s new stuff. We’ll talk about that, one second.

Dr. Weitz:            Yeah. The average primary care doctor who doesn’t really study this stuff a lot, who’s not really up on supplements. The few things they’ve seen about niacin is, “Oh, niacin doesn’t work. It might even be harmful, forget it.” They basically have a negative view of niacin but, that’s because of a couple of studies that weren’t really valid, right?

Dr. Kahn:             Yeah. The idea of people that had an almost normal lipids trying to raise the HDL, called the AIM-HIGH Study and another study with a very odd form of niacin that had a combination drug. So, for many years we used just plain old niacin or prescription niacin and saw good results in the blood work and had reason to believe we saw some benefits in the arteries but, never has there been a substantial study; a hundred people, 500 people. So it’s untested. Problem is that  niacin’s cheap and niacin’s generic. Who’s going to come up with $80 million to do a three years study looking at carotid arteries. It’s a hot potato. The exciting news but, it’s not…

Dr. Weitz:            By the way, what dosage do you find you need with niacin? Do you get results with 500, how much do you have to take?

Dr. Kahn:             I will start a person and I’ll say the name of a brand. It’s not my company. I use a over the gutter brand called Endur-Acin, E-N-D-U-R-A-C-I-N. It’s been used for decades. It’s inexpensive and I will start 500 twice a day, warning the patient about flushes, rash, take niacin with applesauce so you don’t get as much rash, or with a nonfat yogurt. Typically, they don’t complain that much but, I will try and work them up based on labs to 1500, maybe 500 or more than a thousand a night, off into a thousand out of a thousand. You can go higher: 3000, 4,000 but, you really got to watch that patient. The flush isn’t bad. I take niacin a lot just for the fun of it.

Dr. Weitz:            Yeah the apple contains quercetin and that’s what we need to help counter the flush. So you might be taking quercetin now as part of your immunity programs, So you can probably…

Dr. Kahn:             Exactly. That’s a study Merck should have done. They did niacin with a noble prostaglandin inhibitor. And the study gave niacin a bad name. You should have done the niacin with applesauce study. And we could have probably been much more optimistic. Now, just recently, I don’t know, five years, there’s been a growing emphasis. We need a pharmacologic approach. I will say exercise, please. If your lipoprotein (a) is found to be high, exercise. It’ll improve all your other risk factors. It doesn’t do much to move lipoprotein (a) though. You can drop your cholesterol substantially with exercise and weight loss. There’s one distressing study, if you lose weight, your lipoprotein (a)  goes up. Oh my God but, exercise anyways. There’s a 2018 study that a whole food plant diet healthy, bright colored may lower lipoprotein (a) but, it was a modest amount. It’s not the kind we expect with…

Dr. Weitz:            In your book you mentioned coffee.

Dr. Kahn:             Yeah, coffee a little bit. It could lower it. So there’s a lot of reasons to drink coffee rather than Coca Cola or Mountain Dew.

Dr. Weitz:            That can be the new marketing campaign for Starbucks.

Dr. Kahn:             That’s right. Coffee for your lipoprotein(a). We may even put niacin in coffee beans and we could corner the market. But, a little company called Akcea came up with something called antisense oligonucleotide, ASO. This is not a word we say too often but, as the gene for lipoprotein(a) produces RNA, this thing binds and mimics what should happen normally to stop. So you don’t make lipoprotein (a) it’s an antisense oligonucleotide. It’s actually an injectable once a week product.  And about 280 people with high lipoprotein (a) and some sort of vascular disease, completed a study published late 2019, very little side effect injecting this once a week.  And about an 80% drop in lipoprotein (a). The company, I’m not sure if it was bought or merged with Novartis. One of the giant pharmaceutical houses. And so this spring there was supposed to be a 7,600 patient study moving forward now; placebo, the same drug, high lipoprotein(a), vascular disease. Because you can’t get FDA approval nowadays.  Dropping lipoprotein(a) doesn’t get you FDA approval. You got to show heart attack, stroke, safety measures and all the rest. With COVID-19, I’m sure recruitment and follow up has been very, very difficult. So we can only hope they can get that study really quickly going and enrolled. So by 2024, that was the original estimate, we’ll get some data. I’ll say two others actually to be thorough because your audience is sophisticated. There is a very bizarre therapy. You inherited the other kind of genetic cholesterol. Your cholesterol was 700 and at 32 years old, you had a stent.  There are people out there, one in 250, one in 500.  And it may be very difficult to get your cholesterol down with lipitor and other drugs in the market.  There’s a procedure that’s like dialysis. It’s called lipopheresis.  They stick a needle in your vein.  They take blood out for two, three hours.  It filters but, the filter doesn’t get rid of kidney products. The filter gets rid of cholesterol. Your plasma goes back in your body. Three hours later, you got a bandaid, you can go home and two weeks later you come back and do it again. So your LDL cholesterol, if you have that problem can fall 95% in three hours and it’ll slowly go back up and do it again.  That has been shown in the United States, in Europe and it’s insurance covered for the right person to decrease your risk of heart attack, stroke, and all the important measures.   It’s also approved for lipoprotein(a), very few places doing, Germany’s a hot hotbed. They got thousands of people with cholesterol disorders that use that approach. And you might find that Cleveland Clinic and perhaps UCLA or Cedar Sinai, you’ll find one or two programs in the state if they’re a densely populated state. Lastly, there’s an injectable cholesterol drug that is FDA approved called Repatha. And probably it turns out they’re very powerful lowering LDL cholesterol but, they modestly lower lipoprotein-little-a. They’re just not approved for that. So if I submit to insurance, my patient Charlie needs to get his Lp(a) down and I want to use… That’s the other name for lipoprotein(a), Lp(a). I want to use Repatha at $6,000 a year. They’ll tell me that’s not appropriate. We can only use it to treat LDL cholesterol. So, you work around that and help to get a patient on that if they meet the criteria.

Dr. Weitz:            And then there’s the Linus Pauling thing with vitamin C.

Dr. Kahn:             Oh, so good you mentioned that, which goes back to what we said 40 million years ago. We’re dependent on vitamin C exogenously. That’s called food usually because our collagen production is dependent on intake of vitamin C. So he hypothesized, he wrote an article in 1990 and then he died in 1994. He was like 95 years old. So he’s 91 years old writing original research. I think there’s lipoprotein(a), vitamin C thing is real. And if people would just take in more vitamin C and lysine. The two essential components to make strong collagen, and then this lipoprotein(a) thing would be neutralized. It would circulate in the blood but, it wouldn’t be able to actually harm arteries. That was a theory till 2015, when his protege a guy named Matthias Rath, did a mouse study. And the mouse study confirmed the theory. There’s still no human data.  What’s the bottom line. I have a lot of patients with high lipoprotein(a). What’s the harm to take in two, three, four or five grams of vitamin C powder or capsules. Certainly to eat the foods rich in vitamin C.  And what’s the harm to add 1500 milligrams a day of lysine as a powder or capsule.  But, you won’t see the blood level necessarily go down.  There really isn’t a way of objectively to monitor it. So I have to tell my patients it’s faith based therapy until the definitive study is done that shows we blocked lipoprotein(a) from being the sticky cholesterol. That’s the idea and makes it not so sticky to your arteries. Cool stuff.

Dr. Weitz:            Yeah. I think you mentioned a low dose aspirin as well.

Dr. Kahn:             Well, because of the vascular risk you might argue. You could talk about Nattokinase, Lambrokinase.

Dr. Weitz:            I was just going to ask about that.

Dr. Kahn:             There has been a study suggesting in a high lipoprotein(a) patient. And certainly if you have abnormal calcium score, or if you find a center that does carotid ultrasound medial thickness. If you have plaque, you’re probably going to want to be on a 81 milligram aspirin anyways.

Dr. Weitz:            I saw an article that showed EPA from fish oil had some benefit as well.

Dr. Kahn:             These are all… That’s the problem. Other than niacin, carnitine, modest, HRT, hormone replacement, modest. CoQ10, flaxseed and Omega 3, really modest. There’s been an estimate that you really need to drop lipoprotein(a) something like 50 to 60%. It was a modeling thing to expect that you’re going to see a significant drop in event. So it’s important to get to that point. The future is some sort of gene editing and I’m not a world expert on gene editing. There’s a new company I would call Verve Therapeutics, bright people and a lot of money right now. And they just announced in an animal model that they were able to cut out and turn off an LDL cholesterol gene and a triglyceride gene and successfully dropped blood levels of those markers, provocateurs of vascular disease significantly.  Nobody’s yet got to that point to do it for the lipoprotein(a) but, with 90 million people in this country alone, somebody is going to get hot on the trail of finding out how to do that. That may be the next five to 10 years. It’s very hopeful. It raises all out of other questions. You’re a 54 year old man or woman at your doctor, and they tell you your a lipoprotein(a) is high. What do you say to your 25 year old kids? Because there’s a chance your spouse may or may not have lipoprotein(a) as a genetic inheritance. But, your kids may or may not. Should they know at age 20,25 that their smoking habit is double jeopardy and their cheeseburger habit is double jeopardy. I would argue why wouldn’t you want to be fair with the data and not scare but, educate. American Heart has something called the simple seven on, or it should be the simple eight. Do a little bit more if you’ve inherited Lipoprotein(a). It doesn’t have to be the scariest conversation in the world.

Dr. Weitz:            Yeah. Everybody thinks about heart disease for people in their fifties and sixties. But, they’ve done autopsies on 17 and 18 year olds like I think in Vietnam. And a lot of them had atherosclerosis that had already started then. So this is long term process…

Dr. Kahn:             Very slow progressive deterioration on blood vessels, that is detectable in your teens, twenties and thirties but, we just don’t have a system that encourages that. So, yeah. I would want my kids to know. I happened to have had… You really only need the blood test once and if you’re normal, you’re done. And I’m normal and my wife’s normal, so our kids not going to have a high level, assuming they’re my kids. You never can really be sure. But, if it was a different situation I would want them to know.  Just the BRCA gene, a lot of conversation about that.  And we’re getting a little better at measuring pancreatic cancer genes and other disease states.  You can tailor your life a little bit in favor of avoiding the disease.

Dr. Weitz:            Right. Great. So I think that pretty much wraps it.

Dr. Kahn:             Yeah. I’m trying to think of there’s any wow factor.

Dr. Weitz:            We talked about diet a little bit. Anything else about diet?

Dr. Kahn:             Now, there was originally a paper 20 years ago that a high… I don’t want to get into diet wars. There’s a bunch of ways to eat poorly. And there’s a bunch of ways to eat in a healthier pattern. There was a study some 20 years ago that a higher saturated fat diet may lower lipoprotein(a). It was also modest. Subsequent studies haven’t confirmed it. In fact, there’s an acute feeding study, take humans, measure their lipoprotein(a) for six hours. When you feed them a diet high specifically it’s called palmitic acid and stearic acid, the long chain saturated fatty acids find the meat in animal products. You really get a spike in lipoprotein(a). It actually has a little bit of cool studies have been done that… And this gets into why we have in our blood, if I take you to the cath lab and do an angioplasty and stenting, which is part of my history and training.   And you measure lipoprotein(a) for a few hours, it spikes up for a while and then it falls back to baseline. It has called an acute phase reactor. And the idea there is perhaps we don’t want plaque to form. That it’s fighting with plasminogen, it’s kind of reacting to this activated balance of clotting and unclotting. There are some little neat factors in some of the studies that have come up. But, I just want to emphasize again, the biggest challenge will be your listener has a annual physical scheduled next week after July 4th or after [inaudible 00:40:40] whatever it is, goes to the doctor and says, “I heard this really interesting podcast, and I want you to check my blood.” And the doctor’s going to say, “I don’t think our lab does it. I’ve never really heard about it.” Because doctors who’ve been in practice for a while are smart and wonderful and good meaning people by in large for sure.

                                But, no pharmaceutical reps coming by right now. No grand rounds lectures coming by right now. It’s in the medical literature. Anybody can just go look it up. There is a nice site, lipoproteinafoundation.org. A woman who had a heart event in her thirties. I love people that take their personal problems and turn them into a passion to help others. And the woman that’s behind Lipoprotein(a) Foundation is one of those women. It could be a man but, everyone I know who’s done it is a woman. And it’s a very informative website. It’s a little conservative. They don’t encourage niacin. They’re waiting for definitive trials. Their board of academic advisors are good academic doctors that like to see big outcomes studies. I honor that but, real people right now are challenged by their levels. And so one-on-one, you can be a little bit creative with people.

Dr. Weitz:            Right? And then we talked about exercise, right? Exercise obviously is beneficial for anything related to lipids.

Dr. Kahn:             You better believe it. And changed particle size and particle number and insulin resistance goes away. And you can’t depend on some pharmacology that might come down the road in four to five years. So you’ve got to do the hard work but, consistently we see over and over the lifestyle, the avoidance of smoking, the regular fitness, the real food diet, the emphasis on sleep, stress management, optimal weight is the pathway that has been shown recently to help prevent Alzheimer’s disease type 2 diabetes, inflammatory diseases. And it’s the heart program. I mean, body reacts, you know it; oxidative stress and inflammation. I know it can damage all the organs or if you play your cards right and do the hard work, it can avoid damaging all our organs.

Dr. Weitz:            Excellent. So how can our listeners get a hold you, find out about your book?

Dr. Kahn:             Yeah. I mean the books and all the online sellers of course it did spend March as the number one heart book on Amazon, which is always a treat because I didn’t have a whole big press team behind me. I tried to blab about it. Some, because I really want people to know about it. I’m at drjoelkahn.com, D-R-J-O-E-L-K-A-H-N.com. And I see patients and I do a lot of interviews and I have a podcast. And like you said, it was very kind of give me a shout out. I just like to educate and like you, if I’m going to educate, you got to read, you got to study, you got to learn. So it’s the best of medical practice when you’re fired up about bringing people new stuff. So you do a great job of that. And I appreciate you letting me share this time with you.

Dr. Weitz:            Absolutely. And I thank you for joining me today.

Dr. Kahn:             So what’s the other thing we learned today? Don’t wear a denim checked shirt on a [crosstalk 00:43:58]. I started with that before we went live and it looked like some kind of electric Kool-Aid, 1960s experimentation. So I feel down to a simple green shirt.

Dr. Weitz:            I was listening to one of your recent podcasts and you were talking about fish oil and some people have kind of been maligning fish oil because there was a couple of studies that maybe fish oil might lead to prostate cancer risk.

Dr. Kahn:             Right. But, nutrition science is tough. [crosstalk 00:44:36].

Dr. Weitz:            It turns out that both of those studies that were authored by [Borowski 00:44:40], both of them were based on levels of DHA and EPA in the blood. Neither study were patients given fish oil.

Dr. Kahn:             Right. That is an issue you can see on meta analysis that included people that got a hundred milligrams of EPA DHA in the same database that got 2000 milligrams, which is probably a much far reasonable and therapeutic level but, you lump them all together and you dilute out the good studies with studies that may have been dramatically under-dosed. And who’s the group you’re studying, it goes on and on. That’s the challenge. That’s why once in a while the Cochrane database will come out with a statement that most people feel is of higher quality on a nutrition topic. And no one study changes everything forever with very rare exception. You just got to put it all together and say where does this fit in the big picture?

Dr. Weitz:            Exactly. Awesome, Joel.

Dr. Kahn:             Thank you.

Dr. Weitz:            Thank you. Talk to you soon.

Dr. Kahn:             I hope you have a wonderful summer.

 

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Microbiome with Kiran Krishnan: Rational Wellness Podcast 163

Kiran Kirshnan discusses The Microbiome with Dr. Ben Weitz and the Functional Medicine Discussion Group.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

                                                                             



Kiran Krishnan is a Research Microbiologist and has been involved in the dietary supplement and nutrition market for the past 20 years, including hands on involvement in university research.  Kiran is a Co-Founder and the Chief Scientific Officer at Microbiome Labs, a leader in microbiome and probiotic research. He is a frequent lecturer on the Human Microbiome at Medical and Nutrition Conferences.  He is currently involved in over 18 novel human clinical trials on probiotics and the human microbiome. Kiran is also on the Scientific Advisory Board for 7 other companies in the industry. Kiran has published clinical trials in peer-reviewed, scientific journals and several global patents in his name.  The new stool test he has helped developed is the Biome FX

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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. Phone or video consulting with Dr. Weitz is available.



 

Podcast Transcript