Supercharge Your Metabolism with Steph Lowe: Rational Wellness Podcast 183

Steph Lowe discusses How to Supercharge Your Metabolism with Dr. Ben Weitz.

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Podcast Highlights



Steph Lowe is a sports nutritionist and yogi from Melbourne, Victoria and she is the founder of The Natural Nutritionist and author of Low Carb Healthy Fat Nutrition.  Her website is TheNaturalNutritionist.com.auHer podcast is Health, Happiness, and Human Kind.       

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. Today our interview is with Steph Lowe, who’s a sports nutritionist and Yogi, all the way from Melbourne Victoria in Australia, and she’s the founder of The Natural Nutritionist and the author of the Low Carb Healthy Fat Nutrition book. And, so we’re going to talk about the low carb high fat diet and especially as it relates to metabolism, so thank you so much for joining me today Steph.

Steph Lowe:       Awesome to be here, thank you.

Dr. Weitz:            Good, so maybe you could start by telling us your own personal journey, how you came to become a nutritionist, and how you found now the low carb high fat diet?

Steph Lowe:       Yeah, for sure. So, I mean, like a lot of people in the industry I do have my own personal journey with food, which started back as a teenager when I decided I wanted to lose weight to achieve this happiness that I thought that being thin would create.

Dr. Weitz:            Did you achieve happiness?

Steph Lowe:       I did not. I cut all fat from my diet, I became very disordered, and my poor mother was so worried that she took me to see a dietitian. And I still remember sitting in the dietician clinic thinking how amazing this woman’s job was, that she gets to sit here and talk about food, so I definitely know that the seed was planted then. Not surprising, when you cut all the fat from your diet you start to have mental health issues because your brain is predominantly fat, so I then experienced what was never diagnosed but certainly felt like depression, and I met someone who convinced me to cut gluten from my diet. This is over 15 years ago, I wasn’t a nutritionist, really no one knew what gluten was and how to maintain a gluten free approach, but I was pretty desperate to feel better that I was willing to try anything thing.  And for me personally, the difference was night and day. So, I started to have a lot more clarity of focus, a lot less issues with regulating my mood that I was really inspired to learn more. So, it started as gluten free but it quickly became understanding more about the healing power of food, and when you learn that for the first time it’s pretty mind blowing that we haven’t been taught that from a young age. So, I was inspired to go back to uni and study my post grad in nutrition, so I had what we call- 

Dr. Weitz:            We learned about the food pyramid, right? 12 servings of bread and pasta every day.

Steph Lowe:       Yeah, exactly. And in Australia, and it’s obviously the same way you are, that’s what we define as healthy, and we certainly over the last five or more years have really understood how wrong we had it. So, I set myself a mission to unpack a lot of the myths in the nutrition space, especially the food pyramid and how fats have been demonized for five decades, so I got my qualifications as a nutritionist and started The Natural Nutritionist in 2011. So, that was a while ago now if we think about how rapidly the real food space has evolved in that time, but I was a triathlete doing long course distances like 70.3s or half Ironman, and naturally that will is really high carb. I remember going for long bike rides and being told to take multiple gels that just make you feel sick, and when you read the ingredients the logical mind would definitely tell you that it doesn’t make sense to be fueling with all this sugar.  So, I was determined to find another way. So, I do work with a lot of long course athletes to this day, but my niche is different as my journey has evolved because, as you would know, real food movement and certainly the low carb movement is pretty big now which is amazing, because we need to be having this conversation and moving away from the food pyramid.

Dr. Weitz:            So, tell us about the low carb high fat diet and why should someone follow it?

Steph Lowe:       Yeah, so there’s a lot to discuss there because my version of LCHF, it stands for lower carbohydrate healthy fat, so lower as in context to the food pyramid. So, you said before 12 serves or sometimes we see six to eight serves of whole grains per day, but regardless, that’s 400 or more grams of carbohydrates per day. And what that creates is what we see in western countries, we see not only blood sugar issues and cravings, and the weight gain that occurs with excess carbohydrates, we’re now seeing chronic diseases that are all inflammatory in nature, that have origins in excess refined carbohydrates and sugar. So, it’s a disaster. Versus lower carbohydrate healthy fat, we’re actually talking about real food. So, food that comes out of the ground, off a tree, or from an animal, and the latter is an option of course, you don’t have to eat animal products, but we’re looking for food with the lowest degree of human interference, because we know it all have the highest degree of nutrient density, the opposite is true to [inaudible 00:05:46], so if we see food or we look at food that has a high degree of human interference it’s nearly always going to be really nutrient poor, and that’s not what our body needs.

Dr. Weitz:            So, what are healthy fats?

Steph Lowe:       Healthy fats should be predominantly Omega-3s. So, our anti inflammatory fats that come in whole food forms like olive oil, olives, oily fish, nuts, seeds, avocado, for example.

Dr. Weitz:            Olive oil and avocado are necessarily high in Omega-3s.

Steph Lowe:       Well, they certainly contain Omega-3s and they are these beautiful whole food forms. Avocado, for example, naturally contain some omega six, but we don’t want to be eating too many omega sixes, but the real issue are the pro-inflammatory seed oils like that we use through the 80s and 90s.

Dr. Weitz:            Which are those?

Steph Lowe:       Well canola is a big one that still really popularized to this day, but it’s really any- [crosstalk 00:06:45]

Dr. Weitz:            Now, some people like canola because they say it’s higher in Omega-3s.

Steph Lowe:       Yeah, look and certainly the vegan movement really celebrates canola oil. I personally disagree with that, because we know that the optimal ratio for health is a one to one ratio between our Omega-3s and omega sixes. So, we’re not saying don’t eat any omega six, but using it as your predominant oil can’t makes sense because you would be creating a pro-inflammatory environment, and there’s incredible studies in the literature around the role of that one to one ratio.

Dr. Weitz:            Well, that one to one ratio is kind of extreme, I mea, that’s not I don’t think generally accepted, I’ve certainly heard people say the one to one ratio is maybe why our paleolithic ancestors ate, but if you look at most of the normative values for, say, Omega-3 to six ratio, they typically say under four to one is considered normal, is considered optimal.

Steph Lowe:       Depends on your health goal, it’s like our blood test reference ranges. You can certainly set yourself a goal of “normal”, or we can look at what optimal is, and everyone has their own goals around what they want their health and their longevity to look like.

Dr. Weitz:            One to One is tough to achieve though.

Steph Lowe:       Do you think so?

Dr. Weitz:            Oh yeah, I need- [crosstalk 00:08:06]

Steph Lowe:       On a whole food diet?

Dr. Weitz:            I think so. I think so, because most of the fats are still not going to be Omega-3s, olive oil is basically omega nine, and there aren’t that many foods that are really high in Omega-3 other than fish oil, flax seeds, so it’s hard to get one to one in Omega-3. I know I measure mine regularly and I try to keep it at two to one, but to do that I have to consume about eight grams of fish oil a day. So, it’s not easy to get to one to one, there aren’t that many foods that are super high in Omega-3, even if you have grass fed beef it’s still not predominantly Omega-3, it’s higher in Omega-3, but… Anyways, but so what are other healthy fats besides olive oil, avocado.

Steph Lowe:       So, then we need to look at saturated fats, which naturally have been demonized for five decades. Now, it’s been disproven in the literature, but unfortunately it’s a myth that is hanging around quite strongly. And, again, I think it’s perpetuated by specific food trends, but if we, again, think about what food has the lowest degree of interference, I support the use of things like coconut oil, grass fed, butter and ghee. And then there are additional grass fed animal fats for those that are inclined. We only need to be having about 20% saturated fat from that component of healthy fats, but we do need to acknowledge that when we look at what saturated fat is, by weight 25% of it is in our brain, it’s a really important component of all cell membrane, and is a foundation building block for hormones.

                                So, we need to stop demonizing saturated fat but, at the same time, we don’t need to be eating just a huge plate of steak with a slab of butter on top. I think there’s lots of extremes in the health space, whereas my version of LCHF is actually largely plant based, where eating about six, if not more, cups of vegetables per day on a good day. And that’s what everyone can agree on, almost everyone, I’m not talking about the carnivore here, but almost everyone can agree on the role of a fiber rich diet with plants predominant. If we look at the Blue Zones, for example, people think they’re vegan, they’re not really, they don’t eat a lot of meat but they do eat eggs and seafood in small amounts, but what the common denominator is, is plants. And I think that’s an important conversation, because if you look at the food pyramid it doesn’t really celebrate vegetables it celebrates bread and cereals, and almost everyone I meet is probably eating between one to two cups of vegetables per day. And so, it’s well under our goal of that six cups.

Dr. Weitz:            Yeah, it’s hard to get a lot of vegetables in, most people are not used to eating vegetables and they’re not super tasty or super rich, so you have to get used to eating a lot more vegetables to get yourself off that rich, super palatable, standard American, standard Australian diet.

Steph Lowe:       Well, yeah. The addictive food, you’re right, when you’ve got poor blood sugar control and you’re addicted to carbs, you’re not going to crave broccoli, it’s going to taste quite bitter and you’ll find it more of a chore to eat, versus one of the major immediate benefits of LCHF is blood sugar control. So, you can do way more than a 12 hour fast without being hungry, you can eat every four or five hours, you don’t have cravings, you don’t crash at 3:30, or 4:00 o’clock, and your taste buds change. So, food that once you thought was delicious will taste ridiculously sweet or unpalatable, and then vegetables will start to taste really nice, and pumpkin will taste sweet, and you’ll actually really enjoy that food, it just takes time to adjust, like anything.

Dr. Weitz:            And, so you get better long term energy because you’re relying on fats rather than getting carbs.

Steph Lowe:       That’s the thing, carbohydrates, especially refined carbohydrates, cause that blood sugar rollercoaster. So, it’s a disaster during the day for energy and productivity, but by the afternoon it becomes pretty impossible to deal with when we’re having cravings and really struggling to stay awake, for a lot of people were relying on more caffeine, perhaps, whereas LCHF you have just beautiful stable energy, stable blood sugar, great satiety, and my clients they will definitely notice that shift in their cravings, which is, that’s proof in the pudding. We don’t need these carbs and high sugar foods to prop us up anymore we’re burning fat that energy.

Dr. Weitz:            Are there certain specific patients or categories of patients who maybe don’t do as well with a higher fat diet? I’m thinking of perhaps people with unfavorable lipid profiles, and history of heart disease, or maybe people who have one or two copies of the apoE4 gene.

Steph Lowe:       Yeah, so there are definitely some more detail that we need, and that’s why I think testing is really important. So, if you’re going to embark on a low carb diet there’s lots of different tests that you would do, and certainly your blood lipid profile and some genetics could be fascinating. Now, the thing is about how we have interpreted a blood lipid profile over the last five decades is, we’ve done that very incorrectly, we’ve just basically look at total cholesterol, and if it was high we’ve assumed heart disease risk, which we know is hugely incorrect.

                                So, the first thing that we actually want to look at is what the inflammation is, or is not. So, we look at triglycerides less than one, which would pretty much almost always rule out any heart disease risk, but we do want to dig deeper than that. So, we look at the total cholesterol to HDL ratio- [crosstalk 00:14:09]

Dr. Weitz:            Like glycerate’s less than one, maybe in the United States that would be under 100, I think.

Steph Lowe:       Yes.

Dr. Weitz:            Yeah, okay.

Steph Lowe:       The units are always going to catch us up, but the ratios are fine. So, when you look at a total cholesterol to HDL ratio we want at 3.5, and that tells us that even if we have LDLs, or high LDLs, that they ere large and fluffy, so they protect the heart. Whereas the higher that total cholesterol to HDL ratio is, and certainly five and above, will tell us that there’s small dense particles that carry plaque and that’s problematic for cardiovascular health. So, we definitely need to be interpreting our blood lipid panel differently, and then it will- [crosstalk 00:14:51]

Dr. Weitz:            And even better would be to get advanced lipid profile that includes lipid particle size.

Steph Lowe:       Yeah, you can do testing now, can’t you, so rather than just interpreting and using correlated information, you can do advanced profiles and look at your lipids. Anyone that’s, say, older who might have more risk factors like family history or carrying extra weight around the middle, you can do [inaudible 00:15:18], a coronary calcium score, there’s many more diagnostics that are far more indicative of cardiovascular disease health, than just looking at total cholesterol.

Dr. Weitz:            Yes, for sure. So, how is your` low carb high fat diet different than, say, paleo or ketogenic?

Steph Lowe:       Yeah, there are some obvious similarities in that with focusing on real food, so that’s very much the Paleo model. But, the thing is with keto is, by definition it’s- [crosstalk 00:15:56]

Dr. Weitz:            By the way, real as opposed to refined, or processed?

Steph Lowe:       Yeah, exactly. Food that comes in a packet or a box. So, keto is quite low carb, so it’s somewhere between 25 and 50 grams of carbs a day usually, and more typically the lower end of that, especially if someone’s got type two diabetes or metabolic syndrome, but that is quite low and should be prescribed when someone has a metabolic condition, and we would know that by diagnostics, again, so glycated hemoglobin or HbA1c, the higher it is, the more say on the other side of 5.3 it is, the more you’re insulin resistant. And so then the obvious solution to that is to address the insulin resistance by lowering the carbohydrate, but if you have a HbA1c of 5.3 or lower, like a five, you don’t need to be only eating 25 to 50 grams of carbs per day.  If you’re a male athlete who does some intensity, you could be eating up to 150 grams of carbs a day, so that’s more than three times a keto diet, but for some people, not everyone, but they’re still experiencing all the benefits from a clarity of mind, a concentration, a performance, a recovery, and a longevity benefit, and it’s a lot more food and a lot more sustainable. So, I think it’s important that it’s really individualized.

Dr. Weitz:            Does it matter the time of day people eat their carbs?

Steph Lowe:       There’s a lot of different theories on that, as you would know, so what we want to understand is a lot more about the exercise program or schedule, because certainly high-intensity exercise is naturally going to be utilizing muscle glycogen as the fuel. And so, many people feel like they recovered better if they eat whole food carbs like fruit in a smoothie the hour after a high-intensity workout, the same doesn’t apply for anything aerobic in nature because that’s naturally a more fat burning session.

Dr. Weitz:            What about carbs before the exercise to fuel the exercise?

Steph Lowe:       There are some people that feel much better if they do pre-load with carbohydrates before high-intensity exercise, but the thing about high-intensity exercise is that it’s really- [crosstalk 00:18:24]

Dr. Weitz:            By the way, what do we mean by high-intensity exercise?

Steph Lowe:       Well, there’s lots of [inaudible 00:18:30], but as a general rule we use the MAF formula, so it’s Phil maffetone formula, and so 180 minus your age would tell you where essentially that crossover point is. So, higher than that would be considered high-intensity, whereas lower than that would be aerobic or low intensity. So, it’s a formula that you use, 180 minus your age.

Dr. Weitz:            So, if I were doing a traditional heavyweight training session where I’m doing sets of, say, maybe eight to 10 reps with as much weight as I can, and maybe taking a minute or two rest in between. Is that a high-intensity or are we talking about doing maybe a circuit training where you’re going from one exercise, or one set to the other with very little or no rest, and maybe lighter weight. So, are those both high-intensity, what’s high-intensity?

Steph Lowe:       It all depends on the heart rate response, so everyone is going to be really different.

Dr. Weitz:            So, it all depends on the heart rate?

Steph Lowe:       Yeah, they both sound like they’re potentially high-intensity to me, because of the volume of weight in the first example, and then of course the circuit nature is nearly always high-intensity. But, then it becomes really individual, which is why we tend to use heart rate, so it’s not so subjective. Some people use RPE which is that rate of perceived exertion, but it’s very vague, we need to know how to interpret that. And so it’s not a clear definition, whereas, if you get to the end of a session you know what your average heart rate is, you can call it, so you know what you really need to refuel with.

Dr. Weitz:            And you’re saying for high-intensity you don’t necessarily need carbs before, but you should have carbs afterwards to refuel your glycogen?

Steph Lowe:       Yeah, the thing is about that, if you have it prior, a lot of people find I start to get digestive issues, because when you start exercising naturally your blood flow goes outwards, so to heart, lungs, legs, extremities, et cetera. So, you don’t have the blood flow coming into the gut, so we tend to find our digestion it’s compromised, and we see many examples of that certainly in Ironman races where people experience a lot of unnecessary gastrointestinal distress, and it can happen in much more mild versions of that when people eat before exercise.

                                If it’s later in the day and we’ve been up for many hours and we’re training in the evening, and lunch has been hours ago, and dinner is not for another couple of hours, then usually we’re going to feel better if we’ve eaten, but the same wouldn’t apply to the morning, because if we wake up we haven’t depleted any muscle glycogen, we’ve only depleted a little bit of liver glycogen overnight, and that’s irrelevant for training. And so, we don’t have anything to replenish, and we feel more often much better without having anything prior.

Dr. Weitz:            And so, is it important to get a certain amount of carbohydrates within a certain period of time after the exercise, do you believe in that glycogen replenishment window concept?

Steph Lowe:       I do, but it doesn’t need to be 30 minutes or anything ridiculous, because that’s the other thing, the same applies to our digestion on the other side of high-intensity. Almost everyone will say to you, they don’t feel like eating straightaway, and that’s because their body is diverting the blood flow outwards again it’s not coming into the gut. So, we tend to want to wait until we’ve actually cooled down, maybe do your stretches have a shower and get yourself organized, and then think about eating, rather than running to the kitchen for fear of not recovering, which is a myth that’s been perpetuated by the protein powder industry. So, I think it’s going to be quite individual, but I’d say roughly an hour. And it’s only between 30 to 50 grams of carbs usually for a female up to na male. It’s not bowls of pasta or anything like, again, we might have been told.

Dr. Weitz:            What about endurance athletes who maybe are going to go on a two hour bike ride?

Steph Lowe:       Yeah, so it depends on how fat adapted you are or are not. If you’re just starting out and you’ve been following a high carb diet, then naturally you’re not going to be able to do two hours without fueling because your body is very sugar burning in nature, so that’s why we see people needing to have gels or Gatorade or different versions of that. But, when you’re fat adapted, and in fact, a good barometer of how fat adapted you are, is when you can do two hours fasted, when you have the ability to do that on wat, lemon and salt, our natural electrolytes.

Dr. Weitz:            Should fat burning athletes maybe have a packet of peanut butter or almond butter, in other words, should they have the fat version of the carb load in the middle of their training session?

Steph Lowe:       So, it depends on the goal of the session. So, certainly if the session continues to be aerobic in nature, so under that 180 minus your age, and you want calories, you can definitely be doing that from fat sources. It’s just going to depend on whether that’s practical for the type of exercise you’re doing, there’s nothing wrong with having some carbohydrates after that two hours, but what we don’t want to choose is gels or Gatorade which play with our blood sugar and spike and crash us. So, that’s why we tend to look for more natural carbs or products like Generation UCAN, or SFuels, because they’re designed to support that fat burning metabolism, but give us a small amount of carbohydrate to help us extend those long- [crosstalk 00:24:11]

Dr. Weitz:            What are products you just mentioned?

Steph Lowe:       So, Generation UCAN is made from a modified corn starch, so it’s been heat treated in such a way that it has a slower release, so it’s a slower release in terms of that carbohydrates, a bit like how you do low GI, we want it to be slower release, and so we can fuel off those carbs rather than spiking and crashing and needing more. And SFuels has a similar concept, they use some MCT oil in there, as well, which we know increases fatty acid oxidation, and they’ve got their own proprietary blend but the concept is quite similar in terms of it being a fuel to help us for that longer session, without impacting our metabolic goals and our fat burning capacity.

Dr. Weitz:            Is this high fat training program catching on among athletes, if we were to say survey athletes in the Olympics, what percentage of them you think are using a high fat fueling program?

Steph Lowe:       I don’t know if the Olympics is the right example because that a lot of high-intensity exercise there, so-

Dr. Weitz:            Okay, so what’s a right example?

Steph Lowe:       I think that’s why we see it happening in sports like Ironman Triathlon, because it is a really perfect example of where you need to be fat adapted, because some people are out there for 17 hours. So, it’s not possible to consume that many grams of carbohydrates every hour upon hour when you’re out there for seven to 17 hours, and so it really does suit the more aerobic athletes, ultra runners, triathletes. Now, I’m not saying that people in the live Olympics can’t do it because they’re all going to do aerobic sessions as part of their training, but I just don’t think it is as popular as they are yet. It should be because it is the best approach for longevity and managing inflammation, which naturally helps recovery and longevity, but we just need to acknowledge that it would need to be applied, very specifically for someone who’s doing a lot of high-intensity exercise.

Dr. Weitz:            Yeah, how does low carb high fat benefit metabolism?

Steph Lowe:       So, if you’re eating a food pyramid and you’re eating those 400 grams of carbohydrates per day, your body relies on sugar so you’re in that constant sugar burning state, when we burn sugar we also produce those reactive oxygen species and they are pro-inflammatory, so that’s why we see issues with recovery, issues with our inflammatory markers, and then unfortunately those chronic lifestyle diseases that happen after time. Whereas fats burn clean, there’s only byproducts of carbon dioxide and water, so there are no inflammatory species, reactive oxygen species, and we, again, create this fat burning metabolism which means that we have fat to burn as our fuel, so as our Diesel, versus sugar which acts more like petrol.

                                And then we have those benefits that I was talking to you about before, like the blood sugar control and the satiety, but it really is the inflammation that’s the most important piece because, again, we know that there’s so many lifestyle diseases that have that inflammatory nature, and most of them could be avoided, like type two diabetes doesn’t need to exist. It is a lifestyle disease that comes from a high carbohydrate diet in someone that’s genetically inclined to become insulin resistant, and I meet people who still think that type two diabetes is a life sentence. And to me that’s tragic that no one’s told them that there’s a dietary fix to put that disease into remission, they think it’s a life sentence of taking medication and running the risk of lots of side effects which come from the medication, and the increase in medication required when the weight continues to go up, and their diabetes continues to get worse. That’s a real tragedy of this century.

Dr. Weitz:            Oh, absolutely. Yeah, I’m a chiropractor and I also do the functional medicine, and so all our patients come in for chiropractic, and we had a patient a couple of weeks ago, and helping him with his back and then I noticed that he had some blood sugar issues and was pre-diabetic, and I asked him what he was going to do about his pre-diabetes and he said, “Oh, my doctor said, just wait until the blood sugar gets higher and then we’ll put you on medication.”

Steph Lowe:       And so we have, unfortunately, a reactive health care system, whereas you and I are very proactive. So, a blood sugar issue can be addressed with a lower carb diet, so you don’t need to wait until you’ve been diagnosed with diabetes to fix it, and I think-

Dr. Weitz:            Oh, it’s absolutely insane but our system which is controlled by insurance companies actually doesn’t recognize that concept, so his doctor probably can’t even bill for pre-diabetes, so we can’t really under the insurance system do anything until the patient can get a diagnosis of diabetes.

Steph Lowe:       I know, and so that’s why you go to a doctor when you’re quite sick, and perhaps a chiropractor or a nutritionist when you’re looking to improve your health, right?

Dr. Weitz:            Exactly.

Steph Lowe:       Because we would obviously be able to be much more proactive than that.

Dr. Weitz:            And it’s insane to just get put on medication and not change your diet and lifestyle for a diseases caused by diet and lifestyle.

Steph Lowe:       And there are many examples of that. I think it’s the same with, unfortunately, what we’re seeing with the Alzheimer’s and Dementia epidemic. That has come partly from the low fat era, it’s a metabolic disease, and we’ve depleted our brain of its primary building block, we shouldn’t be surprised that we’re seeing this but it’s absolutely heartbreaking that people are going through this, when they’ve been on statin drugs totally stopping their cholesterol production for years, if not decades, and no one’s really talking about this until the year 2020, and that’s another tragedy that we could have avoided.

Dr. Weitz:            Oh, absolutely. Another factor there is the incredible amount of toxins that get into us from our environment, from the food, from the air, from all the chemicals being dumped into our environment. And so, those toxins-

Steph Lowe:       Again, lifestyle.

Dr. Weitz:            Yeah, absolutely.

Steph Lowe:       For sure.

Dr. Weitz:            Yeah.

Steph Lowe:       I agree, and I think there’s so many lessons. I’ve got a little one, she’s 18 months, and I think to myself, “I don’t know what the world is going to look like when she’s my age, but I hope that we won’t have as many regrets as we do now.” Like when we look at, say, my parents who are in their 60s and 70s, unfortunately I think that generation have been the unluckiest so far in terms of health, because they’ve live through the low fat era, they’ve lived through the polypharmacy era, they’re the ones that have been taking proton pump inhibitors, statin drugs, blood pressure medication, et cetera, et cetera, 16 pills when they get up in the morning. And no one has taught them about the power of food and what you can do to actually come off many of those medications, whereas with my knowledge my children won’t be taking medications, and hopefully that will continue. And it’s important because Big Pharma unfortunately are not interested in our health, they’re really just interested in profit, largely.

Dr. Weitz:            Oh absolutely. Unfortunately I’m in the same generation with your parents, but not following the same path.

Steph Lowe:       Yes, exactly, of course there are many exceptions to the role, but you probably see it in your friends. Do you have friends or people, friends of friends that are taking lots of medication, and I think that’s something that-

Dr. Weitz:            Yeah, it’s tragic.

Steph Lowe:       … could be… Yeah, again, avoided.

Dr. Weitz:            A polypharmacy route, and then the medications counter the side effects of the other medications.

Steph Lowe:       I know, and it continues, that’s how someone could possibly end up on 16 meds.

Dr. Weitz:            Oh, absolutely. So, what are some of the drawbacks, what are the negative aspects of following a low carb high fat diet?

Steph Lowe:       Yeah, so I said to you off air that I think because people like bread, and I’m joking but I’m not because people have these real attachments to certain foods. Now, the way I approach things is 80, 20. So, when I work with a client one on one, I’d never tell them I could never eat bread again, if that was their thing, of course we talk about quality and maybe looking at homemade examples, or how to do it better, what to eat with that bread, et cetera, for blood sugar control. But, ultimately I think if we take an approach to low carb that’s balanced, there aren’t going to be many drawbacks because in that 20% of your week you could technically eat whatever you want.

                                Now in my 20% I’m still not going to drink heaps of wine and eat rubbish food, but that’s each to their own right, I’ve just learned over the years that sort of food and those choices would make me feel horrible, and I’m just not willing to pay the price, but I don’t make that decision for anyone else. It needs to be sustainable and that’s the main goal.

Dr. Weitz:            Right, so I think one of the important things to emphasize is, there are versions of following a low carb high fat diet whereas, when we were talking off air, the person’s having a big steak with butter and cheese and very few vegetables, and so they have a very unbalanced high fat low carb diet. And that’s where I think you’re going to get into problems with missing out on important phytonutrients, and others essential vitamins and minerals that you would get from having a high plant rich low Carb high fat diet.

Steph Lowe:       Yeah, I agree with you, and that’s why I think keto has gone a bit wrong. I meet a lot of people doing keto, and the amount of dairy that they’re eating and the number of coffees with cream and drinking, it’s really misguided that we need to be even consuming dairy at all, there’s no nutrient that we’re going to miss out on if we don’t eat dairy. Now, if you like it any preference quality and you treat it as an occasional food, then go for your life, but I’m talking about people that have cheese with everything for their fat, and cream and every coffee, and so on and so forth. But, really, vegetables are an afterthought or, as I said earlier, we want this to be plant based, you can eat fruit, you should be eating berries, and you can eat sweet potato.

                                And you asked me before about what time we can eat carbs, there’s a lot of people that feel like if they do have some sweet potato at night they sleep a lot better because of that serotonin and melatonin relationship, and that’s something that is good to trial and error, as well, because you don’t want to do keto or low carb and then not be sleeping, because the impact of poor quality sleep is horrific, that’s going to take 10 years of your life.

Dr. Weitz:            Right, so there are potentially some negative hormonal consequences of having too few carbs.

Steph Lowe:       There’s negative hormonal consequences of being extreme, honestly, people, I think it’s the diet industry, we’re so used to being 1200 calories, eat less, move more, or starve yourself to be skinny, or only chicken and broccoli to put on muscle, and there’s all these things that we’ve seen over the last 20 or 30 years. And then when you jump into keto or low carb, you become so obsessed about your macros, your online diary, your finger pricking, or your breath ketones, or whatever it might be, that you lose that capacity to see the forest for the trees, because you want to take an approach that’s sustainable. And I just don’t think being extreme is the answer ever.

Dr. Weitz:            So, you’re advocating on your high fab program that people are essentially running on ketones, but you don’t advocate measuring ketones through urine or blood or breath.

Steph Lowe:       You can, so I’m not not advocating, I’m just not… I just think, for many people, it’s not going to suit them, and those that want to do it can do it, and that’s awesome, but we just need to realize that certainly initially we can get some good numbers and understand when we hit that 1.5 to three millimoles of that therapeutic ketosis. But after that, if we’re really efficient at using ketones we’re burning them, so they’re not in the bloodstream, so we might get low ketone readings, but we fast for 16 hours, we only eat, every five we can do two hours aerobic training fasted and there are all these incredible barometers, no inflammation in the blood markers, et cetera. So, there’s so many other barometers that I think give us much more powerful information beyond trying to get so obsessed about every day being in this goal, or in this range, when perhaps we’re actually burning those ketones for fuel.

Dr. Weitz:            So, if people want to measure ketones, should they measure them in blood or should they do the breath testing that’s now available?

Steph Lowe:       I think both can really be good, I many years ago I bought one of the breath ketone meters, and I found that quite easy to use and quite practical, it’s certainly more affordable than doing it via blood, like people that are finger pricking all day will start to really chew through those sticks obviously, so there’s a few variables that one would consider. I don’t mind either, do you have a preference?

Dr. Weitz:            No, not necessarily, I think the blood is probably more accurate, but less convenient.

Steph Lowe:       Yeah, I’d agree.

Dr. Weitz:            Yeah, so you also advocate intermittent fasting, a 16 hour fasts as part of your program.

Steph Lowe:       It depends on the individual, so if it’s a female who’s got some hormonal issues going on we wouldn’t be jumping into 16, eight. We know that the sweet spot for women is 12, 12 or 14, 10. We have to acknowledge that most of the- [crosstalk 00:38:29]

Dr. Weitz:            So, you’re talking about 16 hours of fasting, eight hours window of eating, or 10 hours of fasting and 14 hours-

Steph Lowe:       So, If I said 14, 10, it would be a 14 hour fast with a 10 hour eating window, and we find that’s the sweet spot for women usually. Most of the research that’s done around intermittent fasting is in college aged male athletes, so we don’t want to take that data and apply it to women. Now, there are some women that have been doing low carb for many years that are either postmenopausal, so they can jump into 16, eight, or those that are really well versed and have a good hormonal balance as referenced by what is a healthy menstrual cycle, and they might do 16, eight twice a week, but I don’t prescribe more than that for a female.

                                But, men tend to have more free rein here, due to that lack of hormonal fluctuation across the month, so they can do 16, eight, but like anything you want to qualify it. So, you don’t go into the gym and start swinging 80 kilo kettlebells, so you want to start where you’re at and then build on from there. So, it’s the same with fasting, you want a minimum of 12 hours, so don’t eat from eight until eight, and then you might add on from there and just make sure you’ve got good blood sugar control, craving control, and that the day doesn’t unravel because you fasted too long, you don’t have your head in the pantry by four or 5:00 PM.

Dr. Weitz:            And what are the advantages of adding this intermittent fasting?

Steph Lowe:       It’s just the perfect opportunity to accelerate that fat burning, because when you’re not eating your body moves into that fat burning state, so you’re really accelerating your ability to be fat adapted, and then 16 hours is incredible because we start to promote autophagi which is that cleaning out of dead and disease-like cells. So, it’s like PAC-MAN goes in, mops up all the potential issues that could be occurring, we know that’s great for managing inflammation, resting the gut, for anyone that’s got digestive issues it’s magic, and then there’s some really powerful longevity benefits that we see with fasting when it’s done appropriately.

Dr. Weitz:            Great, and of course exercise is a great way to promote [inaudible 00:40:47], often not mentioned.

Steph Lowe:       Yeah, very true. What’s the three eat introduced strategies that are about longevity? I think we’re still waiting for a magic pill, but so far there isn’t one. It’s real food, it’s sleep, it’s movement, it’s fasting, it’s nature- [crosstalk 00:41:07]

Dr. Weitz:            Actually, the latest anti-aging compound I’m hearing about is Spermidine.

Steph Lowe:       Oh, really?

Dr. Weitz:            Yeah, there’s always a new one, so…

Steph Lowe:       There is, there is. When we will probably continue to be magic pill orientated, but I think when we go back to the proven answers, they’re right in front of us so far, which is good to know.

Dr. Weitz:            Yeah, which is sleep, rest, healthy diet, exercise…

Steph Lowe:       Time in nature, time with loved ones.

Dr. Weitz:            Time in nature, yeah. Okay, thank you so much for joining us Steph, how can listeners and viewers get a hold of you?

Steph Lowe:       Yeah, my online home is thejnaturalnutritionist.com.au, and I hang out mostly on Instagram @thenaturalnutritionist.

Dr. Weitz:            Okay, that’s great. Thank you so much.

Steph Lowe:       Thanks, Ben.



GI Map Tutorial with Dr. Tom Fabian: Rational Wellness Podcast 182

Tom Fabian, PhD discusses How to Interpret the GI Map Stool Test with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on October 22, 2020.

[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

2:01  Quantitative PCR vs Whole Genome Sequencing.  The GI Map stool test uses quantitative PCR, which is the best way to detect specific, clinically relevant bacteria or other microorganisms. It also tells you specific quantities, which is important to detect overgrowth and to allow you to see if levels are increasing or decreasing over time.  It can also allow you to detect microorganisms, like H. pylori, that are in pretty low concentrations.  Whole genome sequencing technology is better for getting an overall picture of the microbiome, but it is not good for clinical diagnosis and does not include any physiological markers, like calprotectin.  While quantitative PCR is highly accurate, the ability to detect something comes down to the choice and the design of the primers. Primers are designed for specific, individual strains or organisms.

12:50  The team at Diagnostic Solutions has designed the GI Map stool test with a focus on both research and clinical experience and it helps clinicians to understand the relationship between physiology and the gut.  You can see three common dysbiosis patterns: 1. Insufficiency dysbiosis, 2. Inflammatory dysbiosis, and 3. Digestive dysfunction.  Insufficiency dysbiosis is a lack of beneficial bacteria. And there can be a combination of these three.

15:56  There is some confusion that stool tests do not provide information about the upper gut but only about the lower gut/colon.  But this is not true.  There are a number of bacteria on the GI Map stool test that are more common in the upper gut, including H. pylori, which grows predominantly in the stomach, and the bacilli class of the Firmicutes phylum that includes species like streptococcus, lactobacillus, enterococcus and staphlococcus, which grow predominantly in the small intestine.  These species thrive in higher oxygen environments like the small intestine, whereas the colon is more anaerobic. Bile is present in the small intestine and the species mentioned above are also bile tolerant.  The Proteobacteria phylum, which we tend to think of as inflammatory microbes, are also much more prevalent in the small intestine than the large. Pseudomonas is linked to inflammation in the duodenum and it is also linked to issues with gluten and other food sensitivities.  Also, pseudomonas thrives on simple sugars and amino acids, which are prevalent in the small intestine.  They are also very bile tolerant and you can find these in the bile ducts and in the gall bladder.  Some of the data as to which species thrive in the small intestine comes from Dr. Mark Pimentel’s group, which mapped the microbiome of the small intestine, the Reemagine Study, which was published earlier this year.  [Mapping the Segmental Microbiomes in the Human Small Bowel in Comparison with Stool: A REIMAGINE Study]  

In the colon, the Clostridium class of the Firmicutes phylum tends to dominate and one of the key species is Faecalibacterium Prausnitzii, which is a major butyrate producer.  The Bacteroides group of the Firmicutes phylum is a major group in the colon. Akkermansia is a well known species in the Verrucomicrobia phylum, which is also one of the key groups in the colon. They thrive in an anaerobic environment and tend to thrive on complex fibers, as well as the mucus ecosystem, and the mucus layer in the colon is much thicker than in the small intestine.

22:17  Here are a list of organisms seen on the GI Map that are predominantly in the upper GI Tract: 1. Enterotoxigenic E. coli, 2. Vibrio Cholerae, 3. Yersinia enterocolitica, 4. Cryptosporidium, 5. Giardia, 6. Norovirus, 7. H. pylori, 8. Lactobacillus, 9. Bacillus, 10. Pseudomonas, 11. Staph, 12. Strep, 13. Citrobacter, 14. Klebsiella, 15. Fusobacterium, 16. Candida. 

Here are a list of microorganisms on the GI Map that are predominantly in the lower GI tract/large intestine:  1. C. difficile, 2. Enterohemorrhagic E. coli, 3. E. coli 0157, 4. Enteroinvasive E. coli/Shigella, 5. Entamoeba histolytica, 6. Bacteroides fragilis, 7. Clostridia, 8. Akkermansia mucinophila, 9. Faecalibacterium, 10. Methanobrevibacteriacea, 11. Microsporidium, 12. Blastocystis hominis, 13. Dientamoeba Fragilis.

25:47  H. pylori’s presence can be clinically relevant, esp. if it’s high, even without any virulence factors present.  Tom said that the presence of H. pylori is often associated with reduced stomach acid.  If the virulence factors are present, the two that stand out as most significant with the most research are cagA and vacA.  Virulence factors tend to work together, so the more that are positive, the more likely they will be significant.

33:26  Dr. Sam Rahbar, Integrative Gastroenterologist in Los Angeles, asked if bacteria like Klebsiella and Citrobacter fruendii are found in the stool, should these be seen as markers of dysbiosis or are they potential pathogens that should be targeted for treatment? Dr. Fabian explained that they are opportunistic pathogens that can exist in the gut without any effects or can potentially be part of a pathogenic process. For example, Klebsiella can be associated with certain autoimmune conditions, including inflammatory bowel disease, psoriatic arthritis, and ankylosing spondylitis.  [Here is one article discussing the connection between Klebsiella and Crohn’s and Ankylosing spondylitis:  The Link between Ankylosing Spondylitis, Crohn’s Disease, Klebsiella, and Starch Consumption.]  While a pathogen in the gut may be a trigger for autoimmune disease, it’s not yet clear whether eliminating this bug will improve the autoimmune condition. 

38:58  If a potential pathogen like H. pylori is present as either high in red or a number above the <DL that is black color on the report, whether it creates a problem for a patient depends upon the overall health of the gut and the microbiome.

43:00  If Pseudomonas is high on the stool test, that does not imply that it has colonized the large intestine. This bacteria mostly colonizes the small intestine and the stomach. 

43:57  If the secretory IgA level on the GI Map is low, that is an indicator that the bacteria in the microbiome that produce butyrate, like Faecalibacterium, are at low levels.  While it is a good idea to build up these beneficial butyrate producers in the microbiome with probiotics or prebiotics and more fiber in the diet, that can take some time. In the short term, some clinicians will recommend supplements like colostrum, Saccharomyces boulardii, L-glutamine, and even vitamin A to increase secretory IgA levels.

46:06  Calprotectin is a marker of inflammation in the colon.  If calprotectin is low and the patient appears to have a lot of gut inflammation, the inflammation is probably in the upper GI tract.  For example, Pseudomonas has been shown in research to cause inflammation in the upper GI tract. Candida is inflammatory and if often colonizes anywhere in the upper GI tract, even the oral cavity.  If you have H. pylori, which can cause inflammation in the stomach, you will not see an increase in calprotectin.

52:14  Inflammatory Dysbiosis.  There are particularly inflammatory bacteria in the Protebacteria phylum and some are in the subclass called Gamma Proteobacteria.  These include: E. coli, Salmonella, Shigella, Vibrio cholera, Yersinia enterocolitica, Enterobacter, Morganella, Pseudomonas, Citrobacter, Klebsiella, and Proteus. A lot of them have been shown to secrete the inflammatory type of Lipopolysccharides.  Dysbiosis in the mouth, like with periodontitis, leads to the increase of pathobionts like Klebsiella and Enterobacteria, which can then translocate to the gut.  If bacteria like Klebsiella are able to colonize the gut, this can activate the inflammasome.  If there is a lack of beneficial bacteria in the gut, then bacteria like Klebsiella will be more likely to colonize.  When you see Klebsiella, you should look at the patient’s oral health. You also want to look at indicators of low stomach acid, such as H. pylori or are they taking proton pump inhibitors.

55:48  Digestive Dysfunction Dysbiosis.  Elastase is a marker for pancreatic insufficiency.  If we see H. pylori, then often stomach acid is low. Also if we see overgrowth of Pseudomonas, Enterococcus, or Staph or Strep or if we see Faecalibacterium low, these indicate that stomach acid is low.  Research suggests that if Kebsiella is overgrown, this is a bacteria that often comes from the oral cavity or the respiratory tract, esp. if there is low stomach acid.




Tom Fabian, PhD is an educator and medical consultant with Diagnostic Solutions Laboratory to help clinicians learn to better interpret the GI Map Stool test. Clinicians can sign up for a professional account to order the GI Map stool test by going to DiagnosticSolutionsLab.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. Our topic for tonight is we’re taking a deep dive into the GI MAP stool test.  Tonight, we have Tom Fabian, PhD of Diagnostic Solutions and so I’m sorry for everybody who’s missing the [Biden vs Trump] debate.  And I’m sure there’s going to be a lot of poop discussed, but we’re going to have a much higher level discussion of poop tonight. So Tom, thank you for joining us tonight and I’m sure we all have a lot of questions about our favorite functional medicine stool test, and so we hope to develop some clinical skills to be able to better help our patients.

Tom Fabian:       Absolutely. Well, thanks so much Dr. Ben for inviting me to join your discussion group. And I look forward to interacting with everyone here, and hopefully giving everyone a better understanding of GI MAP and how to better apply it in clinical practice. All right.  So I’m going to go ahead and fire up the PowerPoint here.  So first I’ll just share my screen.  So tonight we’re going to be focusing on a deep dive into GI MAP. So this presentation is meant to be flexible since this is a very interactive group.  So Dr. Ben, if you have any questions in the meantime, definitely feel free to interrupt, or if anyone has anything that I’ve found over, they don’t really understand. I’m happy to stop and we can just cover whatever we can cover in the amount of time.

Dr. Weitz:            Maybe I’ll ask just one quick question since there’s a lot of different types of stool tests that are out there. Can you talk about the difference between the technology used for the GI MAP stool test, which is quantitative PCR, and how this is different than say whole genome sequencing, stool testing?

Tom Fabian:       Sure. Yeah, so they are different technologies for different purposes and you get different types of information. So starting with meta genome sequencing–that’s a DNA based method as is qPCR, at least the type that GI MAP is using. So we’re looking at detecting the DNA, for specific organisms or for genes, specific genes. So for example, in the instance of toxin genes, you can basically detect any aspect of DNA either way with either type of test but that’s kind of one of the areas where the similarity stops. So metogenomic is used, especially if you look at research for kind of a broad overview, a survey of the microbiome and the genes of the microbiome encodes to get a sense of the overall community. So there’s a lot of ongoing research in that area to figure out of the hundreds of species that you can potentially detect with that method. What does that actually mean? So that’s a lot of ongoing research and there’s really not a whole lot of conclusions we can make definitively about most of the species.  A lot of them just have not been well studied yet, of course we’re learning more every day.  So that’s one of the advantages of sequencing as you can potentially get kind of a more high level, bigger picture of the ecosystem.  But the challenge is if you want to measure specific clinically relevant organisms particularly quantitatively, so you can see what their levels are, whether they’re increasing or decreasing over time and with treatment, you really need a more quantitative method.  And especially when you look at sort of the composition overall of the microbiome, so you have very abundant species all the way down to species that are barely detectable. So there’s a really wide range of abundance levels for different species. Some of the species, in fact, quite a few of them on the low end of that range are clinically significant classic example would be H. pylori. H. pylori is mostly in the stomach by the time it’s in a stool sample, it’s usually pretty low concentration if it’s present.

                                So that’s difficult to pick up these low abundance species in typical kind of commercial based sequencing, because the ability to detect these low abundance organisms and to detect them in a way that’s at least reasonably quantitative depends a lot on the number of sequencing reads. So you may have heard the terms, sequencing depth, sequencing reads and that’s expensive to do that. So most of the commercial type testing doesn’t really go that deep. So you get a picture of the more abundant ones at the top, and that may include some of the ones in the middle, but oftentimes cannot identify the ones that are on the low abundance and of things very accurately. So that’s really where qPCR shines. In fact, it’s kind of like a technology that you want to use to find those needles in the haystack. And I’m actually going to go through a few examples here in this presentation. And I do have a couple of slides about qPCR as well, I can elaborate on that just a little bit, but that’s one of the main differences. Also a lot of the metagenome sequencing companies. In fact, I’m not aware of any right now that also include physiological markers. So to really get some insights clinically into what’s going on in the gut, you need to know both sides of the equation, microbiome, as well as what’s going on with digestion inflammation and things like that.  So you get a more complete picture, even though you have fewer markers because these types of tests focus on organisms that have been established to be clinically relevant and also these physiological markers. And then with that careful quantitation, then you can start to really see patterns and trends and things like that. And I kind of like it to say, you’re just looking at blood glucose levels on our standard lab test or a hemoglobin test. If all you got was plus or minus, higher or low, or sort of high, medium, low, that gives you a kind of a rough idea of what the levels are, but hemoglobin A1C of 5.6 is very different clinically from say 7.5. Although, in some measures, both of those might be considered kind of on the high end. So quantitation really is important in that’s part of a really a big part of what makes a marker more clinically relevant. So that’s kind of, sort of at a high level tip of the iceberg. What’s some of the key differences are.

Dr. Weitz:            Okay.

Tom Fabian:       Technologies.

Dr. Weitz:            Good.

Tom Fabian:       Okay.  You can tell from the title here. So we’re going to really focus on clinical insights, how to get some clinical insights out of GI MAP, particularly by connecting the dots.  So that’s really where the more advanced users get the most clinically relevant information out of GI MAP has learning how to connect those dots on the test with what’s going on clinically as well. And then of course, that’s all the point of all that is so you can get better clinical outcomes by really understanding what’s going on in the gut. So really in terms of connecting the dots, you have to know something about the dots, and which ones are most important and then how to connect them. And that really has to do with the microbial ecosystem as well as GI physiology and those two interact heavily. I’m going to go through a couple of examples in this presentation as well for basically illustrating how those dots are connected and can really yield some great clinical insights.

                                So in terms of qPCR which is also known as quantitative PCR or real-time PCR, so sometimes we’ll see ages RT-PCR on the purpose of that, the reason it was developed in research and is also used a lot clinically now is it’s really good for highly accurate identification and quantitation of microbes. I have heard some sort of… When you look at social media and you look at some of the comments that are out there, there’s a lot of misunderstanding of methods. So I’ve heard some sort of competing companies and other prominent folks that are out there in the community say that GI MAP uses 16 sequencing, which is pretty far from what we actually use. So we actually again use qPCR, quantitative PCR, but that it’s ability to identify something accurately comes down to the choice and the design of the primers. You can design primers that are highly specific for an individual strain, for example, you can detect right down to the strain level, for example, that’s how we detect pathogenic strains of H. pylori, C. diff, some of the other pathogens, is based on detecting them at the strain level.  So again, it’s especially good for low abundance microbes, there’s also the issue of absolute versus relative quantitation and it’s a little bit technical. I don’t want to get into that right now, unless anyone has questions, but absolute you’re looking at how much of that organism is present per say, gram of stool versus sequencing, which is all relative to what else is there. That could be a problem because if something goes up, that can make it look like something else is going down, when in fact it may be the same level, it’s just that it’s all relative. So it treats every sample as if it’s the same amount.  I do have one quick figure here to kind of illustrate that. And that’s actually in this figure from this particular article, which is quantitative microbiome profiling links gut community variation to microbial load. So it was published in a prominent journal, Nature, a couple of years ago where they compared relative versus quantitative approaches and they actually found that the absolute quantitation, especially when they looked at a Crohn’s disease patient was extremely important because without looking at absolute quantitation, you miss the whole picture of general decrease in microbes in the gut. And that’s a key feature of for example, Crohn’s disease. So I’ll look at… Show that data here in the next slide. So this is a pretty complicated diagram, but the main point here is on the left is a different samples that basically where the data is expressed in a relative sense. So every sample is treated as if it’s the same amount, starting amount, and all the different taxa indicated by different colors. So all the different types of microbes make up percentage of that pie, but you don’t really know if in person A, that the overall levels have gone down say F after antibiotics or after an infection unless you look at it from an absolute standpoint, and that’s what you see here. This is the breakdown, also expressed in terms of total amount per gram. You can see here on the side, it says per 10, they live in cells per gram.

                                So essentially you can see that they’re some individuals that have quite a bit less overall sort of total microbiome in their gut. And they found that to be very clinically significant. That’s one of the big difference between sequencing and qPCR. A qPCR is basically looking at things from an absolute standpoint. So the big question there is really why is that important? And again, I kind of alluded to some of those important clinical relevance type aspects, but it really allows you to differentiate low, normal and high levels at a much more detailed level.  So you can identify trends and patterns and that’s a big part of the connecting the dots with GI MAP. And that’s also critical for assessing the clinical relevance and your treatment approach, because you want to see if you do a retest, that organism may still be there, but it may be responding well, you may have gone down a couple of orders of magnitude in quantity showing that your approach is working. That’s really where quantitation is important.

The other thing that we bring to the table in terms of kind of a differentiator for GI MAP is, how we present our interpretive and educational information. So our staff has a really wide range of expertise, industry experience in Functional Medicine, clinical testing, several PhDs, et cetera.  And so we bring all that kind of cross disciplinary expertise to the table, particularly with clinical experience mixed with research and we really focus a lot on the latest research so that we can focus on these interactions, and GI MAP is really all about the second part of the equation helping clinicians understand the potential interactions between the microbiome and gut physiology.  So a key thing to understand here is there’s a lot of different aspects of physiology and the gut that really come into play once we understand them at a certain level that can help us understand how to interpret a stool test and what it may mean as far as these underlying issues. So we may, for example, see that, you’ll see here on the list pH is one of the major factors throughout the gut that affects the microbiome and vice versa, same with oxygen, the first nutrients from the diet as well, flow rate digestion, especially stomach acid and enzymes, immune factors, et cetera.

                                So a lot of factors can affect the interaction between the microbiome and our health. And that’s really reflected in GI MAP through three common dysbiosis patterns that we’ve identified over time, just in our overall experience with GI MAP, so those really boil down to 1. Insufficiency dysbiosis, which is a lack of beneficial bacteria, so that’s important to understand how to identify that on GI MAP, 2. Inflammatory dysbiosis, again, very important for a wide variety of diseases, autoimmune inflammatory diseases, and it’s also important to understand how to identify that. And then lastly, 3. Digestive dysfunction dysbiosis, which is kind of a generic term that we use because various aspects of digestion may be compromised or reduced and have an effect on the microbiome and the microbiome in some cases can actually have an effect on digestion. So once again, I’ll go through examples of this and in many patients, they can have a combination of these types of dysbiosis that reflect that interaction between physiological imbalances and the microbiome.

                                So just to note, we do have a resource on our website, a downloadable PDF that lists what markers constitute these different patterns. We will be updating that sometime shortly within the next couple of weeks or so, and then we will make that available on our website. But we do have that as a current resource that was created a couple of years ago, so it’s just a little bit out of date at this point. The other thing that we really kind of weave into this based on research, and how that applies clinically beyond sort of this holistic high-level integrative perspective of looking at the whole gut, a big part of that is recognizing upper versus lower GI MAP microbes. That’s something that you may have heard.

                                Some clinicians claim that with stool testing, you can’t get any insights at all, except into what’s going on in the colon that you basically don’t really understand from a stool sample what’s going on in the small intestine for example, it turns out there’s a lot that you can gain from that. You don’t get necessarily a completely accurate picture of the composition in compartments that are sort of higher up in the GI tract, but sort of the classic example is H. pylori.        We didn’t know that that is detectable in stool, and that certainly yields important clinical information with regards to what may be going on in the stomach, so think of this as kind of a domino effect that you want to get a bit of an understanding of what’s going on higher up in the GI tract, even as high up as the oral cavity.  And one of the examples I’ll go through that’s features one of the markers on GI MAP, for a lot of patients that may actually come from dysbiosis originally in the mouth. And then you want to understand how these physiological imbalances result in its presence in the gut and what it may be doing there.  So to really get into this a little bit more, it’s important to understand a little bit about the composition of the upper GI MAP microbiome.  It’s not as well studied as the lower GI, the colon microbiome, but we’re learning much more about it especially in the last few years.  Mostly what’s dominant in the upper GI from the mouth down to small intestine are a large class in the Firmicutes phylum called the Bacilli.  So that species and groups like streptococcus, lactobacillus, enterococcus and staph. We do have these groups on GI MAP when you see them overgrown, it’s likely that they may reflect imbalances in the upper GI tract. And there’s some just basic information about the physiological conditions that they thrive in, they like higher oxygen environments.  So they don’t like the anaerobic environment in the colon, unless the colon environment’s been disrupted.  They like simple nutrients that are highly available in the small intestine.  Bile is in the small intestine, so they’re bile tolerant, et cetera,.  Also, organisms from the Proteobacteria phylum, which we tend to think of more of the inflammatory microbes, the dysbiotic microbes, they’re much more prevalent as a percentage in a small intestine. So typically they constitute say 20% of the microbiome in the small intestine and only 2 to 5% in the large intestine. So proportionally they’re much smaller in the large intestine.

                                A lot of the research has come out on Pseudomonas, which you do have on our tests, actually going to go back to that, linking Pseudomonas to inflammation in the duodenum, for example, and linking that to issues with gluten and kind of the broader picture of food sensitivities. They also thrive in a higher oxygen environment, also thrive on simple nutrients like sugars and amino acids, highly bile tolerant, you can actually find many of these in the bile ducts and in the gallbladder.  So they’re very bio tolerant, so really important group in the upper small intestine.  Composition of lower GI microbiome at a high level, the most abundant groups in some ways fairly simple, the Clostridium class really dominates and that’s the..in the colon, the largest class or largest group in the Firmicutes phylum, and one of the key species is Faecalibacterium Prausnitzii which we do have on GI MAP as well. That’s a major butyrate producer, again, it’s in the Clostridium class, which is the dominant group in the Firmicutes phylum. And then there’s a Bacteroides group, which is the major group, typically in most people in the bacteria Firmicutes phylum, Akkermansia is a well known species in the Verrucomicrobia phylum, which is also one of the key groups in the colon. They thrive in an anaerobic environment, generally that whole ecosystem, at least in a healthy individual thrives on complex fibers, as well as the mucus ecosystem.  So the mucus layer in the colon is much thicker than in the small intestine. So that’s one of the reasons why there’s a more significant you can see ecosystem in the colon. So this is data from Dr. Mark Pimentel’s lab that was published just earlier this year. This is just basically showing… You can see at the bottom here on the X axis duodenum, jejunum, FD, which is their term for the furthest distance the scope could go in the ileum. So it essentially means ileum for the most part compared to a stool sample. So the take home point here is the different colors represent the different major groups in the different compartments here, but it’s fairly consistent across the small intestine and then suddenly you have this huge change in the large intestine, which is reflected by the fecal sample. So that’s really reflecting that big change in physiological parameters from the small intestine, which again has a higher oxygen content, et cetera, usually lower acid levels, higher pH, then the colon very different environments particularly because of the fact that it’s anaerobic.  So that’s why anaerobic species thrive there that ferment carbohydrates. So a big difference and that’s really key to understanding this sort of localization aspects to interpreting stool tests. And this is the Tyler study mapping, the segmental microbiomes in the human small bowel in comparison with stool, the Reimagine study. And again, this is a study that was just published earlier this year by Mark Pimentel’s lab. [Mapping the Segmental Microbiomes in the Human Small Bowel in Comparison with Stool: A REIMAGINE Study]

Dr. Weitz:           Yeah. We were lucky enough for Dr. Pimentel to join us several months ago.

Tom Fabian:       Oh, you did? Okay, great. I have to go back and make sure I check that out.

Dr. Weitz:           Yeah.

Tom Fabian:       So this is a summary of markers on GI MAP based on research that indicates where they’re predominant in the GI tract. We just sort of broke it down between upper GI and lower GI, with the upper GI being on the left and then the lower GI being on the right. So not all species or groups are known in terms of research that’s available in terms of where their predominance is, and then in other cases, they may be prevalent in both but both of these groups here research supports the predominant primarily either in the upper or the lower GI tract. So once again, there’s quite a few markers on GI MAP that are likely reflecting what’s going on in the upper GI. Again, the classic one being H. pylori, GRD is another, well-known microbe that basically thrives in the upper small intestine. The two that I’m going to focus on here just briefly in this presentation are Klebsiella and C. diff. So one example of an organism that’s present more commonly in the upper GI and also the oral cavity and then less prevalent in the lower GI except in cases of potential inflammation.

                                So as far as stool composition, just to kind of summarize it primarily reflects the colon composition. So that’s sort of intuitive, but also that’s what research shows as well. And of course within the column, there’s a mix of luminol and mucus associated microbes, with the composition primarily dominated and fecal samples with luminol microbes. But definitely you get a sense of the mucus associated microbes such as Akkermansia. It’s also dominated by anaerobic Fermenter bacteria in particular, the Clostridium class in the Firmicutes phylum and then the Bacteroidetes genus in the Bacteroidetes phylum. Those are far and away, the two most dominant groups in the microbiome in most individuals, at least in Western countries. Microbes from the upper GI tract can be present in stool, but usually in really low numbers.

                                So that’s of course where qPCR comes in, because we can still get some good insights based on the presence of some of those low abundance type organisms. So once again, this is just sort of back to the figure from the Pimentel study showing the breakdown of these major groups across the small intestine and stool. Of course, the question is why we’ll get into some of that a bit more as well. So that guy somehow made a mark there. So really, I think it’s important to consider since we can detect potentially some of these upper GI microbes. Some of them are better established as being pretty exclusive to the upper GI tract. Again like H. pylori and Giardia. Pseudomonas, mostly research does indicate that it’s likely thriving in the stomach and the upper small intestine and so far, most studies indicate that it’s not present and are not active, usually not active in the large intestine.

Dr. Weitz:            Are you going to have time to go into H. pylori? And if not, can I ask a couple of questions now about H. pylori?

Tom Fabian:       I’m sure. Yeah. I’m happy to answer questions right now, but it’s H.pylori.

Dr. Weitz:            Okay. So if we see H. pylori present, but there aren’t any virulence factors essentially it’s my understanding that that’s not super important. Correct?

Tom Fabian:       So as far as H. pylori its presence without virulence factors, it is important apparently, we certainly see a potential clinical impact quite often when it’s present and especially if it’s high.

Dr. Weitz:            O.K., so when we look at the numbers, like the normal says 1.0 e3, now what’s considered high?

Tom Fabian:       High is generally that’s what that cutoff level is indicating. So above that number is considered high, below that number is considered detected.

Dr. Weitz:            Like if it’s 5.0 e3, is that a little high or a lot high? Is it a lot high if its e4, e5 that makes it a lot high, right?

Tom Fabian:       Right. Yeah. I mean, because those are orders of magnitude, but definitely clinically in the E three range is high and it’s of course you have to take everything into the context of the patient and how that patient’s presenting symptoms that may be related to that, but also we can see a pattern on GI MAP. And so there’s a lot of research showing, for example, the H. pylori, regardless of virulence factors likely reduces stomach acid in majority of people that have a chronic infection, and so we have an overall digestive dysfunction pattern that I mentioned briefly earlier that is often associated with H. pylori, and it’s one of the ways that we can gauge based on just the test markers and connecting the dots, doesn’t look like this is having an impact in the ecosystem and then of course the clinician has to decide, is that relevant to the patient’s symptoms and how the patient is presenting?

Dr. Weitz:           So you’re saying if we have a patient with elevated H. pylori and it seems like it might correspond with the symptoms, it might be worth treating, even if there’s no virulence factors?

Tom Fabian:       It would be worth considering, a lot of clinicians do, but I think the… When it comes to functional integrative type clinicians, a lot of clinicians will often focus more on antimicrobial approaches versus going straight to antibiotics. So it’s not a scenario that would be kind of in conventional medicine it’s the more looking at the potential virulence in relation to things like potential for stomach cancer ulcers also things like that. Some of the more serious outcomes that are tied, the risk for those types of outcomes are tied to the virulence factors. But the more mild sort of to moderate effects based on just depression of stomach acid still can be clinically relevant for patients, but it may not warrant sort of complete eradication for example.

Dr. Weitz:           And in some of the virulence factors more important than others?

Tom Fabian:       Based on research so far, the answer is yes. The two that stand out the most, partly because they’ve been well-researched, but seem to be especially required for the more significant inflammatory outcomes and that would cagA and vacA.  That’s important to point out though that virulence factors tend to work together and so generally the more you see on the test, so the more that are positive, the more likely than that could be a more significant scenario.

Dr. Weitz:           One more quick question, just in general, in terms of any bacteria or pathogen or potential overgrowth when we see the number there, but it’s less than the normal that could still be significant?

Tom Fabian:       Right. Now, again that’s really where clinical judgment comes into place, so-

Dr. Weitz:           Because it’s really well, it’s has <dL> right? Like super low.

Tom Fabian:       Exactly. Yeah. That either means it’s just not there at all or it’s presence at a low level.

Dr. Weitz:           Okay.

Tom Fabian:       We often do see that based on interacting with clinicians that their judgment is, and also based on what we see on the pattern on the test that [inaudible00:30:31] can be clinically significant for some patients, again, mostly in that context of potential for contributing to dysbiosis and reduce digestion.

Dr. Weitz:           Okay, great. Go ahead.

Tom Fabian:       So that’s really kind of… It was actually a great time to talk about H. pylori because that is kind of the classic example when you hear certain folks out there saying you can’t really get any information about the upper GI from a stool test, that’s simply not true because H. pylori is sort of the case in point. We can certainly get some great insights into what may be going on in the stomach in that case.

Dr. Weitz:            And of course, zonulin gives us some information about the upper bowel as well. Right?

Tom Fabian:       Right, exactly. So qPCR, again, just kind of that analogy that it’s great at finding these needles in the haystack. H. pylori is a good example. There are a lot of the metogenomic type tests, metagenome sequencing that generally aren’t as good at detecting H. pylori let alone quantitating it. So when you really want to know about a clinically relevant organism, qPCR is a very effective way to assess that. So let’s talk a little bit about the insufficiency type of dysbiosis. So this is something that probably a lot of clinicians who worked a lot with GI MAP have seen, you may see a really broad insufficiency like we see here for this patient where there are a lot of markers in the normal bacteria section that are deficient, at the phylum level that’s certainly one of the most important levels to look at because those two groups together make up the bulk of the microbiome, particularly in the colon.  So when they’re both deficient, that’s telling you the microbiome overall is probably deficient and then all those beneficial functions that they serve are probably also deficient. It’s also a great to focus, particularly on Akkermansia and the E. coli bacteria, and those are two Keystone species. So once again, when one or both of those are low that can be pretty significant in terms of indicating that the colon ecosystem is not so healthy. The other thing I want to note about kind of connecting the dots on GI MAP is we do lots of research.

Dr. Weitz:            Let me just see if I could throw a question in Dr. Rahbar who’s joining us tonight is a integrative gastroenterologist. Let Dr. Rahbar ask a question. Let see, I’m going to unmute you Sam, why don’t you go ahead and ask your question. Did I unmute you?

Dr. Rahbar:          Can you hear me?

Dr. Weitz:            Oh yeah. Now we can hear you.

Dr. Rahbar:          Okay.

Tom Fabian:        Yes, I can hear you.

Dr. Rahbar:         Yeah. I have several questions since we use this lab quite frequently, and I kind of use my common sense approach to it.  For example, I see sometimes practitioners wanting to treat Klebsiella and Citrobacter fruendii in the stool. And I always question, are these specific pathogens, or are these markers of dysbiosis?  It means that, do you need to look at it as dysbiotic flora or like if I got Shigella or something in the stool I would say, okay, you’re going to have some specific bug that I have to treat it.  Or campylobacter.  At least from the literature that I see, I don’t recognize these as specific pathogens of the gut, indications of disease.  So I usually respond that maybe you treat SIBO some other dysbiotic scenarios, but I wouldn’t target a specific one, but Dr. Fabian, I wanted to get your opinion on this one without just saying something. 

Tom Fabian:       Absolutely. Yeah. I mean-

Dr. Weitz:           And these are two markers that are listed in the section potential autoimmune triggers.

Tom Fabian:       Right. And that actually is one of the examples I’ll be covering here in this a little bit, so that’s really why it’s considered an opportunistic pathogen. So opportunistic pathogens can exist in the gut without any effects at all or they can potentially be part of a pathogenic process. So they’re not generally recognized at least in the gut as being outright pathogens. That picture is probably going to change a little bit with some of the organisms like Klebsiella, where we do see that it’s more frequently now associated with things like inflammatory bowel disease, et cetera.  So it’s beginning to square where it’s not thought of as sort of an outright infection, a specific infection like salmonella, but it is part of the pathogenic process in some cases. So it’s kind of in that gray area, and that’s a perfect example of where clinical judgment really to come into play in combination with really understanding how to connect the dots with a test like GI MAP.  So you can really get a sense for, does look like this is a problem, or does it look like it’s for this patient probably not much of a problem.  And that’s, well-documented research some people can have relatively high levels of Klebsiella and no evidence of inflammation.  Other people can have high levels and have inflammation, but the big difference often is the ecosystem.  If they don’t have as many of the beneficial bacteria, they may be more likely to have inflammation.

Dr. Rahbar:        Right and if I may say something, obviously we need to evolve into this to understand if we correct that, whether it reverses the immunological abnormality or not.  We can say that this is part of the autoimmune trigger but if you fix it, does it fix your autoimmune problem?  And that answer obviously is not clear.  And so far, I don’t think if you just change that bug, you’re going to see it, but we have to see how that answer is going to evolve.  I wanted to ask you a question regarding the H. pylori.

Dr. Weitz:            So actually, let me just ask that same question again. Tom, is there any data showing that if we have a stool test that shows potential autoimmune triggers and we reduce that particular bacteria, that we may have a positive effect on their autoimmune disease?

Tom Fabian:       That’s a good question. So I’d have to go back and kind of dig through some of the research that I have to see what specific studies there are, mostly to date what I’m aware of is, those are associations and a few cases, there may be some kind of mechanistic insights suggesting there might be a causal link. But mostly to date, a lot of those are based on associations. I’d have to go back and again, dig through the research to see if I do have some studies that specifically talk about whether or not if they’re addressed, does the disease reverse or do some of the symptoms improve?  Not entirely sure.

Dr. Weitz:            Yeah. I just had a patient today who has Ankylosing Spondylitis and he has high levels of Prevotella [I meant Klebsiella] and there’s data showing that that can be directly related to how the Ankylosing Spondylitis is created in the body.

Tom Fabian:       Right. Yeah, definitely for some of them, at least it’s suspected, and some evidence that there might be some kind of molecular mimicry, for example where the immune system reacts to protein on the pathogen or the opportunist that then looks very similar to a protein in the body and then the body develops an immune reaction to those proteins as well. So that’s kind of an ongoing thing. I think it’s mostly well established for one of the oral microbes, which is Porphyromonas gingivalis, but there’s probably a growing list of examples there.

Dr. Rahbar:         Dr. Fabian, may I ask a question regarding H. pylori, we occasionally find this in duodenal aspirate as interesting that even in the stool test sometimes the marker comes up as red and sometimes it’s black. I agree that the best value is below <DL, below the detectable levels. So if any amount is showing would it be abnormal whether it’s in the black or red zone?

Tom Fabian:       That’s a good question. So certainly below detection limit, if you’re aiming for eradication or greatly reducing its levels from a therapeutic goal, then certainly that’s what you’d be looking at. Now there’s with any sort of microbe, I mean, except for outright pathogens and H. pylori is kind of more on the opportunistic pathogen category versus something like enterohemorrhagic E coli, which is not really pathogen. Those you generally don’t want to see those in the gut at all of course.  When there’s H.pylori there’s some debate as to whether or not complete elimination is always desirable. It really depends on kind of looking at all the risk factors, but some data indicates that there may be some increased risk for other conditions by completely eliminating H. pylori. So what we know mostly from research is that most of these types of opportunists in the gut like Klebsiella, H. pylori, as long as they’re kept in check by healthy gut and healthy microbiome, they may not be a problem.   So that’s kind of where that gray area, low levels for some people may be fine, because maybe they have an overall healthy stomach, they have a lot of Lactobacillus, for example, in the stomach, which is definitely one of the known healthy groups in the stomach and a healthy ecosystem. Then they may be fine and there may be no reason to target H. pylori, but if people are having symptoms that could be ascribed to it, plus we see a signature on the test and there may be other considerations as well.  Some clinicians may decide that they want to at least try to reduce that and see if that helps symptoms for that patient.

Dr. Weitz:           Does it make sense to also do a H. pylori breath test or antibody test to confirm it?

Tom Fabian:       Some clinicians feel that because it really depends again, on the scenario and the risks, say if you have lots of virulence factors and there’s a history, family history of stomach cancer or anything like that, there may be scenarios where you really do want to make absolutely sure that it’s eradicated, if you’re trying to eradicate it or even just verifying the levels over time. So there are some clinicians that prefer to do multiple tests. Just to really get a better handle on it. PCR is very sensitive. So it is often a scenario where we’ll see a low level detected where a breath test or a stool antigen tests may be negative.

Dr. Weitz:           By the way, is PCR ever too sensitive?  Is it ever the case that it’s picking up things that maybe are no longer there?

Tom Fabian:       That’s a highly unlikely scenario as far as past infection. So it’s a very different scenario than say antibodies, which can linger for a long time. DNA from organisms, especially in the gut is highly unlikely to linger, partly just from the simple fact that materials moving through within a certain period of time.  So if the microbe isn’t attached and to be attached to it has to be alive, because it has to actively produce those proteins that allow it to attach.  So it’s not likely, that it would be detectable past a certain relatively short period of time on the order of days.

Dr. Weitz:            Okay. And Dr. Greenberg asked if the Pseudomonas is high, does that imply that it’s overgrown in the small intestine or that it has also colonized the large intestine?

Tom Fabian:       So far there is no research supporting that it can colonize or at least colonizes on any sort of frequent basis in the colon. All the research to date supports that it’s mostly in the upper GI and stomach.

Dr. Weitz:            Okay.

Tom Fabian:       Really it’s niche where it thrives. I haven’t yet come across a single study. It can be detected, of course that’s how we pick it up. It really doesn’t seem to thrive in the colon. In fact, specific studies have looked at that based on transcription gene expression, and Pseudomonas is one of those that when you look at gene expression methods is not detected in the gut, meaning it’s not active.

Dr. Weitz:            Okay. Yeah, go ahead.

Tom Fabian:       Okay. So coming back to this section where were talking a little bit about the beneficial bacteria and what to look for when there’s a lack of beneficial bacteria. In addition, of course, to the normal bacteria section you really want to make sure you pay attention to secretory IgA. So we do know that, the main stimulus for normal physiological ranges of secretory IgA is the normal commensal microbiome, through secretion of Butyrate and other products that stimulates the production of secretory IgA. So we see a really strong correlation there.  Typically when there’s a lack of at least, one of the key groups of beneficial bacteria, we often see low secretory IgA.  Clinically it appears that the lower, the number like we see here, the more likely that is to reflect lack of Butyrate producers.  So you’ll often see, for example, really low secretory IgA below 100 when Faecalibacterium, for example, is also very low.  So it’s kind of a great overall marker for lack of beneficial bacteria.

Dr. Weitz:            So, if we see this on a test with a patient who maybe has some other infection or parasite at the same time, would we best be trying to improve their microbiome with probiotics or prebiotics, or would be better to directly try to stimulate their immune system with colostrum or some products like that have an immunostimulatory effect?

Tom Fabian:       A lot of clinicians will focus on both building up, the microbiome can take time depending on what’s going on. So if you need a more immediate effects then those types of supplements, Saccharomyces Boulardii, L-glutamine even Vitamin A, has been shown to be necessary for normal secretory IgA levels. So supplement approaches certainly can help bridge that gap until the beneficial bacteria are recovering. So again, that’s a really important marker to pay attention to that has a very strong correlation with lack of beneficial bacteria.

Dr. Weitz:            I just want to ask about the fecal calprotectin, which is a marker of inflammation. I’ve had a number of tasks where that was normal, and not particularly high, but the patient has a lot of gut symptoms and it just seems like their gut is really inflamed. So, why would that number be low if their gut’s really appears to be inflamed?

Tom Fabian:       That’s a good question. So it’s a good marker for inflammation particularly in the lower GI. So if you look at studies on Calprotectin, for example in relation to H. pylori, so Calprotectin in stool, there’s not much of a correlation, so we know the H. pylori can cause inflammation in the stomach but that doesn’t reflect so much, in ability to detect it in stool. So one possibility is that you may have upper GI inflammation, if they’re inflamed and that’s likely in a lot of cases. So for example, Pseudomonas, lots of new research shows, that when that’s overgrown that’s likely causing inflammation, doesn’t always mean it is. So again, you want to take into account the big picture but if it’s significantly overgrown that’s a significant possibility that could be causing inflammation the upper GI. Candida is known to be inflammatory often colonizes pretty much anywhere in the upper GI tract, even the oral cavity. So that’s one of the major reasons if they seem to be inflamed and Calprotectin looks fine, maybe more on the upper GI.

Dr. Weitz:            One of the patients [I meant practitioners] asked that, she had a patient with Ulcerative colitis. Calprotectin was 660 on the GI MAP a week later, the calprotectin was 150 on a standard lab.

Tom Fabian:       So, it’s difficult to kind of compare among labs due to, we know what our lab does. Our lab certainly does everything that’s required of a CLIA lab and then some, so we know that our markets are internally validates very well, but we can’t speak to other labs in terms of how they perform the test and also do their validation, but also be aware that Calprotectin is a marker that can change over time.

Dr. Weitz:           So if you change, can it change quickly in a week?

Tom Fabian:       But actually, yeah.

Dr. Weitz:           Okay.

Tom Fabian:       Yeah. Because, it’s really responding to what’s going on in the gut. Now, if you have chronic inflammation, that’s not necessarily changing, you shouldn’t expect to see that changed. Generally though, if you’re doing a retest say after treatment and you want to see what’s happening with the levels, it’s always recommended to use the same lab that you started with. So you have that consistency and baseline because otherwise, you’re factoring in possible methodological differences.

Dr. Weitz:           Yeah. I have to say sometimes this sort of question comes up when I’m managing a patient as a Functional Medicine practitioner/Chiropractor, and then the patient goes to see a standard GI doctor and they send them to LabCorp or Quest and get a different result and then they scoff at this test.

Tom Fabian:       Right. Yeah. I mean, that’s always going to be an issue when you’re comparing tests. We see that, like I mentioned with H. pylori where a patient may be negative with a stool antigen test, they do a PCR test and because of the sensitivity level, we pick it up and the other lab with the other method, didn’t pick it up. So, it’s ideally you’re doing the same if you’re kind of comparing time points with the same test.

Dr. Weitz:           Okay, good. Go ahead.

Tom Fabian:       Okay. So on the next slide, it’s just kind of a visual reminder of what we’re looking at. So, we’re so used to looking at tests, the numbers and kind of thinking about things a bit more in the abstract when it comes to the gut, because we can’t see the ecosystem.  It’s important to really kind of come back to sort of the visual understanding that we’re talking about the bugs, and this is the lumen side towards the top, and you can see the bugs here. And if these are largely representing beneficial bacteria, there’s secreting, creating factors, particularly short chain fatty acids that are absorbed into the mucosa. That then basically elicit effects, particularly from the immune cells and the Epithelial cells, certain Epithelial cells, the Goblet cells, respond by producing mucus and then certain immune cells, the Plasma cells respond by producing secretory IgA, and the secretory IgA is secreted in the mucus layer. So just kind of another quick little clinical Pearl is you’ll often see low secretory IgA along with low Akkermansia. And that’s indicating that likely this mucus layer that includes mucus and secretory IgA could be deficient. You can see here, it’s representing that this mucus layer is keeping the microbes away from the mucosa, which is important to keep the reactivity of the immune interactivity down. So that’s part of the whole immune tolerance type, a phenomenon is preventing overreaction of the immune system to harmless microbes.

And so just a little bit more about the Firmicutive bacteria to these phylum, just to reiterate they’re anaerobic and they’re dominant in the colon and the main source of short chain, fatty acids, and those short chain, fatty acids have many important effects. One of which public have a little bit of time to go through here and a little bit when I go through one of the studies, but there are definitely overall key for colon health particularly in terms of protection from pathogens and opportunists. So it’s not common to see some of these opportunists, particularly under Autoimmune triggers, for example. And when we do see them, that suggests possibly the overall beneficial bacteria may be deficient.

So the other information you’ve already talked about, so we’ll move on.  I just want to touch briefly on inflammatory Dysbiosis. So this is a subset of the inflammatory kind of the main inflammatory types of organisms on GI MAP.  So there are particularly inflammatory bacteria in the Proteobacteria phylum. Most of them tend to be in a subclass or subgroup called Gamma Proteobacteria. So they’re all fairly related. A lot of them have been shown to have the more inflammatory type of LPS, for example. But quickly I want to focus on Klebsiella.  So that’s something we’ve talked about a little bit so far here, as an example, there’s this really interesting study that just came out a little while ago.  Actually just this past summer.  So the title is Intermucosal connection between the mouth and the gut and commensal pathobiont-driven colitis.   So this is basically showing that the connection between Dysbiosis in the mouth and Dysbiosis in the gut, and then what can happen in between. So they say here real quick, Periodontitis leads to expansion of oral pathobionts, including Klebsiella and Enterobacteria species, which were both on our tests and the oral cavity amassed oral pathobionts are ingested, then translocate to the gut.

                                So basically swallow pass through the stomach and then end up in the lower GI tract, particularly if there’s not enough stomach acid, where they activate the inflammasome in Colonic mononuclear, Phagocytes triggering inflammation. And I want to go on to a little bit more information here. So they say in the article, this evidence suggests that at least two conditions must be met for oral pathobionts to topically colonize the gut.  First, the colonization resistance of the gut resident microbiota must be disrupted often, meaning that you have a lack of beneficial bacteria enabling the oral microbes to invade the gut.  Hence intestinal inflammation favors the growth of Enterobacteriaceae, that’s kind of a subgroup that includes E-coli, Salmonella, Klebsiella, et cetera in cleaning bacteria transmitted from the oral mark, because one more thing I want to highlight from this article is alternatively neutralization of gastric acid or inhibition of acid secretion could promote ectopic colonization of oral bacteria in the gut.  For example, it has been reported that the use of Proton pump inhibitors, which reduce production of gastric acid leads to increased colonization of mouth resident bacteria in the gut, consistent with his observations been reported that gastric acid inhibitors worsen clinical outcomes in IBD. So definitely this is an important article that kind of follows up on earlier research showing this integrative approach. You’ve got to take the whole GI tract into account.

                                When you see Klebsiella come up on a test, the questions you want to ask are, is there evidence it’s causing inflammation? You may even want to check with the patient, ask the patient about their oral health. You may want to look at indicators of stomach acid because it may be telling you this patient might have insufficient stomach acid. So lots of, kind of connecting the dots there when you see these various organisms. So that’s talked a little bit about the insufficiency Dysbiosis, inflammatory Dysbiosis. Those two are really linked. As you can imagine, when you have a lack of beneficial bacteria, that’s one of the key factors that allows these inflammatory microbes to grow in the lower gut. I just want to touch on the Digestive Dysfunction Dysbiosis. When we think of digestive dysfunctions, most clinicians go straight to this digestion section and look at the markers.  Steatocrit is looking at fat malabsorption in this case, it’s high.  Elastase is a marker for pancreatic enzyme deficiency or our production in this case it’s low. But if you see those normal, does that mean digestion is fine?  And often times the answer is no. Fortunately we can get some additional insights by looking at the patterns of the microbes and what we know about certain microbes, such as H. pylori.

                                So it’s just kind of coming back to what I talked about that this review article basically came to the conclusion that most patients chronically infected with H. pylori have Gastritis and also Hypochlorhydria, not necessarily all.  It’s important to know that not everybody that has H. pylori has low stomach acid but a pretty large proportion of them do seem to have low stomach acid and that low stomach acid for various reasons on this case, they’re looking at Proton pump inhibitors leads to certain types of Dysbiosis that’s really reproducible. So they mentioned here in the highlighted area that Streptococcaceae and Enteroccaceae species are among the most common that you see elevated. Also PPIs are risk proceeded infection. So I’ll get to that. Hopefully we have a little bit time later on here too. Sometimes decrease with E coli bacterium as well. So these are the patterns that we can see, for example, in relation to low stomach acid, there’s a lot of research backing this up, particularly with the Fermicutes phylum. Many studies have replicated that, finding that you see elevated levels of those in stool when patients have been shown to have low stomach acid. And so this is just an example of a patient that had high H. pylori, so suspected low stomach acid, again, not diagnostic for low stomach acid, but something to think about. You’re looking for an overgrowth pattern. We’d see the overgrowth pattern typically in the normal bacteria section.

                                This would be pretty significant. We don’t always see it, this prevalent with so many markers elevated. But we often do see this overgrowth pattern, particularly with the Firmicutes phylum. And then in this case, we also saw Faecalibacterium was low, which really follows that particular study that was found to be low as well. With low stomach acid, your opportunistic bacteria is really where you’re going to see the most common evidence of overgrowth. That’s where the Enterococcus species are and Streptococcus. So if those are high, then suspect that stomach low stomach acid may be an issue. And then some of these others too, like Pseudomonas can also be overgrown and stomach acid is too low, or there’s other.

Dr. Weitz:            Can I ask about Methanobrevibacter?  So we know that methane SIBO is now IMO according to Dr. Pimentel. And so therefore it’s an overgrowth of methanogens, like methanobrevibacter, Methanobrevibacter smithii, and so if the patient has a positive SIBO breath test for methane SIBO, would we necessarily see elevated levels of Methanobrevibacter and, what if they don’t correlate?

Tom Fabian:       That’s a good question. So they generally do seem to correlate as far as we can tell but not always. So that is an important factor to consider that sometimes you can have an increase in bacteria or in this case, microbials because Methano bacteria is they actually are archea, not bacteria kind of closely related, but and so you can have an increase in function, of microbes in some cases without necessarily a significant increase in their numbers. Now that said, on our test and based on looking at literally thousands of tests over the last couple of years then the methanobacteria family on our test tracks very closely with overall evidence of overgrowth on our test. And you’ll see here in a moment, if I get a chance to get to the one of the slides here that talks about that more, it’s, it’s really a direct reflection of the level of fermentation, particularly in the colon.  So when you see methanobacteriaceae in our experience it seems to be clinically relevant anytime it’s in the E nine range, not even above the cutoffs.  It’s highly correlated with this. So generally, yes. I would say when, when patients have also had a breath test, they will have some level of methane detected. But it’s not necessarily a hundred percent correlation for example.

Dr. Weitz:            And somebody asked a question about H. pylori, which is can it also increase stomach acid production, depending upon where the H. pylori is?

Tom Fabian:       Yeah, that’s true. So there is some evidence that in some cases that can be the case during more than acute sort of early infection. And it really does depend, apparently there’s some conflicting research on it. So it’s not really all that well studied, but it does depend on where in the stomach it’s infecting and the extent of the infection. Now, there is some evidence based on a couple of studies I came across that typically the infection can migrate in the stomach over time. And I forget which direction if it’s antrum to corpus or corpus to antrum, but the overall conclusion was that it tends to long-term be more consistent with hypo or Hyper. But some patients may have an increase in acid depending on where the infection is.

Dr. Weitz:           Okay.

Tom Fabian:       So this is just kind of showing you in this example that Klebsiella was elevated which again is something we often see when there’s other evidence suggesting low stomach acid. And that goes along with that research that suggests Klebsiella may often come from the oral cavity or possibly the respiratory tract, which is also another common location for Klebsiella. And then it may get into the GI tract to those routes when stomach acid is insufficient. I’m going to go ahead and skip this here other than, of course, whenever you see an overgrowth of inflammatory species and we had that list higher up on one of the other slides oftentimes, but not always, you’ll see Calprotectin elevated. So there is a correlation there. We see it most commonly in, for example, patients that have already been diagnosed with inflammatory bowel disease we often will see that connection between higher Calprotectin and higher levels of inflammatory species.

Dr. Weitz:           By the way, if pancreatic elastase is low, is the best recommendation is to recommend that they supplement with pancreatic enzymes or are there other recommendations?

Tom Fabian:       That’s a good question. So a lot of clinicians do take that route to help compensate. But of course you want to also ask the question what may be contributing to that.

Dr. Weitz:           Right.

Tom Fabian:       So there may be issues with the pancreas itself. Of course, Pancreatitis, things like that may play a role for some patients, but even low stomach acid can lead to lower release of digestive enzymes. That might be another factor for a lot of patients that can be gut-brain axis issues.

Dr. Weitz:           Interesting. Low acid leads to low pancreatic enzymes?

Tom Fabian:       It’s a contributor. Yeah.

Dr. Weitz:           Okay.

Tom Fabian:       It wouldn’t be considered, if you say you have really low elastase are rate sufficiency. That’s, well below that 200 cutoff it would probably be unlikely that that’s the sole contributor unless for example stomach acid is exceptionally low. You may be wanting to look into some other contributing factors at that point.

Dr. Weitz:           And if steatocrit is high, that’s fat in the stool, is the best recommendation to give them a lipase, fat breaking, fat digestive enzymes, or is bile going to be more beneficial or both?

Tom Fabian:       Good question. So just based on the presence of the excess fat in the stoool you can’t tell directly just from that which upstream process is affected.  Now, if you do see that our last days is really low, particularly if there’s outright insufficiency, meaning well below 200, then it’s more likely that, the highest steatocrit would be caused by lack of lipases from the pancreas as well. But you can also have a scenario where there’s insufficient bile but it’s probably less appreciated is issues in the small intestine, which is where fats are primarily absorbed, where they’re supposed to be absorbed in a healthy gut. So if you have an inflamed, small intestine, and you’re not able to really absorb fats as efficiently.

Dr. Weitz:           Such as if you have SIBO.

Tom Fabian:       Exactly.

Dr. Weitz:           Okay.

Tom Fabian:       Right. Just have a few more things to go through and then based on time, do you want me to stop here or take more questions or do you want me to continue on for a couple more slides?

Dr. Weitz:           Go a couple more quiet slides.

Tom Fabian:       Okay. so again, these are the three main Dysbiosis patterns that learning to recognize them can give you a lot of insights into what’s going on in the overall gut, in terms of physiology and the microbiome, and even some insights into say lower versus upper GI issues, I’ll skip this, but we all know that of course pH is one of the key factors along the GI tract. We mostly think of stomach being the key kind of checkpoint. So when you may unfortunately ingest pathogens, for example, food poisoning if you have good stomach acid, then they’re less likely to survive the transit, but what’s less appreciated is that slightly acidic levels in a healthy colon, especially the ascending colon, are almost as important and helping to keep pathogens and other opportunists from colonizing your colon. So I’m just going to go through a quick example of that here. This is a really interesting paper that was published recently, so the title is Inhibiting antibiotic-resistant Enterobacteriaceae by microbiota-mediated intracellular acidification. So that’s in the Proteobacteria phylum, that’s a particularly inflammatory group.  So inhibiting that group by microbiota mediated, intracellular acidification. So just to kind of cut to the chase, they mentioned Klebsiella and E coli as kind of the examples they’re looking at here. And then the highlighted in orange part towards the bottom says Klebsiella pneumonia, Escherichia coli, Proteus mirabilis by acidifying the proximal colon and triggering short chain, fatty acid mediating intracellular acidification. So essentially what they showed in this study is that normal levels of beneficial microbes that are producing adequate levels of short chain, fatty acids literally inhibit the growth of these pathogens by basically producing the short chain fatty acids that then are taken up by those cells and that satisfies the cells and basically prevents them from growing.  So that’s one of the ways in which these beneficial bacteria, like Clostridia, Bacteroidites can help to keep those pathogens in check. So once again, when you see those at high level particularly Klebsiella or Proteus that’s one of the things we’ll be looking at is evidence for low beneficial bacteria. And they actually showed in this study that just restoring the beneficial bacteria and the short chain fatty acids can be enough to address those pathogens. So that’s kind of an example where you don’t always have to resort to antimicrobials.  Restoring gut balance may be sufficient.

Dr. Weitz:           Can I just ask a question about anti-microbials?  I interviewed Dr. Jason Hawrelak a few months ago, and he mentioned that he thinks that taking anti-microbials like Berberine can significantly damage the microbiome.  Do you think that that is something that is liable to happen?  Do we see evidence of that?  In other words, can natural anti-microbials produce damage in the microbiome?…   The way antibiotics can say, for example.

Tom Fabian:       Generally, no, we have not seen that. Not even close.

Dr. Weitz:           Okay, good.

Tom Fabian:       Mostly when we see a really broad deficiency pattern, it’s related to antibiotics or other pathology like IBD or something like that.

Dr. Weitz:           Good.

Tom Fabian:       Real quick though, I think he was referring to at least the research I’m aware of on Berberine in one study a few years ago, showed that it can long-term or high doses can reduce diversity. But it was in an animal model in mice. So that suggests maybe not taking super high doses for a long time would be-

Dr. Weitz:           By the way what’s a high dosage? Because for example I’m using Berberine not only for gut patients, but we use it to help manage metabolic factors and I also use it as a sort of a substitute for Metformin in anti-aging programs.

Tom Fabian:       Right. Good question.

Dr. Weitz:           It works synergistically with Metformin to manage blood sugars, so.

Tom Fabian:       Right. So that was really just one study and I have not come across any additional studies on that and again it was a mouse study. It was a very high dose though. Something maybe equivalent to a least more than five grams per day for humans. Again, you have to take those kinds of things into account that if it was just an animal study and it was super high dose, maybe it doesn’t apply to real world settings. Right?

Dr. Weitz:           Okay.

Tom Fabian:       But that’s not been our experience. The patient is on strong antimicrobial botanicals. Don’t seem to develop a deficiency pattern based on what we see on GI MAP so far.

Dr. Weitz:           Right. Good then that’s been my experience as well.

Tom Fabian:       Okay. So this actually, it’s kind of interesting that we talked about that, because I won’t go through this full case. It’s not really a full clinical case, but just a quick example of an older female history of bladder cancer was on long-term Amoxicillin antibiotic for five or more years. Main complaint was just Chronic diarrhea. So of course there was a suspicion of antibiotic associated diarrhea in this case.  You can see here very broad deficiency, which would be pretty much expected from such a long-term exposure to an antibiotic.  But just based on what we’ve talked about before with the insufficiency, you would expect that this would potentially lead to overgrowth of opportunists or pathogens.  And sure enough, you see Pseudomonas and Klebsiella overgrown and it turns out that those two are the ones that are known to be resistant typically to Amoxicillin.  So, we’re seeing exactly the pattern you would expect based on that patient being on that antibiotic.  This kind of scenario to me is very important. You’re thinking about, which gut tests you want to go with and how good is a gut test? And you can kind of debate validation approaches and all these things and sequencing versus PCR. But in the end of the day, it really comes down to “Does this clinically validate?” And as you know a patient for example, is on an antibiotic long-term, you would expect to see patterns of this. If you don’t see patterns like this, there may be some individual variation, but when you… So that’s just something to keep in mind as you’re going through some people may try different gut tests. You want to make sure that the test you’re using clinically validates and that it makes sense based on the patterns that you’re seeing.

Dr. Weitz:            Can I just comment your test looks at, if there’s pathogen what antibiotics might be effective for those pathogens, some of the stool tests, in which in the past, I know used to use natural anti-microbials, how come you don’t include that?

Tom Fabian:       That’s a good question. So I’m not sure of all the reasons why I know part of it is we wanted to kind of keep our test to molecular that’s what our lab does, that other sort of approach to look at potential sensitivity involves culturing. So that’s part of the picture, but also how realistic is it from a couple of different standpoints that what you’re measuring on a Petri plate with one organism really translates to how effective that’s going to be in an actual, vast, complicated ecosystem. You don’t really know that plus most clinicians tend to use common formulations.  Some do use single ingredient approaches.  A lot of clinicians use formulations that they found to be generally effective.  So it’s not necessarily going to affect what they use clinically either.  So it’s not always clinically useful information.

Dr. Weitz:           Okay.

Tom Fabian:       I think I’ll skip all of this here just real quick. And one more thing about Klebsiella and also Morganella they have been linked to excess Histamine production.  So again, be thinking of these things, when you see Klebsiella overgrown you want to kind of look at the context are beneficial bacteria lacking. Does the patient also potentially have Histamine intolerance symptoms, et cetera. So the more you know about these microbes, the more you can potentially clinically connect those dots. This is the only thing I was going to show and I’ll stop at this one. This is a little bit of a complicated diagram, but it’s representing the colon on the left side is the proximal colon and moving on across horizontally to the right towards the distal colon. There’s a lot of research showing basically the dynamics in the colon so that you understand better, why a patient may have say a high Firmicutes, low Bacteroidetes why they might have Sulfur-reducing bacteria and methanogens.

                                So the main point I wanted to make here is generally in the first part of the colon is where most of the Fiber fermentation, Carbohydrate fermentation is going to happen, that can release hydrogen and then basically that part has to kind of start happening first before that hydrogen is available for the methanogens.  And then basically further down the line would be the Sulfur-reducing bacteria, which tend to be more in that latter part of the colon.  Where also bacteroidetes tend to dominate and that’s going to be affected by transit time and other factors too.  But there’s a lot of, sort of modeling that’s being done to understand the ecosystem.  And I think this is a great visual and understand why do we see high methanogens on our test when there’s high Firmicutes that are showing you that there’s a general overgrowth pattern, probably because they’re fermenting, generating H2 and then promoting methanogen growth.  All right.  So that’s in a few additional slides, a lot of material that we could always cover.  Maybe we’ll have an opportunity a part two at some point.

Dr. Weitz:            Okay.

Tom Fabian:       Yeah, so I bring that in, so really it’s all about connecting the dots and just learning. We have a lot of educational information because we offer the consultation. So I encourage everyone to take advantage of those resources because the more you can connect the dots, the more you can get out of the stool tests in terms of good clinical insights that can really help you be more effective in helping your patients and clients.

Dr. Weitz:            I have one more question I’d like to ask and then, I’ll see if anybody else has some additional questions. I’ve interviewed several clinicians. One of whom is very prominent and feels that some protozoa like Blastocystis hominis and D. fragilis are commensal and not something that we should be concerned with. And he’s been talking about that quite a bit.  And I think it’s common for a number of Functional Medicine practitioners to see that on a GI MAP stool tests and say here is likely the cause of your problem and are used to treating it and getting results.  And then I also talked to, in another recent Podcasts another practitioner Ilana Gurevitch and she felt that in patients where correlated with their symptoms, very important to treat blasto and D fragilis. What do you think are these pathogens, commensals or does it depend?

Tom Fabian:       Good question. So they’re not likely to be commensals based on our experience because we don’t see them in the majority of patients. It’s commensals tend to be present in the majority of individuals. I think the real answer is probably somewhere in between. So if you look at the research, most of the research suggests that Blastocystis in particular and possibly [inaudible01:18:16] their conclusion and in most of the research is that for the majority of people that have them, they’re not a problem because most of those people are asymptomatic, but I think they’re thinking of them asymptomatic in a conventional sense, not a functional sense. So they may be ignoring TiVo and these other things, mild GI symptoms, et cetera, and not taking those into account. With GI MAP, we only see, I would say probably more than 95% of the time when we see blastocystis and, or [inaudible01:00:18:50], Fragilis, it’s a long with that digestive dysfunction pattern. I don’t think I’ve ever seen blastocyst is just sort of by itself with no other patterns where it’s kind of like the obvious cause of things.

                                It’s almost always in the context of things like H. pylori, maybe candida, general overgrowth. So the question is what’s causing the symptoms? Now trying to pin it on an individual organism, some may be more important than others. H. pylori often is because of its effects on stomach acid. Candida often is because we know it has, it can cause inflammation like you got Pseudomonas, blastocystis I think is somewhere in between probably for some patients, if they have a certain subtype and it’s a really high level that may be more significant than if it’s there at a low level.

Dr. Weitz:            Okay. So one question that came in is what causes Insufficiency Dysbiosis? Is it low stomach acid?

Tom Fabian:       That’s a good question. So recent research indicates the antibiotics are often a major cause even long-term because what can happen is antibiotics can actually effect the mitochondria in the cells that line the colon, in a way that makes the gut environment less favorable to those beneficial bacteria. So, that’s at least one example of pharmaceuticals that may have that effect. Certainly lack of fiber in the diet. That’s been correlated with lower levels of these beneficial species, any source of inflammation.  So inflammation is highly detrimental to many of those beneficial bacteria. So whatever gets inflammation going that can really turn the tide.  One of the other contributing factors and it’s related to low digestion is too much protein in the colon.  That could be from just high protein diet or not digesting well.  But this process of sort of breaking down amino acids, which is called protein fermentation, and then breaking down carbs which is carb permutation. So primarily fibers they’re antagonistic.  So the less fiber you have, and the more protein you have in the colon, that can really also be detrimental to those beneficial bacteria.

Dr. Weitz:            So another question is how does the Ketogenic diet, and I would even throw in there, how about the carnivore diet impact the microbiome?

Tom Fabian:       I’ve actually only seen two cases so far and they were all almost identical and they were probably one of the… There were both among the worst cases I’ve seen as far as Dysbiosis. That’s a perfect example of this sort of… The sayings of tests don’t guess, or the opposite of that is treat the patient, not the test, right? Two different philosophies or ends of the spectrum. When you see that, so in both cases, the patient improved in symptoms, they had typical GI symptoms, gas bloating, apparently issues with carbohydrates. So they went full carnival symptoms improved. And yet you look at the gut microbiome and it looks terrible, lots of inflammation in both cases just massive Dysbiosis. So the question is, well, is short-term improvement in symptoms, are you setting the stage for long-term problems? And is there another way to address those symptoms without kind of ruining the microbiome? So good question. I mean, I guess time will tell, from everything we know about the microbiome, those results look terrible. They really would be considered by almost everybody is really bad [inaudible00:40:45]

Dr. Weitz:           Okay. And one more question, is it necessary to stop digestive enzymes before collecting the stool sample? In fact, are there any other recommendations that should be taken before collecting the stool sample?

Tom Fabian:       Not really a lot of us can depend on the clinician goals in terms of what you want to see. Do you want to see how your patient is doing on the treatments or do you want to see them of course, before treatment, et cetera?

Dr. Weitz:           Well, I guess if they’re taking enzymes, would that affect the pancreatic elastase levels?

Tom Fabian:       There’s not much evidence that does now.

Dr. Weitz:           Okay.

Tom Fabian:       Certainly, with acid, that’s typically not in the enzyme formulation, so, you wouldn’t literally affect it from just coming from the antibiotics or the main one, if you do take antibiotics we recommend waiting at least 30 days post antibiotic treatments, maybe 60 days to allow the microbiome to recover somewhat.

Dr. Weitz:           Okay. Excellent. Thank you so much, Thomas.

Tom Fabian:       It was my pleasure. Thank you.

Dr. Weitz:           Great. And thanks everybody. And we’ll see you next month.



Atrial Fibrillation with Dr. Aseem Desai: Rational Wellness Podcast 181

Dr. Aseem Desai speaks about Atrial Fibrillation 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

9:58   Arrhythmia is an abnormality of the heart’s electrical system that can result in bradycardia, where the heart rate goes too low and often presents with fainting or extreme fatigue. It can result in tachycardia, which is when the heart rate becomes fast and in some cases can go above 200 beats per minute.  And then there are irregular heartbeats, which are broken down into two categories: 1. Benign, which include premature beats that can occur from the top chamber of the heart, the atria, or the bottom chambers of the heart, the ventricles. 2. Conditions like Atrial Fibrillation (AFIB), which are quite dangerous and can cause stroke, congestive heart failure, as well as reduced quality of life.

11:09  How dangerous AFib is depends upon your stroke risk factor, which is determined by the CHA2DS2-VASc scoring system. C is for congestive heart failure. H is for hypertension. A is for age. D is for diabetes. 2 is for prior strokes or blood clots. A higher score is correlated with a higher risk of stroke.  Even though age increases the risk of AFib, there are significant numbers of young people with AFib, esp. athletes. For example, NFL players have 6 times higher risk of AFib. This may be because athletes tend to have a lower heart rate and people who have a very low resting heart rate have an increased risk of having premature beats and these can be a trigger for atrial fibrillation.

14:07  Dr. Desai does not think it makes sense for those with a low heart rate, like athletes, to attempt to raise their heart rate with increased sodium consumption or by taking licorice.  Arrhythmia does not occur simply because you have a low heart rate. A resting heart rate of 40 or 50 is only one factor along with drinking a lot  of alcohol, sleep apnea, or goes on to gain weight after retirement goes on to develop high blood pressure or diabetes.  It is the over activation of the parasympathetic nervous system that can trigger arrhythmias like AFib. This is not to say that being stressed out, in flight or fight mode too much of the time and having overstimulation of your sympathetic nervous system is not also a problem and a risk factor for AFib.

18:01  Some of the most common risk factors for AFib include: 1. age over 65, diabetes, 2. high blood pressure, 3. thyroid disease, 4. heavy alcohol use, 5. sleep apnea, and 6. obesity. Even one glass of alcohol is associated with an 8% increased risk of an AFib episode.  Chronic high blood pressure increases the stretch in the left atrium, the the top left chamber of the heart, which is the trigger for AFib. There is an inflammatory component with AFib, which is why diet and supplements can be beneficial.  Environmental toxins can be triggers for AFib. And there is a close connection between the gut and the heart and gut issues can trigger heart problems.  Acid reflux can be a trigger for AFib, since the esophagus sits right behind the heart.  Even just eating really large, fatty meal can activate the vagus nerve and trigger an AFib episode.

27:37   Diet can play a role in preventing and controlling AFib, though this should be individualized to each person.  The Mediterranean diet is probably best for most patients, though some do better on vegetarian or a lower carb diet like Paleo.  Some patients are able to take care of their AFib purely with diet and lifestyle modification, though some need medication and some need a catheter ablation procedure. AFib is a progressive disease and AFib begets AFib.  It is an electrical cancer.  Early detection is important and in order to detect AFib, there are some great biometric tools out there, including the Apple watch and KardiaMobile, which you can buy on Amazon for $90.




Dr. Aseem Desai is a cardiac electrophysiologist (EP), a physician specializing in heart rhythm disorders.  He has been caring for people with atrial fibrillation (AFib) for over seventeen years and currently practices in Orange County, California.  He has published a number of scientific papers and he just published his first book, Restart Your Heart: The playbook for thriving with AFIB. His website is DrAseemDesai.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 for joining me again today. Our topic is atrial fibrillation with Dr. Aseem Desai. This is actually the most common form of arrhythmia diagnosed in clinical practice. It’s estimated that between 2.7 and 6.1 million Americans are living with AFib. I got that from Dr. Desai’s book. Interestingly there’s such a broad range I guess it’s not clear necessarily whether people know they have this or not, but that’ll definitely be something we want to understand.  But as our population ages AFib incidence is increasing. So I just mentioned arrhythmia, so what is arrhythmia? Well this is basically a problem with the rhythm of the heart which occurs when your heart beats too fast, too slow, or irregularly. Some forms of arrhythmia are harmless while others can cause serious damage and even death. Your heart has four chambers. There are two upper chambers known as the atria and two lower chambers known as ventricles. Your heart also has a built in electrical system that controls the coordinated contraction of the muscles of these chambers resulting in your heart beating between 60 and 100 beats per minute while at rest.  If the heart beats too fast this is a type of arrhythmia known as tachycardia. Well with slow heart rate is known as bradycardia. Atrial fibrillation is a type of tachycardia that originates in the atria and it can be a serious condition that can lead to stroke if it’s not controlled or managed properly.

Now we’ve had a number of discussions about the cardiovascular system on this podcast, but we essentially have focused on conditions like how to prevent and reverse atherosclerosis and hypertension.  So essentially we focused on, to use a analogy from construction, we’ve focused on the plumbing, and then the engine that helps drive the blood through the body which is the heart. But now we’re going to talk about the electrical system of the heart. Our interview today is with Dr. Aseem Desai who’s a cardiac electrophysiologist which means that he’s a physician specializing in heart rhythm disorders. And he’s been caring for people with atrial fibrillation for over 17 years and currently practices in Orange County, California. He’s published a number of scientific papers and he just published his first book Restart Your Heart: The Playbook for Thriving With AFib. Dr. Desai thank your for joining me today.

Dr. Desai:             Thank you very much Dr. Weitz. Thank you for having me.

Dr. Weitz:            So before we get into the specific questions about the cardiovascular system, I noticed that you and I have something in common which is that we both have an undergraduate degree in philosophy. How did you come to study philosophy with an interest in cardiology?

Dr. Desai:             I love it. I love that I’m meeting a fellow philosopher. We could talk about Aristotle the whole episode here. Yeah no so I was part of the seven year medical program at Northwestern so as a high school senior you gain admission to college and med school at the same time, and the idea was to foster an interest in liberal arts. And so we did have a double course load. Pre med as well as liberal arts major, but it really kind of opened my mind. I think I tend to look for challenges and I don’t know about you Ben but this was probably one of the biggest challenges was reading philosophy and writing the papers. And what’s interesting is to this day I still use a lot of the logical reasoning, the deductive reasoning even when I’m doing, when I’m taking care of heart patients and making diagnoses.

Dr. Weitz:            Right. I know for myself one of the things that I got out of philosophy is when you study philosophy you learn that there’s not a lot of concrete answers, but you want to get closer to those answers. And the way you do that is by being critical and asking good questions.  And so I think that’s also important in medicine to be critical when people make statements and challenge them and try to get closer to the best answer we’ll have at that point in time.  So I think that’s helpful–how philosophy has helped me.

Dr. Desai:             Absolutely Ben and to your point I also think it keeps you with an open mind, a beginners mind. 

Dr. Weitz:            Yes.

Dr. Desai:             I think that as physicians we do have a tendency to not have that and especially…

Dr. Weitz:            We think we know everything yeah.

Dr. Desai:             Yeah. Right. Exactly. And so I think that, I mean I look forward to learning as much from you as you will from me perhaps during the podcast and as well as your viewers. I always welcome feedback, your listeners. So I do think that these two philosophers on this podcast today will have a lot to say to each other.

Dr. Weitz:             So how did you come to specialize in heart rhythm disorders?

Dr. Desai:             Well it’s very personal. So when I was about three, my dad had a heart attack. He was 37 at the time and although I don’t have much memory of that, I think many things for kids, they get ingrained in your brain even if you may not be able to process what’s going on. And he was an oncologist so I actually saw him not only as a physician but I saw him becoming a patient and I saw how this heart disease really robbed him of enjoying his life and he was fearful that he was going to have another heart attack.  And so as I went through college, high school and then college, I had an interest in science and unfortunately in the middle of medical school, me second year of medical school he actually suffered a cardiac arrest.  And he was in India at the time and in most cases the cardiac arrest is actually due to abnormal rhythms from the ventricle, from the bottom chamber.  It’s called ventricular tachycardia and ventricular fibrillation.  And in many cases as you mentioned with regards to the plumbing of the heart, a heart attack or a blocked artery, the clot that forms in a plaque can actually induce the ventricular tachycardia and ventricular fibrillation and cause sudden death.  So I think that really got me focused on the electrical system of the heart. And as I went through training and residency and then in fellowship I just found the electrical system quite a challenge. To be honest I was terrified of cardiac arrhythmias when I was a medical resident.  I mean they were really hard to understand and interpret electrocardiograms which are the recordings that we do for the heart’s electrical system and I don’t know about you Ben but mentors kind of come across your paths in different ways.  When I was a medical intern at Stanford and I was sitting reading EKG’s as part of the cardiology rotation. And it happened to be right near the electrophysiology office and electrophysiology is the branch of cardiology where we do study and treat these rhythms.  And one of the attending physicians saw me reading EKG’S and came up to me and said, “Hey you want to write a paper with me on IV Amiodarone?”, which is a drug that we use for cardiac arrhythmias.  And the next thing I knew I was writing a paper. Had no idea what I was doing, but I did publish it and I think the story goes on from there.

Dr. Weitz:            Yeah I had sort of a recent experience with arrhythmia.  I had a EKG done and after the EKG was done my doctor left the room, came back, and repeated it. And then decided to leave the room and repeat it again, and he brought another doctor in. So in between I got up and looked at the sheet of paper that read out, and the paper read that this patient is having an acute MI and I was feeling completely fine. And he came back in the room and I said, “Hey doc. Whatever’s going on, I could have something wrong with my heart, but I am not having an acute MI.”  And so it turns out I have a early repolarization variant.

Dr. Desai:             Mm-hmm (affirmative).

Dr. Weitz:            And which is something that happens in people who are athletic and so then I also had to have hernia surgery recently and I had to make sure everybody was on board with this. That they suddenly weren’t going to freak out when I was under anesthesia and somewhere or anywhere along the line that somebody saw my EKG.

Dr. Desai:             Well I think you make a great point Ben that you actually should carry a photocopy of an EKG.  If you have an abnormal EKG and it’s truly normal just a variant of normal which is what early repolarization is it’s always a good idea to actually carry a copy of it.

Dr. Weitz:            I do I have it in my phone.

Dr. Desai:             Yeah. Yeah. Yeah because like a radiologist with chest x-rays, as cardiologists we often will look at an old EKG to really get a sense of is there a new change and it really illustrates the room that we have to move on our artificial intelligence algorithms and these EKG machines.

Dr. Weitz:            Certainly the readout from that machine was not correct. Maybe you could explain a little more about exactly what is arrhythmia?

Dr. Desai:             So arrhythmia is a generic term used to describe any abnormality of the heart’s electrical system and that can result in something called bradycardia where the heart rate goes too low and often presents with fainting or extreme fatigue. It can result in tachycardia which is where the heart rate goes too fast. A common symptom there would be a sense of a racing heartbeat, and sometimes if the heart rate goes fast enough, and in many cases it can go over 180, 200 beats a minute, people can faint with that as well.  And then you have irregular heartbeats and so irregular heartbeats are really broken down into two categories benign which include what we call premature beats that can occur from either the top chambers of the atria or the bottom chambers of the heart, the ventricles. Or conditions such as atrial fibrillation which are quite dangerous and can cause stroke, congestive heart failure, as well as reduced quality of life. So it really is a generic term, arrhythmia. And it encompasses bradycardia, tachycardia, and irregular heartbeats, AFib being the most common. But it’s important to mention that not every irregular heartbeat is AFib.

Dr. Weitz:            How dangerous is AFib?

Dr. Desai:             It’s actually very dangerous. It depends on your stroke risk factor score first off. So we use a scoring system called CHADSVASC. It’s an acronym and you calculate the number of points that include some such as congestive heart failure, high blood pressure, age, diabetes. And as you add up these points there’s a lot of large databases that have shown that once you hit a score of 2 or higher your stroke risk is actually quite high with AFib and it continues to go up as the points get added up and so we, just like many areas of medicine and I’m sure in your case as well, you look at a person’s health and you do a risk stratification, priority stratification and it’s no different with AFib. So you can have young patients actually that get AFib, especially athletes.  We’re seeing a larger population. Those patients tend not to be as high risk for stroke but certainly impacts their quality of life though.  NFL players have a six times higher risk of AFib compared to their counterparts. Most people don’t realize this.

Dr. Weitz:            Really? Why do you think that is?

Dr. Desai:             That’s a good question. So we’ve now learned that the nervous system is a big component of heart rhythm problems. So the nervous system, just like inflammation is a big part of many different illnesses including coronary disease and GI issues. The nervous system, the autonomic nervous system which includes the Fight or Flight which is the sympathetic and the Rest and Relax–the parasympathetic, actually is heavily involved in the genesis of cardiac arrhythmias. So for example, athletes have often a low resting heart rate and that has to do with the vagus nerve. The vagus nerve, being that part of the nervous system that helps to preserve your energy really. There’s no point in your heart rate being 90 beats a minute when you’re sleeping. So a good conditioned athlete often has a low resting heart rate.  But just like anything in life, extremes may not be a good thing and people who have a very low resting heart rate have an easier ability to have what are called these premature beats that I referenced earlier.  Why I said that premature beats are benign, that’s not exactly true.  If you have enough premature beats, especially from the atria and under the right perfect storm so to speak it can be a trigger for atrial fibrillation so one thought with the football players and other athletes including triathletes for example is that this low resting heart rate predisposes to these premature beats.  Because there’s a longer time interval between beats with a low resting heart rate so it’s easier for these extra beats to be a trigger and if you think of AFib as a fire, you have the matches and you have the wood.  And the matches would include something such as these premature beats, would include things such as alcohol, variety of other factors.  And then the wood are the risk factors for AFib which would include things such as age over 65, diabetes, sleep apnea, a whole host of things that we can get into.

Dr. Weitz:            So would it make sense for an athlete who has a lower resting heart rate, for example myself, actually when I was on when I was in the pre op, they, my heart rate was right around 50 and down to 48 and up to 55 and they kept going, “Oh. You’re an athlete. You’re an athlete.” And they were freaking out a little bit. Does it make sense for somebody with a low resting heart rate to try to raise their resting heart rate?

Dr. Desai:             Well it’s a good question and the problem with this is you can’t really do that from the standpoint of, I mean other than taking in stimulants such as amphetamines.

Dr. Weitz:            Well could you for example take in more sodium? Could you eat licorice? We just heard about somebody who ate so much licorice that they died actually.

Dr. Desai:             Right. Yeah the problem with licorice consumption is that it more predisposes to dangerous heart rhythms rather than purely increasing your heart rate.  And it’s not that low heart rate in and of itself.  It’s, with arrhythmias like AFib it’s the perfect storm.  So we’re now learning there’s quite a bit of complex genetics with AFib. So not every athlete with a heart rate of 40 or 50 is going to get AFib by all means, but if that athlete consumes a lot of alcohol, if that athlete has unrecognized sleep apnea, if that athlete puts on weight after they retire and goes on to develop high blood pressure or diabetes, that’s really, it’s that adding up of risk factors.  It’s just that when you have a low resting heart rate that kind of puts you at a little bit of a higher risk.  But we’re still working it out. We’re still trying to determine what’s going on. But you ask a good question which is, is it the heart rate itself? And I would say no it’s more, it’s that over activation of the parasympathetic nervous system.  And it’s not just the heart rate.  The actual vagus nerve, when you stimulate it either in laboratory models or even when we’re doing a procedure called catheter ablation, and you stimulate the vagus nerve which you can do, it’ll actually trigger AFib and it has nothing to do with low heart rate. It’s literally stimulating that nerve and the release of the acetylcholine and other components that can be a trigger for arrhythmias.

Dr. Weitz:            Now is it the overstimulation of the parasympathetic or the sympathetic?

Dr. Desai:             That’s a great question. So now we believe in most cases it’s actually the parasympathetic that’s the problem.

Dr. Weitz:            Well that’s interesting because and when we have patients who have anxiety or they have adrenal problems or they have fatigue, we’re always working with them to increase parasympathetic stimulation because the thought is everybody’s stressed, everybody’s in sympathetic mode all day long and that’s why they’re drinking caffeine because they want to be in this sympathetic mode because they’re not sleeping enough and they’re trying to get more work done, etc.

Dr. Desai:             Well you’re absolutely right. For emotional and mental stress and even physical stress, I mean the parasympathetic nervous system’s a very important part.  You I’m sure are aware of heart rate variability and using heart rate variability in certain breathing techniques activates your parasympathetic nervous system. 

Dr. Weitz:            Exactly.

Dr. Desai:             So it’s not so much as you mentioned about calming down your fight or flight.  It’s about enhancing your rest and relax.  It’s about enhancing your parasympathetic nervous system.  The only reason why I’m commenting on this from the standpoint of arrhythmias is that the parasympathetic has been implicated honestly both parts of the nervous system have been.  So we clearly see sympathetic triggers if someone’s under a lot of stress and their heart rate goes up, they can end up having more premature beats.  So it’s not, I would just say anything out of balance in the body, right, is not a good thing. And so when you come to AFib we love using this term the perfect storm.  You have a few risk factors, you have a few of these matches, you have a little bit of that wood, and then it creates the fire and that’s why on a given day there’s something or a combination of things that could lead to a patients first AFib episode.

Dr. Weitz:            Well it’s interesting when we’re talking about these risk factors because it seems like this comes up all the time. At this point we’re still going through this COVID-19 pandemic, and what comes up all the time is that people are likely to have a worse prognosis if they have any of these chronic diseases like being overweight, having hypertension, having diabetes, having sleep apnea, having lung disease. These are the same chronic conditions that are so prevalent in our society that they make it more likely that you’re going to have AFib.

Dr. Desai:             That’s absolutely right and if you look at obesity for example that it one of the number one risk factors for AFib and there’s a lot of different mechanisms that are thought of with regards to that. But obesity itself leads to many of the other conditions you mentioned. The diabetes, the high blood pressure. Chronic high blood pressure increases the stretch in the left atrium which is the top left chamber of the heart. That’s the trigger for AFib. There are so many different types of mechanisms, but as you mentioned with COVID this inflammatory component is critical right?  I mean that’s why people get this multi organ system failure. That’s why people get this myocarditis that you’re seeing in cardiac cases.  And so many cases, or many people believe I should say, that AFib is along the same lines. It’s an inflammatory disease. It’s, so you do see elevated biomarkers in the setting of AFib.  We just don’t know what to do with those biomarkers, but we do know that there is an inflammatory component like many things. I think that’s also why probably treating your body with food as medicine, that certain foods definitely and supplements definitely do help cardiac arrhythmias, but the other, I think what distinguishes it a little bit, AFib from some of these other things we’re talking about is this interplay with the nervous system so I think the gut, as you know the enteric nervous system and the gut there’s that secondary nervous system. The heart has it’s own nervous system, and so it’s interesting to see this sort of two way street between the brain and the heart and the brain and the gut, and I think when those things are out of balance and it’s usually nature and nurture, there are some genetics probably and then there’s environmental triggers.  So many things we’re not aware of right? We don’t even, there may be multiple toxins in the environment that are big components of causing AFib that’s to why one person gets it and one person doesn’t. So there are well defined risk factors: age over 65, diabetes, high blood pressure, thyroid disease, heavy alcohol use, sleep apnea, obesity is the big one. And then there’s one that we really haven’t determined yet. But I would say that you see this I call it the electrical epidemic, AFib. It’s an epidemic because as we get older we’re living longer, and so it’s arthritis of the electrical system. So when you get AFib when you get older, you could be a totally healthy person. Lived a totally healthy life, and still get AFib. And it has to do with scar tissue that builds up in your electrical system just like it would in your knee. So that is, that’s the age related factor of AFib. And then you have that obesity component that our society as you mentioned Ben, I mean we’re getting unhealthier and unhealthier and the obesity epidemic is probably a big reason why we’re seeing AFib.  We’re seeing a lot of AFib in our practice right now so our patients who have AFib are getting more AFib right now during COVID. Two reasons we think.  One is increased alcohol consumption.  One glass of alcohol is associated with an 8% risk of an AFib episode. It’s not a small thing. And then the lack of physical activity and weight gain.

Dr. Weitz:            Yeah and the stress as well.

Dr. Desai:             The stress is huge absolutely. We see, it’s interesting you mentioned the stress. Just in observation there’s a lot of people who, they’ll be in AFib, they’ll go into this AFib episode at home. Their heart’s racing, it’s going irregular, they’re feeling terrible because the heart’s an engine so when you go into AFib you lose about 30% of the pump efficiency of your heart. It’s almost like losing a few pistons in your engine. That’s what the atria do for you and when you go into AFib the part of the heart muscle beats very poorly, very chaotically. So people are feeling terrible and they go into the hospital and they’ve been sitting in AFib even sometimes for a few days and they go into the hospital and the doctor is getting ready to shock the heart back into rhythm called the cardioversion which is often something that’s done for AFib. And literally you’re getting ready to press the button and the person converts to a normal rhythm. And the hypothesis here is that people feel safe when they get into a hospital in this context. Not always. But in this context they feel safe.  And so we see it over and over again where people, that’s why I’m a big believer in mindfulness. I do a daily mindfulness practice. I have a lot of interest in that, and we definitely see through activation of the parasympathetic and calming down that fight or flight response. I mean I mentioned all of these things about parasympathetic and arrhythmias, but don’t get me wrong. It’s not that the parasympathetic is bad and it causes arrhythmias.  It’s just that we’re learning specifically in athletes, but what’s also interesting is GI triggers for AFib. So people who have acid reflux, the esophagus sits right behind the heart, or people who eat a really large, fatty meal activates the vagus nerve. So again it’s these, it’s over activation.

Dr. Weitz:            Yeah I mean, be honest with you in my practice we see a lot of patients with GI disorders, especially irritable bowel syndrome and reflux. These functional disorders, and they’re extremely common.  When you combine those with obesity, and 70% of the patients in this country are overweight, you add in the rates of diabetes and hypertension and some of these other conditions, it’s surprising that we don’t have more people with AFib.

Dr. Desai:             Oh absolutely and I’ve been on different kinds of shows and I’ve talked about these things and one of the things I started realizing and gotten humbled about is patients are saying to me, they’re like, “This is great. You’re telling me all these bad things. How do I change my life?” And I don’t know if you’ve heard of Thrive Global. It’s a organization funded by Arianna Huffington and it’s an amazing…

Dr. Weitz:            Oh I know who she is, but I haven’t heard of the organization.

Dr. Desai:             So yeah. So Arianna and I had a chance to connect as I wrote this book, partly because of my interest in mindfulness and I reached out to her to get her thoughts on the book, and she invited me to be a contributor for this website.  So for your listeners out there I would definitely encourage you to check out this website thriveglobal.com because they’re addressing so many issues of COVID right now.  Parents who are working from home, schooling people at home. I mean everything really under the sun. But what I like, their theme is microsteps.  So to make a behavior change, it’s a micro step.  It’s not what we used to think which is, 21 day challenge.  Give up this.  It’s really making those small changes every day and then, and building on that and having that accountability.  So I just wanted to mention that because you and I are having this great discussion about all these risk factors, but I don’t want people to be demoralized into thinking that there, it’s, there are ways to change, and I know that you do that you do that on a regular basis with your patients.

Dr. Weitz:            Absolutely and the greatest thing that could come out of this COVID crisis is if there’s more awareness about doing something about these chronic diseases that result from poor diet and lifestyle like we’ve just been talking about like obesity and hypertension and diabetes and etc. etc. We, America needs to wake up and get healthy and exercise and eat healthy and get control of their stress and all of these chronic, all of these conditions like AFib are, we’re going to see less of.

Dr. Desai:             Yeah I totally agree. I mean it’s interesting, a virus that is decimating part of humanity is also connecting part of humanity and waking up part of humanity that all of these thing’s we’re talking about, these are huge risk factors for massive COVID infection and poor outcomes.

Dr. Weitz:            Yeah.

Dr. Desai:             So I think you’re right. People are sort of saying well this is this end goal that we all have of not wanting to get infected and certainly not wanting to have a bad infection.



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:            Are there certain diets that are associated with less risk of AFib or that can be beneficial for patients that have AFib?

Dr. Desai:             Yeah I think that the… 

Dr. Weitz:            And keep in mind the background is that there’s a lot of confusion today as far as what the best diet is and it’s almost like partisan politics.  We’ve got the vegans on one side and the people who only eat meat, the carnivores on the other side.

Dr. Desai:             Right.

Dr. Weitz:            And then we’ve got the Paleo and the Mediterranean [crosstalk 00:28:12] and everybody’s claiming that their diet is the best.

Dr. Desai:             Yeah and I think it raises the point. This is for AFib, this is for diet. You have to individualize to your case. You may have a certain blood type if you believe that, where a certain diet is better or you may have a lot of chronic inflammatory disorders whether it’s fibromyalgia or lupus or even cancer and a vegan diet with all the data we know about reducing inflammation on that. So as cardiologists we typically recommend the Mediterranean diet. There’s a fair amount of data with regards to that. Lean proteins, good fats, but I think that it really comes down to balance. But you also have to look at your individual situation because whatever food plan you adopt, you want to adopt something that you can stay with the long term.  Yeah you can have your cheat day once a week or what have you, but you want something that’s really going to sustain you long term which is why I’m not a big fan of things like Atkins and really high fat diets. I agree sugar is not good, but I think you really have to individualize and AFib is the exact same way. No two patients with AFib are treated the same or are the same. So some people, they may be able to take care of their AFib purely with diet and lifestyle modification. Losing weight, not drinking alcohol, etc. etc. Treating sleep apnea which is very unrecognized as trigger for AFib.

Some people, they need a medication in some cases. Some people need a catheter ablation procedure and there’s other kinds of things that we can do, but AFib is a progressive disease.  AFib begets AFib. This is an electrical cancer. People need to know about this disease. They need to know how to screen themselves for it. They need to know how to help their loved ones with it because you don’t want to wait until someone has stroke to figure out that they have AFib.  And nowadays with all these great biometric tools, Apple has their EKG function on several of their watches. KardiaMobile has a device you can buy $90 on Amazon. These are devices that actually allow you to record an EKG and tell you with a reasonable amount of accuracy, not perfect that you may be having AFib.  So we are big proponents now of early detection, early intervention.  So if someone gets diagnosed with AFib for example you don’t want to just say, “Lifestyle and diet and let’s regroup in four weeks.” Every episode of AFib even if it’s five minutes and this is really important changes the cellular and electrical architecture of the heart to want to have more AFib. It’s a muscle memory thing.   So we’ve had cases of patients where they think they’re only having one or two episodes a year, where in fact they were having a lot more silent episodes, but that’s common actually while people are sleeping. Silent episodes of AFib they don’t feel anything and their AFib is progressed by the time they go to treatment. So early detection, learn how to take your pulse after you brush your teeth. It should be like a metronome. It shouldn’t be fast and irregular.  Many patients have very subtle symptoms. This is really common. 

Dr. Weitz:            Yeah what are the symptoms of AFib?

Dr. Desai:             Yeah I’m glad you asked. So the, it depends on your age, so younger people and we’ve seen people as young as 18 by the way, tend to get that rapid, irregular heart rate. The palpitations that we described. But it’s more than just skipping beats. It’s a tremendous amount of fatigue or shortness of breath because again the engine analogy, you lose pistons when you go into AFib. That’s different. If you’re having these skipping beats, these premature beats, you don’t lose pistons in your engine. You, they may be bothersome but you don’t feel terrible and with AFib that’s the big thing is this general sense of lack of energy, fatigue, shortness of breath. But what’s interesting is that as people get older, and especially people who aren’t that healthy who aren’t that active, they may not be aware at all they’re in AFib.

                                They’ll show up for gallbladder surgery as pre op and they’re in AFib. We that so commonly. And then you ask them, “Well over the last six months or year, have you noticed a change in your endurance or activity level?” “Yeah I have I just thought it was I was getting older.” We hear that so commonly. Well it’s not until you restore someone’s rhythm back to normal which is what we often do in those cases at least once. At least as a trial. When someone says they don’t have symptoms with their AFib, we believe as electrophysiologists that unless there’s a strong reason not to, everyone, or most people I should say not everyone, most people should have some kind of attempt at restoring the rhythm. Because you don’t know how much you’re actually having symptoms of something until you restore the rhythm. It’s like having a bad knee and doing less.   You don’t really, and decide to have a knee replacement and realize that you could do more. So that, it’s the same thing with AFib. It’s the great masquerader. It’s electrical cancer. There’s so many different presentations and that’s why the early detection and these devices that I mentioned are so important.

Dr. Weitz:            So the most common symptoms, list four or five of the most common symptoms.

Dr. Desai:             Yeah so most common symptoms, fast irregular heartbeat called palpitations, shortness of breath, sometimes chest discomfort, tremendous fatigue, and that would probably be, and then unfortunately stroke is an often common presentation of AFib where there’s no symptoms. But I would probably say the fatigue part and what’s, the key thing with any of these arrhythmias in the beginning, they’re episodic so what’s different with the heart, the coronary arteries, the three coronaries, they’re, it’s plumbing as you mentioned. So if you have a blockage, it’s going to show up on a stress test. It’s going to show up on a variety of testing. AFib, it can come and go. It’s like the electrical system in your car or your house. It’ll act up sometimes, and then it won’t be there. So you show up to a doctor’s office for an EKG and then you come back in six months and you’re in normal rhythm, you could be having AFib that night and you don’t know it and it’s not until you go from this in and out AFib which is called paroxysmal to continuous AFib which is called persistent that people really then get diagnosed.

                                And the problem is by the time you get to persistent, the treatments are much less effective. We have lots of ways of treating people with persistent AFib, that’s an important point. One of the reasons I wrote this book is people are, there’s so much misinformation out there. People are told they have to live in AFib. It’s too far gone, there’s nothing that can be done, and in the introduction of the book I talk about a man who was told that for five years continuous AFib and we got him to rhythm because of current technology. It’s also lifestyle changes. So those will probably be the most common symptoms. I wanted to circle back to your question which I really didn’t answer about diet. Magnesium is really important with regards to, and I think the important thing about magnesium is you can’t go based on a blood level. 90 something percent of magnesium is stored in your tissues, not in your blood [inaudible 00:34:59][crosstalk 00:34:59]

Dr. Weitz:            Right.

Dr. Desai:             And that’s the same with potassium as you know. So we have a low threshold to recommend a magnesium supplement to someone with heart rhythm issues unless they have advanced kidney failure that’s really the only time where you want to be careful about the magnesium. As far as a specific diet I wouldn’t say, I’d be curious to see if you’ve come across anything in your research. I haven’t come across anything that says this diet is really good for AFib, but I would definitely argue that anything that results in reduced inflammation in your body is likely going to be a good thing for AFib. If nothing else it’s going to help your risk factor’s right? It’s going to reduce your obesity and all these other things which then help your AFib so it’s really about trying to prevent the AFib. Now its [crosstalk 00:35:39]

Dr. Weitz:            There are now a number of forms of magnesium [crosstalk 00:35:44] we use frequently in our office and so there’s magnesium citrate, magnesium glycinate is known to be better absorbed and have less issues with bowel laxity. We’ll [crosstalk 00:35:59] use magnesium citrate if someone is constipated. We use magnesium threonate which has been known to affect the brain and central nervous system a little better. Is there a form of magnesium that you think is more effective for AFib?

Dr. Desai:             I’m so glad you asked that because a lot of people just go to Costco or what have you and pick up whatever magnesium is on the shelf and this is nothing against Costco by the way, it’s more [crosstalk 00:36:26]

Dr. Weitz:            I’m with you.

Dr. Desai:             Yeah magnesium oxide is one of the [crosstalk 00:36:29]

Dr. Weitz:            I got this big giant bottle of fish oil for five dollars.

Dr. Desai:             Exactly. Well there’s a reason why it’s five dollars. So, but magnesium oxide is probably one of the worst absorbed forms of magnesium. And it’s one of the most common sold ones in stores. So yeah the ones you mentioned are great. Magnesium citrate, it actually comes, I love Natural Calm. Natural Calm is a product that you find online, you find in stores. [crosstalk 00:36:54]

Dr. Weitz:            It’s a powdered form of magnesium. [crosstalk 00:36:57]

Dr. Desai:             Yeah it actually comes as a gummy. Now the gummy has some sugar in it, so you’ve got [crosstalk 00:37:01] to be careful about that one.

Dr. Weitz:            Forget the gummies.

Dr. Desai:             Forget the gummies. So but magnesium citrate is a good one, magnesium glycinate as you mentioned, Doctors Best is a really good brand for magnesium glycinate for example. Magnesium malate. Malate is a really good one. And taurate, magnesium taurate. So taurate has kind of more of a specific cardiovascular effect. Sort of derivative or related to taurine amino acid and there is data with regards to taurine and heart health and even rhythm. So there’s a company Cardiovascular Research Lab makes magnesium taurate that we will often prescribe to people. So it’s really about just getting people to take it. And I always tell people go based on the serving size of the bottle. People always ask what dose you should take. It’s really, it’s very manufacturer specific, company specific, but I would say those would be the main ones to consider.

Dr. Weitz:            Yeah I would like to say when it comes to magnesium, manufacturers are often very careful and often will recommend one tablet or something line that. But they have no idea your particular circumstances.

Dr. Desai:             Right.

Dr. Weitz:            And for the most part the only side effect of taking more magnesium is that you’ll get diarrhea and you’ll [crosstalk 00:38:12] know that pretty quickly. So- [crosstalk 00:38:15]

Dr. Desai:             Right.

Dr. Weitz:            You very well may need 400, 600, even 1000 milligrams would not be at all excessive for our magnesium need so a lot of time just what says on the bottle may not be [crosstalk 00:38:29] what you need.

Dr. Desai:             I’m glad you raised that point, Ben. A few things. One is we’ve seen cases where if we give someone magnesium glycinate. Hey go based on the serving size on the bottle, continue to have rhythm issues whatever the rhythm issue is and then we add in another magnesium. So the combination of magnesiums. Know that I’ve had one patient who said, “Well the glycinate didn’t work but when I added in the taurate and lowered the glycinate.” You know so you really have to titrate based on if you’re taking it for palpitations for example, or AFib you want to titrate it based on your episodes. Is your heart calming down? That’s the point of the magnesium is there’s what’s called phase two of the action potential in the heart and the electrical system is part of your heartbeat, and magnesium and calcium have this exchange pump in the heart cell and that’s the theory behind why magnesium helps so much as a stabilizer of the electrical system. And the point you made about the GI distress, so we do have a fair number of patients that just can’t tolerate any form of magnesium orally.

                                So you have magnesium foil. You have bath flakes. There are other ways of taking magnesium that you can absorb some. [crosstalk 00:39:34]

Dr. Weitz:            And the glycinate has less effect on the bowel. But [crosstalk 00:39:39] taurine is another supplement just used [crosstalk 00:39:41] individually. Have you had experience with using that?

Dr. Desai:             Yeah I have one gentleman actually who, and of course I’m telling you stories about different people. We don’t have [crosstalk 00:39:50] these large randomized crowds, but I have this one gentleman who, he struggled with premature atrial beat. So these are benign things but it just debilitated him because if you’ve ever had one it feels like your hearts going through this rollercoaster. And so he tried initially the Natural Calm. That didn’t really work for him, he switched to the glcinate that didn’t really work for him. So then we had him on magnesium malate, and then we added a little bit of taurine in. And that, not the full dose of taurine that’s often recommended. And that really calmed him down so I do think that there’s a role certainly for taurine. My go to if someone’s having rhythm issues or heart issues is to say start with magnesium. Start with glycinate as you mentioned is well absorbed. If it doesn’t work maybe consider magnesium taurate or Natural Calm. And then if you continue to have issues that’s where you start to think about these other things.

                                And it’s also important to mention just for your listeners, there are a lot of drugs that deplete your body of magnesium and you have to be aware of that. Proton pump inhibitors for example that block acid secretion for ulcer disease notice deplete the body of magnesium. The diuretics [inaudible 00:40:59] deplete your body of magnesium and potassium so to your point Ben, those are people who probably need to have a super dose of magnesium because they’re losing so much of it. And the last point about magnesium I’ll make is intravenous magnesium has a powerful anti arrhythmic effect and what that means is we have people who have come into the hospital with AFib or with what’s called ventricular tachycardia dangerous heart rhythm and you just give the magnesium even with a normal level and it has this amazing immediate calming effect and I mentioned with the magnesium that the serum level is not very helpful. You can ask your doctor to order what’s called a RBC magnesium level within the blood [inaudible 00:41:36] and that tends to be a little bit more accurate.

Dr. Weitz:            Yeah we use that regularly. A few other supplements. Have you had any experience with coenzyme Q10 which is frequently recommended for heart health?

Dr. Desai:             Yeah I obviously recommend it to my patients generally for heart disease [crosstalk 00:41:55] treatment or prevention. [crosstalk 00:41:55]

Dr. Weitz:            By the way CoQ10 since we’re talking about nutrients that are often depleted, cholesterol lowering drugs like statins deplete [crosstalk 00:42:01] the body of CoQ10.

Dr. Desai:             Yeah it’s so interesting how we have people and so many treatments that fight each other. I mean it’s just they’re in the ring together and they’re fighting each other and it’s sort of like you’re not really sure what that outcome you’re having.

Dr. Weitz:            Oh yeah. We, statins increase your risk of diabetes and some of the most common diabetes drugs increase your risk of heart disease so.

Dr. Desai:             Right. Exactly. So I’ll be honest with you. I don’t really have a lot experience or knowledge of specifically Coenzyme Q10 and it’s impact on the heart’s electrical system or AFib. Have you come across anything in that regard? [crosstalk 00:42:34] With Coenzyme Q10 [inaudible 00:42:34]?

Dr. Weitz:            I’ve, yeah I’d seen some studies on it and CoQ10 seems to have a lot of benefits for congestive heart failure for a series of issues with the heart, so it’s probably one worth experimenting with and another one is hawthorn berry which is often [crosstalk 00:42:52] included in supplements for hypertension and heart health.

Dr. Desai:             Yeah my feeling on supplements is as you know there’s a lot of criticism from western medicine on these I think having functional medicine is such an amazing step forward. That you have physicians and practitioners from all different disciplines really focused on maintaining function not so much on giving a pill or doing a procedure. But I think that people just need to be careful that the supplement alone isn’t going to necessarily fix the problem. And you really, there is definitely a role and we do a lot of catheter ablation so I’m a very integrative electrophysiologist, but I’ll be honest catheter ablation if you look at all the different treatment options for AFib, I’m talking about people now who have the disease that is not being managed by just diet and lifestyle. It is a highly effective form of treatment and there’s a lot of misinformation including from healthcare providers about the efficacy of catheter ablation that nowadays with early AFib, the early onset of AFib peroxisomal we have some trust rates of almost 85 to 90% with a [crosstalk 00:44:03] risk of around 1%.

Dr. Weitz:            What do you hear healthcare providers saying that’s incorrect about ablation? What’s [crosstalk 00:44:12] the common misconceptions?

Dr. Desai:             It’s too risky and it doesn’t work. And then number two is it’s not going to work for you, patient, because your AFib is too far gone. And so, and then the third is well it doesn’t make sense to treat your AFib or try to get you into rhythm because you’re not having any symptoms. So those are the three. And this book that I wrote is not just for patients or family members. This book is for healthcare providers. Not just for education, but It’s hard to, nowadays in a 20 minute patient visit how are you going to talk about such a complex disease and we just have these kind of five page pamphlets that really don’t tell you much. So the idea is really to provide people with a little bit more detailed information. But catheter ablation for the listeners who haven’t heard the term, it’s simply a way of destroying abnormal tissue and preserving normal tissue. So destroying cells that aren’t supposed to be there. So if you think of the sources of AFib which are called the pulmonary veins as capsules of AFib sending out sparks, then we, well with kind of the fire analogy that we used.

                                We’re essentially creating some insulation around the fire. We’re creating insulation around a broken wire. Drug therapy, there’s a role for it, but anti arrhythmic drugs, which is what we use, they have such a high side effect in toxicity rate and at best the most effective one which is amiodarone has only about a 40 to 50% long term success rate. So again our first step always with heart disease or any kind of disease including AFib is diet and lifestyle. Lose weight. That can make a huge, I’ve had patients that have had ablations and they were overweight and then, and their AFib kept coming back. And then when they lost the weight, their AFib didn’t come back. And that’s something that shame on us as electrophysiologist in our field that we’re now learning you have to optimize those risk factors before and after any intervention to have the best outcome. And there is this mentality unfortunately in our society about sort of quick fix. Do an ablation, there’s a lot of sort of altered expectations. People come in and think that the ablation is going to reduce their risk of stroke or fix their AFib.

                                And it’s a big [inaudible 00:46:26] this is what you do. It’s a big picture functional medicine holistic standpoint. You’ve got to manage everything. Everything’s got to get in balance.

Dr. Weitz:            Yeah. I guess when I think about AFib the idea of doing a procedure that could potentially cure it instead of having to take some of these drugs for the rest of your life that have all these side effects. To me that sounds much more appealing. On the other hand, when I watched one of your videos describing how you do the ablation, boy it is a really complicated procedure that involves threading this little wire into the vein, going through one side of the heart into the other side of the heart and it makes me realize you really want an expert who’s going to do that because it is, at first watch you think oh well just go into this part of the heart and just burn this little thing and everything’s fine. It’s like I just fix this electrical socket and it’s a really complicated procedure.

Dr. Desai:             I’m so glad you mentioned that. That’s important feedback for me. Because actually that’s how, electrophysiologists consider AFib ablation to be one of the easiest procedures we do. Because the femoral vein is a vessel in your groin, we put an IV in there, we thread the catheter through the IV so there is no cutting, and there’s a, it’s a straight shot into the heart. That’s our mindset because we deal with it everyday right? But we don’t think about the other side of it, and I should really think about redoing that video because if that video sent a message to you that this is a really complicated procedure, it’s actually changed a lot over the decades and so it’s actually become quite a simple procedure. There’s, for example we use something called the cryoballoon.  It’s a balloon. We go to these four different structures in the heart. We freeze each for basically 210 seconds and we’re done. The actual ablationt takes only 20 minutes. A lot of it’s set up, a lot of it’s technology and things like that, so.

Dr. Weitz:            Okay.

Dr. Desai:             I’m glad you mentioned that because I have to really rethink what I’m putting out there now because it can look a lot more complicated that it is, you know?

Dr. Weitz:            Yeah. Yeah. You were talking about some and the risk is you go through one [crosstalk 00:48:37] side of the heart to the other and you know.

Dr. Desai:             And I’m not discounting that. I mean [crosstalk 00:48:43] to your point, you don’t just want to go to, you know whenever you’re having a procedure done or any treatment you want to go to someone who has high volume, done a lot with a low complication rate. And that’s the case with anything that you do on your body.

Dr. Weitz:            Absolutely. Absolutely. Including getting chiropractic adjustments or- [crosstalk 00:48:59]

Dr. Desai:             Including getting chiropractic adjustment absolutely. Yeah I mean for sure.

Dr. Weitz:            So what are some of the most common medications that are used?

Dr. Desai:             So oftentimes beta blockers include drugs such as metoprolol, atenolol, these are drugs to what we were talking about earlier about the fight or flight sympathetic nervous system. Those are drugs that block the effect of that on the electrical system of the heart so naturally they lower the heart rate, they lower the blood pressure. And so they can be effective if someone especially has a rapid heart rate. There’s a drug called propranolol which often has an anti anxiety effect as well which can be helpful for premature beats. But the problem is that those drugs aren’t easily titratable and so especially for young people often don’t like being on them because it really blunts your heart rate response to exercise, so people feel tremendous fatigue. It can exacerbate depression. It can exacerbate insomnia. For men it can exacerbate ED. So there’s definitely trade outs.

                                But what’s nice about beta blockers is they typically don’t harm you compared to other drugs that we use. Calcium channel blockers such as one called diltiazem and one called verapamil, these lower adrenaline in a different way and what’s nice about them compared to the beta blocker is not as much fatigue but they do, they can cause constipation and some ankle swelling. Those two classes of drugs have about a 40% efficacy rate for AFib long term. So not the highest. And then you have the next tier of drugs called anti arrhythmic drugs and there’s about five or six that we choose from. And these drugs, if you think about the heart’s electrical system as a bunch of doors opening and closing those are what we call ion channels and this is what these different electrolytes like we’re talking about, magnesium and sodium and potassium and calcium, these move in and out of the heart cells and the electrical system and it generates current. Just like you think of any electrical thing it generates a current. And so the drugs actually block these different doors, these doorways called ion channels and so as a result the drug can manipulate the current.

                                Well sometimes that works well in treating AFib and other issues, but sometimes it manipulates the current too well and it slows the heart rate down too much or it creates a dangerous rhythm called ventricular tachycardia and so the problem with drug development with AFib is that there’s been no improvement in decades. And one of the reasons why is that we still don’t have a good handle on the genetics, and we still don’t have a good handle on how do you create a drug that’s just specific for the top chambers of the heart, but do not affect the bottom chambers of the heart? Cancer for example, oncology, wonderful drugs now targeting the immune system. Same thing for many other conditions like rheumatoid arthritis, psoriasis. We don’t have that quite yet for the electrical system, so those are the two, and so the anti arrhythmic drugs would include drugs such as amiodarone, sotalol, propafenone, flecainide, multaq, tikoson, in case your listeners if they’ve ever heard of those drugs they have an efficacy of about 50% long term with very high side effect profile.

                                And again I, my job here is not to push ablation. Obviously I am biased. I do a lot of ablation. Of course I am biased and I believe in it, but I have been humbled in many cases where we ablate, AFib keeps coming back, and one day a spouse comes to the office and mentions the husband snores and we have this aha moment, “Oh I should’ve done a sleep study.” And then I do a sleep study and the AFib disappears and it’s that much of a connection between sleep apnea and AFib.

Dr. Weitz:            Yeah. There’s a huge connection between sleep apnea and a whole series of [crosstalk 00:52:34] chronic conditions and it’s definitely underdiagnosed and I think part of it just because people don’t want to be put on a CPAP machine and they don’t [crosstalk 00:52:44] want to get diagnosed.

Dr. Desai:             Yeah I’m glad you mentioned that. Not that I’m a sleep specialist, but what I, I refer a lot of patients for either home apnea link studies which is where you can screen it at home, or a sleep study and the top number one reason why people don’t show up to the appointment or don’t want to have it done is they don’t want to get a CPAP machine. And my experience has been in many cases it’s because they didn’t have the right mask, they didn’t have the right pressure setting, they didn’t have the right education. They were just given a machine, it was ordered, they dropped it off one day and they suffered with it and then there was no follow up. So I think it’s important for people to know and then there’s a lot of other treatments. There’s dental appliances as you know. There’s stimulators now. Medtronic makes one for example for treatment of sleep apnea for different, for like the tongue for example the glossopharyngeal nerve. So, but it important to treat. And the number one way to treat is to lose weight and [crosstalk 00:53:37] that’s such a big trigger.

Dr. Weitz:            Yeah there’s also a correlation between low vitamin D levels and sleep [crosstalk 00:53:43] apnea.

Dr. Desai:             Yeah. I didn’t know that actually is that true? I didn’t know [crosstalk 00:53:47] that.

Dr. Weitz:            Yeah there’s a few studies on it. I interviewed a dentist who was described how he saw a number of his patients turn around with getting the right amount of vitamin D.

Dr. Desai:             I’m going to have to keep that in mind because so many of our patients have sleep apnea. [crosstalk 00:54:02]

Dr. Weitz:            Now in his case he felt it was important to get the vitamin D to the optimal level not the [crosstalk 00:54:07] normal level. So not [crosstalk 00:54:10] just over 30 but say in that 50 to 70 range.

Dr. Desai:             Okay. All right.

Dr. Weitz:            Nanograms per milliliter.

Dr. Desai:             Okay.

Dr. Weitz:            And then I guess blood thinners are recommended sometimes too to prevent stroke which is one of the side effects.

Dr. Desai:             Yeah I think it’s important you touch on that. So stroke is the most catastrophic and so the mechanism of a stroke is a blood clot forms in the heart through a substance called thrombin and the anti platelet drug such as asprin for example don’t work that well on thrombin. They work well on clots that form in the coronary arteries or in the brain but in the heart with AFib the atrium doesn’t beat properly, you have this sort of lifeless bag of contractions so the blood clot can form stagnant blood. And so we traditionally have had blood thinners such as Coumadine or Warfarin which has a lot of challenges. Efficacious but a lot of challenges. And then there are a whole host of neuro drugs that aren’t so new anymore. Eliquis, Xarelto for example, Pradaxa. And It’s nice these drugs actually have been studied in very large trials now showing relatively low bleeding risks. We use, it’s all about the risk assessment. So you have the CHADSVASC acronym I mentioned earlier, you add up the points to determine who’s at high risk for stroke and AFib.

                                And then you have what’s called HASBLED, H-A-S-B-L-E-D, and that is another acronym and that actually tells us who’s at risk for bleeding on a blood thinner. And we can compare the two to then say, well this 80 year old person who has a high risk for stroke also has a high risk for falls because they fell three times in the last year. So that is someone we may refer for there’s a set of procedures called left atrial appendage occlusion procedures. A device called Watchman for example that you see a lot on commercials now. [crosstalk 00:55:58] [inaudible 00:55:58] scientific. But these are devices that help isolate the part of the heart that is the source to the clot from traveling elsewhere. So the Watchman is like a little basket that get implanted in the heart, and it’s typically done, I mean these are invasive procedures, but they’re not cutting open the chest, you’re doing it still through the femoral vein for example. So there’s definitely options for people, but one thing I would definitely say to people is if you can’t take a blood thinner because you’ve had a side effect or for whatever reason, get evaluated by a cardiologist or I think especially and electrophysiologist because you may be a candidate for one of these other procedures and you don’t want to have a stroke. [crosstalk 00:56:36]

Dr. Weitz:            Right.

Dr. Desai:             That’s the most catastrophic thing.

Dr. Weitz:            Yeah. One more question. This is just kind of a personal case from one of my patients. I have a longstanding patient and he kept getting AFib from, he felt like it was coming from drinking something cold. Does that make any [crosstalk 00:56:54] sense?

Dr. Desai:             Yeah it’s that vagus nerve again. [crosstalk 00:56:57] [inaudible 00:56:57]

Dr. Weitz:            Oh okay.

Dr. Desai:             [inaudible 00:56:58] nervous system. Yeah [inaudible 00:56:59] a triathlete. Every time he drank Gatorade at the end of the race he went into AFib. How much of a reward is that? You just finished a race and you go into AFib because of the Gatorade. So yeah you get esophagal stimulation. Really hot, really cold beverages can stimulate the vagus nerve. And then the esophagus is right next to the vagus nerve so there’s actually a direct sort of mechanical type stimulation. So yeah there is actually reason for that [crosstalk 00:57:24]

Dr. Weitz:            Well interesting you know we talk about the vagus nerve all the time when [crosstalk 00:57:27] we talk about gastrointestinal conditions so.

Dr. Desai:             Yeah. Yeah. I  kind of feel like the vagus nerve is getting a bad rap now. It really is important. It [crosstalk 00:57:35]

Dr. Weitz:            Well absolutely it’s a pathway for communication through the body [crosstalk 00:57:41] between the brain and the gut, and the gut and the brain, and the gut and the heart, and the heart and [crosstalk 00:57:45] the gut.

Dr. Desai:             And it’s so important. When we mentioned earlier, and maybe this is a good parting note is stress is pervasive and there are so many great ways for creating toolboxes to deal with stress. The classic stuff like exercise and being in nature and things like that. But mindfulness and breathing techniques and even simple things a few minutes a day, it activates that parasympathetic nervous system that helps to counterbalance that fight or flight response. We were built to run away from dinosaurs the problem with this is that we think that a conflict at work is a dinosaur. And sometimes it actually may be [crosstalk 00:58:18] a person may look like a dinosaur. But sometimes not and so but our brain, our limbic system and our fight or flight response and everything interprets the threats that way so its important for us to always be mindful of how we are interacting with people. We can just, that way we can kind of show up as the best version of ourselves and not be so reactive that we have choices on how to act.

Dr. Weitz:            Yeah. Big scary arm chair dinosaurs. Doc.

Dr. Desai:             Yeah. That was a great way of saying it without saying it. I love that. I love that.

Dr. Weitz:            What’s the best way for listeners and viewers to get ahold of you and contact you and?

Dr. Desai:             Yeah. Yeah. So the book is called Restart Your Heart: The Playbook for Thriving with AFib. It’s on anywhere books are sold including Amazon, Barnes & Noble. If you go to my website which is draseemdesai.com D-R-A-S-E-E-M-D-E-S-A-I .com I have a ton of information about the book and where to purchase, but also I have a blog, lots of complimentary advice there. We have a variety of different videos and things like that. And then I am very active on social media so especially on Instagram and Facebook we even have AFib groups and things like that, so it’s @draseemdesai. That goes for Twitter, LinkedIn, Facebook, Instagram, and then I have a YouTube channel as well @D-R-A-S-E-E-M-D-E-S-A-I and you can direct message me or reach out to me or follow me.

                                I definitely, I thrive on feedback. So that’s the only way that any of us, I mean your feedback about my video, I’m going to go look at that video now because your feedback about my video is important because I may be scaring a lot of other people and I need to change the way that video looks, so yeah. That’s important feedback.

Dr. Weitz:            Okay good, doc. I enjoyed the conversation and then when I put it up in about five, six weeks I’ll send you links and hopefully you can share it with your followers.

Dr. Desai:             Yeah I’d love to and love to give you a roo. Thanks to Dr. Weitz for this conversation today. I appreciate you having me.

Dr. Weitz:            Great. Thank you. Thank you.



Facts and Myths with Adrenal Fatigue with Reed Davis: Rational Wellness Podcast 180

Reed Davis discusses the Facts and Myths with Adrenal Fatigue with Dr. Ben Weitz.

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Podcast Highlights

0:30  This discussion is about a condition that exists in patients who have been suffering with fatigue and other symptoms related to dealing with chronic levels of stress.  This condition has been called Adrenal Fatigue and the concept is that over time, after dealing with high levels of stress and having to respond repeatedly by producing higher levels of adrenaline and cortisol, the adrenal glands become unable to produce optimal levels of cortisol, much like the pancreas becomes unable to produce adequate levels of insulin in diabetics.  But this condition was never sufficiently proven in scientific studies and most of the conventional endocrinological medical establishment never accepted this concept and it has become increasingly accepted by the Functional Medicine world that adrenal fatigue, per se, does not exist as we have thought about it. However, we also know that a large number of patients have been successfully treated by Functional Medicine practitioners for fatigue and other conditions believed to be related to adrenal problems with herbs and other very safe nutritional supplements, so something positive must be going on.  Check out Ari Whitten’s detailed analysis on adrenal fatigue from his Energy Blueprint podcast: Is Adrenal Fatigue Real? 

6:23  The construct of adrenal fatigue has been useful, even though the science has come to show that it may not be exactly what is happening. When we are under stress, out flight or fight sympathetic nervous system takes over and that kicks off an endocrine response from the adrenals and some other organs.  Both adrenaline and cortisol are released, both of which are produced by the adrenal glands.  Such patients are often stressed out, have extra weight gain, low energy, poor sleep, don’t like to exercise, they might get dizzy when standing, they may have sensitivity to light, irritability, etc.  These patients may be self-medicating. They may rely on coffee in the morning and alcohol at night to sleep. We still see the same patients with the same symptoms and they still have low cortisol, it’s just that we can’t place all the blame on the adrenals.  The adrenals never lose their ability to produce cortisol, so it is the signalling coming from the brain and the sensitivity of the receptors that are more to blame than the ability of the adrenal glands.




Reed Davis is the Founder of the Functional Diagnostic Nutrition (FDN) Certification Course and the D.R.E.S.S. for Health Success Protocol.  He is an Environmental Paralegal, a Certified Nutritional Therapist and Fitness Coach and he served as the Health Director and Case Manager at the Better Health & Wellness Center in Poway, California for over 10 years.  One of his specialities, beside training Functional Medicine practitioners, is teaching how to interpret lab tests.  Reed teaches a certification course for Functional Medicine practitioners, Functional Diagnostic Nutrition, which you can access by going to FDN.today/drweitz.   

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, our topic for today is facts and myths with adrenal fatigue with Reed Davis. Our topic is about a condition known as adrenal fatigue or as some people refer to it as adrenal dysfunction. And it’s been discussed in functional medicine circles for decades. The concept is that due to too much and chronic levels of stress, at first, your body adapts by your adrenal glands, which react to stress by producing more adrenaline and cortisol.  So therefore initially, you may have excess levels of cortisol, and this can result in difficulty sleeping and anxiety and other symptoms related to being in a state of excess stress. After a period of chronically over producing adrenaline and cortisol and these other adrenal hormones, in order to help your body cope with the stress, your adrenal glands become exhausted, much the way your pancreas becomes exhausted in type 2 diabetes after having to produce so much excess insulin in response to sugar surges and at some point is no long able to produce adequate insulin or perhaps any insulin at all, requiring the patient to have to take insulin injections in order to control their blood sugar.  So in this stage of exhaustion, which we often refer to as adrenal fatigue, your adrenal glands are unable to produce adequate levels of cortisol for what your body needs.  And cortisol levels are often measured in the Functional Medicine world through salivary levels and typically we do a four-part cortisol test, measuring salivary cortisol levels in the morning, midday, afternoon, and evening. On the basis of these measurements, Functional Medicine practitioners often recommend adaptogenic herbs, glandulars and other nutritional supplements.  And then medical practitioners may put patients on hydrocortisone.  There’s some controversy over whether these salivary cortisol levels are accurate, since salivary cortisol levels measure free, unbound cortisol, and only 3 to 5% of total cortisol is free. So this may not be representative of cortisol levels in the body.

Now, the conventional medical establishment never got on board with this concept of adrenal fatigue.  So here’s a typical quote from an endocrinologist from Cedar Sinai, Dr. Anat Ben-Shlomo, quote unquote, “Adrenal fatigue is the notion that our adrenal glands get overworked by stress and stop producing the hormones we need, including cortisol. It’s a medical myth.”  This view has also been put forth by the Endocrine Society and other medical groups. And there’ve been a ton of papers published on this concept that adrenal fatigue does not exist.  Now, the Functional Medicine world continued to promote this concept about adrenal fatigue, since we do these salivary cortisol levels, we see significant improvement with our patients using our nutritional protocols and adaptogenic herbs, et cetera. However, in the last five to 10 years, it’s become increasingly understood by some, many, certainly not all in the Functional Medicine world that the adrenal glands actually never lose their ability to produce hormones like cortisol.  And this view has recently been expressed by a number of prominent functional medicine doctors, including Chris Kresser and Ari Whitten. In fact, Ari did perhaps the most exhaustive detailed analysis of many of the studies and what should be concluded is that while some studies showed a decrease of cortisol levels, some studies showed an increase in cortisol levels, but most patients with symptoms of adrenal burnout or fatigue actually had normal total cortisol levels and Ari reported this incredibly detailed analysis in one of his Energy Blueprint Podcast.  So he did a great job with that.  On the other hand, we have all these Functional Medicine patients who’ve been successfully treated with adrenal fatigue, so there must be something going on.

                                So I’ve asked Reed Davis, the founder of the Functional Diagnostic Nutrition Certification Course and D.R.E.S.S. for Health Success Protocol to come on to perhaps give us some information about exactly what’s going on with this so-called adrenal fatigue with these patients who are fatigued and have these other symptoms. Reed Davis is an environmental paralegal, a certified nutritional therapist and fitness coach and he’s also served as the Health Director and Case Manager at the Better Health and Wellness Center in Poway, California for over 10 years. And one of his specialities besides training functional medicine practitioners and health coaches is teaching how to interpret lab tests. Reed, thank you so much for joining me.

Reed Davis:         Hey, thank you, Dr. Ben, it’s good to be here and hopefully answer some questions.

Dr. Weitz:            Absolutely. So unfortunately, there’s a little bit of delay because Reed’s up there in the mountains without the best internet connection. So Reed, perhaps you can start by explaining, what are the adrenal glands and what are their functions?

Reed Davis:         Well, that’s a good place to start, I guess, but I wanted to just back up a bit and say that the construct of adrenal fatigue was very, very useful before the science let us know that it wasn’t ever written in stone that you have adrenal fatigue, but it was never written in stone. It’s just a useful construct because they are considered the stress organ. And you’re absolutely right, when you’re under stress, you go into a fight flight mode, and that has to do with both the nervous system, you basically are going to go into the autonomic, the anxiety mode, the fight flight, that’s basically your sympathetic nervous system. So you get sympathetic dominant, and that actually kicks off an endocrine response.  So when you get scared, run off the road, get chased by a bear or whatever the heck, yelled at by your boss or something upsets you, the first thing that happens to your nervous system, you go into that fight flight, the sympathetic kicks in, and it’s so that you can fight or you can run away, it’s a survival mechanism. The adrenals are involved along with some other organs, because they can produce adrenaline, number one, adrenaline is an amazing hormone. It makes you feel good, makes you able to run fast and these kinds of things, or fight hard, whatever it might be. And along with that comes cortisol. They’re both made in the adrenal glands, but they’re made in different parts of the adrenal glands.

                                So that’s why they’re considered the stress organs. And they’re just some little triangular shaped organs sitting up your kidneys, the kidneys are known as the renal gland and add means above or on top of, basically. So they’re on top of the real or kidneys, very useful little organs. And they’re basically told what to do by the hypothalamus pituitary, and again, the sympathetic nervous system. And again, I thought it was a very useful construct back in the day, 20 years ago, someone would come in feeling stressed out, did some weight gain, maybe some low energy, poor sleep, don’t like to exercise, they might even get dizzy on standing, eyes are very sensitive to light, kind of irritable, things that.   The same people often are self-medicating, they need some coffee in the morning, might even need some alcohol to get to bed at night. Another common thing was crashing in the middle of the day and these kinds of things.  So since the adrenals are involved in fight flight and they would take a lot of the blame for those types of symptoms.  You can go through all the anatomy, physiology, biochemistry, I’m happy to go as deep as you want on this, on the adrenals, but it turns out that they were getting the blame somewhat erroneously.  They’re still really involved, but if they’re not producing cortisol mostly and that’s what we used to call adrenal fatigue when you had very low cortisol, there’s other reasons for it.  It’s just the signaling, the cell receptorship and interplay and so there’s a lot of moving parts there, so we just can’t call it adrenal fatigue anymore.  It doesn’t mean you don’t have the same symptoms, they’re just coming from multiple places and now we know we need to do two things and then I’ll let you chime in here. Now we know we need to do two things. One is to resolve the stressors that got you there in the first place. And frankly, I always took that approach even 20 years ago, the adrenals, well, we don’t want to just treat the paper, there’s supplements you can take to raise cortisol or what have you, we used to do licorice root and all kinds of things and people would feel a little bit better, but the real answer is to reduce the stressors and that could be quite a job, figuring out what they are and those are the real cause of those symptoms.

Dr. Weitz:            Okay. So why don’t we talk about what some of the causes of this fatigue that our patients are feeling aren’t?

Reed Davis:         Well, when you’re stressed and I don’t mean just getting cut off in traffic or yelled at or some of these mental, emotional things. If it was just that, and it was occasional, you’d be fine. Your cortisol would go up, the adrenals would kick in, you would get some adrenaline and then momentarily later you’d get some cortisol, cortisol sticks around longer. It actually just enhances the fight flight mode, but it doesn’t last more than say an hour, then you’d go back to normal, quote unquote, normal. Well, I picture zebras getting chased by lions and as soon as the lion catches one and starts eating it, the rest of them go back to normal. You see on discovery channel, they’re eating grass in the background because they’re not under stress anymore, not as long as they’re not being looked at as something to eat.   So now with us, it’s actually built in, we have this stress response and it’s the adrenaline and the cortisol and some other things, but it’s constant. We’re not under ordinary stress anymore, we’re under daily assault. There are tens of thousands of chemicals in the environment that can invoke the same kind of adaptive response. So your body just knows, it’s really smart. There’s an innate intelligence in every cell tissue, organ and system that says we’re under attack. And so you couple that with watching TV and all the relationships and your relationships with people and with money and with driving through traffic, whatever it might be, and then add on top of that injury and trauma and weakness and imbalances in the body.  So I’ve studied stress since about 2001, when I found out it was the reason for 80% of all doctor visits was based on stress and even up to 50% of all diseases were stress related. And so I started studying stress and I just categorized it, all that mental, emotional stuff, your life, things like that and a lot of times we’ll get used to it, we think it’s normal. And the same thing with the chemical salts, a lot of which we don’t even know they’re there, it’s in your food, it’s in your beverages, it’s in your clothing, it’s in your furniture and your draperies and your carpeting, it’s in your household cleaning products, it’s in your personal care products, things that are stressful, things that the body reacts in a similar way to.

Dr. Weitz:            You’re talking about environmental toxins?

Reed Davis:         Exactly, yeah. So all of that adds up to where it’s just a constant assault and your body, it can get tired of that crap and dysfunctions occur and you end up with all kinds of things upstream from the symptoms, but the symptoms remain the same, that stressed out, crashing in the day, needing coffee, immune system problems, the energy, brain fog, poor memory, all these different things come from assaults from stress, the adrenal glands are one organ involved. And they were getting the blame, all the blame for a long time.

Dr. Weitz:            So what other organs are helping us deal with stress?

Reed Davis:         Well, the sensory organs in the brain are really important. You have what’s called the limbic system, which is mostly considered the emotional center, also, olfactory–sound comes in through there and it can be loud noises scare you, that’s because the limbic system sends signals almost directly to the adrenals to make adrenaline and you get that feeling. And then again, cortisol would kick in and you have the messages going through the hypothalamus pituitary, so they are another couple of little organs up in the brain and they send the chemical messengers, the stimulating hormones to the adrenals.  So that complicates it a bit, well, what’s stimulating the hypothalamus and the pituitary? That again could be in the environment, it could be the circadian rhythm, it could be other hormones, it could be toxins, chemicals, drugs, there’s so many things that can stimulate the sensory organisms or organs in the brain, they’re very sensitive. They’re little tiny things, they can only take so much and they will send out what you might call bad signals. Oh, by the way, it makes it very interesting if you like anatomy or physiology, you’ve got the adrenals aren’t one organ, you have the medulla in the middle that basically stores and releases the adrenaline upon signals from the autonomic nervous system, your sympathetic branch.  And then you have signals coming from the hypothalamus/pituitary to three separate layers. If they want to know the names of them, that’s zona fasciculata, zona glomerulosa and zona reticularis, they make different hormones. The cortisol is only made in one. Another one makes your DHEA, which is the parent of sex hormones that is supposed to counter regulate cortisol. And then you have the aldosterone and mineral corticoids that regulate sodium/potassium levels and so on, your blood pressure, blood volume, and hydration…

Dr. Weitz:            Hang on one second, Reed. And these three zones are different areas in the adrenal glands, correct?

Reed Davis:         Yes.

Dr. Weitz:            Okay. What do they call it again? One more time?

Reed Davis:         Well, there’s the zona glomerulosa, that is the outer layer of the adrenals, and that makes your aldosterone, it’s the electrolyte and fluid balance in the body, blood pressure, sodium potassium levels. The point was that there are different things affecting the signaling organs in the brain, and then it could send good or bad signals or mixed signals and you have four different areas within the cortex, within the adrenals. There’s the cortex has the zona glomerulosa, it makes the aldosterone, the zona fasciculata makes the cortisol and the zona reticularis makes the DHEA, dehydroepiandrosterone was counter regulates the cortisol. These things by the way, are not just made in the adrenals, so if you want to get even more interesting, some people might say complicated or complex, it is very complex.

                                Your skin makes cortisol. If you get a little nick or a tiny insect bite, your skin makes its own cortisol, your skin has the same kind of axes as the HPA to adrenals. That’s why… What is cortisol? It’s an anti-inflammatory and it’s a pain killer. So you’d want some extra cortisol if you get a bite in the skin, or if you get punched in the face, same thing. So you’re going to make these things that regulate blood pressure and fluid balance in the body, why? Survival, you’re going to get from the fasciculata, the cortisol, which raises blood sugar, enhances the action of adrenaline, it is very anti-inflammatory and it’s the main signal by the way of catabolism.

                                Catabolism is what breaks your body down, which you might need to do to maintain the blood sugar levels. And finally, there’s the zona reticularis, it makes the DHEA, that counter regulates the cortisol and it’s the precursor to all your sex hormones, including estrogen and testosterone. So you can start to see why someone under a lot of stress, and you’re messing with the signaling organs, you’re messing with the organs that receive the signals, and you can have quite a lot going on there, that’s why I have one diagnosis for everybody, it’s called metabolic chaos. And that’s a term I use to just describe what’s really going on. I just find it the most interesting, fascinating area, stress and how the body reacts to it.

Dr. Weitz:            So you’re giving some complex information about cortisol and it’s interesting because there’s a tendency to see some of these hormones and other substances as good or bad and some people see cortisol as bad, high cortisol is bad. So cortisol has all these important functions and it’s neither bad nor good, in fact, it’s good and bad, depending upon the levels and whether it’s being appropriately secreted at the right times. Now, how is DHEA counterbalancing cortisol?

Reed Davis:         Well, DHEA has its own direct benefits on the body, it’s very anabolic. And so when you talk about the adrenals and testing for the adrenals, you’re talking about, maybe not the condition of the adrenals themselves, but just the levels of production, which again, we know we have mixed signals coming to these different layers and these different layers, they don’t swap the substrates. There’s no such thing as the pregnenolone on steal. The cells inside the zona fasciculata cannot steal pregnenolone, the parent hormone, from the other zones. And so that was another big myth that was shattered. And what would I look at because I was trained in a chiropractic office over 20 years ago, to think about balance and resilience.  Now, what really defines health could be considered to be balanced, everything’s balanced and cortisol DHEA would be two things you really want balanced in your body. You don’t want cortisone dominance. Remember cortisol dominance over time leads to a catabolic state and the body’s breaking down. Catabolism is the breaking down. You’ve seen people who are completely stressed out like runners who purposefully stress themselves out. They do a very unnatural thing by running 20 or so miles and their bodies are broken down. The cortisol has just pretty much even broken down their meat. Why? To maintain blood sugar levels.

Dr. Weitz:            Occasionally, I’ll have a patient who’s maybe been on cortisone for some months and even years for some chronic condition like asthma or some auto immune condition and often they have lost almost all their muscle, you can see that severe catabolism.

Reed Davis:         Yeah, exactly. And so you want the cortisol and DHEA to be balanced. They’re both coming from the adrenals for the most part. I said the skin makes cortisol and the brain makes some DHEA, but probably 80% is all coming from the adrenals. And so that would give you balance in a couple of ways. If it’s all about balance, what do we want to balance? We want to balance cortisol and DHEA, and you’re balancing the catabolic with the anabolic, your body breaks down and builds up, breaks down and builds up. You’re also balancing, cortisol is your stress hormone and DHEA could be considered your sex hormone, a main hormone responsible for the sex hormone.  So you want stress and sex to be balanced up, that’s for sure. And you want catabolism and anabolism to be balanced out, and that’s for sure. And you can tell, people, doc, you know this, when you explain this to your patient, to your client, and no one else has ever explained it to them, why they feel so crappy? Look, you’re out of balance and this is why, you got all this stress and your body is breaking down and it’s not building up in a way that’s working for you. And so what do you need to do? Reduce the stress, there’s modalities and things. If it’s physical, see a chiropractor.  If it’s energetic, you can see an acupuncturist and get some things moving, that we have seen that be helpful. If it’s mental, emotional, there’s lots of help in that area. And if it’s chemical, biochemical, well, you can eat better, get rid of all the toxins and things that are in your food and beverages, as we mentioned, the environment is so full of it, all the other stressors. And I think supplements are very helpful too, to support these systems.


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Dr. Weitz:             So what’s the best way to measure adrenal levels and cortisol levels?

Reed Davis:         It depends who you’re talking to. When I started, it was just us doing saliva testing only, way back in the days of John Lee, you mentioned [inaudible 00:25:14] he’s been around a long, long time. A lot of other good docs, but they were considered out of the box, kind of like you mentioned, conventional or standard medicine didn’t address this at all, but nowadays, science has grown, it’s expanded. I still think saliva testing is very good, but there’s not much hormone in the saliva. So you’re measuring very small amounts. You have to be very careful. I like the ease of collection, people can take the kits home, you can take it morning and noon and afternoon and nighttime cortisol, you can wake up in the middle of night and take cortisol. You could never do that with blood. Who’s going to go get four or five blood draws in one day? That’s never going to happen.

Dr. Weitz:            Right.

Reed Davis:         So blood’s not very good for this although there’s other ways to skin the cat and I know people who do a good job with blood work, they just don’t get the circadian rhythm the same way. So then there’s also urine, and there’s a 24 hour collection, which is useless. Total cortisol doesn’t mean much. You really need to look at that circadian rhythm, but now there’s dried urine. So dried urine can be done. It’s still not exactly in the moment as bioavailable saliva, but there’s a lot more hormone in urine and it can be measured that way too.

Dr. Weitz:            Do you like the cortisol awakening response. Do you think that’s a significant improvement?

Reed Davis:         Yeah, I like that. Lots of saliva testing catches that now. We’ve learned that some people, again, it’s all dependent on whose test results you’re looking at and why would you want cortisol awakening response? Well, some people stay in that sympathetic state all morning. They get up and they’re panicking and they can’t calm down and you can see it in their cortisol levels. Basically, you would take a first waking cortisol, remember it’s rising as you wake up, it’s what helps you wake up and cortisol rising at nighttime with a drop in low blood sugar, whatever it might be, cortisol kicks in to raise blood sugar and it happens in the morning. So when you first wake up, you call it a baseline.

                                Now, about half an hour to 40 minutes later, it’s going to reach its peak for the day. And then it should come back down in the next half hour or so to within 25, 30% of where it started, you don’t want it staying up that high. What’s very interesting about some people who tend to lean towards high perceived levels of stress, they have, wherever it is when they wake up, baseline, then a half hour, 40 minutes later, it’s quite high. And then the next one, instead of coming down, it stays high or it doesn’t come down very much. So you talk to that person and they perceive life as shitty and it matches perfectly with their test results, it’s so interesting to see that. So you can then coach those people up on lifestyle changes they can make to bring it down. You don’t want to stay in that state generally.

Dr. Weitz:            So what kind of lifestyle changes would you recommend to help bring somebody who is in a state of higher cortisol levels?

Reed Davis:         There’s so many different stressors and stress reduction is a huge part of our program and it could be coming from mental, emotional, as we said, it could be coming from the environment, including what you eat. So we have people tell us, if you talk to people, you can find out a lot about them and where they think it is and you just begin to get good at making impressions, forming impressions about people. You might say, “Well, this is a mental, emotional thing and you could do some deep breathing, meditation, you could do some pausing to be thankful and say, well, it’s going to be a better day than yesterday.” And lots of positive psychology things are very useful. And again, I think point of view is huge and these people are worried and what have you, so there’s other people who specialize, that’s what they do. They do that type of counseling.

                                I’ve used emotional freedom technique. And again, I think prayer and gratitude and point of view are more my style and it comes naturally to me, but other people need other modalities or therapies. Other people, we think about, because the same spikes in cortisol could happen throughout the day. You could see it at lunchtime. Wow, why is it so high above range at lunch? Well, it could be that you’re sensitive to something you’re eating, or something else is going on, but you can actually see that stuff. If you have a food sensitivity, that can spike your cortisol because it’s inflammatory and what is cortisol again? It’s an anti-inflammatory. And then if you see spikes in the afternoon or spikes at night before bed, so you can get to know the person and they can get to know themselves.      When you have good interpretations and you have good impressions, if you’re good at impression, forming and assessing, you can walk a person through a lot of this, just showing them the facts on paper itself lets them know, you’re not crazy, there really is something going on, let’s take a look at it and you have some objective criteria there plus how they feel and it can work out to be a real good relationship. So there’s other stressors obviously, but [crosstalk 00:31:05].

Dr. Weitz:            So you’re saying that anything that creates inflammation in the body is liable to lead to higher cortisol levels. And you mentioned food sensitivities is one, I’m assuming high blood sugar spikes is another?

Reed Davis:         Well, low blood sugar would be why your cortisol would go up, so if you don’t eat right, you have to eat in order to maintain steady blood sugar levels and energy and satiation and sense of well being and things. So if you’re eating right, you should also be able to maintain what we call stable cortisol levels or within range, normal circadian rhythm. And there’s no question about it, humans are diurnal, they’re not nocturnal. So we find people with highly disrupted circadian rhythms and they’re not sleeping at night, they’re sleeping in the day, all kinds of things going on.  So that matters too then. Sleep becomes important and exercise becomes important and reducing other stressors known, those are the easier ones. The unknown ones are even harder because you’ve got electromagnetic frequencies and you’ve got radiation and you’ve got parasites and bacterias and funguses and viruses and biofilms and Lord knows what else is in there, especially these days, right? So there is a system is the main thing, there’s step-by-step, you can sort out metabolic chaos and that’s what we’ve been known for 20 years, right Doc? Helping people sort it out.

Dr. Weitz:            Absolutely. So let’s say you get a patient in your office and they’re complaining about fatigue, you’re going to take their history and then what’s the next thing you’re going to do?

Reed Davis:         I would run labs on every person just because I don’t like guessing. And a lot of other people run labs too, but they guess about which labs to run and I really don’t. And it’s because over 20 years, I started recognizing patterns. So the typical practitioner clinician listens to the complaints of the patient and says, “Well, it sounds like this.” They’re forming an impression based on how that person looks and your vital signs and different intake and largely, their complaints and history and say, “Well, it sounds like it could be thyroid.” And then they’ll run a test on thyroid. So they’re guessing about what tests to run, because it sounds like [inaudible 00:33:47]. For other people, it sounds like the adrenals, or it sounds like parasites, or sounds like [inaudible 00:33:53].

Dr. Weitz:            Of course, one of the reasons we’re doing that is to try to be efficient and cost effective.

Reed Davis:         True, true. Well, it’s also just the heuristic being used. It’s go after the symptoms. The most immediate cause of the symptoms, but that heuristic leaves a lot on the table because it could be any damn thing really far upstream or a combination of things, which is more likely the case. So with me, I just run five labs in every person because I have no clue. I try to avoid it sounding like… I might do it like, “Well, it sounds like [inaudible 00:34:29], but I have no clue if it is. So why don’t we just run… I really run six assessments on every person and there is an investment for that person.

Dr. Weitz:            What are those six assessments that you do?

Reed Davis:         I look at the hormones, including the adrenal and sex hormones. I look at the immune system, I look at digestion-

Dr. Weitz:            Hang on a second. The hormones you measure through urine, saliva or a serum?

Reed Davis:         I still like the kits, the saliva kits, because people can take them home and do it. They can also do that with dried urine and they’re both good tests. It just depends on your practice and what your intention is for that person. I’m looking to develop the most holistic protocols possible. Other people are looking more to treat maybe the imbalances in estrogen and progesterone, even cortisol, DHEA, they use a lot of products.  So they’re taking the shortest distance between the labs and what products to recommend and I take a more holistic approach with what lifestyle to recommend, which I said could include some supplements. So when I look at the… It’s H-I-D-D-E-N, Doc, if you want to know the magic assessment formula, H-I-D-D-E-N, it spells hidden and [inaudible 00:35:56] things are hidden, but it’s the hormones, immune, digestion, detoxification, energy production, and nervous system balance. It’s really autonomic looking at balance between sympathetic and parasympathetic. We just call it in nervous system or nerve… So it’s hormone, immune, digestion, detoxification, energy-

Dr. Weitz:            So how do you measure immune function?

Reed Davis:         Well, there are measurable things that have to do with the immune system. For one, the gut, which is about, according to Mark Hyman, it’s 80% of your immune system, but I think we knew that 20 years ago, it was huge. And so you have something called secretory IgA, you have other immunoglobulins, now we have zonulin, that’s some little markers. We can also look at the go to bed flora, if there’s not enough good flora, that would also affect digestion. So some of it is hard with the visuals and the teaching, which could take a while. 

Dr. Weitz:            So to measure immune and digestive functions, you’re going to do a comprehensive stool test? What’s your favorite stool test?

Reed Davis:         Well, I ran one this morning. I haven’t emailed you. I’m always experimenting with new tests, but I like the GI map. I like the Bio-Flora 1, but they went out of business. So I like looking at microscopy and antigen testing and the other test, the culturing. Hardly anyone is doing culturing in these ways where humans are involved in the lab work. Nowadays, it’s all electronic, it’s all high tech and it’s just DNA, PCR type stuff. So there’s a lot of ways to skin that cat. The fact is though, we’re not looking for the disease so much or what’s the bug, “Oh, how do I kill it?” We’re looking at, “Why do you have it again?”  It’s the environment. So if you ran those labs, and I would look at an IP, an intestinal permeability test, there’s different ways to do that. There’s the old fashioned challenge, there’s blood, there’s antibody tests you can use, there’s lots of ways to do that, but it’s a preponderance of the evidence, it’s up to the practitioner. You want to be trained in forming these impressions and because you want to give that person things to do, not just things to take, that’s my opinion. And so-

Dr. Weitz:            Okay. So you’re going to do a stool test, and so for the intestinal permeability is adding on zonulin, is that sufficient or do you use the lactulose mannitol intestinal permeability?

Reed Davis:         I love that test. I like the old fashioned lactulose mannitol. That’s a great test because you’re actually getting a view of the topography inside the gut. If your lactulose is high, you have a leaky gut, you’re letting too much of this large molecule sugar get through and be recovered in urine. So it’s not supposed to be able to pass through very much. If a large amount is passing through, it’s all in a gradient and these things, by the way, are all moving targets, just changing on a regular basis, but you can detect a high recovery of lactulose tells you, you probably will see high zonulin in most of those cases.  Leaky gut’s more of an immune problem, but the lactulose mannitol doesn’t look at it that way though, through the immune system, it looks at it through physical topography, it’s a map. It’s almost like a camera when you know how to interpret it right. Now, with the mannitol, that’s a very small molecule. There should be a reasonable amount of that gets through the villi, but villi can be blunted, the brush border can be gone, you can see that on other certain markers. And if they’re blunted, you’d have low mannitol recovery when you should actually be seeing a fair amount. Now, there’s two red zones for the mannitol, because if it’s too high, then you could have extra porous villi, so they’re also beat up, it’s a dysfunctional gut, if you will.

Dr. Weitz:            Yeah, it’s interesting, I would say. I would say the lactulose mannitol test is something a lot of us used to do, and we gave up on it because we can almost assume most of our patients have leaky gut.

Reed Davis:         Yeah. But here’s the other things, these things are all in a gradient, like I said, and they tend to be moving targets. So it’s nice to know how are they doing now and what direction can we get them to move in? So you can see it’s not real blatant, by the way, the literature says, if the lactulose to mannitol ratio is in a certain range, then they’re fine, I highly dispute that. I’ve looked at thousands of these tests and correlated them with patients. And so I know that you can feel the standard interpretation, and yet there’s a healing opportunity there. Now, that’s the phrase you want to burn in your brain, is healing opportunity. Can this be improved upon? Yeah, I guarantee it can be. And you’ve got to look at the rest of the environment in that gut though, why is it looking beat up here?

Dr. Weitz:            Okay. So you’re-

Reed Davis:         That’s where the food sensitivities and [inaudible 00:41:42].

Dr. Weitz:            So your initial testing, so far you said that you would do hormones, you would do stool tests, intestinal permeability, what are the other components of your testing?

Reed Davis:         I like very, very much to look at things like oxidative stress, that’s a healing opportunity. Also, the food sensitivities [crosstalk 00:42:13].

Dr. Weitz:            So for oxidative stress, what would you look at? Would you look an 8-deoxyguanosine?

Reed Davis:         Yeah, that’s one. There’s also lipid peroxides. The hydroxy-guanosine looks at DNA damage from oxidation, but it might not be that bad yet. You’ll see cellular membrane damage, and you can detect that through lipid peroxides. Genova has oxidative stress 2.0, it measures both. Things like that give you healing opportunities, it’s how can I direct this person’s lifestyle medicine and then of course, it always leads you to another layer, where’s this oxidative stress coming from? I mean, if the person smokes, that’s one reason, but if they don’t, where do you go from there? Overexercise? Probably not.  And on and on and on. There’s some other markers that I really missed that have gone off the market. Urinary bile acid sulfates was one, it showed liver congestion, because remember, detoxification is also very critical. So I look for these clues or these healing opportunities, and by a preponderance of those things, can form an impression about a person, how much work they have to do. That’s why that IP test, even if it isn’t so clear, it tells you, “You’ve got all this stuff to improve.” Any adrenals will come back, right? You get rid of all this other crap, that’s the only way to fix those adrenals.

Dr. Weitz:            So is-

Reed Davis:         So the food sensitivities is large. Some of the bugs are worth treating, but some are just part of a bad environment. And then you can add [inaudible 00:44:08] on that.

Dr. Weitz:            Which bugs are worth treating and which bugs are just part of the normal environment?

Reed Davis:         Well, if a person’s symptomatic, you’re going to throw some anti-microbials down the pipes for anything listed as a parasite, a pathogenic bacteria, anything from salmonella to blastocystis hominis. You’ve got bugs and you have bigger bugs, but again, I’ve always looked at it-

Dr. Weitz:            Hey, you’ve just mentioned blasto, there’s some controversy over blasto and there are some practitioners who feel that it’s not worth treating and it’s actually just a normal part of that.

Reed Davis:         I think that it’s definitely a pathogenic species and it’s not unique to humans, you can find it in other animals and when they have it, it can get quite virulent. Humans, maybe it’s not as virulent as some other pathogens, but it contributes to chaos in the gut, it exudes their exudates from it and it doesn’t belong there. So the real question is, is it commensal, can your body get along with it? But to say it’s normal, it’s supposed to be there, I don’t know of any benefit it has. I mean, there’s a lot of verbiage around that thought that they say we need a balance of good to bad flora in the gut. So there’s all this microbiome in there, is it all friendly?   No. Well, why would unfriendly stuff be there? Well, it’s to keep your immune system in shape. If you had no bugs, you wouldn’t need an immune system. If there was nothing dangerous around. And then when something did come along, it would kick your ass. And so we have these things hovering to keep us active and ready for the worst, the worstest stuff. And so I don’t think in some people that I would… I wouldn’t treat everyone just because I saw some blasto, it depends how they’re doing. It depends how much is that contributing to all the chaos in their body? And if it’s a particularly bad case, I mean, we call it blastocystis hominis because it’s in humans. In a rat, it’s called blastocystis rati. In a beaver, it’s called blastocystis beaver, whatever those are, you get me? So it’s a parasite. It just may not be real virulent and parasitic, but it’s a bug that don’t belong there using my proper medical phrasiology.

Dr. Weitz:            Okay. So is that pretty much all your testing? Are there other tests that go into your initial testing panel?

Reed Davis:         The E and the N, so H-I-D-D is real simple, a matter of fact, those I figured out in fairly short order that everyone coming in the office, they’d already seen five or 10 practitioners, they weren’t better yet and I knew there had to be a better way. And I wanted to be the last person they have to see. Now, that was pretty much dreaming at the time, but I did figure out a few things. And if you can find healing opportunities within hormone, immune, digestion, detoxification, help that person to restore a balance and what have you, get those things working better, increases their resilience and last but not least, the EN, the [inaudible 00:48:21] I added on later when I started learning the importance of food with regard to the oxidative rate.

                                So we burned fuel basically, we all know how energy is produced and it’s produced by eating, it’s made from food, and we process it and we metabolize it the way that produces energy. So that cell is produced on a cellular level so that that cell can do its job. Do you have to teach that cell what it’s job is? No, that’s built in, that’s the intelligence. So you just have to fuel it right and keep interferences out of the way. And so energy production becomes a huge consideration because people are eating the wrong fuel mixture. If you’re a fast oxidizer and that’s inherent, that’s a genetic inborn quality.

                                And if you are a fast oxidizer, you better eat more slow burning fuel, the proteins and the fats, they burn slower. So if you’re a fast oxidizer, you have just been in a bonfire, you don’t want to put paper on it, you won’t get any energy out of that, it’ll just be gone. So you take a typically and traditionally really fast oxidizer. When they eat carbs, they don’t get energy, they don’t get any satiation, they don’t get a sense of wellbeing, either. They pretty much feel like crap all the time and they end up overeating and that shows a blood sugar off and on and on.

Dr. Weitz:            What do you mean by a fast oxidizer?

Reed Davis:         So it’s just the rate at which you burn fuel. Some people are genetically faster oxidizers, they burn their fuel faster on a cellular level. We don’t want to go into the Krebs cycle and citric acid cycle.

Dr. Weitz:            How do you determine if somebody is a fast oxidizer?

Reed Davis:         I use a very simple test. Some people say they can tell through other means more like chemistry. I haven’t learned that and I’m not sure about it, but I use a test called the metabolic typing test. And I discovered this when I met Bill Woolcott, who wrote The Metabolic Typing Diet, about this. Now, he didn’t invent it either, people smarter than all of us figured this stuff up, but there’s definitely the production of energy. Yeah, it’s online, but it’s got a lot of subjective questions, it’s not just objective. There’s questions about psychological traits, there’s questions about dietary habits and physical characteristics as well.

                                So psychology, physical and dietary habits things, and you can land on a certain place and then you have to dial it in through actually eating that way and dial it in and do a little bit of checking, but once you know what the things are to check, it’s fairly simple. To dial in the oxidative rate, dial in at least your proper ratio approaching fat and carbs. Real quickly, I’ll tell you this quick, my cousin’s a priest up in Canada and he had two Cree Indian villages for his parishes. And I was asking him one day, how’s things going and what do they do for a medicine man? And since he’s a priest, he said, “Well, I’m the medicine man.” And I said, “No, no, I meant when they’re sick, if they get… Then he says, “Oh, Christ, they’re all sick.” He goes, “They all have diabetes. It’s the worst health on the planet, these villages.” Why?

                                Because they don’t fish anymore, they don’t hunt anymore, they don’t eat wild natural grains in the summertime anywhere, they eat a bunch of crap that’s Tim Horton donuts and fried chicken or something. And so, here you have these extreme, fast oxidizers, and they’re just eating carbs and they don’t get energy and they feel lousy, the biggest cause of death up there is suicide. I think as a priest, he makes his living on weddings, christenings, and death, but anyway, they’re all sick and they just go to the government clinics and get their insulin, it’s a sad thing. But why are they all sick? Genetically, they’re not eating right. Yeah, it’s so obvious. It’s just so obvious.

Dr. Weitz:            Okay. So I think we’re probably ready to wrap. So how can folks find out about your functional training programs?

Reed Davis:         Yeah. Well, thanks for that. We set up a URL that everyone could go to and you could put it in your show notes, it’s FDN, that stands for Functional Diagnostic Nutrition, that’s the course and program I teach, Functional Diagnostic Nutrition. So it’s FDN.today/drweitz.

Dr. Weitz:            Okay.

Reed Davis:         Fdn.today/drweitz. It’s D-R-W-E-I-T-Z. And that way we could see [inaudible 00:53:44].

Dr. Weitz:            And who takes this course? Is this for doctors, is it for any functional medicine practitioner, is it somebody who’s new to functional medicine?

Reed Davis:         Well, all the above. We have a lot of allied practitioners and we teach health coaches and again, any kind of allied practitioner. I’ve had people take the course just for their own edification and that alone is worth the price of admission. It’s a very reasonably priced program for what we deliver, which is a ton, a heck to of training.

Dr. Weitz:            How long a course is it?

Reed Davis:         It’s going to take the average person who has a life, six to eight months. I’ve had people do it in three months, but I know they just plow through it. Again, I would call this the perfect compliment to a functional medicine practice and the practitioner, him or herself, should actually take the course, and maybe have some staff go through it with you. And we also have people for hire who practice this, who are otherwise not physicians, health coaches, the sort of the upper echelon elite health coaches. Again, I started this back in the 90s, myself training and my pursuit of trying to be the last person someone needs to see, I ran thousands and thousands of labs on thousands of people.  I was told by the labs, “How many doctors have you got working there? I said, it’s just me. And there was doctors working there, but I was the only one running labs and was told some very complimentary things, especially by the clients and patients coming in. I mean, I got miracle stories just from, forget the diagnosis and treatment of the paper, it’s the person, it’s what are the healing opportunities? It’s staying true to those and giving the person things to do at home. From your own practice, I’ll finish up Doc, from your own practice, coming in your office is great, but what they do in between visits is what makes it all come together.

Dr. Weitz:            Thank you, Reed for spending some time with us and giving us some information. Check out his Functional Diagnostic Nutrition Certification Course.



Detoxification and Healing with Dr. Isaac Eliaz: Rational Wellness Podcast 179

Dr. Isaac Eliaz speaks about Detoxification and Healing with Dr. Ben Weitz as part of 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

8:44  Detoxification is a process that involves a preparatory phase, an exposure phase, a binding phase, a discharge and elimination phase and support and balance, all of which happen together.

9:06  The preparatory phase is helpful when you are going to do a targeted detox, which is often done in the change of seasons, such as in the spring and the fall.  It can also be done before or after certain disease treatments, such as after chemo or radiation in cancer patients.  With respect to diet, it’s a good idea to start preparing for the detox by shifting to an anti-inflammatory detox diet by eliminating allergenic foods and reducing exposure to toxins in food. It’s also a good idea for people to ask themselves what do we want to detoxify, to get rid of on both a physical level and on an emotional/psychological/spiritual level?  Detox in the spring is designed to allow us to be more active, to be stronger and it is more liver related and more muscle related. It’s preparing the body for greater challenges. Detox in the fall we are preparing for the winter, which is the more dormant stage. It relates more to letting go of the past and asking for forgiveness.

13:31  We should address the issue of biofilms because biofilms in the gut will bind and sequester toxins and metals, will protect bacteria and viruses, interfere with elimination, nutrient absorption, promote and protect coinfections and thrive in an inflammatory environment.  And biofilm and inflammation are mediated and rely on sticky cell surface protein Galectin-3. Galectin-3 is the building block of the biofilm.  We can break the Galectin-3 structure of the biofilm using PectaSol-C, modified citrus pectin, which is a nutritional supplement developed by Dr. Eliaz.  PectaSol is also a powerful binder to heavy metals and a prebiotic, so it helps to promote a healthy microbiome.  There is also a sort of biofilm in the body, which is atherosclerotic plaque.  There is a well known connection between gum disease and heart disease and this is related to the biofilm in the gums, which are Galectin-3 driven.  Galectin-3 promotes both gum disease and heart disease.  Dr. Eliaz explained that his patients with Lyme Disease will feel relief immediately when using modified citrus pectin. For optimal detoxification you all need B vitamins and cofactors and botanicals can help with elimination in the gut, bladder, lungs, skin, etc.  Dr. Eliaz has developed a product, Detox Complete, that includes these ingredients.

20:09  When we look at the detox process we see the rhythm between preparation, exposure, binding, discharge and elimination, and support and balance.  Support and balance requires a healthy microbiome, so taking a prebiotic and a probiotic may be helpful.  Some chemo drugs, like Adriamycin, will not work if there is a disrupted microbiome. When the microbiome moves from survival to harmony, it is a good thing, and a microbiome in harmony serves us well.  





Dr. Isaac Eliaz is an MD and acupuncturist and he has been a pioneer in the field of integrative medicine since the early 1980’s, with a specific focus on cancer, immune health, detoxification, and mind-body medicine. He is the founder and Medical Director of Amitabha Medical Clinic and Healing Center in Santa Rosa, CA.  He is the developer of PectaSol-C, the only researched form of Modified Citrus Pectin and other nutritional supplements which are available through EcoNugenics and his professional line, Clinical Synergy.     

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.  Thank you, everybody for joining. I’m Dr. Ben Weitz in case you didn’t know. And this is the functional medicine discussion group meeting. And we’ve been meeting through Zoom since COVID started. I enjoy these zoom meetings. But it was a lot more fun meeting in person and personal relationships. And so I’m looking forward to the point when we can get back to that. So I hope you’ll consider joining some of our future meetings. In October 22nd, we’re going to get a tutorial on the GI-MAP stool test with Dr. Jeff Ingersoll of Diagnostic Solutions. November 19th, Dr. Steven Sandberg-Lewis will be joining us for some yet to be decided gut related topic. And we’re not going to have a meeting in December. And I haven’t worked out the schedule for 2021 yet, so I guess I better get to work.  I encourage everyone to participate tonight. And so type your questions into the chat box. And I’ll either call on you or ask Dr. Eliaz your question when it’s appropriate. And if you’re not aware, we also have a closed Facebook page, The Functional Medicine Discussion Group at Santa Monica that you should join so we can continue to conversation when this evening is over. I’m recording this event and I’ll post it on my YouTube page and I’ll include it in my weekly Rational Wellness podcast. And if you haven’t listened to the podcast, you should really check it out because we have excellent interviews with many of the top doctors in the functional medicine world.

And our topic for tonight is detoxification, transformation and healing with Dr. Isaac Eliaz. I want to thank very much, Clinical Synergy, ecoNugenics, which is the proper name for the company.

Dr. Eliaz:               For doctors, the doctor line is Clinical Synergy.

Dr. Weitz:            Okay. And so I want to thank them for sponsoring tonight’s event. So Isaac, can you tell us what the promo is for tonight? There’s a couple of specials for everybody.

Dr. Eliaz:               Yeah. I mean, so I think that companies, there’s going to be an email going out, there are two different codes because of some limitation of the website.  So one is the 15% discount on all Clinical Synergy products.  This is a professional line.  But then I asked them to make a special promo for our liquid probiotics because it’s really on a class of its own compared to any other probiotic.  And I’ve been importing it from Europe for years. It wasn’t available in this country. And then we reformulated, we added our POS, pectic oligosaccharides so I asked the company to buy six and get six free so you can really try it yourself. Give it to patients. It’s the kind of products that once you try, you don’t stop using. It’s an amazing, it’s really, I’ll share when I have some section, there are some products that are hard to explain until you try them. It’s like talking what is sugar until you taste sugar. It’s theoretical. It’s really at a class of its own. So I really, so I asked them to do a special code so people can get a great deal on it, you buy six and you get six free.

Dr. Weitz:            Great, everybody’s going to get an email. In fact, you may get one from Dr. Eliaz’ company and from me as well. And in case I wasn’t clear, if you have a question, type it into the chat box, and that way everybody can see it as well. So, Dr. Isaac Eliaz is a medical doctor and acupuncturist, and he’s been a pioneer in the field of integrative medicine since the early 1980s with a specific focus on cancer, immune health, detoxification, and mind body medicine. He’s the founder and medical director of Amitabha Medical Clinic and Healing Center in Santa Rosa, California. He’s a developer of PectaSol-C, the only research form of modified citrus pectin, and many other incredible nutritional supplements which are available through his company, Clinical Synergy. And perhaps most importantly, besides caring for his family, his patients and his business, Isaac cares for humanity and the planet. And he’s such an incredible human being that I’m honored to know him. And thank you for joining our meeting tonight.

Dr. Eliaz:               Thank you. I love the opportunity to come to your group.  I’d like it in person better, it’s true. We have some great evenings that are very crowded with people I already know.  But Zoom meanwhile is filling in, you know?

Dr. Weitz:            Yeah.  So now you’re going to share your screen and you’re going to do a presentation?

Dr. Eliaz:              Yes. So here we go. It’s okay. Can you guys see this?

Dr. Weitz:            Yep. Yep, we can see it.

Dr. Eliaz:              Okay, so good evening, everybody. And we are going, let me see if I can kind of clear the sharing button to the bottom. Good. Okay, so tonight, we’re going to talk about detoxification, transformation and healing and multi system holistic understanding and critical applications. So we’re going to cover a lot of ground today. And I’ll do my best not to get lost in too many details and a certain area that I will go through quickly, because you guys are experts in it, maybe more than me, and you’ve heard a lot about it. But I want to give you both a bigger understanding of what detoxification is and we usually learn and think about, but also give you today, try to be as practical as I can.  Okay, here we go. So what we’ll cover today is we’ll about a deeper understanding of detoxification, how to design a balanced and powerful detox program, detoxification, the relationship with the microbiome, which would be very relevant for next month’s lecture, intensive seasonal detoxification. I’ll talk a little bit about the difference between a full detox, which this is a perfect timing from a Chinese medicine point of view. Fall started three days ago, and compared to spring detoxification, and both in daily detox strategies, and how to avoid detox pitfalls in the healing crisis, which is really something that you really don’t have to see at all.  And again, we’ll talk about Galectin-3 and its role specifically today in detoxification and in the microbiome and gut health.  And detox challenges as the use of therapeutic apheresis, it’s a lot of my life’s work.  It’s a part, I’m part of the establishment of having NIH grants, publishing with institutes like Harvard, with the leading conventional doctors.  So part of my background is that in one level, really I’m kind of out of the bell curve when it comes to my esoteric and holistic understanding kind of growing with this approach, since I was a teenager from being in Korea and meditating and doing yoga, and spending years and years of two months in retreat and learning from great masters in Tibet and treating them and being a creative person and the same time, being a solid researcher that publishes regularly, and works with always dozens of leading research institutes in over 60 different patents and NIH grants, and really collaborating with the people at the top of conventional medicine, with the people in the real top interesting, they’re very creative, the ones that are really there that have gotten there, they’re often very creative, I learned a lot from them.

                                So when we look at a detoxification, we want to really see it as the process. And the process is the preparatory phase, an exposure phase, a binding phase, a discharge and elimination and support and balance and they of course happen together, except for the first stage, the preparatory phase. And this is more when we do a targeted detox, which is very often done in the changing season, the spring and the fall and done before certain disease treatments, let’s say for cancer after, for example, what do you do after chemotherapy?  What do you do after radiation?  But we won’t talk. My main focus in my medical practice is cancer, but we won’t talk about it in the context of cancer.  Today is more about the gut, because also the large intestine, it relates to the lungs, to the fall season, so it’s a good season to talk about the lungs. So when we look in the preparatory phase, we really want to have the body mind scope, we really want to go all over. So for my diet, it’s a good idea to start preparing for the detox so if you’re about to do a detox yourself or recommend to your patients to do it, it’s going to take a few days a week or two, and start shifting to anti-inflammatory detox diet, eliminating allergenic foods and reducing exposure to toxins in food, in products, in environment and the idea is one, we are reducing the toxic load in advance. And we are freeing our detoxification enzymes, our detoxification systems, so they can actually help us in the detox process. The GI support is very important because the large intestine, the intestine in general, large intestine specifically, are really our main elimination organs.  And we really need our microbiome, we really need our intestinal barrier and elimination to be ready, so when we excrete into the gut, there is no reabsorption. It’s a very important stage that we really want to emphasize. Let me just move the picture of everybody to the bottom, that would be good.  And very important, many people detoxify.  But not too many people ask themselves, what do we want to detoxify?  What do we want to get rid of?  So when somebody prepares for a detox, I would ask them, “What would you like to get rid of, on a physical level, on an emotional level, on a psychological level, on a psycho spiritual level?”

                                And in this sense, the fall and the spring are very different. This spring, we’re coming out of the winter, out of less movement, and we are preparing for longer days, more activity during the summer.  So detox in the spring is designed to allow us to be more active, to be stronger, and more liver related, muscle related. It’s preparing the body for greater challenges.  The fall season prepares more for the dormant stage.  It’s interesting to know now we are between Rosh Hashanah and Yom Kippur, and Jewish New Year is a time when we kind of, it’s a season where we weigh what we did good, our deeds, our positive, the negative deeds and we balance it.  That’s very much the fall season, the mental season, the judgment season, and we look at it and we ask for forgiveness, we let go. So detox is also a process of forgiveness, of letting go, of discharging.  So especially in the context of the fall, it relates more to the past, to letting go.  We’re moving into the darkness, we’re moving into the end of life, from a seasonal point of view, from the annual cycle point of view, and this year especially is a year when we ask, “Oh my gosh, what a year.  What do you want to really let go of?  So this is the detox part.  And towards the end, when I summarize, I’ll talk a little bit about the transformation and healing. That’s another power that is not often the event recognizing detoxification. Also the part that I will not be able to cover here, which are how every organ responds to the detox cycle. I talked a little bit about it in my book that I’m finally going to come up out with, which is going to be called The Survival Paradox. It really explains this.

                                That’s not good. Okay, for the moment, let me make sure there’s only one slide here, okay. All right. So, after we prepared, we want to expose the toxin intersections. And here today in the context of the colon, we really want to address biofilms because it’s a key strategy in day to day addressing chronic infection and in detoxification, because biofilms will bind and sequester toxins and metals, interfere with elimination, nutrient absorption, promote and protect coinfections and thrive in an inflammatory environment. And biofilm and inflammation are mediated and rely on sticky cell surface protein Galectin-3.  Galectin-3 is the building block of the biofilm.  It’s like the structures, it’s like the skeleton of the biofilm.  So it’s important to really understand the importance of biofilm and the role of Galectin-3 in this specific context.

                                So when you look at binding, there is a great advantage to using PectaSol, modified citrus pectin, and the reason is because modified citrus pectin not only breaks the Galectin-3 driven structure of the biofilm but it’s also powerful binder to heavy metals and a powerful prebiotic, and specifically if you want to address more issues like toxins within the gut, not only systemically, then you can combine it with alginates, which have a different profile of binding, which I will get to soon. I just want to mention this so that I often talk for an hour and a half and I forget to be practical. So today I made a point of being practical.  So once we have the preparation, once we have the exposure, now we are ready for the discharge and elimination. And I’m not going to talk a lot about this, because you guys are experts in it and this is such a popular topic with different SNPs and different changes in the liver. But in general, if there’s an imbalance where phase one is overactive than phase two, which is common, we get stuck with a lot of toxic material in the circulation.

Dr. Weitz:            By the way, Isaac, when we have toxins, how often are biofilms involved? Are they involved a lot of the time?

Dr. Eliaz:               In general, from a gut point of view, they’re involved all the time. And the biofilm, we really look at the biofilm as a concept inside the gut. But in the body, the “biofilm” will be atherosclerotic plaque. When you look at people with heart disease, the connection between gum disease and the heart relates to the biofilm in the gums, which are Galectin-3 driven, so you see studies that Galectin-3 promote gum disease and heart disease. So yeah, so this biofilm structure are available in inside us, it’s where different viruses can hide, et cetera, et cetera. So we need to think about it. But I will get into a whole section on biofilm. So we’ll get to it, because we have to look at biofilm as a microenvironment. And what Galectin-3 does, by creating pentamers, it creates microenvironments or what we call in Chinese medicine, book structure, isolated book structures, areas we no longer have control. It’s also a place for us to box and isolate things that are hard for us, toxins, heavy metals, that we don’t want to deal with for a good reason and toxic emotion, toxic traumas.

                                But Galectin-3 for example, gives you an opportunity to open it up and clean it up. So when we look at this, so in many levels, phase one activates a lot of this toxin from a liver point of view, and phase two, gets it ready for elimination, for excretion, of water soluble waste. So really, we really have to understand the concept of discharge and elimination. It’s a key, key, key concept bigger than just phase two. Phase one and phase two is just an expression of it. What do I mean? If we look at discharge and eliminations, discharge is making something that is toxic evident to the body, for example, heavy metals. And you can see why I’m a proponent of modified citrus pectin because not only it will break the biofilm in the pentamers of the Galectin-3, and will release some of the inflammatory ligands and neutralize them, it will bind to the heavy metals also, which we published a number of papers on, you get something that addresses both phases.  It’s like for example, in Lyme patients, they will feel really good with using modified citrus pectin. They will feel a relief immediately. They don’t get this aggravation, because it addresses both of it. So for my philosophical point of view, you are opening the drawers, and you’re throwing everything into the kitchen flow. That’s discharge. Elimination is cleaning up the mess. So we have to be equipped to do both of them in a balanced way. And then you’ve got the different B vitamins and cofactors, et cetera, that all of you are very, very knowledgeable, but also you want to make sure you’re taking botanicals that helps in elimination, gut, bladder, lungs, skin, all of them.  And I’m not talking about this specific formula as it is called Detox Complete. It’s specifically designed around this philosophy of supporting the different organs that there is. I’m having some… Okay, here we go. Let’s make sure I didn’t skip two slides, I didn’t.

Okay, so as we look at the whole process as a movement, we can see the rhythm between preparation, exposure, binding, discharge and elimination, and support and balance. And when it comes to support and balance, we want to also realize that we are bombarded with pesticide and agriculture toxins all the time. We want to make sure we eliminate them as part of the support and balance on a short term and on a long term basis, and we support the microbiome and that’s why I’m talking specifically about this prebiotic and probiotic. Well, okay, cool.  Okay. So I want to talk a little bit about the microbiome and its whole movement from survival to harmony. Maybe it’s a great place to look at our body. If we look at our body, we have it in every range… I don’t know why they say 39 trillion cells, I have no idea why. But if you look at the literature, let’s say around 50 trillion cells, trillion, not million, not billion, trillion, which is a million times million, or million times 1,000 times 1,000. It’s hard to comprehend the number.  Now, you know how many reactions every cell of this 50 trillion has every second? There is argument in the literature between hundreds of thousands and 1 million reactions a second in every cell.  Every cell in this amazing body, these 50 trillion cells producing million reactions.  I mean, we can’t even comprehend the number.  Basically, we are right now, it’s 10 to the minus 18.  And if we just wait a little bit longer, we’ll be more than Avogadro’s number.  And so it’s really incomprehensible, and all of these cells are working in harmony. And within it with a microbiome, there is an argument how many creatures are guests in the microbiome, some people say 100 trillion, some people say 1.3 of the amount of cells, like, 50, 70, 60, 70 trillion, a lot of them. And they work in concert with us. We have a symbiotic relationship between our microbiome that have been developed over generations, over evolution, and it’s actually multi generational. And the microbiome serves us really well. Just to give an example, if we take a drug like Adriamycin, which is a very common anti cancer drug for multiple cancers, and we take antibiotics, the drug will not work because we disrupted the microbiome.  Our microbiome knows to activate the drug that we’re using for our own to fight diseases outside our bodies. That’s the level of the wisdom of the microbiome. So when the microbiome is in harmony, it serves us well. But it has an ability to become aggressive when it feels threatened. Right? If we look at our survival reaction in reaction to danger, we either survive with fighting or with running away. So the flight response that we have in the running away is controlled by the sympathetic nervous system. It’s immediate as we know, but if we relax, it will go away. If we are constantly under sympathetic pressure, we start getting metabolic changes, increase in cortisol, increase in glucagon, increase, say of course, in epinephrine, adrenaline, norepinephrine. And as a result, insulin spike and everything goes into a mess. Metabolically, our survival protein is Galectin-3. Galectin-3 is in charge, is our alarm and it sets off the alarm. And as such, it allows us to respond to injury very quickly. But the response is devastating. It’s just like there’s something dangerous and you start a fire to burn it and then you get and make a fire, kind of what we’re leaving right now in California, because the injury repair by Galectin-3 uses inflammation and fibrosis.

                                So in infections, Galectin-3 will respond within minutes, respond very, very quickly, before any cytokine or before anything else. Now we have to remember we are not the only one who wants to survive. The microbiome also wants to survive. So the moment the microbiome senses stress, danger, it will activate itself through Galectin-3, right? We know Borellia, Lyme disease, Candida, they know how to do it. The moment they sense suddenly, we feel our rash from Candida in five minutes. It knows, it senses it, it uses Galectin-3. It affects insulin receptors and it starts spiking things like interleukin 1b, interleukin 6. And I will share a study on it a little bit later on it is a mega, mega study that we are about to submit to a high impacting period or journal in sepsis. So when you address a microbiome, you got to understand this movement from survival to harmony.

                                So for example, when we talk about Lyme disease, patients with chronic Lyme, if they got heavy antibiotics before, it’s so much more difficult to handle. I used to treat a lot of Lyme because of family members were in Lyme, but they are all completely 100% back. So I’m back to more cancer, I just take very difficult cases, and all of them turn around, all of them. And I just never use antibiotics, because they understand this movement from survival to harmony. It’s built within our ability to survive with 100 trillion organisms as long as we respect them.  So from this point of view, I want to talk about this lecture. So when it comes to the microbiome, there’s another crazy phenomena, which is time and space. What is good for us in the gut is going to kill us if it goes through the gut, right? If we get the same bacteria coming through the gut, into our circulation, we are dead very quickly. It’s called sepsis. And again, it’s enhanced, and it’s created by Galectin-3. Ben, make a point for me to share the study towards the end, okay?

Dr. Weitz:            Okay.

Dr. Eliaz:               Just to give you guys a sense of how dramatic it is.  It’s really a landmark study that will be published shortly. So who are we? Who is a microbiome? It’s a high complex and diverse and dynamic really community. I like a lot to use bees as an image of the community as a ex beekeeper who is about to start doing it again, about 100 trillion microorganisms, several thousand different organisms with millions of communication links, and includes protozoa, fibroid, bacteria, viruses. It’s not only bacteria we tend to forget. Common core microbiome really is a multi generational, the interpersonal variations are maintained over generations within family. Fascinating.  So the structure of the microbiome is weak, really a glycobiome. There’s really highly glycosylated mucus in its epithelial interface. And it’s separated really, it’s a thin layer of host derived glycoproteins and glycolipids around the surface. So for example, from the image of Chinese medicines, if there are any Chinese doctors in the audience, or people interested in Chinese medicine, we really look at the digestive system in Chinese medicine as not being part of the body, because you think you can eat something, it goes through the digestive tract and come through the anus, and we never interacted with it. It’s these boundaries that are so important in creating the separation. So the mucosa associated microbes are important for nutrient exchange. They help us to absorb nutrients, communication with the host, immune system, and pathogen resistance. It’s a delicate balance. And of course, when we have dysbiosis, it’s thrown off. It’s thrown off if we take probiotics and studies in the wrong way in mega dosages. We also have to respect how we address the microbiome when we want to support it. So the glycobiome has evolved with mucus degrading enzymes and mucus binding extracellular protein such as Galectin-3. And these bacteria in mucus degrading enzymes, they disrupt the tight junctions. So the moment the gut is under stress, we are under stress. We have more aggressive bacteria, they bind very strong to the gut, and they create leaky gut.

                                I mean, a very multiple examples like Staphylococcus aureus, and different other bacteria that use Galectin-3 as their anchoring. As I mentioned to Ben before the lecture, COVID-19 spiking protein, now this is on the COVID itself. It’s not that is uses it, is practically identical to Galectin-3. So it uses a structure practically identical to Galectin-3 to attach to the surface, and in normal tissue, Galectin-3 highest density is in the lungs, so right there. And when we talk about Galectin-3 in a few minutes, you will understand a little bit better what I mean when I talk about this glycosylated mucus because what happened, Galectin-3 is able to bind to carbohydrates, so glycoprotein, glycolipids, all of these structures use Galectin-3 to bind, to create a shield. The pentamer is a biofilm, it’s literally a shield. I mean structurally, it’s not an esoteric thing, we know the structure. And then you bring new blood supply, you create an hypoxic environment, you have sticky molecules like integrase, you have lipopolysaccharides. So galectins will now carry the labor polysaccharide and create a toxic inflammatory response. It’s all happening, really exciting to understand.

                                So the loss of biodiversity is a loss of balance between our self survival cooperating because if you think about it, survival is a basic evolutionary for all of us. If the microbiome realizes that for its survival, it has to support us because when we die, the microbiome dies, it’s going to be synergistic. But if it feels threatened, it’s going to behave differently. We all went through this situation. When we are relaxed and friendly and suddenly we are threatened, boom, we’re ready to fight. So really, so dysbiosis changes the permeability of the gut, but [inaudible 00:32:05] endotoxin translocation LPS, which is specifically carried by Galectin-3, and systemic inflammation.

                                So really maintaining a healthy diverse microbiome can balance, target and avert a toxic biofilm in the gut because of the potential membrane, promoting its integrity and reducing systemic inflammation.  Oops, a moment, here we go. So the most important factors in creating balance in [inaudible 00:32:34] from human epigenetics and microbiome, the expression, the stress related to expression, early life conditions, maternal microbiome, nutrition, preterm birth, C-section, breastfeeding versus formula, genetic factors, hygiene, diet, antigenic foods, high fat, high sugar, fiber, different medication like antibiotic, stress, toxic exposures, inflammation, lack of exercise, infection, and issues of the nervous systems, the gut, brain connection, we’re all very aware of it. I know a lot of people are talking about it. And again, lack of exercise is a stressful situation, because mitochondrial function is not functioning well in your gut into one block and you’ll get more anaerobic glycolysis happened in the synthesis, so you can see how different things can end up in the same place.

                                But this process can most of the localized [inaudible 00:33:32] systemic effects. And gut brain connection is one very good example because when we have dysbiosis, we have lack of short chain fatty acid, lactic acid, acetic acid, vitamin biotic factors, getting mutagenic [inaudible 00:33:49] component if they get absorbed in the systemic circulation, because of leakage in the lining, and you’ve got endotoxin that is released into the gut and now actually it’s moving into the system. And it can cause an inconsistent production of neurotransmitters, about 200 billion neurons in the gut. And it causes immunodysregulation both on the localized and the systemic level.

                                And that’s why in functional medicine, naturopathic medicine in the spleen, stomach school in Chinese medicine, we recognize the importance of the gut in digestion. And also it’s hard to really change it. So I want within this to really look a little bit and understand the role and targeting of Galectin-3. Again, the focus today is our lecture about detox and the microbiome. But again, we’re a little bit extended because we don’t have to stick to such to a pinpoint approach.

                                So really, Galectin-3 is startikng alarming from setting the alarm that something is wrong to driver of chronic disease. If you think about what a survival protein does, any [inaudible 00:35:06] in order to survive, our cells have to develop normally. It’s survival, if you look at Darwin’s survival of the fittest, we have to reproduce. So Galectin-3 plays a role in intracellular development, for example, embryogenesis of the kidneys, and it kind of finishes when we are born, [inaudible 00:35:31]. But then extracellularly, and through membrane receptors, cell surface receptors, when we feel that there is a danger, the cell gets a signal, mRNA starts producing Galectin-3, it’s back in vesicles, it’s shipped out of the cells. And we got trouble.

                                Usually it’s done by macrophage, but also cancer cells are able to do it in extracellular matrix and [inaudible 00:36:06] stem cells can do it. So it really will activate the initial immuno response to acute infections. So for example, the study that I mentioned before, we just finished the studies. It is an integration of evaluating patient who are being hospitalized in the ICU with sepsis with no pre existing condition like kidney disease, heart disease, cancer, and they have no signs of kidney damage. And they’re hospitalized in the ICU, and at the same time, we did an animal, a study on the most translated sepsis model, sepsis AKI, acute kidney injury, which is a huge problem that is overlooked in medicine, that is called a cecal ligation puncture, you puncture the cecal, and enema starts getting an infection within a minute. So [inaudible 00:37:10] for this, and my approach was that Galectin-3 will spike before the cytokine, and indeed, Galectin-3 spikes within minutes, it peaks in two hours, two hours, and it’s down in eight hours.

                                If I take these animals, and I give them PectaSol for one week before the injury, even not after, before, I reduce the mortality by three fold. I lower the Galectin-3 level spike after two hours significantly. I lower dramatically the level of interleukin 6, especially at 24 hours. And I prevent kidney injury dramatically. And this study is done as part of my development of developing a Galectin-3 apheresis column that can pull everything out, because it’s what a septic patient is in the hospital. If we look at the septic patients, the level of Galectin-3 at admission within the study will determine one, who will die from sepsis later on in the ICU, and who will get acute kidney injury, highly significant, kind of mind blowing. Remember, clinically no signs of kidney injury. You don’t know. You don’t know who is going to die. Galectin-3 will tell it to you in advance. Why? You understand why people have [inaudible 00:38:43] CP.

                                I mean this is just one example of category we never talked about, sepsis AKI. We always thought it’s a chronic thing, actually it’s an acute thing, because it will instigate recruitment infiltration of immune cells to site of infection. And then you get your mess, your immune response, your cytokine storm. I mean, talking about cytokine storm for years. I mean, you guys know. I lecture about it to you guys. And now suddenly because we can’t treat it, we can’t turn the damn Galectin-3 off, it goes crazy. And it drives systemic inflammation, profibrotic, proliferating [inaudible 00:39:21], echo the inflammatory in molecules, promote biofilm establishment that drives cancer growth. How can it do it and can it do such a different thing? It can do it. I’ll show you in a moment. I’m in the slide now.

Dr. Weitz:            How quickly does modified citrus pectin work? If somebody were in an acute situation and starting to go into a cytokine storm and they were given modified citrus pectin, could it have an effect at that point?

Dr. Eliaz:               It’s a great question. So for us, it’s my other pocket, I have in my medical device. I want to be very dramatic. But MCP will make a difference. For example, we have a very well known environmental, he shared the story. And I forgot his last name in the San Diego, which had a strong infection in his head and was going into sepsis, didn’t respond to antibiotics, and the doctors were ready to amputate it. And he went on high dose, high dose PectaSol with the probiotic, and within 24 hours it resolved. Because this animal study’s showing the power of it. So you just take it, take 20 grams a day, you just load your body. But of course, when somebody is under total storm in the ICU, they can’t take anything already. But that’s really the value of this.

                                And the problem is that we’re not aware that our chronic disease are often small, tiny insults, infectious, emotional toxins on a continuum and each of them does a small damage and we never recover. When I talk about Galectin-3 and maybe I’m going, not really off topic, I mean I talk a lot about it in my book. Really I use a Buddhist concept. It’s like a bird flying in the sky or like riding in water. You want to respond and to have no leftover debris once inflammation goes away. Galectin-3 prevents this from happening. It keeps going and then suddenly, the cytokine that was so necessary in the short term become pro inflammatory and cause all of this damage.

Dr. Weitz:            Will the Galectin-3 be given intravenously?

Dr. Eliaz:               No, MCP. I mean, there’s work on drugs with it. But the much quicker way to do it in such a situation is to pull it out with apheresis. But for right now for ICS, I mean, for me, MCP is my key supplement right now is what’s going on, definitely what I mentioned. Again, this is just for doctors. It’s a limited lecture. So if we look at the Galectin-3 structure, we can see the N terminal structure. When I point with an arrow, you guys can see it right there. Ben, can you see the arrow?

Dr. Weitz:            Yes.

Dr. Eliaz:               There you see the ligands, you see the ligands. That’s the carbohydrate ending, galacturonic acid ending of different proteins, different ligand. People are aware of lectins. Galectin is a galectin binding protein. Lectin in general is a carbohydrate binding protein. So galectin specifically bind to carbohydrate, and then it creates these nasty pentamers, either by a pentamer binding straighter pentamer or by using ligands. So if it can bind to dozens and dozens of different ligands, it can have such diverse effects. That’s why you understand, we do research on one of these ligands on one specific one, let’s say VGF, a VGF receptor that causes VGF. So you take a VGF receptor, it will cause VGF, which will cause new blood growth for cancer.

                                Well, that’s only one ligand out of dozens at MCP, the Galectin-3 can carry. Well guess what, it can carry it anywhere in the body. Crazy, you know. So one thing which is amazing, a paper that was published in October 2019 that kind of made me commit to putting more energy into my medical device and putting it out because I realized, oh my God, I can save millions of lives, even if I just want to meditate now and not work as hard and I’m working hard because raising money is tough is that we realized we there was a study that showed people patients during CABG, during coronary artery bypass graft. But that’s a study, it’s 1,200 patients, 23 ICUs in Europe, no pre existing conditions. Most patient was CABG, just suddenly they find out that for the first time, pressure, they don’t have any and often they’re not sick before and they are rushed into doing a coronary artery bypass.

                                The levels of Galectin-3 before the surgery is that no kidney disease, no heart disease known before will determine who will get kidney injury in the ICU afterwards and who will end up getting cardiac remodeling, cardiac fibrosis and chronic kidney and heart problems and mortality. The level of limit is before the surgery, but then they did a study on mice and they stopped the circulation to the kidneys for a short term. And they stopped the circulation to the arteries, to the legs. Nothing happened when they stopped the circulation to the legs. But when they stopped the circulation to the kidneys, Galectin-3 got excluded. It went to the heart, it mobilized macrophage, and it created heart damage. When they use it on mice or you call knockout mice, it cannot do Galectin-3, or when they gave our MCP to this mice, no damage to the heart. But here was a crazy thing. With the [inaudible 00:45:39] mice, and they injected to them bone marrow that could produce Galectin-3, and they created the damage to the kidney, the signal from the kidney damage, remember when I talk about the alarming, the signal from the kidneys travel to the bone marrow, cause excretion of Galectin-3, the travel to the heart mobilized macrophage into an inflammatory macrophage and caused heart damage, really looked like a landmark study.

                                It was in one of the American Heart Association journals. It was important enough that the editorial board commented on it how important is the study? This is why when I told Ben there’s so many papers now. So Galectin-3 lattice formation promotes establishment of biofilms because it’s a dynamic extracellular J like polymer formed by cross linking with surface glycoprotein, glycolipid. So all of these different glycolipids can attach to the Galectin-3 pentamers, galectins, glycoprotein and glycans, and the references are in the bottom.

                                Okay, so Galectin-3 promote adhesion and invasion of pathogen. Elevated Galectin-3 expression in damaged epithelial gut lining will bind to pathogenic bacteria, viruses, fungi, allowing for tissue adhesion and invasion, and pathogen will exploit Galectin-3 to augment the capacity to colonize and survive. That’s a survival. You can see what I’m trying to convey when I teach. And it’s not something as convenient as giving protocol. I want to think it was the image, the survival image. You can see the pathogens also want to survive. Now, this is part of what’s going on in our country, this divisiveness. It comes from a survival response, from creating different realities, different micro environment. If any of you didn’t see the documentary, The Survival Dilemma, you got to see it. But how’s the social media is creating what is happening now. Why? It creates micro environments of people that have the same thought and have the same belief, that surrounds themselve in isolation. And why they do it? Because they can advertise the same thing to this group.

                                And then this group doesn’t like the other group. And that’s why we are in a losing proposition situation. And that happened between us and the environment, global warming. It’s all the same. It’s a survival reaction. It’s a fighting survival reaction. So if we can recognize it, it becomes very, very important. So Galectin-3 will drive this cycle of dysbiosis because it will affect the leaky gut. It will promote I-1 and interferon alpha, it will promote IL-17 and, IL-6 [inaudible 00:48:42] alpha. All this is well published. And again, it will overburden the liver and will cause multiple toxic effects. The liver is a fascinating organ. It gets both venous blood and arterial blood. And it’s part of its rolling, dealing with past stuff and detoxifying and dealing with the future generation, the only organ that has this kind of behavior.

                                Okay, so what affects citrus pectin, what it does, it binds to Galectin-3. It takes out, it dismantle or blocks in advance like what it did in our study with the mice, this ligand that causes the inflammatory response, and then it breaks down the pentamers into monomers and it breaks their microenvironment. So this is from again, one of American Heart Association journals. So in the context of the biofilm, it will disrupt the biofilm to expose toxin infections. So again, it’s fundamentally different than regular fiber because it has a much lower molecular weight. It has a low level of esterification. And it’s of course, it’s clinically proven so really when it comes to MCP, there’s only one MCP, only PectaSol. I don’t want to go in great detail about the detail of MCP, we don’t have time, but the neutral sugars, the arabinose, xylose and rhamnose are very important for the immune system and for detoxification, and also MCP has 10% of monogalacturonic 2, which is an immune enhancing compound in [inaudible 00:50:32].

                                So, when we combine it with sodium alginates, we get a wider range of detoxification because alginates are powerful in binding to radioactive isotopes as is PectaSol. We published a paper on it, it binds to dioxin like compounds, pesticides, heavy metal, toxic bile and preventing reabsorption. So when you combine them, you get detoxification in the gut with the alginate and you get systemic detoxification with PectaSol. So MCP will inhibit the critical step for biofilm hosted [inaudible 00:51:10] because the Galectin-3 and the ligand, it’s what really promotes biofilm [inaudible 00:51:16] adhesion. I want to go a little bit faster on this so we have time for question. So, we see these are some of the sticky, these are some of the ligands that are bound to Galectin-3, ligands that are synced neuroinflammation, fibronectin and cell surface adhesion integrations and by the way, will affect the thyroid function in different proteoglycan intensive process. How it happens, I don’t go spend a lot of time with it, but initial adhesion, attachment adherence and then the process stopped with EPS, with extra cell polymers that are producing in the whole site.

                                So, biofilm also sequester heavy metals. So biofilm bacteria sequester heavy metals, EPS and polysaccharide bind to heavy metals and bacteria in the biofilm adopt a more toxin resistant phenotype than free swimming bacteria. Very important, the moment we break the biofilm, we reduce the toxicity and the dangers of the bacteria and there are various mechanism to protect against heavy metals such as efflux pumps, where they can kind of throw the heavy metals out of the cell similar to drug resistance in cancer. So in treating biofilm, you need to address release of heavy metals. So the advantage of the binder, remember in the beginning, the advantage of the binders of always using PectaSol, you are binding to heavy metals, it’s well published. I think we have four or five papers that we know high affinity to lead, to mercury, to arsenic or to cesium, to uranium. We published a paper on family with high uranium showing increased excretion from the gut.

Dr. Weitz:            Is there any question about mcps ability to actually bind? Can MCP actually physically bind the metals?

Dr. Eliaz:               Yeah, of course it does. There’s no question about it. We actually proved it, we actually showed it. It’s well known because of its side chains, definitely. But it has to be at lowest esterification. That’s why PectaSol is unique. You have to change the structure to allow room for the metal structure to bind to it because of the hairy sides of the pectin. Like a few slides ago to these ones where RH, AR, AR, AR, these are the areas where the heavy metals but it has to be challenged is if you’re esterified, there is no longer a challenge. So that’s the issue see here with the esterified, like here, here it’s esterified, there’s no more charge. So it combined is neutralized. And this is why it needs to be. That’s why it’s so important, a low esterification, let me just try to move fast enough to where we were.

                                So for example, studies showing that MCP reduced proinflammatory cytokines, so this is in the nervous system and microglia cells treated with LPS, it’s significantly new counts, significantly it reduced compared to control interleukin 1b, interleukin 6, very significant. Again, these are the nastiest cytokines, it will cause problems. And specifically for the microbiome, our MCP was shown in a number of published papers with the USDA. Again, it’s an independent papers. Most of our papers are independent, I mean, I did microbial effects against multiple strains of staphylococcus ROs including MRSA and additive and synergistic, but to say that the effect is combination of MCP and safer toxin, which is very important in Lyme. So this is all published papers.

                                MCP demonstrated enhanced lactobacilli growth. That’s a prebiotic quality of it, in human fecal culture and anti-adhesive effect against Shiga toxin producing e. Coli, inhibiting binding to cell and reduction of the cytotoxicity of the Shiga toxin. So again, the multiple action of pectin inhibits inflammation in fibrosis, protects vital organ and insists and regulates immune function, inhibits adhesion and establishment of biofilms, support healthy microbiome and intestinal integrity and bind systemic toxin heavy metal. It’s more in the context of today. We didn’t touch cancer, autoimmune disease, all that stuff. That’s not the topic today.

                                Okay, so environmental [inaudible 00:56:31] agricultural toxins, we have to be aware of, and one thing that I neglected to be aware of, but in the last few years, is the critical role of pesticide glyphosate. One of the big issues with pesticides is that they will accumulate in the ground. So for example, in Israel, where DDT is a pain since the 60s, you still find high level of DDT in adipose tissues of breasts 50 years later. That’s a problem with pesticide, so many countries now are banning glyphosate. Mexico just joined the list. United States, it’s incredible. It’s like in United States, in 2012, 1.1 billion pounds of pesticides a year. 1.1 billion pounds, which means between three and these days, it’s more so four pounds of pesticide for each of us a year.

                                I mean, just imagine, just put it in grams. Put it in grams, two kilograms. So every day, we have to take six grams of pesticides. That’s how much it’s put in the ground. And it’s going to get to us at some point, because it will accumulate. So again, a lot of political pressure but so now, the WHO is taking, the position is stronger about the danger in non Hodgkins lymphoma and I’m going to go a little bit quick so we can cover everything. A strong correlation with thyroid cancer with increased level of corn and soy that are genetically engineered to be roundup ready. Look at this, you can look at the correlation between this and the thyroid cancer. Kind of crazy, right? And connection with autism in the Central Valley is very, very, very clear.

                                So wait, how did I get here? Oh from here. So glyphosate also can insert itself into protein synthesis. It’s a glycine analog. And it’s a glycine analog, it has an effect on leaky gut, causing celiac like disease. And also, of course, it’s a narrow excitatory effect because glycine is an inhibitory neurotransmitter and it exchanges with it because it’s so similar in structure. And as you can see, and then it will bind to become an excitatory neurotransmitter in the brain. So there’s an argument is how much glycine can really inhibit glyphosate. There’s literature that say that it can exchange with it, but it can definitely prevent the binding of glyphosate to the mucous membranes of the gut.

                                Because glyphosate is water soluble, it’s very well absorbed. Look, how small it is. It’s nested like a tiny, like the smallest amino acid and so you can understand why it’s absorbed so easy. So, glycine will help to prevent the attachment to the gut. And this, so we created a formula with four ingredients that kind of addresses the issue, which we integrate into the detox program and we also integrate into the daily life. And we’re trying to address both pesticides, a lot in the gut because we get them all the time. And we are using a whole kelp that has iodine, and other trace minerals to allow to exchange with bromide, chloride and fluoride. The formula, we really include kelp, which is I mean, is as organic as we can get, and it’s very clean, and it has a standard dynorphin. The amount that we have in a daily dose is about, it’s about 600, 700 micrograms, so it’s really a dose. It’s the right dose. It’s not very high, and then it should take double, it’s 1200.

                                We use regular citrus pectin, which is highly branch, it’s different than MCP, because we wanted to bind to fit soluble toxins and pesticides. Many pesticides are liquid soluble. We use glycine and we use sodium alginate because sodium alginate is a different profile and it works very well with citrus pectin. So it will help, and sodium alginate will help to absorb glyphosate when paired with a positively charged molecule. And in this sense, I will talk about what you can add to it in a moment.

                                So these are some studies showing how kelp enhances intestinal barrier function again and prevent LPS, which is negatively charged and kelp is positively charged. So from a gram negative bacteria, it’s important for us to try to protect it from creating a systemic effect. This is research about glycine links to a higher level of glutathione. So, glycine really increases the production of glutathione in a significant way and also helps survival in patient following [inaudible 01:02:31]. So when you look at, so this is when we look at alginates, when people kind of take [inaudible 01:02:39], which is a herbicide, there is a significant improvement in survival with alginates and alginates is an efficient biopolymer for example, a lot of herbicides like [inaudible 01:02:53]. So it’s really used for toxic swamps.

                                So the combination with high molecular weight kicked in helps to do it in the gut. When you take MCP of course, you have the systemic peeling effect and that’s why we combined the glypho detox together with PectaSol together with probiotic. Citrus pectin is well established, it can bind to DDT, to DDE. All of these are fit solubles. So you can see the difference in the dosages in adipose tissues in the liver, in the kidney and the brain of the different DDE and DDE prospecting, very significant, all of them statistically significant in animal studies.

                                And also in general, fibers enhance the fecal expression of dioxin isomers and specifically peptins do it very well. Now it’s interesting when we combine alginate with chitosan, which is, which is available in the shell of seafood. And the chitosan is positively charged. So when you combine them, you actually can bind to glyphosate and remove it from water. The reason why you don’t just chitosan is because it doesn’t bind to herbicide at all. These are different published papers. So combining them, it’s a good thing. In my next formulation of this product, we’ll be adding this into the formula.

                                So the next, so now I want to talk about specifically about the next generation of symbiotics, prebiotics plus probiotic. This is really my favorite product that I’ve been importing from Denmark for years. And now I reformulated together with using pectic oligosaccharide I showed you all the research right on our POS, take this as the POS so we are adding it to the fermentation process. So why this product in a class of its own, because it’s not like another peel or another, it’s actually live food. The eight different strains of probiotic are fermented on organic molasses. So the molasses is what allows them to grow. There is no more sugars left.

                                It’s fermented on 19 different organic herbs, and it’s fermented on the pectic oligosaccharides. And what you get is you get a live product. Of course, it’s different than kombucha in the power but it’s along the same principle. And you’ll feel the difference in your gut from literally the first dose, the first dose. For the people that makes a difference, it’s something that they say you don’t leave your house without it. So it’s composed of probiotic, prebiotic that create this synergistic effect. And it really is life. It is energy on its own. It’s grown, everything is grown bio dynamically in a bio dynamic farm. And we use organic berry juice, not just flavor, but actually the juice all organic from different berries.

                                So very unusual product and because, so it’s really not about the number of bacteria. There’s the issue of loading the gut with tones of certain bacteria that may not be the right for a person. But it’s about allowing the gut to heal itself. So the different probiotics can be probably it’s a typo, different lactobacillus I’ll show you pectic oligosaccharide in 19 organic herbs in their organic molasses. So during the fermentation process, we produce two types of organic carboxylic acid, lactic and acetic acid, eight strains of life connected probiotic, the herbs and the pectic oligosaccharides. And the lactic and acetic acid lowers the pH below 3.5, where harmful bacteria cannot live. Lactic acid is used as a signal substance to the body to promote our unity and acetic acid promote peristalsis so you get normal bowel movement. It acts as a fuel for muscles and brain and antimicrobial and fungal and the organic acids help to keep the intestine tight and is a source of nutrition for intestinal cells.

                                So these are different bacteria, bifidus, [inaudible 01:07:38] lactase, lactobacillus acidophilus, [inaudible 01:07:40], rhamnose and salivarius and lacteus streptococcus and thermophilus. And these are some of their unique properties and ability to adhere to the intestinal causa, resistance to intestitnal bile, this form LMD is almost exclusively the L active form. So they really offer very, very, very nice synergistic qualities.

                                And these are different herbs that they are growing. So the herbs are there, the herbs are not in the formula, you don’t get herbs but it’s cultured on the herbs. So these are very organic of course. It’s a large selection of different detox in digestive herbs that really support the digestive process. The idea really is to feed the bacteria with a nourishing food similar to my [inaudible 01:08:40], the mushroom box where I grated herbs.

Dr. Weitz:            Some of these herbs like oregano have antimicrobial properties.

Dr. Eliaz:               Yeah, yeah, definitely.

Dr. Weitz:            Won’t it kill the probiotics?

Dr. Eliaz:               No, no, they don’t because they are really just in the fermenting process and you don’t want to look, it’s a good question. Absolutely not. We check this, the spores are active. But it’s really, really got to look at it as a whole formula, not as one is one ingredient or another. This comes really from the digestive schooling in the European herbal from a coffee, it’s different than the Chinese but you can see the licorice, which we had in the the level of the stomach, the pomegranate, which has metabolic function and has warmer qualities but a lot of spices, dill, oregano, parsley, pepper. I mean these are edible herbs that we use, rosemary, and we know just like we know about curcumin, these are digestive herbs, these are the digestive system so we are extracting this active and allowing the bacteria to activate it.

                                And I think about it’s really similar to the concept of renewal of the microphyte, and then the POS prebiotics stimulate the activity of prebiotic. And they also help to produce short chain fatty acids, like acetate, again acetic acid that are present. So these short chain fatty acids are very important as energy sources. And they’re very important for the physiological function of the gut. So we get, so the kind of signature that you take it and you just feel a difference. So this is something about our studies with pectin oligosaccharide, dietary fibers are known to be prebiotic and low molecular weight and esterification enhance the effectivity of the PectaSol. So this is from a published paper, the first report of POS selecting for higher lactobacillus levels during mixed batch fecal fermentation. So when you ferment feces is that POS specifically stimulates the healthy bacteria, very interesting study. It was done on pigs with the USDA.

Dr. Weitz:            Oh, wow.

Dr. Eliaz:               I’m just going to proceed a little bit quickly. These are some other studies showing again, that POS in [inaudible 01:11:33] was additive effect and synergistic in two strains and organic molasses. Again, so this is the product and it can be taken. It could take in a one to two tablespoon twice a day. It’s very good to combine with PectaSol. It’s an ideal combination. I actually put it in my PectaSol. You can put it in different drinks.

Dr. Weitz:            Now since PectaSol is a binder, is it okay to take other nutrients with it?

Dr. Eliaz:               Yes, yes. It’s not a problem because it’s really nutrients, I mean, if you want to take it 10, 15 minutes before food so I won’t take it like if you take a multivitamin, which you take with food, but even 15 minutes before food, it’s enough. It doesn’t interfere with the absorption of calcium or magnesium because of the high affinity for heavy metals. And we’ve published on it. It’s a very good question. So this is again, what we discussed today, the prepare, expose, bind, discharge and elimination. And the system and I know we covered a lot and time went by really quickly.

                                And so now I want to talk to you about something that I specifically specialize with, which is therapeutic apheresis. Therapeutic apheresis is a process, it’s a medical procedure that involves removing whole blood from a patient, separating the blood into individual component, meaning the first thing that we do actually is this is not as good of a description, we separate the cells from the plasma, and then we take out specific components from the plasma, then we put them together, and then we return them.

                                So from a research point of view, I have a company called Eliaz Therapeutics, where I’m trying to develop the Galectin-3, a column just for Galectin-3, which is related to the antibody, because if selectively we can remove it, we can affect AKI sepsis is our primary target, also CKD and NASH, which is a huge problem and enhance immunotherapy and good for lung fibrosis. So it’s a single apheresis. And we are now in the development stage. We’ve been doing it for eight, nine years, seven, eight years. And we are hopefully with the right fundraiser will be in clinical trials in about a year. And one thing that we’ve done to prove our concept so these are the different ligands, some of them that came attached into the Galectin-3. As you can see, lipopolysaccharides will enhance sepsis, collagen, elastin, laminine will enhance fibrosis, here we’re marking one and three and CD-45 where if you block them, you will shut down the immune response covering desmoglein and integrins wherever they are.

                                Maybe we didn’t put the integrins with the sticky molecules and cancer metastasis, et cetera, et cetera. So what we do when you use a blocker, you are exchanging with the ligands. When you use an apheresis model, you are pulling out the whole thing with all the ligands in it. So get rid of everything. And that’s why it’s so powerful and it works so quickly. So for example, we did a study with Harvard when we injected MGH in special pigs that are developed for xenograft transplant. And in this study, we wanted to see if we create inflammation in the skin by injecting something called complete foreign adjuvant similar to BCG, you create very big inflammation. And you can see this as an active group there is no inflammation, look at the tissue compared to the control group. Look at the redness and lack of resolution in ulcers and look at the tissue, very dramatic. This was published, we published this with me being first author and the last author, the other with Harvard in the Journal of Clinical Apheresis, the main apheresis journal, so two different papers we’ve done.

                                In the clinic we use in different way for life. In the clinic, I’ve pioneered the use of LDR apheresis, which is an FDA approved device that is [inaudible 01:16:10] space for hypercholesterolemia. And I use it for inflammatory conditions together with supplement, together with special IVs. In cancer therapies, it helps chemotherapy, radiation immunotherapy. My biggest focus now is chronic kidney disease, degenerative diseases. I’ve now turned about eight out of eight chronic kidney disease patients, some of them on dialysis or pre dialysis, all of them together with MCP. So really, for the people who can afford it, we actually don’t charge a lot but the fee costs thousands of dollars. It really makes a difference and of course, in muscle activation in pandas, in mold exposure, detoxification, amazing results.

                                I myself make sure to actually get this treatment. I got one yesterday. It’s really a proven regenerative treatment. For the people here who use regenerative medicine or use different biologicals in what they call asimilar biologic, tissue biologics, it’s a completely different response when you do the apheresis and then you do the regenerative treatments, and so the apheresis protocols that we do specifically do IVs that we introduced during the apheresis and immediately after. And it also allows drugs and compound to better reach targets before chemotherapy, before immunotherapy.

                                We know now that immunotherapies, checkpoint inhibitors, if the patient Galectin-3 levels are high, for example, they will not work. So here we are moving just a little bit of Galectin-3. We are moving about 70%. But we’re moving a lot of other inflammatory and growth compounds. So that’s an example. So I actually, in most centers, the doctor just prescribed I look at every big, so what I’ve found, it’s called the signature. So you can see like the large intestine, this patient has a tumor in the large intestine used to. You can see the accumulation, crazy, right there.

                                And this is a picture from today. It’s not as good but enough you can see. The bubble, this is just a bubble. But you can see this circle with empty and this kind of line going up. So when I come back, it’s clearly for me, I tend to see this visually, but that’s the esophagus and the stomach. So as the patient, how is the stomach doing, and they say, “It’s my last place where I’m suffering.” So whatever came out, these are all debris. These are all growth factors, inflammatory factors. It’s unreal, I’m going, I now presented in the three last International Society for Apheresis conferences. And now they’re finally realizing this stuff is good for inflammation, but I’m going to present these pictures, like in 2021, I got to start collecting them.

                                It’s unreal, the signature, how you can see the patient problem like the big and people know by me, I will diagnose them just by the way the big looks, you will see a kidney shape, you will see a heart shape. It’s unreal. Anyway, this just came today, I rush to put it in, this [inaudible 01:19:27] because it is just mind blowing for me. So you have to be open, no concepts, just open your mind. And so I also discovered this specific device can cause an anaphylaxis in certain patients that they weren’t able to solve it for 25 years. But now they move to this device. I was able to solve it very simple just by giving high dose magnesium sulfate IV. It moves you from a sympathetic, from a survival mode to a biased mode. The patient no longer responds.

                                So now we just submitted the paper. We got accepted with revision that we just submitted, seven cases in the biggest center in the country for apheresis that could not handle the treatment, even with IV steroids. All got an anaphylactic shock. They use my protocol. Not all of them are tolerating it. So we basically saved the life of seven patients. So this is a presentation. This is a picture when I was teaching meditation retreat in Israel before the COVID about a year ago. And so this is my email for any of you who need my website. And this is for Clinical Synergy. If you need any help, please call us and the company will help you. And I just finished at eight. But if any of you still want to ask me any question, let me just-

Dr. Weitz:            Well, we have some questions here. So I’ll just go ahead and ask. Somebody asked about spore based probiotics versus other probiotics. What do you think about the bacillus strains?

Dr. Eliaz:               You know, I can’t say that I mean, explain the different strains, I must say. I’m a great believer that for probiotic to work, we got to respect and nourish the microbiome. That has been my approach. So that’s really what I presented, and you’re welcome to any other strain. But really, once you try it, usually I don’t see it on a product and push it like this. But I tell you that a patient of mine was so anxious about this SynerGI that they will come and buy supplies for six months, because I have to bring it from Europe in case it runs out. It just changes your gut. And why? Because of this synergistic, and I think with the [inaudible 01:22:02] issues, loading a gut with too many probiotic can be an issue, if it’s not the right profile for the patient. When you give the gut the right food with a little bit of bacteria, which is of different properties, you allow the body to readjust.

Dr. Weitz:            Well, just to play devil’s advocate, and one of the arguments for spore based probiotics is because they’re encapsulated in a spore. They get all the way down to the large intestine without getting broken down, whereas other probiotics get killed on their way down.

Dr. Eliaz:               This is why the SynerGI is the probiotic are in a spore form. So when we tested the activity, it takes 24 hours and then they get activated. So they actually don’t get killed in the distance.

Dr. Weitz:            So these are like lactobacillus and conventional strains. How do they end up in a spore?

Dr. Eliaz:               It’s something about the process. We’ve actually analyzed it, and when you give them the active conditions, they get activated and start growing. So we haven’t had an issue. And one of the things that you see with him from a clinical point of view, not like a gut bacteria expert. One thing that I’ve seen more dramatic with this is for example, patient with ulcerative colitis that are bleeding in the rectum. You will see an improvement in the first 24 hours.  So it goes all the way to there. It changes the motility, you got to look at this as changing the health of the gut. It’s a difficult concept.

Dr. Weitz:            That’s amazing if you can see positive improvement in somebody with ulcerative colitis in 24 hours. Somebody asked about histamine access and does modified citrus pectin help to reduce histamine?

Dr. Eliaz:               It will indirectly. And the reason is because the histamine reaction is often cytokine storm driven. And it’s going to come through the roof and for example, not only histamine, but for example [inaudible 01:24:34] response with ACE2 receptor with the COVID is Galectin-3 driven. So yes, definitely. So you will see decreasing allergic responses, and I think it’s one of the mechanism why we see improvement in Lyme patients, definitely.

Dr. Weitz:            Somebody asked, can you speak about the role of Chinese medicinal mushrooms and inflammation?

Dr. Eliaz:               Yes, it’s a great topic. So, Chinese mushrooms are very rich in oligosaccharides. And they’re very important in regulating the inflammatory process and the immune response. And that’s why they are so essential especially now. I mean right now is what all we are going, my two main products are MCP and medicinal mushrooms. And specifically, my reason why I use mushroom in ImmuneMax because I grow the mushrooms on herbs that are immune enhancing antiinfectious and antiinflammatory. So it’s very similar concept. So this is the one thing that I never skip.

Dr. Weitz:            Somebody asked how to get PectaSol and mix batter. And David Trader made a suggestion. And he said that he found that by first putting eight ounces of water into a shaker bottle with a nettle ball, and then adding the PectaSol-C. That helps. But do you have any other suggestions?

Dr. Eliaz:               So that’s a great, that’s one way. Remember, it’s a saccharide so it doesn’t get broken with heat. So what I do is I put a tiny bit of regular water. So as I put the PectaSol, and the lime one dissolves better. And I put a tiny bit of regular water and then I put hot water. So it’s not boiling, but it’s hot. And you don’t touch it, because the PectaSol is such small grains, that if you right away shake it, it will clump. Let the water absorb for two or three minutes, and then you can add then a little bit more water, you stir really well and you add more water and it will dissolve perfectly. The trick is not to mix it right away, to let it absorb the water first.

Dr. Weitz:            Interesting.

Dr. Eliaz:               Then once it’s warm, and it’s not too hot, it’s like around like 40 degrees centigrade, that’s when I will add the SynerGI into the mix.

Dr. Weitz:            Great. So I think that about wraps up the questions. So I thank you so much for joining us.

Dr. Eliaz:               Somebody asked me about mixing with applesauce. That’s actually a good idea, not a problem.

Dr. Weitz:            What was that? Mixing with applesauce?

Dr. Eliaz:               It’s not a problem at all. So thank you, everybody, for tolerating me with so many details.

Dr. Weitz:            No, it’s great. We really appreciate it. And thank you, everybody, for joining us, and we’ll see you next month.

Dr. Eliaz:               Take care. Bye bye.

Dr. Weitz:            Thank you.

Dr. Eliaz:          Bye. Thank you.

Dr. Weitz:            Thanks.



Strengthen Bones with Dr. John Jaquish: Rational Wellness Podcast 178

Dr. John Jaquish speaks about Strengthening Bones and Osteogenic Loading 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

2:39  Dr. Jaquish became interested in improving bone density when his mother was diagnosed with osteoporosis in her mid to late 60s and she was worried about having to give up playing tennis and hiking with no way to reverse her condition.  Dr. Jaquish sought out a group in society that was able to build bone density and he found that gymnasts were most effective at this because of the impact of jumping and then landing on the ground.  Gymnasts sometimes impact the ground with up to 10 times their bodyweight.  Research shows that high impact exercise improves bone density:  Effects of high-impact exercise on bone mineral density: a randomized controlled trial in premenopausal women.

But nobody wants older people to go through high impact exercise, so Dr. Jaquish developed some machines that can provide the benefit of high impact without the risk.  His mother had a T-score of -2.5 and after 18 months of using these machines, she was back to a T-score of just under zero and she has maintained that till now when she is in her mid 80s.  These machines place you in the position you would likely be in to absorb high impact forces, such as the position you would have your arms in if you were to trip and fall forwards, with your arms at a 120 degree angle.

8:40  Those participants who go through the Osteostrong program are holding their arms and legs in one position while pushing or pulling against a load, but Dr. Jaquish says that this is not isometric because there is a range of motion that occurs from the compression of their bones.  Dr. Jaquish pointed out that this compression of the bones will also lead to joint compression and this will lead to fibrocartilage growth, as well as bone growth. 

12:06  The force created in the Osteostrong machines is created by the participant pushing or pulling against the machine, rather than a computer generated force.  The computer system is capturing the output created by the person that compresses its own bone mass and joints.  According to Dr. Jaquish, a force of at least 4.2 times the bodyweight is required to stimulate new bone formation. Here is a study completed by Dr. Jaquish and fellow researchers that shows 24 weeks of going through the Osteostrong Center protocols for 24 weeks improved bone density in the hip by 14.9% and by 16.6% in the spine: Axial Bone Osteogenic Loading-Type Resistance Therapy Showing BMD and Functional Bone Performance Musculoskeletal Adaptation Over 24 Weeks with Postmenopausal Female Subjects. 



Dr. John Jaquish has a PhD in biomedical engineering and he is the inventor of Osteostrong, which are wellness centers utilizing medical devices that can load the bone and reverse osteoporosis. Dr. Jaquish speaks around the world and can be found at JohnJaquish.com. Dr. Jaquish has also developed the X3 bar for muscle strengthening, which you can find information about at JaquishBiomedical.com.  Information about Osteostrong can be found at Osteostrong.me.

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 enjoy listening to our podcast, please give us a rating or review on Apple Podcasts. And for those who’d like to see a video version, please go to my YouTube page.  And if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Today our topic is, how to improve bone density with osteogenic loading with Dr. John Jaquish. We have recently focused on osteoporosis in episode 164 with Dr. Lani Simpson and we explored some of the most effective diet, lifestyle, supplements, and medications for improving bone density and bone health. Osteoporosis is a major health issue affecting 44 million Americans over the age of 50. Osteoporosis can lead to fractures that can be disastrous for our health, especially hip fractures which result in death in 24% within one year of the fracture.

                                                Dr. John Jaquish, our guest today has a PhD in biomedical engineering, and he’s the inventor of OsteoStrong, which are wellness centers utilizing medical devices that can reverse osteoporosis and create more powerful fracture resistant athletes. He’s recently partnered with Tony Robbins to help market his centers. Members go through a four device circuit that takes approximately 10 minutes and done once per week has been shown to significantly increase bone density up to 14% in one year. Most other scientific studies have failed to show a consistent increase in bone density with conventional weight training. In fact, according to Dr. Jaquish, conventional weight lifting is a waste of time as is traditional cardiovascular training like biking or running. Dr. Jaquish is also a research professor at Rushmore University, and he speaks around the world. Dr. Jaquish, thank you so much for joining me today.

Dr. Jaquish:                         Thanks for having me.

Dr. Weitz:                            So maybe you can start by telling us about how your desire to help your mother got you started on this topic of improving bone density.

Dr. Jaquish:                         I did it for my mother, yes. She was diagnosed with osteoporosis, and she was pretty distraught because she was prescribed some medications and she didn’t like the side effects she read about. Neither did I. But she said, “This is just going to totally limit my life.” She felt like she was too young to just sit at home and watch everybody run past the window, because it was going to be something that she believed would change the quality of her life just for fear of fracture.

Dr. Weitz:                            How old was your mom at that time?

Dr. Jaquish:                         She was in her 60s.

Dr. Weitz:                            Okay.

Dr. Jaquish:                         In mid-late 60s, but she was very active. She played tennis, and she hiked a lot. Not just walking around a yard, like 15-mile hikes.

Dr. Weitz:                            Right.

Dr. Jaquish:                         Like a real hiker. So I saw her just having to go through the mental exercise of just giving up on everything she liked and I didn’t like that at all. So I said, maybe there’s a population out there that has figured out how to get their bone to respond. And by getting to bone respond past childhood, being able to really build a serious of amount of bone mass. And so I said, “Let me look into this.” Of course, she had nothing to do, so she was like, “Yeah, sure, go ahead.” And so I did, and I found those super responders is gymnast. They build bone density, very high levels. Now, they also fracture a lot of bones because they’re going through high impact. They hit the ground with sometimes 10 times their body weight.

Dr. Weitz:                            A lot of joint injuries too because my daughter was a gymnast from age four.

Dr. Jaquish:                         Sure, yeah. There’s probably… Some of your patients are probably past gymnast who have all kinds of lifetime injuries that they got when they were teenagers or even younger.

Dr. Weitz:                            Yeah.

Dr. Jaquish:                         Yeah. So there’s an unfortunate part of the sport, but it has allowed us to learn a lot. Unfortunately, the amount of research that has been compiled on high impact is plentiful. It’s in the thousands of studies. It’s very obvious what impact does. But of course, that’s the opposite of what’s recommended by most physicians. Most physicians say, “Well, resistance exercise is good.” It’s a really irresponsible recommendation because there’s no dosage associated with it. So aspirin is good for headaches. Well, how much? Five milligrams or 5,000? Well, five milligrams will do nothing, 5,000 will kill you. But 350, that works for almost everybody.  So having a dosage associated with the recommendations are important. So when looking through all of the data, I thought nobody wants older people to go through high impact type exercise. But what if I were to create a series of medical devices that would give the benefit of high impact without the risks? So for example, being in an isolated position where I’m just in a position I would naturally absorb high impact. So I’m going to trip and fall. I’m not going to try and brace myself like this. I’m going to be about right here, 120 degree angle of inclusion from upper arm or lower arm.  So if I’m in a position and I can brace for that impact, I can handle far more than my body weight, sometimes four or five. If we’re talking about my legs, 10 times my body weight. And as soon as I made that discovery that this was just through trial and error that even untrained athletes could hold five, six times their body weight, I thought, wow. We can build a device that will trigger bone growth in the body based on the process that’s supposed to happen physiologically but doesn’t because of our avoidance of high impact. So I prototyped these devices. I treated my mother with the prototypes. Within 18 months, she had the bones of a 30-year-old and she was back to a T-score of just under zero. She never quite got to zero. She’s hovering around there now and she’s in her mid 80s.

Dr. Weitz:                            Her original T-score was what?

Dr. Jaquish:                         Negative 2.5. I read the diagnosis.

Dr. Weitz:                            Okay.

Dr. Jaquish:                         Yeah. And so within 18 months, it was totally reversed. So like I said, there’s thousands of studies that talk about the force that’s associated with impact, but then the studies conclude, but these forces aren’t practical for anyone other than high performance athlete. Untrue, it’s just the way they’re applied. So that’s what the devices at OsteoStrong do. They are incredibly effective. They’re incredibly quick. It takes just a few minutes to go through the protocol and you can only go through it once a week, because bone has a very different metabolic rate than musculature or your lungs or whatever, from a different kind of exercise. We don’t call it exercise.

Dr. Weitz:                            So are they going through a short range of motion or are they just holding one position?

Dr. Jaquish:                         Well, that’s a great question. A lot of people who don’t really look at the technology thoroughly make a mistake and call it isometrics. It is not, because there is a range of motion, but the range of motion comes from the compression of bone.

Dr. Weitz:                            Aren’t you compressing the joint still?

Dr. Jaquish:                         Yeah, oh yeah, of course. And then the joints adapt also based on what we learn from the Benjamin and Ralphs study in 1996. You put axial compression through a joint, which is where the joint is the most optimized, and you grow… There’s fibrocartilage growth that thickens the tendons and ligaments around the joint capsule, so making the joint stronger, more powerful. And not that even somebody who’s bone on bone, there’s still going to be bone on bone, but they’re going to have a better support of joint and that can cut down on their pain.

Dr. Weitz:                            Now it’s not really physiological in a sense that, normally, you would sit down and you would stand up, or you would push yourself away. You’re normally using your muscles through a range of motion when you’re doing activities and weight training is really designed to duplicate some of those normal activities. But this is-

Dr. Jaquish:                         Not at all. When you move something… If you watch movers, guys who professionally move stuff, they don’t use a full range of motion. They’re trying to be efficient with the way they move their body. They’re not going to squat all the way down when they go to pick up the piano to make sure they get a full range of motion. That is not how we functionally move at all. But if you look at a runner, if you look at a sprinter, you use seven degrees of flection behind your knee where you have 180 degrees available. Why don’t you use 180 when you sprint? Because you wouldn’t go anywhere. That’s why. So it’s a full range. Now, full range has its place for sure.

Dr. Weitz:                            If you were a football player and you were kneeling down. And when you’re coming up to block somebody, you’re going through starting maybe in a deep squat and coming up and pushing.

Dr. Jaquish:                         No.

Dr. Weitz:                            No?

Dr. Jaquish:                         No, you use your strongest range only. I train over 10 NFL players with my other product.  And no, you don’t… Full range of motion is nonsensical to athletes and to functional movement. Now, sometimes we go to a deeper range of motion, like getting off the toilet for activities of daily living for elderly people.

Dr. Weitz:                            Right.

Dr. Jaquish:                         You have that discussion with your patients all day long. Because somebody who has a knee injury, getting off the toilet, it got a little harder.  They’re talking to you about it, how do I improve the joint health?  How do I… Activities of daily living full range of motion.  But if you’re looking at performance movements, not at all

Dr. Weitz:                            Interesting.

Dr. Jaquish:                         No.

Dr. Weitz:                            Now, when patients get loaded on these machines, do you start at a lower level and gradually increase it?

Dr. Jaquish:                         The computer system is actually capturing their output, so it’s whatever force they create. We measure the force that they create. So nothing is being placed on the body. The body’s creating the force and compressing its own bone mass and joints.

Dr. Weitz:                            Uh-huh (affirmative).

Dr. Jaquish:                         That way, we let… Instead of trying to have some software system that’s trying to outsmart your injury potential which has never worked in human history, we use neural inhibition as the limiter. So if something becomes uncomfortable, even unconsciously uncomfortable, your body starts to shut the muscles down. And so you get to the maximum output every time. And as the bone mass adapts week by week, that number goes up and up and up.

Dr. Weitz:                            So can the average 70-year-old person produce four times their body weight in force?

Dr. Jaquish:                         Sometimes they have to build up to it. 70, usually, they’re right around the minimum dose response, because it’s 4.2 actually in the hip joint that it takes to begin growing bone. But they usually see that within two or three weeks.

Dr. Weitz:                            It’s interesting. I’m used to seeing people… Every once in a while, you see somebody at the gym when the gyms were open doing a leg press, and they’re just doing a really short range of motion and it’s funny.  I was like, Oh man, that dude is kidding himself.  He’s not doing anything.

Dr. Jaquish:                         Right.

Dr. Weitz:                            But he’s in that short range of motion, he may actually be increasing his bone density.

Dr. Jaquish:                         Yeah, it’s possible. It takes a lot of weight to do it. Usually, when people are doing that, they’re just fooling themselves into thinking that they’re really strong.

Dr. Weitz:                            Right.

Dr. Jaquish:                         You know what I mean? People are like, “Oh yeah, is that what they’re doing?” And I’m like, “I don’t think they know what they’re doing.” But could they be getting a bone density benefit? Yes, they could be.

Dr. Weitz:                            So for participants who go through your OsteoStrong centers, they do that once a week. What other types of exercise do you recommend for them?

Dr. Jaquish:                         Really nothing.

Dr. Weitz:                            What about, say, balance training, since we know a lot of people fall and break a hip.

Dr. Jaquish:                         The balance training is a part of the OsteoStrong protocol.

Dr. Weitz:                            Oh, it is?

Dr. Jaquish:                         Yeah, because it kind of goes hand in hand. You want to… There’s avoiding fracture by avoiding the fall. So that is part of the protocol.

Dr. Weitz:                            So do they do that at the OsteoStrong Center or they do balance exercises at home?

Dr. Jaquish:                         No, they do it at OsteoStrong.

Dr. Weitz:                            Oh, okay. What kind of balance exercises do you use?

Dr. Jaquish:                         It depends. That protocol changes a little bit. You want them to feel slightly off balance, but you don’t want them to actually fall. So there’s a bar in front of them that they hang on to, and they stand on a vibratory platform, a whole body vibration, by the way.

Dr. Weitz:                            Okay.

Dr. Jaquish:                         Yeah.

Dr. Weitz:                            What do you think about that alone as improving bone density?

Dr. Jaquish:                         Yeah, that’s a falsehood, because… And that’s been disproven many times, There’s actually a great piece of research from a Canadian university that shows that vibration does nothing, basically, for bone density.  It does plenty for balance.  It does plenty for activating musculature especially in the deconditioned.  But what they did when the first vibration platforms came out, I actually know the guy who came up with this scam.  It really irritates me, because this is why when you come up with something new in physical medicine that it’s so scrutinized, because there’s so many scams out there.  Alcohol and water, it was going to cure everything, except it really doesn’t do anything.  So at least as far as any research goes, are we going to discover later that it does something else? Maybe.

                                                But thus far, nothing. What they did was they played a game with some of the mathematics of the acceleration. That’s what they would call it. They would always reference the acceleration, how the thing would go up and down. And it went up and down in whatever, 15 miles an hour and your body having… You put under that impact, you’re getting six times your body weight. But the amplitude is so minimal you’re basically just compressing your skin. It’s less than… I think it’s a millimeter at the most. Most of them are half a millimeter. So it’s not getting into your bone because all of your other tissues are absorbing that force.  So when it comes to your bone, your bone’s not getting anything.  So they basically just lie with math and said, “This is going to increase bone density.” But then whenever it was trialed by somebody other than a company, it didn’t do anything

Dr. Weitz:                            Now, what goes into fracture risk is not just bone density, but we also have bone quality, the ability of bone to flex, for example. Do your machines improve bone quality as well as bone density?

Dr. Jaquish:                         Yes. That’s harder to measure. Now, ours… OsteoStrong focuses mostly on trabecular bone. So you’ll see a bone density change within six months or a year, and then you’ll see an even greater change because, typically a DEXA scan is looking at the outer cortex, not the outer cortex really and the inner. The middle of the bone is where the newer bone cells are, and they’re the ones that are absorbing minerals. So the outer cortex is the old bone. It’s not dead tissue just yet, but it’s right before it’s metabolized.  So it’s compact, and it’s on the outside.  It’s the strongest part of the bone, but that’s not where the growth happens.

Dr. Weitz:                            Yeah. I guess, according to Dr. Simpson, I haven’t performed this test yet, but some of the labs that do the bone density can also give you a trabecular bone score, which is supposed to be a measure of bone quality.

Dr. Jaquish:                         Yes, trabecular is much more in the quality category.

Dr. Weitz:                            Yeah. I guess if they have a certain software, they can compute this.

Dr. Jaquish:                         Yeah.

Dr. Weitz:                            So I looked at some of the literature related to being able to increase bone density. I did see a trial called the LIFTMOR trial in 2017.

Dr. Jaquish:                         Out of Australia?

Dr. Weitz:                            Yeah. It showed that heavy weight training using five rep max, squat, deadlift, overhead press plus they had them jump onto a chin up bar and then drop down, did improve bone density.

Dr. Jaquish:                         Yeah. The only thing that did anything was falling off the chin up bar, because that’s where they’re getting the impact. That’s where they’re getting… They’re hitting the ground. Because no one’s… We already know and it’s been shown in multiple studies of very high quality, and this study was… It was more of a exercise science study, so it was pretty low quality, very low sample size, not a lot of controls. The methods section was not well-documented. Nutrition wasn’t even recorded. So okay, it’s a typical exercise science study.  Because I don’t like holding studies to a standard of what we would see in therapy or what we would see with something you find in the European Journal of Sports Medicine necessarily, because usually it’s a smaller study that stimulates a bigger one. But having said that, we know 4.2 multiples bodyweight is what’s required. We know that from big studies, awesome studies that were published in top journals. And so they added impact in with a bunch of weight lifting and they say, weightlifting works. Well, we could do something health-focused with cocaine users and then say, cocaine makes you healthy. No, it doesn’t. It gives you permanent cardiac damage every time you screw around with it.  So it’s just one of those things where-

Dr. Weitz:                            That’s a bit of a stretch for an analogy.

Dr. Jaquish:                         Everyone will get it.  Everyone who listens to this will be like, Oh, okay.  Yeah, that would be obvious.

Dr. Weitz:                            Right.

Dr. Jaquish:                         There’s a great study that was done for basically comedic purposes for researchers where they determined that jumping out of an airplane with a parachute versus not having a parachute with you does not increase your chances of survival. So parachutes are useless. I’m not kidding, they actually did this. You read the conclusion and it’s just like, you would think people were just jumping out of airplanes and just tumbling while they land. And it’s like, I guess you can just jump off of anything and you won’t get hurt. But when you read the methods section, they did this study while the plane was on the ground. So parachute or no parachute, it didn’t even open. Jump from the airplane to the asphalt, to the tarmac.

                                                The point was, this is how people get misled. This is why when you read something in even like the New York Times, the health reporter isn’t really familiar with what they’re talking about. They read the wrong sentence and misinterpret it and then that becomes the new reality for most people. It’s like, are vegetables good or are vegetables bad?  Well, it’s just not that simple.  Sorry.  How many patients come into your office and they really want health summarized into a meme, a sentence fragment? And it’s like, I’m sorry, it’s just not that simple. You should probably… They still write books for a reason.  It’s because memes don’t tell you the whole story and usually they’re wrong, right?  How many times… I bet you every day you tell somebody, you should read this book or you should read that book. Right?

Dr. Weitz:                            Sure.

Dr. Jaquish:                         It’s not that simple.

Dr. Weitz:                            Yes, and the science changes over time and-

Dr. Jaquish:                         Yeah. So I think the LIFTMOR study, it’s like they proved my point. It’s like, Oh, we’re going to do all this weight training. And then we’re going to do this thing that’s just like osteogenic loading and then say weight training works.

Dr. Weitz:                            So you think if they did the five rep max, squat, deadlift, press, it wouldn’t show an increase in bone density?

Dr. Jaquish:                         I can show you 50 studies that’ll give you exactly that.

Dr. Weitz:                            Where they use the five rep max?

Dr. Jaquish:                         Yeah. Maybe not all of them are five. Maybe some of them were 10 reps, some of them were one rep. It doesn’t matter. You know that 4.2 is a minimum dose response. You know that some of the strongest people in the world don’t squat with 4.2 times their body weight. You also know that a leg sled, you’re only getting 40% of the weight because it’s at an angle and most of the weight is being driven into the floor. So people are like, leg press, a thousand pounds. And I’m like, okay. People push cars when their cars run out of gas.

Dr. Weitz:                            Yeah.

Dr. Jaquish:                         Car weighs 3,500 pounds. It doesn’t mean they can bench press 3,500 pounds.

Dr. Weitz:                            Right.

Dr. Jaquish:                         They just got to break the inertia, and it’ll just go on flat ground. You can do it with 100 pounds, 50 pounds.

Dr. Weitz:                            Right. So you also think cardiovascular exercise is a waste of time?

Dr. Jaquish:                         Yeah. So the title of my book is Weight Lifting Is a Waste of Time: So Is Cardio and There’s a Better Way to Have the Body You Want. Now, there’s a lot of caveats to that and I wanted a title that got attention and it sure did. Yeah. It’s a Wall Street Journal bestseller, USA Today bestseller and also an Amazon bestseller. Not that that really means much.

Dr. Weitz:                            No, I think that’s a big deal these days. It really-

Dr. Jaquish:                         What people do is they’ll write a book and then put it in the category of gardening tool buyers guides 2020, and then it’s like, it’s a best seller. Amazon’s got a lot of categories. But I actually was number one for I think… It’s only been out three weeks. I think we’ve been number one the entire three weeks, including the first hour we put it up on Amazon for the subject of weight training, for the subject of fitness and exercise, or maybe it’s exercise and fitness, however they word it. So it was big everywhere. So I sold tens of thousands of copies.

Dr. Weitz:                            Yeah.

Dr. Jaquish:                         And soon, we may be past 50,000 at this point. So what-

Dr. Weitz:                            Yeah, it certainly got my attention and I’ve been lifting weights for more than 40 years.

Dr. Jaquish:                         Sure. So just very briefly because I don’t want to run us out of time and I know you have a limit.

Dr. Weitz:                            Yeah.

Dr. Jaquish:                         Weightlifting is a waste of time, because what I demonstrated was that what you can hold here and what you hold here is seven times difference. So if you have seven-fold greater the capacity, why would you ever lift with a static weight?

Dr. Weitz:                            But the muscles used change. There’s more pecs at the bottom. You switch over to the front delts and you switch to a lot of tricep at the end.  So if you’re not going all the way down, you’re not fully working your pecs, I would say. Sounds like you disagree with that, but…

Dr. Jaquish:                         All the way down. I know-

Dr. Weitz:                            Whatever range of motion you’re going to have. I usually don’t go below this plane but-

Dr. Jaquish:                         We use a full range of motion. OsteoStrong doesn’t, but in the book, which is mostly about why I departed from weightlifting. I always thought it was inefficient. It just bugged me. Every time I would lift weights, I’d be like, there’s a better way to do this. 

Dr. Weitz:                            I don’t know. I just lifted weight this morning, I felt great after doing it.

Dr. Jaquish:                         You’ll feel even better if you do it right. Physiologically… So I take it you have not read the book?

Dr. Weitz:                            I did.

Dr. Jaquish:                         Oh, you did read the book? Okay.

Dr. Weitz:                            Yeah.

Dr. Jaquish:                         So you know that every time we try or every time scientists try variable resistance, it grows more muscle and builds more strength than standard weightlifting.  That was chapter two.

Dr. Weitz:                            Yeah.

Dr. Jaquish:                         Yeah. So when you have the weight change as you move-

Dr. Weitz:                            Right. You’re saying it gets harder as you go through the range, so you want the resistance to increase as you go through the range?

Dr. Jaquish:                         Well, no, it’s easier when you go through the range of motion, so bench press…

Dr. Weitz:                            You can handle more load. Right. So you want the load to increase? Yeah.

Dr. Jaquish:                         Right, right. So you really want high load where you’re capable of handling a lower load to still exhaust the muscle, but also be easier on the joint because the joint grows based on the force you place on it, close to lockout, back to the Benjamin and Ralphs study in 1996. So the joints don’t need a full range. They need impact range which is very small. The rest of the musculature definitely benefits from a full range of motion. So we do use the full range of motion, and especially when it comes to sarcoplasmic growth. There’s two types of muscle growth, myofibrillar and sarcoplasmic.

Dr. Weitz:                            Yeah. People have toyed with this idea for a number of years.  There were some selectorized machines that had a funny shape cam to try to change the resistance during different ranges. I’ve certainly seen people doing, say, a bench press with chains on. And as they lift more, the chains get heavier as they go towards the lockout and even using bands. So people have been toying with this idea of changing the resistance as you go through the range.

Dr. Jaquish:                         They have been. Typically, they break world records if they do it right. That’s really how Westside Barbell… That’s the secret to their success, is using different methods and they have very complicated apparatus which… It’s one gym, and there’s more than 200 world records broken out of that one gym. One gym, one location.

Dr. Weitz:                            Where is that gym?

Dr. Jaquish:                         It’s a suburb in Ohio, and I always… forget the name of the town. But yeah. So they were doing it and it’s kind of anecdotal information. But I approached it from the data I had where I could demonstrate that somebody’s so much more powerful in the impact of greater range of motion. And so the previous approaches to variance would be like, I got X at the bottom and 1.2X at the top, where I’m like, no, no, no, what we need is X at the bottom and 5X at the top. I think the 13th study I described in the book in the Variable Resistance chapter, in chapter two, they demonstrate how the greater degree of variance that they tested… Now, they didn’t go quite as high as I did because I had the bone density data to know exactly how far to go. They didn’t. So they demonstrated that the more variance and less actual weight you’re lifting… They’d have weights and then they’d add bands on a bar.

Dr. Weitz:                            Right.

Dr. Jaquish:                         But the less weight and the more bands, the more growth, because they had a higher variance curve, because it is a very steep curve what we have. It’s not linear at all. It goes like this, because it’s not X at the bottom. Let’s say we’re using 5X at the top, it’s not 2.5 in the middle. It’s X, 1.5X, 5X at the top. So we’re designed the whole product, X3 product to get as close as possible to those curves with very simple and elegant design.

Dr. Weitz:                            And so you also think cardio is a waste of time as well?

Dr. Jaquish:                         It depends on what your goals are. If your goal is to be a distance runner? No, it’s great.

Dr. Weitz:                            What about overall health?

Dr. Jaquish:                         You get a better cardiovascular benefit from strength training, and there’s more than 100 studies that say that.  And the meta analysis, it references. The 100 studies is referenced in the book as well as a few others, some of the highlights. It really shows you can build as good or better cardiovascular health with strength training. Now, the real reason I say cardio is a waste of time is because most people’s goal is losing weight. And when you do sustained cardio, and this research has been out there for 40 years. When you do you sustained cardio, and what I mean is over 20 minutes at a similar heart rate. So as in 

Dr. Weitz:                            Low-intensity steady-state exercise?

Dr. Jaquish:                         Yeah, that’s right.  You surge cortisol and you keep it high for a long period of time. So cortisol does two things, it gets rid of muscle, and it ensures that you keep body fat longer and don’t metabolize body fat and instead metabolize muscular tissue. So you’re losing muscle and you’re preserving your body fat.  That seems to be the opposite of what people want, is just staying fatter longer, which is why when you look at distance runners, they’re skinny fat. They’re not lean.  You look at sprinters and they’re lean.  I know they might be bigger muscular wise.  That might not be everybody’s goal.  But if you want to be a distance runner, you got to run distance and your body will adapt.  You also have to consider the fact that the body is making decisions based on the environment it’s being placed in, like with all exercise.  So if you’re trying to show your body that you want to go long distances, your central nervous system is like an engineering team.  So it realizes you’re trying to become an economy car.  So what do we know about economy cars; lightweight frame.  So you start losing bone density.  People who do a lot of cardio, they lose bone density and so they have a lighter frame, which makes sense. Cortisol is going to increase the storage, as in preserved body fat.  Because if you want to go long distances, you got to be efficient.  You’ve got to carry a lot of fuel with you.  So that becomes body fat. You don’t see many V12 engines in economy cars. So it’s going to shrink the engine too, so you’re going to lose muscle. So you lose muscle, you keep all your body fat, you lose bone density. That has a tendency of shortening people’s lives. I just think it’s a mess. Don’t do it. I can tell you’re loving this. The myth that strength athletes have for cardiovascular endurance really has to do with what is the test and is it the right test? So for example, have you’ve been to Munich Airport? You got to run up and down the stairs four times and go through immigration, get your checked bag and bring that through an examination stall where they never really examine your bag. They just wave you through. But you’re running up and down stairs four times.  It’s crazy, terrible design of an airport, which is really weird, because the Germans design everything great except for the Munich Airport. So I’m with this guy who probably weighs 100 pounds less than me. I’m 240 pounds. He’s a really slim guy, and we’re running up and down the stairs because we’re trying to get a connecting flight to Moscow. I’m out of breath after running up four flights of stairs. And, “Oh man, your cardio is really not very good.” And I said, “No, my legs are four times bigger than yours. Blood has to pump to my quadriceps, which are tremendous. Yours are not.” So it’s like, does the Lamborghini burn more fuel than the Prius? Yeah, it does. It doesn’t mean that there’s something wrong with the gas, it’s just a different machine. And so that’s kind of where that myth comes from, that a strength athlete won’t have as good a cardio health.

Dr. Weitz:                            Okay.

Dr. Jaquish:                         And like I said, there’s 100 studies to back that up.

Dr. Weitz:                            What nutritional approach did you think are most effective for improving bone mass?

Dr. Jaquish:                         High levels of animal protein, really. I know that there’s a meta analysis-

Dr. Weitz:                            Won’t too much animal protein leach calcium out of the bones?

Dr. Jaquish:                         No, never been shown in a real research study, but it has been… So there’s a meta analysis that compares vegan and vegetarian nutrition to a more what they call balanced diet, which it’s all epidemiology research. So what do people eat, and what do they tell you they eat might not be exactly-

Dr. Weitz:                            Food frequency questionnaires which are often unreliable.

Dr. Jaquish:                         Right. Well, it’s like you have when a patient walks in and you ask them how much they weigh. No, you weigh them, because they won’t tell you. They’ll tell you what they weighed in high school. They do it. It’s wishful thinking. It’s like, well, I’m on a diet. So in two weeks, I’m going to weigh this. Yeah, but that’s not what you’re weighing now.

Dr. Weitz:                            So besides a high animal protein diet, is there a thing else you recommend? Do you recommend green vegetables, vitamin D, vitamin K, calcium, magnesium?

Dr. Jaquish:                         Because of the inflammation… So I look at a lot of vegetable… Did you read the nutrition section of the book?

Dr. Weitz:                            Yeah.

Dr. Jaquish:                         Okay. So you know I prefer carnivore nutrition. Yeah, heavy animal protein. The vitamin K and the vitamin D, you’re getting it. You’re getting a lot of… Now, there’s a difference between grass-fed meats and farm factory raised.

Dr. Weitz:                            Right.

Dr. Jaquish:                         You always get the same… Throwing little organ meats in there pretty much gives you every vitamin and mineral. I usually have liver once a week. I don’t emphasize it as much as Dr. Paul Saladino. He eats organ meats daily. I think that’s… Ultimately, if you look at a cow, it’s got 500 pounds of muscle meat and two pounds of organ meat.

Dr. Weitz:                            Right.

Dr. Jaquish:                         So if you eat in that proportion, it’s a 1:250 pound ratio. That’s not a lot of organ meat. But it’s there. So yeah. The people who do the best to build the most bone mass, they have a lot of animal protein. And like I said, oxalates and vegetables are inflammatory. So we know the lower your inflammation is, the more your bone mass can build. And so I really don’t recommend many vegetables at all. It doesn’t mean people can’t eat them and it’s not like an either/or. The NFL guys and the NBA guys, I talked to them about carnivore nutrition. I talked to their nutritionist about carnivore nutrition. I sent them all copies of the book. A lot of them, I sent advanced copies of the book because I even got the Miami Heat’s endorsement on the back of the book.   They’ve shifted most of these athletes to about 70% animal protein as opposed to… The standard Western diet is 70% plant-based. So it’s really that observation. It’s funny, it’s 70% plant-based right now. We were just laughing about epidemiology, we don’t really know much from it, but we know what people buy. And chances are, if they buy it, they eat it. But 70% of calories [inaudible 00:42:40] purchased are plant-based. Now plant-based is also a Twinkie. That came from plants, which… Oreo cookies. I know vegans will eat three or four sleeves of Oreos right in front of me. And they’re like, “Well, they’re vegan. They don’t have any…”   I’m like, “Yeah, but that’s like poison.” It’s not like they have one, they just eat them in a box. But they think because it’s vegan, it’s healthy. So you got to look at what the building blocks in the body are. I really pushed towards carnivore nutrition when I realized how much protein somebody needs to build muscle, and muscle and bone have a synergistic relationship. So even though I was past my days of bone density development, but I still consult on all the research projects of which there are multiple ones going on at different universities focused on the OsteoStrong devices. Yeah. The ones who respond the best are the ones that have the least inflammation and focus on driving muscle. The forerunner to my chapter on nutrition-

Dr. Weitz:                            Aren’t a lot of phytonutrients found in plant foods anti-inflammatory?

Dr. Jaquish:                         So the antioxidants, let’s start with the antioxidants because we’ve been studying that for a long time. You don’t need an antioxidant if you’re not oxidizing. So the idea that I’m going to poison myself and then take an antidote too.

Dr. Weitz:                            But you’re breathing oxygen, right?

Dr. Jaquish:                         Is what?

Dr. Weitz:                            You’re breathing oxygen. So we have oxygen?

Dr. Jaquish:                         Right.

Dr. Weitz:                            So oxygen-

Dr. Jaquish:                         We do not [crosstalk 00:44:38]-

Dr. Weitz:                            In at least oxidative stress, we know oxidative stress occurs in our system.

Dr. Jaquish:                         Right, but the least amount would be better.

Dr. Weitz:                            Sure.

Dr. Jaquish:                         So yeah, I don’t-

Dr. Weitz:                            [crosstalk 00:44:52] probably the osteoclastic activity probably involves… Because we have the osteoblastic, osteoclastic balance that occurs in bone where bone is being broken down and rebuilt. I’m sure the osteoblastic activity probably involves oxidative stress as part of breaking down the bone, but that’s part of the growth as well, because you want to get rid of the bad bone.

Dr. Jaquish:                         Yeah. A, exercise is inflammatory.

Dr. Weitz:                            Of course, exactly.

Dr. Jaquish:                         You can’t avoid it all, but-

Dr. Weitz:                            Very oxidative, very acidic.

Dr. Jaquish:                         Nutritional inflammatories become chronic, because also people eat all the time. So I also recommend time restricted eating. So I only… Right now, I’m eating five meals in a week. So I do a 72 hour of no food period of time, three days. And then I’ll eat one meal a day the rest of the days. So I go nothing in my system and that’s to take down all the inflammation, allow autophagy to happen. I see my scars disappearing. I got a lot of scars and they’re metabolizing [crosstalk 00:46:15].

Dr. Weitz:                            Why do you have so many scars?

Dr. Jaquish:                         I guess I was part of that generation rode motorcycles without helmets [crosstalk 00:46:27] and got ahold of the farm rifle and maybe got hit with ejecting brass a couple of times and burned myself-

Dr. Weitz:                            Okay.

Dr. Jaquish:                         … [crosstalk 00:46:42] I understand that. Yeah. Fireworks, punched through a car window. When a car rolled over, I was the Terminator thinking that that wouldn’t cause any problems.

Dr. Weitz:                            Okay.

Dr. Jaquish:                         Yeah. Here’s one, you can probably see a little bit of the scarring on my arm. My fraternity letters are branded into my deltoid. So a very serious fraternity, a very good fraternity too. So this is like… You could see when I first started X3, it’s the only time I ever took pictures with my shirt off and then been doing that since then. But you can tell in the last two years that it used to have a [inaudible 00:47:34] on it. It was sticking off of my skin half a millimeter. It’s almost gone, and that’s been there 20 years.

Dr. Weitz:                            [inaudible 00:47:46].

Dr. Jaquish:                         [inaudible 00:47:47].

Dr. Weitz:                            Okay, Dr. Jaquish. Any final thoughts you have for our listeners or viewers?

Dr. Jaquish:                         Well, it depends. You know more about your listeners than I do. So what do you think that I can tell them? Yeah, [crosstalk 00:48:07] vegans or they’re going to be upset with me because I say eat carnivores? Do they look at their nutrition like it’s their religion? Because that’s not how you should look at anything.

Dr. Weitz:                            Yeah, I’m not sure who all my viewers are. So I know we have functional medicine practitioners, but we have educated viewers too. So I’m sure there are vegans. I’m sure there’s people who promote Mediterranean diet. I’m sure there’s people who promote paleo or carnivore.

Dr. Jaquish:                         I like the people who tell me that they’re doing hybrid nutrition between… They’re doing sort of keto and sort of Mediterranean. So they’re told bread is great and so are fats. So they just eat pizza. Yeah.

Dr. Weitz:                            Yeah, that’s good.

Dr. Jaquish:                         One of the sad things about the internet is it’s really shining the light on the fact that people want the news that they want. They don’t want the news that’s actually right. So with nutrition research, there are people who are furious with me because I tell them to stop eating sugar and carbohydrates. You can apply carbohydrates in a very intelligent way when it comes to strength training. And if you really want carbohydrates, the time is, time very carefully around your workout and you can get away with it and actually grow more muscle. I described that in the book, but did you read the hyperplasia section?

Dr. Weitz:                            Yeah.

Dr. Jaquish:                         Yes. I say that and I get just hatred messages by usually chubby people with little baby arms. And it’s like, you should be looking for the right answer not the right answer for your hunger, because you’ve been following that one for a long time and you’re probably going to die a lot younger because of that. So there we are.

Dr. Weitz:                            There you are. I thank you for the time spent with us and providing us with some interesting perspectives on building bone and building muscle.



Sleep Hygiene with Dr. Jose Colon: Rational Wellness Podcast 177

Dr. Jose Colon discusses How to Improve Sleep Hygiene 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

1:59  We are seeing more sleep problems due to the coronavirus pandemic.  People are losing sleep because of stress, being sedentary, and because of their economic situation.  Working from home makes it harder to turn your brain off.

8:23  While you may not be able to control if you work from home or not, you should start with the things you can control. Keep to a regular sleep and wake schedule and don’t work in your bedroom. Your bedroom should be only for sleep and sex.  Do some form of regular exercise.

11:31  How to analyse sleep.  There are formal sleep studies. There are sleep logs that you can download from the National Sleep Foundation or the American Academy of Sleep Medicine. There’s sleep tracking with devices like Fitbit and the Oura Ring.  Dr. Colon is most familiar with the Fitbit. It’s not monitoring brain activity directly but it tracks heart rate and movement, which are surrogate markers for sleep.  It works best with women in the 30-50 years of age range and not as well for teens or for seniors.

17:44  Ideal sleep pattern.  When you go into the first stage of sleep, your brain slows down and your heart rate slows.  Throughout the night you cycle first into a deep slow wave sleep and then every 90 minutes into REM sleep. During deep sleep is where your lymphatic (glymphatic) system washes away toxins from the brain.  This is also when you release growth hormone and it is the most restorative form of sleep.  During REM sleep (rapid eye movement) your brain is quite active and the heart rate is almost as high as when you are awake.

20:20  When we do yoga breathing or mindfulness meditation, when you become aware of your breath, you’re slowing your respiratory rate down and calming your heart, which sends signals to your brain to calm.

22:59  Nobody sleeps through the night without some minor awakenings. The awakenings typically happen in the second half of the night.  If you’re waking up a lot in the first two hours of sleep, that may be a sign of a sleep disorder, such as a periodic limb movement disorder or obstructive sleep apnea. 

24:50  The benefits of REM sleep are that you are consolidating memories and it is also when you’re secreting testosterone.  Memory issues can be an indication of not getting enough sleep.  If you stop breathing during REM sleep, that can cause cortical arousals.  This indicates sleep apnea and this can be corrected with a CPAP machine that opens your airways while you sleep. Untreated sleep apnea is a cardiovascular risk factor. A CPAP machine is the most common treatment for sleep apnea, but losing weight can sometimes correct the problem.  There are also dental devices that advance the jaw forward to open the airway.




Dr. Jose Colon is an Integrative Medical Doctor who is board certified in sleep medicine and neurology. He teaches for the Institute of Functional Medicine and he is the author of books for women’s sleep, sleep and mindfulness in children, and infant sleep. He is the founder of Paradise Sleep, an organization dedicated to the education of sleep and wellness. He works at Lee Health in Fort Myers, Florida and his website is ParadiseSleep.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.

Today our topic is sleep, and, in fact, we’re going to also consider sleep during the pandemic. We’re here with sleep expert, Dr. Jose Colon. Dr. Colon, is that the right way to pronounce your name? Is it Colon or Colon?

Dr. Colon:            Colon.

Dr. Weitz:            Colon. Thank you. Perhaps you can introduce yourself and tell us a little bit about your background.

Dr. Colon:            Thanks for having me, Dr. Jose Colon. I am a sleep disorder specialist, board certified in sleep medicine. I’m also board certified in neurology with special qualifications in child neurology. I’m triple board certified in lifestyle medicine as well through the American Board of Lifestyle Medicine. I’m also certified through the Institute of Functional Medicine, Certified Practitioner. I incorporate all of these aspects with my patients to help improve wellness.

Dr. Weitz:            That’s great. We want to talk about sleep in general and get some updates on some of the latest concepts about how to analyze sleep, the importance of sleep and what to do about it. Maybe you want to talk about some of the sleep problems people are having right now since we’re still in the midst of this COVID-19 Coronavirus pandemic in the United States, in fact, around the world.

Dr. Colon:            I opened up by saying thanks for having me, but actually thanks for having me back. We did talk for quite a bit about sleep and sleep disorders, but you’re right, things have changed now with this COVID-19 pandemic.  There are some things that we are seeing right now and then there’s things that we’re going to see down the road. Some things that we’re seeing right now is we are seeing a lot of insomnia. We are seeing a lot of people losing sleep.  The reason for that is threefold, actually. One is stress. The other is the sedentary effect that quarantine causes and then the other, station, where you’re at. You talk about all three. Stress and sleep, they’re not compatible.

Dr. Weitz:            But some of this stress is not easy to deal with.

Dr. Colon:            It’s not.

Dr. Weitz:            If you’re out of work or you’re making less or you have your own business and your business has been affected or maybe it shut down or partially shut down or you’re worried about getting sick or you’re worried about your kids going to school or you’re having to deal with working from home, now maybe you’ve found out you’re going to be working at home for the next year. Your kids are at home too, and you’re trying to deal with all that. They’re going to school online. A lot of these are things that are real that you can’t change.

Dr. Colon:            If you look at the classic model of insomnia, you have predisposing factors, you have triggering factors and you have perpetuating factors as well, kind of like we do in functional medicine. It’s pretty classic that insomnia, there’s some type of precipitating event, something that is life-altering or life-changing, something that causes some threat that causes insomnia. Threat doesn’t always mean that a lion is going to eat you or …  You just mentioned a bunch of threats. Beyond the threat of getting sick, there is the threat of having less work. There is the threat of just everything that you had mentioned there. The sleep and the stress, that’s something that’s causing some more insomnia.   The other thing that I mentioned is sedentary. During a bit, we were really encouraged not to leave the house and gyms were closed.

Dr. Weitz:            Where we are in Southern California, gyms are still closed. For the most part, the tech industry is all working from home. For the most part, people are staying at home, even now.

Dr. Colon:            Exercise is something that’s really very well-known to help with sleep, and, in particular, exercising 150 minutes per week. Not at one time, 150 minutes per week. I have to clarify that because I once said 150 minutes and people were like, “Oh wow, at once.” No, no, no. 150 minutes per week improves sleep quality and the depth of sleep.  When we’re sedentary, we’re not getting that exercise, we’re not having the same amount of sleep drive in the evening. Luckily, our gyms have been able to be open to partial capacity. It’s funny, when they closed the gyms, I did go to the Play It Again Sports, the youth sports and trying to get gym equipment. It was all gone.

Dr. Weitz:            Oh no. Same thing here. Very, very difficult to get dumbbells and plates and things like that. They’re charging five times what the normal price is supposed to be.

Dr. Colon:            You know what I did, I went to Lowe’s and I bought a rope. I took that rope and hung it over my oak tree. I was doing the TRX bands, the TRX bands, just doing some pull-ups, turning around, push-ups, trying to get biceps in. Sedentary lifestyle does lead to difficulty sleeping as well.  Then the last thing that I mentioned was station, where you’re stationed at. The more time that you spend at home, the harder it is to turn your brain off. The more that you’re working from home, the more work thoughts come into your daytime.   The word dormitory, Latin root dorm is dorme. In Spanish, dorme means to sleep. The word dormitory refers to you go out and about your day and then you come to this place where you live at night to sleep. You have that association with sleep.   Now, we’re working from home, we’re doing stuff at home. The amount of time that we’re spending there, what happens? You can’t shut the brain down. 

Dr. Weitz:            The problem is this may be permanent for a lot of people. I heard Michael Dell on TV this morning. He was saying how a lot of these companies realize that all these employees who are working from home, they’re doing fine, and it’s great for the companies because they can pay for less office space. These tech companies not only have massive amounts of office space, but they pay for lunch and meals and coffee and all these other things for their employees. Now that they’re working from home, these companies are going to be saving tons of money, and this is going to become permanent for a lot of people.

Dr. Colon:            It can. Taking a look at those three things, there are some things that are not in our control, but what are things that are in our control. Start with station, with where you’re at. Do everything that you can to keep regular sleep/wake schedules, and do whatever you can to when you work, try not to work in the bedroom. If you can go out to your porch, do it. If you need to go to the kitchen table, do it. If you have a separate office, but that may be a luxury for some people, but if you have that-

Dr. Weitz:            But if possible, if you could have a designated area where you go, “When I go over here, this is work. When I leave there, I don’t do work anymore.”

Dr. Colon:            That’s basic sleep hygiene rules. They talk about the bed, try to use the bed for sleep and sex only. The more stuff that you do in your bedroom, the more ruminating thoughts that you’re going to have at the time that you go to sleep. You just lose the association with sleep. That’s one thing that you could do.  Another, again, as I mentioned, exercise. Do what you can to incorporate some type of exercise. I couldn’t go to the gym for a period of time. As I said, I bought a rope and I worked out from the tree. I did more running at the time than I normally did. Just find something else that you can do exercise-wise to replace.

Dr. Weitz:            By the way, Peloton Company is booming because that’s one alternative for exercising at home.

Dr. Colon:            What was that?

Dr. Weitz:            Peloton, that company is doing gangbusters. Basically you pay, I don’t know what it is, 30, $50 a month, and you get a bike or a treadmill and they have these videotape workouts and there’s other kinds of workouts that you can do.

Dr. Colon:            I’ve known some people who were doing that beforehand and then they reached out to healthcare professionals, “Hey, you could log on.” Everything’s a business as a capitalist. It’s something that you can do, absolutely.  Stress, of course, is do some type of practice of stress release: meditation, mindfulness. Those are my preferences. I’m certified in hypnosis as well. I work with patients in that. I use it myself as well.

Dr. Weitz:            Can you hypnotize yourself?

Dr. Colon:            All hypnosis is self-hypnosis. I cannot control anybody’s mind. I can guide a patient on how to enter into deeper stages of relaxation, into trance. Yes, all hypnosis is self-hypnosis.

Dr. Weitz:            Interesting. I didn’t know that.

Dr. Colon:            Glad we can contribute.

Dr. Weitz:            How do we analyze sleep?

Dr. Colon:            Analyzing sleep can be done in different ways. There’s formal sleep studies that you can get that take a look at one night. There are sleep logs that you can download from National Sleep Foundation or American Academy of Sleep Medicine. You can log wake times and sleep time. Then there’s also sleep tracking.

Dr. Weitz:            What about all these devices and apps that a lot of people use?

Dr. Colon:            The sleep trackers, I really like them. A lot of medical professionals say, no, don’t do that or go throw it away or don’t use it. I like it. I have one myself.

Dr. Weitz:            Which ones do you think are the two or three best ones out there?

Dr. Colon:            What I am most familiar with is Fitbit. I’m most familiar with it for two reasons. Number one, they started it, and then I had so many patients come in with their Fitbit and asking me what it is that they’re seeing, so I got one myself to be able to track my sleep to see what the hell it was about.  Number one, they’ve been around and I’m familiar with it because I personally use the Fitbit. Number two, Fitbit actually has some pretty good data. They presented this data during a technology webinar through the American Academy of Sleep Medicine, and I was very impressed with their data.  That said, the Fitbit gives you a surrogate marker for sleep. It’s not monitoring your brain activity. It does monitor movement and it does monitor heart rate. They have certain algorithms, that based on that, they’re able to track certain sleep.  I’ve found it to be pretty accurate at times. The data says it’s 70% accurate. There’s times that I wake up from a dream and I look and I’m like, “Yup, I was in REM sleep.” I get called by the emergency room in the middle of the night and, yes, I see it, I see what stage of sleep I was in before that and then that I was woken up.  The one thing to know about the sleep tracker is that the data, data is not one size fits all. When I do a sleep study on someone, I’m taking account heart rate norms, if they’re pediatric, if they’re geriatric. The norms are all different from person to person.  Fitbit and all of the sleep trackers have universal data though. That data, those surrogate markers are derived based on who their purchaser is. Their main purchaser are women of middle age, so from 30 to 50 years of age. That’s where the Fitbit gives you the best, most accurate data.  It’s important to know because in a pediatric patient and in a teen, the heart rate is higher. I’ve seen a lot of parents put a Fitbit on a kid, bring the kid in and say, “His sleep is horrible. He’s waking up a lot. He’s never getting into the deep …” It’s because his heart rate is higher and this data was derived based on a different population.

Dr. Weitz:            How about the Oura Ring? Is that more direct data or is that similar to the Fitbit. The Oura Ring seems to have a higher level of detail.

Dr. Colon:            I’ve heard a lot about the Oura Ring. I’m not familiar with it because I don’t have one personally, and I haven’t seen them produce any medical literature data. I think that there’s probably value to it. I’ve seen many people bring many different types of trackers. I’m able to go through it, and I know what I’m looking at. I’m trying to look for sleep cycles, and I make sense of it.  The Fitbit is the one that I’m most familiar with, and I favor that one, but all of these devices have some degree of value to them, and remembering that they’re surrogate markers of sleep, not necessarily a direct measurement of sleep.

Dr. Weitz:            Basically, my understanding, and maybe you can correct me on this, is the main things you get out of one of these devices is: A, the amount of sleep you get, how many times you wake up, and then to what extent you get into REM and/or deep sleep cycles, correct?

Dr. Colon:            Yeah. The data that you get is your heart rate throughout the night, and that heart rate and movement throughout the night extrapolates into everything that you just said.

Dr. Weitz:            Is that the way the Oura Ring works too? It’s all based on heart rate?

Dr. Colon:            I’m not exactly sure because I don’t have an Oura Ring, but I don’t see how else it would work because it’s not connected to your forehead, it’s not connected to your brain activity. There’s no other way that I can see that it works.

Dr. Weitz:            All based on heart rate. Your heart rate gets higher or lower when you’re in REM sleep versus deep sleep versus the other stages of sleep?

Dr. Colon:            Heart rate and movement. There’s a device called actigraphy. That’s a real medical device that looks at movement. When you’re awake, you’re obviously moving more. During periods of quiescent, you’re moving less. It tracks based on movement. These devices, my understanding, it’s the combination of heart rate and movement.

Dr. Weitz:            Basically, could you explain exactly what’s supposed to happen during the night when somebody has an ideal level of sleep?

Dr. Colon:            As you go into the first stage of sleep, your brain slows down. As your brain slows down, your heart rate slows down as well. Your heart and your brain, they’re interconnected, what I call the heart rate and the brain rate.  People have these stages and these cycles of sleep. If we’re not asleep, we are awake. Then we cycle through these. R is REM. People think your REM sleep is your deep sleep but it’s not. It’s actually very active brain time. All throughout the night, you’re cycling first into a deep sleep, then every 90 minutes into a REM period. Every 90 minutes we have another REM period. You have more awakenings in the second half of the night.  Your brain starts to slow down. During this deep sleep, it’s when your brain activity is the slowest. That’s actually exactly what it’s called. It’s called deep slow wave sleep. Heart rates and brain rates are always inter-correlated.

Dr. Weitz:            What’s the benefit of deep sleep?

Dr. Colon:            The benefit of deep sleep, that where your lymphatic systems comes out, and you wash away the toxins into your brain. It’s also the time that you secret growth hormone, and it’s the most restorative part of sleep.  Just like washing machines go through different cycles, your sleep goes through different cycles. Let’s say that you have your washing machine in the deep soak at the beginning, well, that deep sleep is what washes away the toxins and it’s the deepest part of sleep.  Now, in REM, that’s a very active brain period. In fact, the heart rate, the brain rate in REM almost looks the same as that of awake. It’s a little slower, but these two almost look the same. Your heart rate is really elevated during that REM period as well.  These trackers, what they’re doing is that they’re taking a look at both movement but also heart rate fluctuations. When your heart rate is the slowest, it’s saying that you’re in the deepest sleep. Then, all of a sudden, it’ll come up for a moment and it’ll say that you’re in REM. Then it’ll slow down. Even within deep sleep and light sleep, there’s different heart rate fluctuations as well.

                                Let me chime and say something else. Let’s get back to the subject of stress, sleep, meditation, mindfulness. That’s what we’re doing. When we do yoga breathing, when you do an awareness of breath, as you’re slowing your respiratory rate down, you’re calming your heart which sends signals to your brain, and it calms your brain down as well.  Interesting. That’s why people sometimes fall asleep when they’re meditating, or people go to a yoga class, and then at the very end, you get into corpse pose and you do this imagery and you’re breathing slower and people fall asleep.  Interestingly, there’s been times that I’ve woken up and I do a meditation. The Fitbit will tell me that I was asleep. Am I saying it’s wrong, it’s a false? No, I know that I was awake, I was meditating, but that’s the power of meditation that it puts your physiologic body and brain into states of relaxation.



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:            Based on what you showed us about the chart, it looked like the first two, three hours is when you get the most amount of deep sleep. When you have a client who’s having problems with sleep and you find out when they tend to wake up, is that really significant? If they say I wake up in the first hour or two as opposed to I wake up after four hours? Does that have a significance in terms of whether or not it’s more affecting deep sleep versus REM sleep.

Dr. Colon:            You know, that actually has a very big significance. One, nobody sleeps through the night. Everyone has some degree of awakenings that occurs. That’s common to where it’s got a name called NWAK or number of awakenings. If someone actually wakes up four times in an evening, believe it or not, that’s normal. That’s important to know because sometimes people can’t sleep because something is bothering them, and what’s bothering them is that they’re not asleep or that they’ve had an awakening.  Now, typically, you have more awakenings in the second half of the night as you’re transitioning into more of those REM periods. Someone who awakes in the middle of the night or in the early morning, that’s actually a normal phenomenon. We can meditate ourselves back into sleep. If you’re waking up a lot within the first two hours, that may be a sign of a sleep disorder, either periodic limb movement disorder or let’s say obstructive sleep apnea can do that as well.  In obstructive sleep apnea, your airway is being compromised. Remember, in REM sleep, our body is paralyzed so that you don’t act out your dreams. The upper airway has less tone as well. Let me show you something actually.

Dr. Weitz:            By the way, you talked about the benefits of deep sleep. Can you explain what some of the benefits of REM sleep are?

Dr. Colon:            REM sleep, you’re secreting testosterone and in REM sleep, you’re also making memories. In REM sleep, if you remember what you did yesterday it’s because you went into REM sleep and you turned that into a memory. Then there’s some-

Dr. Weitz:            On the opposite end, if you don’t remember what you did yesterday, then that’s an indication that you’re not getting enough REM sleep?

Dr. Colon:            That could be that you’re not getting enough sleep. You’re exactly right. You’re exactly right.  Normally, we breathe. Sometimes we stop breathing. If you stop breathing during the REM sleep, that can cause some cortical arousals. In kids, it’s tonsils and adenoids. In adults, it’s more the upper airway. Here, CPAP opens up the airway. Take a look over here. Look how this person’s going through their sleep cycles. Then look how the heart rate is below 80, and look how it stresses to the hundreds when the oxygen is coming down, and look how it relaxes into the 60s when you start to get the treatment with the CPAP there.  If you look over here, orange are stop breathing events that are a little minor. Green are stop breathing events that are more severe and how it occurs during your REM sleep and that your oxygen is coming down. Untreated sleep apnea is a cardiovascular risk factor.   That said, sometimes, again, regardless of the device, whether it’s Fitbit or I’ve had people come to me with all kinds of devices, and I’m looking at night to night. If I’m constantly seeing awakenings in the REM sleep, that’s not diagnostic for sleep apnea. That’s telling me you’d better get tested for sleep apnea. Many times, indeed, I’ve been correct when I see that.

Dr. Weitz:            Now, a lot of patients hear sleep apnea or obstructive sleep issues, and their first thought is, “I don’t want to wear a CPAP machine. I don’t even want to get tested.” Are there alternatives to wearing a CPAP machine?

Dr. Colon:            Yes, there are alternatives, but let me take a step back. I told you that during the COVID, I’m seeing a lot of insomnia but there’s also going to be a lot of down stream affects. I think it’s pretty well documented that during this whole COVID and the pandemic that weight is increasing. Guess what happens when weight increases? The incidence of sleep apnea is going to increase as well.  If you do have sleep apnea, CPAP is the gold standard. There also are dental devices that are very effective in advancing your jaw forward and treating sleep apnea. These are more for mild to moderate.  There’s these little implantable devices that is like a pacemaker for your upper airway. It’s connected to the phrenic nerve. You go to sleep, you turn it on, it stimulates your upper airway. You wake up, and you turn it off.  There are some surgeries that are available. The surgeries are really not favorable because they don’t really have a high cure rate. What they do is that they make it so that your severity is less and you’re able to tolerate CPAP better.  Even then, there’s other types of CPAP. There’s BIPAP as well. CPAP is continuous positive airway pressure. You breathe in, and the pressure’s eight. You breathe out, and the pressure continues to be eight. Bi means two, so you breathe in and the pressure’s eight, and as you breathe out, the pressure’s four. Bi means two.

Dr. Weitz:            What are some of the symptoms people are going to … I know you covered some of the things in terms of issues with deep sleep and REM sleep, but in general, what are some of the most common symptoms you see when patients are having problems with sleep disorders?

Dr. Colon:            Fatigue is one of the big ones. Sleepiness is another one, concentration, memory, high blood pressure. These are all symptoms that there could be a sleep disorder.

Dr. Weitz:            Now, of course, those are symptoms that are very common. Fatigue could be 20 other things too. We just had a discussion about heavy metals last night. Of course, fatigue and memory issues came up as an issue of heavy metal toxicity as well as fatigue obviously could be a problem with liver problems, adrenal problems, hormones, blood sugar. How do you distinguish that it’s a sleep problem?

Dr. Colon:            How do you find out that you have a problem with metals?

Dr. Weitz:            You’ve got to test.

Dr. Colon:            Yeah.

Dr. Weitz:            You’ve got to [crosstalk 00:29:50].

Dr. Colon:            You do a clinical history. You listen to exposures that a patient may have potentially to metals, whether it’s in the water supply or crappy protein powder or parks.

Dr. Weitz:            I’ve heard about a couple of the protein powders that had lead in them. Is that what you’re referring to?

Dr. Colon:            Yeah. You take a history. In the sleep history, are you snoring? How much are you sleeping? How long does it take for you to get to sleep? It’s part of the core part of the functional medicine matrix there, the lifestyle modifying factors.

Dr. Weitz:            Now, do you find sometimes patients come in with sleep problems and it turns out to be something like heavy metal toxicity?

Dr. Colon:            Yes. I see this because I have the different training.  I’m not thinking only sleep apnea, only sleep apnea, only. No.  There’s times that I treat sleep apnea and they come back and they’re like, “Doc, why am I still tired.” “Let’s take a look at your medication list.” We’ve got a couple of medications that are mitochondrial toxic: Metformin, the statins of which diabetes, having insulin resistant is toxic for the mitochondria as well. You do a history, and then sometimes you do find other things.  I saw a girl the other day that she came to me, she’s got Lupus. We wanted to rule out sleep disorder. It was completely negative. I did a Genova NutrEval on her. Her mitochondria were shot: high oxidative stress, high lipid peroxisomes there, the OOHD was just sky high. You know what else? There was gasoline in … there was some toxicity. She had some gasoline in there probably from the water supply. When things don’t add up, you take a couple steps back, do a further history and you go to it.

Dr. Weitz:            Is that one of your favorite screening tools for toxicities and nutritional deficiencies, a NutrEval?

Dr. Colon:            I like it. I like it. It’s of several that can be done. Genova has some other expanded upon specific toxicity findings. It’s all individualized and basic. What do you use?

Dr. Weitz:            I like the NutrEval. There’s a micronutrient test now that Vibrant Labs has that’s pretty cool. We stopped using SpectraCell because they’re on the verge of bankruptcy and taking months and months to get the results back. We used to use the SpectraCell micronutrient test, but I really like the NutrEval because you’ve got so much data.

Dr. Colon:            I really like SpectraCell a lot and still utilize them. Sometimes the NutrEval gives me more information than I wanted and will confuse a patient. Sometimes it doesn’t give me as much of the nutrient information that I may get from SpectraCell.

Dr. Weitz:            Take a look at the Vibrant version of the micronutrient test.

Dr. Colon:            Okay, I’ll look into that.

Dr. Weitz:            What do we do when we have patients with sleep disorders? What are some of the treatment protocols?

Dr. Colon:            It all depends on the disorder. Number one, you’ve got to identify the disorder. If the disorder is sleep apnea, you get that treated in weight reduction, positional sleeping, CPAP. If the disorder is-

Dr. Weitz:            In terms of weight loss, how much would you say on the average, let’s say you get a patient, a 5’9″ male weighing 260 pounds. Would he have to lose 10 pounds, 20 pounds, 40 pounds before he’d see a significant, just on average, difference?

Dr. Colon:            There is no magic number at all. That doesn’t exist. People are going to lose a certain amount of weight, period. Once they’ve gotten to that, you can retest them.    I had someone who had a sleep apnea that lost seven pounds. When I retested them, they were negative. I’ve had people lose 30 pounds and still have some residual sleep apnea. There is no magic number.

Dr. Weitz:            We’ve got weight loss. What are some of the other treatments?

Dr. Colon:            Let’s say that you have a different disorder. Let’s say you have restless legs or periodic limb movement disorder. There’s medical treatments, there’s pharmacological-

Dr. Weitz:            Maybe you could explain what that is for folks who are not familiar with restless legs.

Dr. Colon:            Restless legs are uncomfortable sensations in your legs. It’s worse at night, relieved by movement. Periodic limb movement disorders are limb movements that occur in your sleep that sometimes are associated with restless legs but not necessarily, and they can cause a lot of sleep fragmentation.  Restless legs, uncomfortable sensations. Limb movements, we move. This person’s moving during the night. This one’s okay. The brain’s all right as opposed to this person, their leg movements are frequent enough and forceful enough to where it is disrupting sleep quality there. There is pharmacol therapy for that, but there’s also some nutritional deficiencies that can cause that. Magnesium deficiencies, iron deficiencies, they can cause restless legs and PLMD. Also, GI issues [crosstalk 00:36:13].

Dr. Weitz:            Magnesium and iron, what are the best tests for magnesium status and iron status?

Dr. Colon:            I’ll go back and say either a micronutrient profile are the best. Serum whole blood testing you can do, but with serum whole blood testing, you get a fluctuation of what you had over the last 24 hours. A micronutrient test is the best way to test for that.

Dr. Weitz:            What about for iron?

Dr. Colon:            Iron is just blood studies. Just flat out iron [crosstalk 00:36:51].

Dr. Weitz:            Do you look at serum iron? Do you look at ferritin? Do you look at-

Dr. Colon:            Ferritin. Ferritin. We actually look at ferritin. Ferritin is supposed to be normal if it’s 30 or 40; however, any ferritin under 70 can give you symptomatic restless legs.

Dr. Weitz:            What other nutritional deficencies are there?

Dr. Colon:            For insomnia, zinc is one. Oleic acid is a big one for insomnia as well. B vitamins-

Dr. Weitz:            For some folks who don’t know what oleic acid is …

Dr. Colon:            Oleic acid is just that.

Dr. Weitz:            Basically it’s Omega-9 olive oil, right?

Dr. Colon:            Yeah, yeah. You need it in order to make neurotransmitters. B vitamins can affect circadian patterns. B-6 helps improve dream recall, so it can affect REM sleep. Zinc I had mentioned as well. There’s a number of different micronutrient deficiencies that [crosstalk 00:38:05].

Dr. Weitz:            What do you like the best marker of B vitamins? Again, you use the NutrEval or do you like homocysteine levels or …

Dr. Colon:            I like micronutrient profiles.

Dr. Weitz:            We got nutritional deficiencies. Are there specific dietary factors that can play a role?

Dr. Colon:            Of course there’s dietary factors that can play a role. If your diet is depleted in something, you’re not going to absorb it, but equally, if your gut is not absorbing nutrients, then you’re going to be depleted. My girl with Lupus there, she had every single micronutrient deficiecy that we can have. She’s like, “But I eat healthy.” I’m like, “Listen, you’re not absorbing it. We’ve got to heal the gut.”

Dr. Weitz:            What did you do for her?

Dr. Colon:            Actually, what I did is first I slapped on, and I didn’t literally do it, but I prescribed multi-vitamin patches. Her gut isn’t absorbing it. We’re working with the micronutrient patch. Then the other thing that we’re going to do is we’re going to [crosstalk 00:39:17].

Dr. Weitz:            Wait, where do you get micronutrient patches from? I’m not familiar with those.

Dr. Colon:            Where do you get anything? You get it on the internet. If you don’t find it on the internet, it doesn’t exist.

Dr. Weitz:            I know, but is there a particular company that you trust for micronutrient patches?

Dr. Colon:            Patch MD multi-nutrient patches.

Dr. Weitz:            Okay.

Dr. Colon:            Patch MD. They also make melatonin patches as well which are good in these kids that can’t swallow pills and won’t take anything. We started with a multi-vitamin patch with her and then we’re going to fiber the gut, a little bit of Inflam-Eze from Nutri-dyn, probiotics, digestive enzymes. A month or two later, after we go through some of this treatment, then we’re going to revitalize the mitochondria and start taking in oral vitamins and Omegas. For right now, we’re just healing the gut and getting the nutrients through the patch.

Dr. Weitz:            I interviewed a dentist at some point who also specializes in sleep apnea. He felt that Vitamin D was potentially a big factor in sleep problems as well.

Dr. Colon:            Yeah, it is. Vitamin D is associated with fatigue but it’s also associated with poor upper airway tone. Vitamin D deficiency can provoke sleep apnea.

Dr. Weitz:            Then, of course, we have blood sugar issues.

Dr. Colon:            Yeah. An untreated sleep apnea can negatively affect blood sugar control.

Dr. Weitz:            And probably [sersa 00:41:05] too, right?  Blood sugar fluctuations can affect sleep. There’s a huge percentage of the population that’s diabetic or pre-diabetic or on their way to it.

Dr. Colon:            The newest evidence shows that high carbohydrate diets really negatively affect sleep.  High glycemic foods before bed likewise. Something [crosstalk 00:41:28].

Dr. Weitz:            Now, you do have some people saying I need the carbohydrates to give me the serotonin release. What’s the reality there?

Dr. Colon:            What happens with alcohol?  Alcohol is sedating but then once the alcohol wears off, you get sympathetic surge. That sympathetic surge disrupts the second half of the evening.  Likewise, high carbohydrate states, they may be sleep-inducing, but once the carbohydrate comes down, it plummets down, guess what comes up? Epinephrin and norepinephrine then comes up. Quality carbohydrates to make your serotonin, yes. Milk and cookies before bed, no.

Dr. Weitz:            Or maybe better some quality fats.

Dr. Colon:            Oleic acid.

Dr. Weitz:            Especially when you have people with blood sugar issues or even type 2 diabetics, they sometimes have trouble maintaining an even blood sugar throughout the night. If their blood sugar drops too much, that can wake them up as well.

Dr. Colon:            Dr. Ben, you know your stuff.

Dr. Weitz:            I think those were the bulk of the questions that come to mind. What other issues would you like to cover, or do you think we pretty much covered it?

Dr. Colon:            No, I appreciate you having me. We’ve covered it. There’s an epidemic of sleep loss during this COVID. Then that epidemic leads downstream to weight gain because of sedentary lifestyle and people being up late eating. That’s something called insomnia-nom-nom-nom-nom-nom-nom-nia.

Dr. Weitz:            By the way, if somebody wakes up in the middle of the night, what is the best thing for them to do? Everybody seems to have something different. One person told me she likes to listen to the radio. Some people turn on the TV. Some people read. Some people get out of bed. Some people feel like if they eat something, it’s going to help them go back to sleep. What do we know about the science, about the best thing to do if you wake up in the middle of the night?

Dr. Colon:            Meditation is great. I’ve been able to put myself [crosstalk 00:44:01].

Dr. Weitz:            Is it better to stay in bed and meditate, or is it better to get out and get back in?

Dr. Colon:            If you’re frustrated, get out of bed. If you’re able to stay calm, just stay in bed and meditate, either an awareness of breath or a body scan meditation. If you’re an anxious person, progressive muscle relaxation. That’s my go-to.  If you want to look at botanicals, I really like L-Theanine. L-Theanine cuts down mind chatter. Athenian is good for reducing anxiety. It’s not sedating. You may say then why are you using it for sleep. You can use L-Theanine during the daytime and not be sedated, but if you wake up in the middle of the night, the last thing that you want is something that’s going to be really sedating because then you’re going to be groggy the next day.  That’s when a liposomal L-Theanine will be helpful. Nutri-dyn makes a good one. Magnesium can be helpful as well. Again, not sedating but there’s things that are calming. Combining that with-

Dr. Weitz:            Quicksilver makes a liposomal L-Theanine as well. In general, in terms of sleep supplements, we have melatonin, 5-HTP, magnesium, L-Theanine, we have these combination products. I think there’s a common thought in the functional medicine community. I’ve heard a lot of people say, and I’ve used this thought process as well, if you have trouble falling asleep, then melatonin is going to be helpful. If you have trouble waking up, then 5-HTP is going to be better. Do you have some thoughts about that or is it better to combine them? Is it useful to add GABA to that mix?

Dr. Colon:            GABA can help reduce anxiety. Everything that you said is correct towards that particular person. Sometimes you can shotgun and try everything. Other times, don’t guess, test. I like doing neurotransmitter profiles. The ZRT neurotransmitter profile with the epinephrin and the melatonin cortisol profiles is money, man. I’ve seen some. It’s been really helpful.  You were mentioning that there were a bunch of different products. Nutri-dyn, again, they make some really good ones. They have this Liposomal Sleep that’s incredible. It’s sublingual, it’s got five milligrams of melatonin, B vitamins, GABA that you mentioned, and then also oleic acid.

Dr. Weitz:            Cool. Okay, Jose, Dr. Colon, how can patients get a hold of you if they want to contact you to get a sleep study or consult with you? You have a number of books available as well, right?

Dr. Colon:            I do. I have some books available. We can go to paradisesleep.com. There, the books can be found. There’s some general inquiries that you can place in there.  Actually, I work for Lee Health in southwest Florida. Essentially, I work for the state of Florida because it’s a government-owned medical system. I have to see my patients from Lee Health, but I do have a website called paradisesleep.com that has a lot of resources for sleep. There’s a place to reach out and ask a question if you need to.

Dr. Weitz:            Do you have any training programs for practitioners?

Dr. Colon:            I don’t have any training programs for practitioners. No, I don’t.

Dr. Weitz:            That’s something you probably should add to your bucket list, do a training program for doctors. That would be something that would be in demand.

Dr. Colon:            I’ll bounce it off of a friend of mine and we’ll see what we can do.

Dr. Weitz:            Sounds good, doc. We’ll talk to you soon.

Dr. Colon:            All right, my pleasure. Thanks for having me.



Parasites and Gut Health with Dr. Ilana Gurevich: Rational Wellness Podcast 176

Dr. Ilana Gurevich speaks about Parasites and Gut Health 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


3:45   Dr. Gurevich said that she finds that in her speciality GI practice 60-70% of patients that she sees with functional GI disorders also have a protozoa or another form of parasite. 

4:17  If the testing shows multiple problems with the GI tract, such as SIBO, a parasite, fungal overgrowth, and bacterial overgrowth, it can be a diagnostic conundrum which to focus on first.  Dr. Gurevich finds that the patient’s history can help determine if the focus should be on the small bowel or the large bowel. If the patient has had lifelong symptoms, then you should focus on restoring the microbiome in both the small and the large bowel.  If the symptoms came on after a recent onset of food poisoning, it might be small bowel IBS.  If it came on after international travel, then you should suspect parasites. If there is a lot of bloating and abdominal pain, then you might want to focus on the small bowel. We have effective testing for bacteria in the small bowel (SIBO breath testing), but there is no good way to rule out parasites, protozoa, or yeast in the small bowel without doing a small bowel aspirate, which is not commonly done in clinical practice. Dr. Gurevich said that she will prioritize treating worms first, parasites next, protozoa next and microbiome and biofilms next.  It’s interesting what giardia does in the lumen of the intestine, which is that it changes the microbiome. [Here is a paper describing this phenomenon: Barash NR, Maloney JG, Singer SM, Dawson SC.  Giardia Alters Commensal Microbial Diversity throughout the Murine Gut. Infect Immun. 2017;85(6):eoo948-16.]   If the patient has microbiome issues and giardia, then it makes sense to get rid of the giardia, which then may fix the microbiome problems. 

8:09  Some practitioners will also do a second stool test that focuses more on the microbiome, but Dr. Gurevich said that we still don’t know enough about the microbiome to really make too much of a definitive analysis from this.  But if she is looking at a microbiome stool test and she sees pseudomonas, she will suspect that there’s a biofilm, which means that there could be parasites, protozoa, and worms that are hiding in the biofilm.  If staph and strep are present, that will also make her suspect that there is a biofilm present.

11:52  There are certain parasites that can show up on a stool test like blastocystis hominis and dientamoeba fragilis that may or may not be pathological.  [Dr. Hawrelak recently appeared in episode 169 of the Rational Wellness podcast and he feels that these protozoans–blasto and D. fragilis–when found are not usually pathological and do not warrant treatment.]  Dr. Gurevich noted that she tried not treating blasto and D. Fragilis after hearing Dr. Hawrelak speak and she was not getting great results, so she went back to treating such patients and this worked better.  She often uses the antiparasitic drug, Alinia, usually for 21 days.  For the parasite, Giardia, she will use two 10 day courses separated by 10 days. Her treatment protocol will vary depending upon when the full moon and the new moon are.  She will do 10 days of Alinia and then the next 10 day cycle she may start 7 days before or 3 days after the next new moon or full moon.  She might use herbal antimicrobials in between these treatment cycles.  Her favorite antifungal product is Clear Four by Pharmax.  Dr. Gurevich notes that she has not had good success using herbal protocols for treating parasites.  She has tried mahonia, wormwood, black walnut, though she has not tried mimosa pudica.  She tried using Paraguard, a popular herbal combination product for parasites and not had much success.  Dr. Gurevich also finds it helpful to treat Dientamoeba Fragilis, though she is not so sure about endolimax nana, which she thinks may be a normal variant. 

27:35  Calprotectin is a marker for inflammation on the GI Map stool test that I have found does not always correlate with the symptomatology and what would appear to be a lot of inflammation in the gut.  Dr. Gurevich likes to run zonulin on all of her patients because if it’s positive it indicates that her treatment protocols should focus more on the small bowel than the large bowel. 

29:42  Dr. Gurevich noted that quercetin works really well in healing leaky gut. She recommends quercetin at a dosage of 2000 mg three times per day for one month.  She noted that if you used such a high dosage of quercetin, it can interfere with thyroid conversion of T4 to T3.  Quercetin is also a zinc transporter, so it helps in immune protocols and there is on study showing it helps to heal leaky brain barrier, so it is helpful for patients after concussions.



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

Dr. Ben Weitz is available for nutrition consultations, 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 us today. For those of you who enjoy the podcast please give us a rating and review on Apple Podcast. There’s a video version on my YouTube page and if you go to my website, drweitz.com you can find complete show notes and a detailed transcript.

Today, we’ll be discussing stool testing interpretation, parasites, and gut health with Dr. Ilana Gurevich. I recently had a fascinating discussion about parasites with Jason Hawrelak and I really wanted to get another perspective on how we should view parasites when they show up on a stool test and how best to treat or not treat them.  Dr. Ilana Gurevich is a board certified naturopathic physician, an acupuncturist, and she currently co-owns two large integrative medical clinics in Portland. She runs a very busy private practice specializing in treating inflammatory bowel disease as well as IBS and SIBO, and other functional GI disorders. Thank you Dr. Gurevich for joining me today.

Dr. Gurevich:                     Thank you Ben for having me again, and I would also just like to say in person your questions, because I listen to a lot of your podcasts, the amount of knowledge that goes into the questions I stop listening and I get so excited. You did an osteoporosis podcast and I swear to God I probably sent it to 10 people.

Dr. Weitz:                          Wow, cool.

Dr. Gurevich:                     It’s like the breadth of knowledge that goes into your questioning I’m sure that you are busting your butt and it is a ton of work doing the podcast-

Dr. Weitz:                          Absolutely.

Dr. Gurevich:                     … so you can get it done.

Dr. Weitz:                          Yeah.

Dr. Gurevich:                     For all the people who are listening get it done.

Dr. Weitz:                          You know what? For me, it’s kind of cool because I always loved school and I feel like I’m always in school because-

Dr. Gurevich:                     That’s funny because what I love about podcast, especially yours, is I feel like I’m going to a webinar, tossing me on my butt and driving somewhere before doing my dishes.

Dr. Weitz:                          Right.

Dr. Gurevich:                     So thank you.

Dr. Weitz:                          You’re welcome. Thank you. Thank you. I thank you for noting that. So as an introductory question how’s your practice doing in the midst of this continuing coronavirus pandemic?

Dr. Gurevich:                     So the positive thing is because since I’m so specialized really my practice very easily transitioned to online. The bummer is what I also do is acupuncture and that does not transfer online. What I have been noticing is a lot of the mental health stuff that people are dealing with in COVID in isolation I was trying to put them on meds, lots of people are suffering from anxiety, through insomnia. I was trying supplementation. I was trying medication. And at some point I was like, can you just come in for some needles, because acupuncture and getting people back in rhythm that fixes a lot of the mental health that suffering people are dealing with right now.

Dr. Weitz:                          Yeah. Yeah, absolutely. All this isolation, especially older people it really makes it difficult.

Dr. Gurevich:                     Yeah, and our clinic I think just like your clinic and every other clinic is taking crazy high end precautions, but sometimes a virtual visit which is totally doable does not replace an in person visit.

Dr. Weitz:                          No, absolutely. I totally agree with that. The chiropractic there’s no way to have a six feet distance giving chiropractic, so we sanitize and we use masks and require everybody else to use masks. So far, we’ve been good, so knock on wood.

Dr. Gurevich:                     Yeah. I’m with you.

Dr. Weitz:                          So how often in practice do you see a parasite on a stool test that may be playing a role in a patient’s health?

Dr. Gurevich:                     Okay, so I’m going to qualify that with my practice is very specialized.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     So by the time somebody waits to see me they’ve probably seen their standard medical GP. They might have even seen another functional medicine provider, so by the time they get to me they’ve been through the ringer, and in my practice for the functional GI disorders 60%, 70% I find is linked to some kind of protozoa or parasite.

Dr. Weitz:                          Wow.

Dr. Gurevich:                     Yeah.

Dr. Weitz:                          So in general, what if you find multiple things, because I know one of my standard protocols a lot of times for gut problems if patients are willing is when they have these sort of IBS type symptoms, gas, or bloating, or diarrhea, or some of the other type symptoms we’ll tend to screen them for SIBO as well as doing a good stool test and it’s not unusual to find several different layers and it’s always a diagnostic conundrum, what do you identify as the primary thing to focus on?

Dr. Gurevich:                     So I actually have a priority. It all comes down to taking a really good history. In that history you want to figure out when their symptoms, has it been lifelong, because if it’s lifelong ever since they’re a kid you’re thinking microbiome. It’s not likely that a newborn baby had some kind of parasite infection, so if it’s lifelong now I’m thinking microbiome. I’m going to think small bowel and large bowel. If it’s some kind of after a recent onset of some kind of foodborne illness that would lead what kind of testing I’m going to do. If it was after some kind of international travel that’s going to lead to the kind of testing I’m going to do. And then, based on also their conglomeration of symptoms, is it really a lot of bloating, distention, pain, small bowel like things?  There is no good way to rule up protozoa, or parasites, or yeast in the small bowel. We have really effective testing for bacteria in the small bowel but that’s it, unless you’re going to do a small bowel aspirate, which no one’s going to do.

Dr. Weitz:                            Right.

Dr. Gurevich:                     If it’s sounding like way more of a large bowel issue then I’m going to think, okay, I want to go down that path and work up the large bowel. When I get results I will always prioritize with treating parasites, protozoa, and worms, and the reason for that is I feel like it’s really well documented that those things change the microbiome. And so, why start anywhere else if sometimes resolving the protozoa or parasitic infection is going to fix the microbiome small bowel issues or the microbiome large bowel issues? And there was a really interesting study and I can get it for you to put in the show notes.

There’s a really interesting study on giardia in particular where they looked at how giardia behaves in the lumen of the intestine. There are parasites that will go and get themselves in the intestine of the human and they’ll be blood, and they’ll be mucus. That’s not what giardia does. What giardia does is it changes the microbiome, right? And so, I’m not going to go after treating a microbiome issue if it’s going to be caused by a parasite that will then correct if you give the body the right enviroment.  And so, I always start there, and worms come first, parasites come next, protozoa come next, microbiome and biofilms come after that, and so that’s my triangle of care.

Dr. Weitz:                          And what’s your preferred stool test or do you use multiple tests?

Dr. Gurevich:                     I really don’t. I really love the GI-MAP.

Dr. Weitz:                          Right.

Dr. Gurevich:                     I love the GI-MAP.  I love it for the money because they have some insurance coverage so like 250 with insurance coverage, 450 without.  I love it because it also gives me functionality and the one thing, I had this ah-ha moment maybe a year ago that I was way under diagnosing exocrine pancreas insufficiency and bile acid malabsorption.  I was missing it and these chronic diarrhea patients were not getting better.  And then, what I always do is I convince somebody to pay me to give them a talk and then I go and do this really deep dive into what do we know about it in the literature, what do we know about it naturopathically, what are our mentors doing empirically with treatments, and when I started realizing this was a huge chunk of my IBS patients and a little bit of my IBD patients it just changed everything, and so the GI-MAP gives me that too.

Dr. Weitz:                          Right. I know some practitioners will do a separate test that’s maybe more specialized on just the microbiome.

Dr. Gurevich:                     I feel like what we are assuming we know about the microbiome is way more than what we actually know about the microbiome.

Dr. Weitz:                          Right, yeah.

Dr. Gurevich:                     But I will also say when I’m looking at the microbiome stool tests there are a couple of things that trigger my thinking. One, is pseudomonas. I feel like with pseudomonas, like I am assuming that if I see pseudomonas on a sample there’s going to be a biofilm there, and then that will shift my thinking to, A, if there’s a biofilm there I could be really missing protozoa, parasites, and worms because they’re hiding, and B, the whole test, like the whole pathology test is a little bit of a question mark because I think things are hiding behind the biofilm.  Strep and staph are the other things that sometimes peak my thought process about biofilm. Pseudomonas always does. Strep and staph if they’re high then that will also inform my thinking.

Dr. Weitz:                          So if staph comes up at all, but maybe it’s still within the reference range do you worry then?

Dr. Gurevich:                     I think it depends. I think it depends on what the rest of the test is looking like.

Dr. Weitz:                          Right. And do you think there’s a problem with false positives with PCR testing for parasites?

Dr. Gurevich:                     I think that there’s a bigger issue with false negatives then there are false positives, but I think there is a likelihood for having false positives as well.

Dr. Weitz:                          Right, because there’s kind of been a debate over the years about what’s the best way to determine parasites and one of the thoughts or criticisms of PCR is there could be potentially evidence, DNA evidence, of a parasite that’s no longer there.

Dr. Gurevich:                     That seems very counterintuitive to me because if they’re segmenting, if they’re taking the DNA segments-

Dr. Weitz:                          Right.

Dr. Gurevich:                     … and I will be honest I have not looked at the literature for this.

Dr. Weitz:                          Right.

Dr. Gurevich:                     But if they’re taking the DNA segments then I feel like if it’s not there what am I seeing. There’s a study that really changed my mind about DNA PCR which was in 2016 that it’s my favorite study. They compared ova and parasite sugar salt stain, immunofluoroscopy, and DNA PCR with known giardia, and it was so gross. The ova and parasite was something like 17 cysts per sample. The sugar salt stain was like 300 something cysts per sample. Immunofluoroscopy found 117,000 segments, and DNA PCR found 300 and something thousand segments.  And so, then I was like, okay, well that’s amazing, and that tells me that’s the best one to use, but they also found that the testing was 64% sensitive, so 56% false negatives.

Dr. Weitz:                          Wow.

Dr. Gurevich:                     Was my math … No. 46% false negatives.

Dr. Weitz:                          False negatives rather than false positives.

Dr. Gurevich:                     False negatives on that particular study, and I looked, I tried to find any literature that I could on comparatives of the different stool testing essays and that was the only study I could find.

Dr. Weitz:                          Yeah.

Dr. Gurevich:                     But I haven’t looked in a couple years.

Dr. Weitz:                            Yeah. No, we’re big fans of the GI-MAP as well, but I know some practitioners like to use two stool tests. I know Ruscio always talks about using-

Dr. Gurevich:                     [crosstalk 00:11:36].

Dr. Weitz:                            … like a PCR test and a culture test.

Dr. Gurevich:                     I mean, I’m thinking it would be amazing and expensive.

Dr. Weitz:                          Right. Yeah, yeah, yeah. That’s always an issue.

Dr. Gurevich:                     Yeah.

Dr. Weitz:                          Okay, so let’s talk about some parasites that show up on a stool test like blastocystis hominis and dientamoeba fragilis that may or may not be pathological depending upon what article you read or who you listen to.

Dr. Gurevich:                     Mm-hmm (affirmative). Mm-hmm (affirmative). So I do generally go after those and treat those. I’ve listened to Jason Hawrelak. I think he’s an amazing amazingly intelligent person. I think he’s been in practice for a long time, and after I started listening to his talk because he’s out now talking a lot about blastocystis hominis and dientamoeba fragilis, and I pulled back on treating them and I tried to do a lot of the other things and I just was not getting a great amount of efficacy and I have been really narrowing into parasites and protozoa for probably the last seven to eight years. I feel like the time they come to me and they have these unresolved symptoms going after the parasites and protozoa it does make a big clinically difference. It really does.  So for blastocystis hominis I usually use a longer course of Alinia. I find that it’s been the most successful.

Dr. Weitz:                          How long a course is that?

Dr. Gurevich:                     21 days.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     I use 21 to 30 days straight. For giardia, I’ll use two 10-day courses.

Dr. Weitz:                          So do you do like 10 days, stop for 10 days, and do another 10 days.

Dr. Gurevich:                     Around the full and new moon because I’m still a naturopath. What I do is I look at the full and the new moon because there is so much empiric evidence and such a history of parasites and the moon, so-

Dr. Weitz:                          So maybe you can explain where this is coming from.

Dr. Gurevich:                     Okay. So there’s a huge amount of empirical information about during the full moon and during the new moon the parasites are going through their cyclical cycle of hatching and laying eggs. I will also say that I come from a long line of psychiatrists and my father happens to be an incredible holistic psychiatrist, and he will always say it’s a full moon. Everybody who’s teeter tottering on that edge of sanity they’re going into the hospital.  And so, I come from this history and then as a naturopathic physician you just see that people feel worse, they get crazier. It feels like the water is boiling a little bit hotter around the full moon. And so, what I’ll do, the way I’ll cycle it out and it’s a little bit confusing is I like to treat for 10 days, so I’ll look at the next full or new moon and start treatments seven days before, and go three days after, right? So a 10-day cycle, and then we give them a break until three days before the next new moon or full moon, start then, and go for 10 days.  And in the interim of that-

Dr. Weitz:                            And by the way, the rational is that the parasites … First, you’re killing the parasites and they may have laid eggs and that the eggs are not going to hatch while you have the antiparasitic drugs in the system, correct?

Dr. Gurevich:                     Right. And then, if they have fungal overgrowth that comes up too, or maybe some kind of microbiome stuff. I might use herbs in the middle of those 10 days just to really try to cover as much because remember parasites and protozoa change the microbiome, and if you’re trying to get much more to a functional microbiome help supporting that with herbal antimicrobials can help.

Dr. Weitz:                            Now, I know a lot of patients are kind of apprehensive about taking antifungal drugs and there are a certain amount of side effects that occur depending on the patient, so what are your favorite herbal protocols?

Dr. Gurevich:                     You know what my favorite, favorite, favorite product is, which I can’t get right now? My favorite herbal fungal product is something called Clear Four. It used to be called Candaclear Four.

Dr. Weitz:                            Oh, okay.

Dr. Gurevich:                     It’s by Pharmax. I swear to God there is some kind of magic in that product. And so, the way that product works is it’s like garlic, cinnamon, oregano, and a probiotic, and there are four tablets, or there’s a tablet and three capsules, and I think maybe it works so effectively because I’m dosing it three times a day. The tablet which is mainly garlic in the morning, the two middle capsules with lunch, and the probiotic for dinner, and it’s a 30-day course, but for fungus I find that there is nothing that I find as effective as that particular product for fungal overgrowth.

Dr. Weitz:                          And what about for the parasites instead of Alinia?

Dr. Gurevich:                     I have never had good success with parasitic treatment and not using drugs, ever.

Dr. Weitz:                          Ever?

Dr. Gurevich:                     Ever. And I tried, but I’m not a herbalist. I think that herbalists are probably going to be more aggressive than I am. How much mahonia can you really have somebody drink before they want to kill you and they’re not compliant?  So I feel like I’ve heard things about Mimosa Pudicas.

Dr. Weitz:                            Right, yeah.

Dr. Gurevich:                     I’ve heard about that. I’ve tried wormwood. I’ve tried black walnut, ParaGuard, it just never. I tried it for years. Sorry.

Dr. Weitz:                            Yeah. No, that’s okay. Everybody has their own experience. We get pretty good results with wormwood and some of the combination products. We use ParaGuard and a concentration-

Dr. Gurevich:                     Yeah.

Dr. Weitz:                            … of wormwood and garlic. I guess some of the data shows garlic can be very effective.

Dr. Gurevich:                     Yeah. I will also cop to the fact that I might be lazy. There is definitely that possibility.

Dr. Weitz:                          Right. Right. And so, if you have a patient who has SIBO and a parasite and you treat the parasite with Alinia do you find that the SIBO resolves, or do you-

Dr. Gurevich:                     At times, for sure.

Dr. Weitz:                          Like what percentage of cases do you have to go ahead and treat the SIBO afterwards?

Dr. Gurevich:                     So that’s a really interesting question because if they come in and they look like they have a large bowel predominant issue I won’t test for SIBO, so sometimes they come in-

Dr. Weitz:                            What does that mean, they look like they have a large bowel predominant problem?

Dr. Gurevich:                     For me to do a small bowel workup I’m looking for bloating. I’m looking for belching. I’m looking for reflux or GERD. I’m looking for some kind of distention. Diarrhea might be there but there’s something that’s telling me that the small bowel is trapping some kind of gas, because I feel like you have air in your stomach you burp, you have air in your large bowel you fart, you have air trapped in your small bowel you bloat, and there is an appropriate amount of bloating that happens to all of us after eating but if it seems excessive, and people are showing me the pregnant abdomen pictures of just bloat, that’s a small bowel workup for sure.  If bloating is not their issue, if it’s more constipation, if it’s more diarrhea but there doesn’t seem to be a big small bowel component I’m going to start by looking at the large bowel.

Dr. Weitz:                            I always have trouble with this whole bloating thing. It’s hard to sometimes correlate when the patients complain about bloating with what we see, and some patients complain about bloating and we sometimes have a tough time figuring out exactly what’s meant by bloating. Sometimes they say they have bloating and it doesn’t appear to be any bloating and they feel it, and then we have some patients that complain about bloating and I think they’re probably just in some cases overweight, not really bloated.

Dr. Gurevich:                     I totally agree with you. Ruscio had this podcast a couple of years ago with this doctor out of the UK.  He was like a tertiary specialist, like to get through the IMH, to get [crosstalk 00:19:49].

Dr. Weitz:                            Oh, yeah. I think I heard that guy.

Dr. Gurevich:                     He was really interesting because he basically was like there are two forms of bloating, and he had this belt that was created called the Bloat-O-Meter. Yeah.

Dr. Weitz:                          The Bloat-O-Meter?

Dr. Gurevich:                     Basically, exactly what you’re saying, there’s the internal pressure that people feel but don’t look distended and then there’s the physical distention that you can see that you can measure with belt loops.

Dr. Weitz:                          Because theoretically the small intestine doesn’t really expand very much and that’s why they feel bloating when there’s gas in the small intestine whereas they don’t feel the bloating when it’s in the large intestine because it’s able to distend, so I always wonder how can it really be that they have this big bloated stomach if it’s coming from the small intestine which really can’t expand very much.

Dr. Gurevich:                     I mean, I think it depends on their morphology. I had a patient who I saw yesterday and she was complaining of bloating. That’s her biggest complaint. She was like this is about average, and I’m looking at her abdomen and I was like, “That looks completely normal.” I think that there’s also that picture of dysmorphia which also plays into some of this.

Dr. Weitz:                          Right.

Dr. Gurevich:                     So I think it is a tricky, tricky thing, but if they’re telling me that that’s one of their symptoms I’m going to start with the small bowel first. If they’re telling me that their symptoms are more defecation related then I’m going to start with the large bowel first and I’m going to start looking at what I can find in there. And then, if we treat and they’re not getting a lot better then I might reflex to a small bowel test. So that’s where it’s tricky for me to give you a percentage because it depends on their history of where I’m going to start a workup.

Dr. Weitz:                          So when you say a small bowel test essentially you’re talking about the SIBO breath test?

Dr. Gurevich:                     Yeah. I’m talking about the SIBO breath test.

Dr. Weitz:                          Okay. Are there any other small bowel tests that you utilize? No?

Dr. Gurevich:                     No. There’s a lactulose mannitol-

Dr. Weitz:                          Okay.

Dr. Gurevich:                     … which I think is a small bowel marker. I don’t use it very much despite the fact that I think it is the gold standard for intestinal permeability.

Dr. Weitz:                          Right. Now, I want to change the topic a little bit. H. pylori is something that shows up on stool tests.

Dr. Gurevich:                     Mm-hmm (affirmative).

Dr. Weitz:                          And the GI-MAP does a good job of having these virulence factors too, but if you get a stool test back with elevated H. pylori and let’s say maybe in patient one there’s no virulence factors do you do additional H. pylori testing? Like some doctors will order the antibody test or … What’s the other test? The breath test for H. pylori. Yeah.

Dr. Gurevich:                     I feel like if I see a virulence factor, if I see the CAGA, or the VACA virulence factor I’m going to move forward with treatments.

Dr. Weitz:                          So only those two?

Dr. Gurevich:                     One those two. One those two, yeah.

Dr. Weitz:                          Really?

Dr. Gurevich:                     Because it has been shown that those two are the ones that are most likely to cause issues. What ended up changing my mind on this was, did you ever read that book Missing Microbes?

Dr. Weitz:                            I know about it but I never read it.

Dr. Gurevich:                     Read it. I mean, he made a really good case for the fact that if they’re not symptomatic H. pylori might really be one of the controllers of the microbiome.

Dr. Weitz:                            Right.

Dr. Gurevich:                     And so, if they’re not symptomatic and I see H. pylori I don’t want to kill anything that I don’t … That’s triple antibiotic therapy. You know what I mean? I’m not going to go after it.

Dr. Weitz:                            Right. I mean, we use herbs, but yeah.

Dr. Gurevich:                     Yeah. I mean, I’m not going to go after it. If they’re symptomatic I think it’s a different conversation.

Dr. Weitz:                            Right.

Dr. Gurevich:                     If they’ve had ulcers in the past I think it’s a different conversation, and if they have those two virulence factors I think it’s a different conversation, but generally speaking if I see it I say I’m not worried.

Dr. Weitz:                            So for people listening to this podcast who might not know H. pylori is generally understood to be the cause of ulcers in a significant percentage of patients and it was something that took a long time to finally be discovered, and the doctor who originally discovered this, Dr. Marshall, had a tough time with the medical community accepting it, and he had himself scoped and he drank H. pylori and then had evidence of an ulcer, and then took this triple antibiotic therapy and had evidence of improvements. H. pylori is now considered a significant potential pathogen, and it usually operates in the stomach rather than in the intestines and it burrows into all of the intestine and leads to acid production and ulceration and stuff.  But maybe it’s a question of degree. Maybe we want a certain amount of H. pylori-

Dr. Gurevich:                     Yeah.

Dr. Weitz:                            … as important for the health of the stomach.

Dr. Gurevich:                     That was his theory, and I feel like symptomatic is very different than a random finding on a test.

Dr. Weitz:                          Have you used the herbal protocols for H. pylori?

Dr. Gurevich:                     I have a couple patients who had. It’s a lot of work but they actually have had success.

Dr. Weitz:                          Right.

Dr. Gurevich:                     I have one in particular she was using mastic gum.

Dr. Weitz:                          Yes. Yeah.

Dr. Gurevich:                     She was using oregano. She was using meadowsweet. Actually, she was one where I was like, “Girl, we had a positive H. pylori with virulence factors.” She was scoped. They found it on scope. She treated it, she was re-scoped, and it was gone, so I think you can totally do it. I think it’s a lot of work, but I think you get a lot less side effects doing it that way than doing it with a drug.

Dr. Weitz:                          Right. Yeah. I know in my practice we have a lot of patients who have a history where somewhere along the line they got put on some antibiotics that seemed to play a significant role in their gut health getting much worse.

Dr. Gurevich:                     Worse. Yes.

Dr. Weitz:                          Right. So let’s see, any other parasites we want to talk about?

Dr. Gurevich:                     Dientamoeba fragilis is an interesting one.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     I feel like that also is the one that causes a lot of symptoms.

Dr. Weitz:                          And that’s another one that some people say is… normal to a healthy gut.

Dr. Gurevich:                     Yeah, so that one sometimes responds to Alinia. There’s one study that says that … God, I never remember how to pronounce this medication.  Praziquantel palmitate works a little bit better. I also will offer that one sometimes. I feel like it will change the microbiome and so that’s why I go after it. And then, often times treating it gets improvement.

Dr. Weitz:                          Right. Any other parasites that you see regularly?

Dr. Gurevich:                     Yes. I see endolimax nana as a tricky one-

Dr. Weitz:                          Okay.

Dr. Gurevich:                     … because I’m not sure. I feel like I’m more on Hawrelak’s side with endolimax nana. I feel like I’ve seen it and it doesn’t present how I expected to see, and sometimes I treat it and they don’t get better, so that one I won’t go after with drugs. I might give them some antimicrobial herbs for that one, so that one’s a little bit of a question mark for me. Those are the three that I see more than anything else.

Dr. Weitz:                          Okay. Do you see giardia?

Dr. Gurevich:                     But that’s a parasite. I don’t think anybody’s going to argue with you.

Dr. Weitz:                          Right. Right.

Dr. Gurevich:                     You treat giardia, you treat crypto-

Dr. Weitz:                          Right.

Dr. Gurevich:                     … you treat entamoeba histolytica. I don’t think anybody’s going to argue about that.

Dr. Weitz:                          Right. Right.

Dr. Gurevich:                     That’s not even controversial.

Dr. Weitz:                          Right. Now, one thing I find interesting coming back to the concept of the stool test is there’s at least one marker on the GI-MAP for inflammation, and it’s not unusual for my practice to see patients who have some significant issues in their gut, a lot of symptoms, and you sort of assume they’d have a lot of inflammation, and they may not at all.

Dr. Gurevich:                     Are you talking about the calprotectin or the-

Dr. Weitz:                          Yeah, yeah.

Dr. Gurevich:                     … zonulin?

Dr. Weitz:                          Yeah.

Dr. Gurevich:                     Are you running zonulins also, or no?

Dr. Weitz:                          Do you run zonulin regularly?

Dr. Gurevich:                     I run it on everyone, yeah.

Dr. Weitz:                          So now, that’s a measure of leaky gut, right?

Dr. Gurevich:                     Right. The reason why I find that useful is it’s the only small bowel marker on that entire test, like that is a large bowel test except for the zonulin because zonulin is literally a small bowel marker. The controversy with zonulin, there’s a couple controversies with zonulin, one all the research is coming out of this one particular lab, and so that’s always a question if people can revalidate what that lab has found.

Dr. Weitz:                          Is that Fasano’s lab?

Dr. Gurevich:                     Mm-hmm (affirmative). Yeah. And then, the other controversy with zonulin is there’re a couple of studies that are looking at zonulin and things that you would expect to make improvement in the zonulin doesn’t always, and I’m thinking dietary interventions in particular.

Dr. Weitz:                          Right.

Dr. Gurevich:                     So I feel like that lab’s an asterisk, and I feel like it doesn’t add very much cost, and that is the only that guides me towards … should I be also looking at the small bowel?

Dr. Weitz:                          I guess for me I started running it and it seemed like we didn’t get a lot of positives and I felt like most of these patients must have leaky gut based on their symptoms and history, and yet this test is saying they don’t so I wondered if this is really worth it.

Dr. Gurevich:                     So that’s funny because I had the opposite thinking with it. My thinking was, okay, so if it’s not positive that means that most likely I need to focus all of my attention on the large bowel.

Dr. Weitz:                          I see.

Dr. Gurevich:                     And if it is positive then I need to start thinking about the small bowel. And the other thing that I’ve discovered kind of haphazardly through clinical practice is quercetin works incredibly to heal up zonulin, which is interesting is I feel like-

Dr. Weitz:                          Just by itself, quercetin?

Dr. Gurevich:                     Just by itself. I use it at really high doses for a short amount of time.

Dr. Weitz:                          What’s a high dosage?

Dr. Gurevich:                     2,000 milligrams three times a day.

Dr. Weitz:                          Oh, wow. 2,000 three times a day. Wow.

Dr. Gurevich:                     For one month, because it does interfere with thyroid conversion of T4 to T3.

Dr. Weitz:                          What?

Dr. Gurevich:                     Mm-hmm (affirmative). Yeah, yeah, yeah.

Dr. Weitz:                          Quercetin reduces thyroid conversion?

Dr. Gurevich:                     Especially at those levels. Especially at those levels.

Dr. Weitz:                          Well, I’ve never used those levels but it’s interesting because we’re using quercetin a lot in the immune strengthening protocols.

Dr. Gurevich:                     I’m using it a lot with viral slash COVID.

Dr. Weitz:                          As a zinc transporter, yeah.

Dr. Gurevich:                     Yeah, and it’s phenomenal. It is phenomenal for that [inaudible 00:30:33] viral conglomerate.

Dr. Weitz:                          Right, but what are you usually 250 or 500 two or three times day?

Dr. Gurevich:                     Yeah. What? Ten times more [inaudible 00:30:42].

Dr. Weitz:                          Oh, really. Wow.

Dr. Gurevich:                     I ran 2,000 three times a day, and that’s what I’m using for the acute viral/COVID protocols also, but it works phenomenally. It also works phenomenally. There’s one study that showed that it’s really good for healing up the leaky brain barrier also.

Dr. Weitz:                          Really?

Dr. Gurevich:                     Mm-hmm (affirmative).

Dr. Weitz:                          Interesting.

Dr. Gurevich:                     I mean, for post-concussion syndrome … I have a great doctor I work with, Dr. Laurie [Mengado 00:31:06] who is very, very well versed in post-concussion syndrome where I send all my MCAS concussion people too. Also, I have this one patient that I sent to her, I saw her for GI, but she had a post-concussion history for like five years, and she was like, “Start her on quercetin. It’s amazing to heal up the brain barrier as well.”

Dr. Weitz:                          Wow. Well, you would expect that something that could help heal the leaky gut would also potentially help-

Dr. Gurevich:                     Heal the brain.

Dr. Weitz:                          … a leaky brain. Yeah.

Dr. Gurevich:                     Totally. And so, basically, the way I’ll use that in the format of a GI-MAP test is I will look, if I treat the large bowel I’ll figure out what’s there, and then I’ll do a GI restoration protocol and if zonulin is elevated I’ll really push quercetin in that protocol.

Dr. Weitz:                          You’ll do that after you’re done getting rid of-

Dr. Gurevich:                     Yeah.

Dr. Weitz:                          … the bacteria or parasites.

Dr. Gurevich:                     Because you kind of have to change the terrain to kind of heal everything up in there.

Dr. Weitz:                          Right. So what’s your favorite gut restoration protocol?

Dr. Gurevich:                     Oh, okay, so quercetin is definitely in there.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     I love zinc carnosine. Are you using zinc carnosine?

Dr. Weitz:                          We go back and forth on it. We tend to use a combination formula that had some zinc carnosine in it.

Dr. Gurevich:                     How many milligrams?

Dr. Weitz:                          It has glutamine.

Dr. Gurevich:                     Oh, like Endozin by Klaire? Do you use that one?

Dr. Weitz:                          I haven’t used that one. No. We usually use the … What’s it? GI Effects.

Dr. Gurevich:                     That one’s got a lot of things in it.

Dr. Weitz:                          GI Revive. Right. Designs for Health.

Dr. Gurevich:                     Designs for Health, yeah. That one has a lot of things in there. My only issue with that one is it doesn’t have high enough quercetin. That’s my only issue with it.

Dr. Weitz:                          Interesting. So you said how much of zinc carnosine are you using?

Dr. Gurevich:                     75 once to twice a day.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     If they have a lot of small bowel stuff glutamine’s always on my differential.

Dr. Weitz:                          Now, that zinc carnosine is not going to raise your intracellular zinc levels because it’s acting in the gut, right?

Dr. Gurevich:                     No. Zinc Carnosine, it’s not naturally produced at all. They take a zinc molecule and they bind it with an L-carnosine. It’s made in the lab, and the reason why I like it so much is because they have a couple of studies that basically show that for ulcers that were created because of radiation, so these are esophageal cancer and stomach cancer patients. They use zinc carnosine after treatment and before treatment and it took these radiation induced ulcers from a grade four to a grade two, or it stopped them from producing as actively.   And so, if they’ve shown that with radiation ulcers there’s no way that they [crosstalk 00:33:59].

Dr. Weitz:                          Oh, that’s interesting.

Dr. Gurevich:                     It’s amazing.

Dr. Weitz:                          What about the patients who have like fibrosis from radiation that they had?

Dr. Gurevich:                     I think it could be too late. I’m not sure.

Dr. Weitz:                          Too late, yeah. Yeah.

Dr. Gurevich:                     Yeah.

Dr. Weitz:                          We’ve been using a modified citrus pectin because that supposedly helps with fibrosis.

Dr. Gurevich:                     Is it working?

Dr. Weitz:                          A little bit.

Dr. Gurevich:                     You know what I think about for those people?

Dr. Weitz:                          Yeah.

Dr. Gurevich:                     Is frequency-specific microcurrent.

Dr. Weitz:                          Oh, okay.

Dr. Gurevich:                     Just because I feel like I don’t know if anything I’m going to give them orally, because it’s so scared over.

Dr. Weitz:                          Yeah.

Dr. Gurevich:                     I feel like it’s changing the way the cells work, which is what frequency-specific microcurrent does.

Dr. Weitz:                          Yeah. I wonder about maybe infrared light too.

Dr. Gurevich:                     Yeah, exactly. I’m thinking more like that, so like re-turn on the cells to function.

Dr. Weitz:                          Right, yeah. Yeah. There’s actually some interesting studies using infrared light for hypothyroid, Hasimoto’s.

Dr. Gurevich:                     Oh, really? Like localized over the thyroid?

Dr. Weitz:                          Yeah, exactly. Yeah. There’s some group out of Brazil that did several studies and got really interesting changes in the [inaudible 00:35:01] cells in the thyroid, actually significant reversal of this autoimmune process.

Dr. Gurevich:                     And you know, that’s not a very expensive intervention.

Dr. Weitz:                          No, I know. Exactly.

Dr. Gurevich:                     Wow. That’s really interesting, actually.

Dr. Weitz:                          Yeah.

Dr. Gurevich:                     Huh. That’s really interesting.

Dr. Weitz:                          So what else is part of your gut restoration protocol?

Dr. Gurevich:                     So quercetin, zinc carnosine, glutamine maybe, probiotics are always going to-

Dr. Weitz:                          What do you mean glutamine maybe?

Dr. Gurevich:                     So glutamine if it’s a small bowel. I’m not using glutamine so much for the large bowel because I feel like the enterocytes glutamine is their preferential treatment for food, but the colonocytes it’s something like 10%. Colonocytes really prefer butyric acid for their food. The trick with that is I’ve never seen butyrate ever. I’ve never seen butyrate do anything helpful.

Dr. Weitz:                          Okay. You’re talking about taking short-chain fatty acids like butyrate separately as a supplement.

Dr. Gurevich:                     Exactly. And I mean, maybe rectally, but that’s also expensive and uncomfortable.

Dr. Weitz:                          Right. So then, you’ve got to feed them the right prebiotics to produce-

Dr. Gurevich:                     Right.

Dr. Weitz:                          … the short-chain fatty acids.

Dr. Gurevich:                     And they have to have a microbiome that will accept the prebiotics.

Dr. Weitz:                          Right.

Dr. Gurevich:                     Or the patients to go through the die off that happens when they’re converting their microbiome. But I am loving prebiotics right now. I would agree, yeah.

Dr. Weitz:                          What’s your favorite prebiotic?

Dr. Gurevich:                     So I use two, Life Extension, it’s called Florassist.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     Which is a chewable. I think XOS. And then, I use a lot of Microbiome Labs, they have-

Dr. Weitz:                          Right.

Dr. Gurevich:                     … a prebiotic, but that one people who don’t tolerate dairy won’t tolerate that one.

Dr. Weitz:                          Right. It has FOS, XOS, and-

Dr. Gurevich:                     GOS, I think.

Dr. Weitz:                          … GOS. Yeah.

Dr. Gurevich:                     Yeah.

Dr. Weitz:                          Yeah, yeah, yeah.

Dr. Gurevich:                      So those are the two that I use and it really is if you tolerate dairy or not.

Dr. Weitz:                            Right. And then, do you have problems with patients who have SIBO taking some of these prebiotics?

Dr. Gurevich:                     I don’t start there.

Dr. Weitz:                          Right.

Dr. Gurevich:                     So I’ll go through a treatment round, and then one of the things that I have been really, really playing around with, which is interesting is using all three or four classes or probiotics simultaneously, so I’ll start them in a class, one lactobacillus bifido, at like 75 to 100 billion.

Dr. Weitz:                          This is like Rusio’s class system?

Dr. Gurevich:                     I totally got it from Rusio. I mean, he’s a very smart thinker.

Dr. Weitz:                          The problem I have with that system is when you look at all the data on probiotics so much of the data is strain specific, so to just basically take 90% of probiotics and go lacto bifido.

Dr. Gurevich:                     Okay. Yes, I agree with you. That being said, I feel like the goal is just diversity, right? How do we get any amount of anything? Like when I’m using my class one, the one that I’m using is Probiotic 10 by Protocols for Life Balance, or Super Pro-Bio by Kirkman, right? I like those, and they’ve got like 10 strains. You know what I mean?

Dr. Weitz:                          Right, but the thing is this is getting back to the same concept as there’s actually been really fascinating research done with lactobacillus, NCMF, 1463-

Dr. Gurevich:                     Right.

Dr. Weitz:                          And that particular one has a certain therapeutic value that just having 10 different ones in that category are necessarily going to have.

Dr. Gurevich:                     Absolutely, and there’s also been really interesting studies that take these combination formulas with like stenotrophomonas and a couple of the species lactobaccilus, and some bifido, and maybe some S. boulardii, and those seem to have efficacy too.

Dr. Weitz:                          Right.

Dr. Gurevich:                     I feel like it’s never in the human body which is so complex-

Dr. Weitz:                          Right.

Dr. Gurevich:                     … you’re never going to be able to isolate from one strain of probiotic.

Dr. Weitz:                          Right.

Dr. Gurevich:                     Which is why I’m like, okay, let’s throw it all at you, and then let’s throw in a prebiotic.

Dr. Weitz:                          So when you say three strains you said a combination product, a saccharomyces boulardii, and then a bacillus.

Dr. Gurevich:                     Four.

Dr. Weitz:                          Yes, four-based, yeah.

Dr. Gurevich:                     And then, sometimes E. coli Nissle 1917.

Dr. Weitz:                          Okay.

Dr. Gurevich:                     And so, I’ll do that for a month and then I’ll throw in a prebiotic for a month, right? Because I’m trying to get it to hold because the problem with probiotics, at the end of the day the problem with probiotics is they’re kind of like air conditioning. When you take them you can get people to feel better. When they stop taking them they go back to the diarrhea they were having before. That’s just a waste of money. I don’t want somebody on a pill.

Dr. Weitz:                          Well, it’s also because you’re taking some grass seeds and just throwing them across the ground.

Dr. Gurevich:                     Right.

Dr. Weitz:                          Right? So they’re not necessarily going to take root.

Dr. Gurevich:                     [crosstalk 00:39:41].

Dr. Weitz:                          So you need the prebiotics which is-

Dr. Gurevich:                     Right.

Dr. Weitz:                            … the fertilizer.

Dr. Gurevich:                     Right, and you obviously need the foundation of every kind of functional medicine. You need them to have a good diet. You need them to be eating fermented foods. The more the better. You need them to be eating fiber naturally in the diet so they’re not relying on a pill. All of that goes without saying. You know what’s interesting?

Dr. Weitz:                          It’s really hard to get like 40 grams of fiber a day not taking an additional product.

Dr. Gurevich:                     I would agree, and I think that patients who seek out functional medicine or naturopathic medicine are way more motivated than the standard American patient, and so if anybody’s going to do it, it’s totally going to be them.

Dr. Weitz:                          Right. Right.

Dr. Gurevich:                     And a smoothie can get you … It’s amazing how much you can shove into a smoothie.

Dr. Weitz:                          Yeah. Yeah. What I have in the morning I don’t think you could actually call it a smoothie but-

Dr. Gurevich:                     Exactly.

Dr. Weitz:                          … kind of like just black goopy mess.

Dr. Gurevich:                     But you’ve met all of your dietary needs in one meal.

Dr. Weitz:                          Exactly. Okay. So I think that about wraps it for me. Any final thoughts you want to leave our listeners and viewers?

Dr. Gurevich:                     Yeah. I just really want to say it’s complicated. It’s complicated, and the nice thing, the luxurious thing for me being as specialized as I am-

Dr. Weitz:                          It’s complicated and you’ve got to be patient if you want to restore your gut health, right?

Dr. Gurevich:                     There’s this one clinical case that just kind of blew my mind. There was this patient, she came into see me, and she flew in to see me so I can manage all her meds and all her labs, and all that, and she was on like, I don’t know, 40 supplements, 50 supplements.

Dr. Weitz:                          Wow.

Dr. Gurevich:                     Every supplement under the gun. And then, I was talking to her and I was like, “You’re also having all of these crazy menopausal symptoms. You also are osteoporotic. It’s actually not even safe for you to be with no estrogen.” Right? And so, really I took away, I don’t know, two thirds of the supplements and I started her on bioidentical hormones, and that was the missing link of getting her to poop. You know what I mean?

Dr. Weitz:                          Right.

Dr. Gurevich:                     It’s so complicated, and getting a good history, and working with somebody who actually does this on a regular basis it’s really helpful. It’s really, really helpful.

Dr. Weitz:                          Well, part of this I think is because treatment by Google and the patients start layering, and they start chopping practitioners. I’m sure you’ve had patients that do that to you, and they call you us, and they get a consultation, and you’re now number 17 in a line of practitioners-

Dr. Gurevich:                     [crosstalk 00:42:17].

Dr. Weitz:                            … which is a part of what everyone has put them on, and so they’re layering this group of supplements on top of this one, on top of this one, and they were not meant to be taken simultaneously with that practitioner or that article’s recommendations. This would be your protocol, not to take that plus this one, plus this one, plus this one, and the same thing with diet where you follow this particular diet that takes out these three food groups, and then another diet that takes out four more food groups-

Dr. Gurevich:                     Yeah. Yeah.

Dr. Weitz:                            … and a third diet, and pretty soon there’s no foods to eat.

Dr. Gurevich:                     Right. I mean, you didn’t even mention that they’re paying a mortgage in supplements.

Dr. Weitz:                            Right.

Dr. Gurevich:                     I mean, I think that’s why, granted I’m biased, but I feel like working with a clinician because supplements are not made for, okay, if A then B. You know what I mean? Supplements are made for, this is the whole picture, this is obviously the priority, why would we do anything else if the priority isn’t working because you are literally just pooping money out your butt.

Dr. Weitz:                            Right.

Dr. Gurevich:                     I mean, it’s difficult because the internet is so accessible and not everybody has access to care. I live in Portland, Oregon. I have 13 naturopaths in my practice. You know what I mean? People who live in Florida. They see some functional medicine doctors who run all these tests and then put them on all these supplements based on the tests but not looking at their symptoms. I understand it is not easy, and I also think if you want to try to figure it out yourself I totally respect you trying, and if you’re flattening out I think getting some extra support is really helpful.

Dr. Weitz:                            Absolutely. And I also think if you can find a right clinician who’s giving you a reasonable treatment protocol based on some reasonable amount of tests being done that makes sense you should stick with that practitioner because I think sometimes all these different, you’re talking about 50 different supplements, comes from I did a consultation with this person who put me on these six different things, and then I read this article that said take these, and then I did another one with this one.

Dr. Gurevich:                     Yeah.

Dr. Weitz:                            I think that’s part of the problem.

Dr. Gurevich:                     Yeah. And also, I just want to say we live in this amazing world where information is so accessible, which is amazing. Never in our history have patients been this empowered to take their own care in their own hands and really guide their treatment plan, and we no longer live in the world where doctor is God, and whatever doctor says I’m going to do.

Dr. Weitz:                            Right.

Dr. Gurevich:                     Which by the way I would love for somebody to be like, yeah, you just tell me what to do and we’re done. It would make my job easier, but we don’t live in that paradigm anymore. It’s really important to educate yourself.

Dr. Weitz:                            Right.

Dr. Gurevich:                     And it’s also really important to understand where your education falls short on the internet.

Dr. Weitz:                            Right. Yeah. And I think at this point there’s so much information out there that our job is really to try to streamline and teach the importance of the right information-

Dr. Gurevich:                     Yep.

Dr. Weitz:                            … rather than just provide more information.

Dr. Gurevich:                     Right, which is I feel like what is luxurious about my job specializing.

Dr. Weitz:                            Right.

Dr. Gurevich:                     Because I only need to know about … I’m like an inch wide and a mile deep. I don’t need to know about your kidneys. I know you have kidneys and I know they’re important, but I know what I know, and so I love staying in my lane, doing this thing, and then go.

Dr. Weitz:                            That’s right.

Dr. Gurevich:                     Let’s get you something that’s more of a generalist.

Dr. Weitz:                            So how can patients contact you if they want to utilize your services?

Dr. Gurevich:                     So you can find me on naturopathicgastro.com, and the nice thing about my clinic is I do have residents who work under me, so if it’s cost prohibitive the residents are much cheaper and we will do educational consults, which means that we can talk to you, do a FaceTime visit, or do a Zoom visit, and then get your history and kind of give you our thought process. If you come into see me then I can run your show for a year and do all the labs and all the pharmaceuticals and all that, but we can definitely give you our brain, and when you work with me or the residents you work with a whole team so you’ve got three brains on your case as opposed to one.

Dr. Weitz:                            And do you offer training programs for clinicians?

Dr. Gurevich:                     So I did. I did my first one. I did nine and a half hours on inflammatory bowel disease, standard of care, and naturopathic interventions for inflammatory bowel disease.

Dr. Weitz:                            Is this part of [Nurala’s 00:46:55] program?

Dr. Gurevich:                     No. I did one for Nurala.

Dr. Weitz:                            Okay.

Dr. Gurevich:                     I did four and a half hours for her.

Dr. Weitz:                            Okay.

Dr. Gurevich:                     And then, I bloomed it into nine and a half hours.

Dr. Weitz:                            Okay.

Dr. Gurevich:                     I did a one class specifically on rectal ozone, which might be my favorite, favorite treatment for inflammatory bowel disease. I did a naturopathic protocols. I did drugs for inflammatory bowel disease, and that one is probably my biggest soapbox because one of the things that I feel like naturopaths and functional medicine doctors do wrong is they’re in this big hurry to get patients off their biologics, and that is very, very risky because biologics form antibodies and if they’re well tolerating their biologics and they’re not having any side effects there is no point of taking people off the meds. The meds are not the enemy. The enemy is the bowel deteriorating and wasting away within the human causing pain and symptoms. Go on.

Dr. Weitz:                            No, go ahead.

Dr. Gurevich:                     So that you can find also on my website naturopathicgastro on “Online Teaching” and that is approved for a continuing ed for naturopaths in the whole country through April 2021 I think.

Dr. Weitz:                            Oh, wow. Cool.

Dr. Gurevich:                     [inaudible 00:48:05].

Dr. Weitz:                            That’s great.

Dr. Gurevich:                     I was like God bless you for listening to me talk. I think anybody hears me talk and they immediately become anxious because it’s so fast, so God bless you for listening to me talk.

Dr. Weitz:                          I’m from New York so it’s normal for me.

Dr. Gurevich:                     That’s the problem. That’s the problem. That’s exactly the problem, if I was from South Carolina nobody would be anxious around me. Thank you Ilana.

Dr. Weitz:                          Thank you so much Dr. Weitz. I really appreciate it.

Dr. Gurevich:                     Okay. I’ll talk to you soon.



Environmental Toxins with Dr. Aly Cohen: Rational Wellness Podcast 175

Dr. Aly Cohen speaks about Environmental Toxins 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

4:22  Toxic chemicals in children.  Children are among the most contaminated because not only do they get exposed in utero, but they may be eating baby food that often has preservatives, chemicals, coloring, glyphosate, and other pesticides. Babies and toddlers spend most of their time on the floor, picking up dusty toys and putting things in their mouths. And their detoxification mechanisms have not fully developed.  If you start getting exposed early in life, you have a long period of time for these chemicals to eventually have damaging effects. Our grandparents had cleaner foods that they cooked, fewer processed foods, fewer chemicals, and they didn’t have lawns sprayed with toxic chemicals. We now have upward of 3,000 toxic chemicals in the food system and their water was much cleaner.

8:27  Chemicals in our food.  To start with, soil has lower nutrient value, which makes it harder for our bodies to defend against the toxic chemicals. Omega 3s, vitamin D, vitamin C, and folic acid are immunologically beneficial and can help block the damaging effects of Bisphenol A and other endocrine disrupting chemicals as well as lead. Having iron deficiency lowers the ability to manage lead toxicity.

Processed foods are overtaking the market. They are cheaper and easier but they are nutrient weak and calorie dense and have lots of chemicals.  A good thing is that the markets now often have frozen organic vegetables, which may even have more nutrient value than fresh, since they are flash frozen, whereas the fresh foods may have been picked and traveled long distances and may be stored in a cooler for up to 6 months.

12:50  The dangers of plastics.  One of the problems with plastics are the chemicals that are used to make plastics either soft or hard. Bisphenol A (BPA) is part of a family of chemicals called phenols that are used to make plastics harder but they are also endocrine disruptors. They act almost like hormones.  But BPA is shown to be harmful at incredibly low dosages, so they take it out and substitute another phenol like BPS or BPFB, which haven’t been studied as much yet.  Pthalates are another class of chemicals used in plastic products from cookware to personal care products and even food ingredients and they make plastic soft and squishy. They may be in the soft grip of cookware. These pthalates are also endocrine disruptors and they can block testosterone and have an estrogenic effect at very low levels.

18:12  Genetically modified crops.  The majority of genetically modified crops are designed to be resistant to an herbicide like glyphosate (the main ingredient in Round Up) that the company that makes the seeds also produces. Mexico just banned glyphosate and it is being banned in every major park due to some landmark lawsuit settlements.This most widely used herbicide, glyphosate, has a multitude of negative health effects, including being a probable carcinogen and being an endocrine disruptor. But there are organic or much less toxic herbicides that can be used.

23:44  The plastic recycling codes on the bottom of plastic bottles in the triangle. There is a number from one to seven. Seven is Bisphenol A or other phenol. Three is polyvinyl chloride.  Six is styrene, like styrofoam.  We should avoid plastic bottles with numbers three, six, and seven.

26:19  Toxins in the water.  We used to use lead pipes and lead would leach into the water. Then we switched to copper and excess levels of copper are also toxic. Now we are using PVC pipes and we know that polyvinyl chloride is not safe either. And our water treatment plants, of which there are about 160,000 are only mandated to test for 91 chemicals under the Safe Drinking Water Act of 1974, while there are 90,000 chemicals on the market.  They don’t have the infrastructure to filter out all of the prescription medications that are found in our sewage. We have coal ash, fracking chemicals, etc. going into our water supplies. The solution is for each of us to filter the water before we drink it and reverse osmosis filers are the most effective ways to clean our water.  Buy a reverse filtration system and have it installed under the sink by a plumber. If you can afford it, get a full house water filtration system.  If you can’t afford either, then use whatever filter system you can afford. 

35:31  Stainless steel bottles and containers are generally safe, though if they are made in China, we should be leery. Nonstick non Teflon cookware that is marketed to be green and safe, such as the porcelein ceramic pans. 




Dr. Aly Cohen is a board certified rheumatologist, integrative medicine specialist, and an environmental health expert in Princeton, New Jersey. She has collaborated with the Environmental Working Group, Cancer Schmanser, and other disease prevention organizations and is co-editor of the textbook, Integrative Environmental Medicine, part of the Oxford University Press Weill Integrative Medicine Library and her new book is Non-Toxic: Guide to living healthy in a chemical world.  Her website is alycohenmd.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 enjoy listening to the podcast, please go to Apple podcasts, give us a 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.

                                Today our topic is environmental health and the role that toxins play in our health. As most of us are aware, our modern life is awash in toxic chemicals, in our food, our air, our water, the materials used to build our homes, chemicals that we apply to our lawns, that are contained in our furniture, our cookware, our cleaning products, our personal care products, even chemicals added to your yoga mats. My wife got a new yoga mat from Amazon and there was a warning, “Toxic chemicals.” It’s like you can’t win.  To quote from Dr. Cohen’s book, “Every day the US imports about 45 million pounds of synthetic chemicals. Each year, about 1,000 new chemicals are put into use. 15 new polymers are patented in the us every week, over 1,000 endocrine disrupting chemicals currently exist, but only five chemicals have ever been banned in the United States under the Toxic Substances Control Act passed in 1976. And the revised Toxic Substances Control Act passed in 2016 has failed to improve the regulatory response to toxic chemicals.” And not to quote from Dr. Cohen’s book, whatever controls might have existed with the EPA prior to 2016 have now been effectively dismantled under an administration that is as hostile to environmental regulation that’s ever existed. The current head of the EPA, Andrew Wheeler is a former coal lobbyists, so the fox is now watching the henhouse. And in fact, this morning, September 1st, when we’re recording this, there’s an article from Bloomberg News that’s titled, Trump Relaxes Limits on Toxic Waste From Coal Power Plants. Just what we need.

                                Our special guest today is Dr. Aly Cohen, and she’s a Board Certified rheumatologist, integrative medicine specialist, and an environmental health expert in Princeton, New Jersey. She’s collaborated with the Environmental Working Group, Cancer Schmancer, and other disease prevention organizations. She co-edited the textbook, Integrative Environmental Medicine, part of the Oxford University Press, Weil Integrative Medicine Library, and her new book is Non-Toxic” Guide to Living in a Chemical World. Dr. Cohen, thank you so much for joining me today.

Dr. Cohen:          It’s my pleasure. Thank you for having me, and I’m sure we’re all going to get a drink after this, separately or on the [crosstalk 00:03:30].

Dr. Weitz:            There you go. We’ll have our Zoom cocktail party.

Dr. Cohen:          Yeah. I have to have humor even though this is such a daunting, heavy topic, and it affects everyone, every culture, every religion, every age group, which is kind of why my platform, which is called The Smart Human, is another area by which I push out really important environmental health information because we are all human, and these chemicals are getting into our lives. It’s a heavy topic, but what I try to do is try to get some humor, and the book that’s coming out is all proactive approaches to try to fix it. So, it’s not meant to be such a Debbie Downer, and then you run off and you just get miserable, it’s really about how do you empower people to make some of these healthy changes.

Dr. Weitz:            Right. Yeah. So, I thought maybe we might sort of loosely organize our discussion today around some of the chapters of your book, and I thought maybe we’d start with chapter three, which is Toxic Chemicals and Kids, and maybe you can talk about some of the exposure that kids in particular have to toxic chemicals.

Dr. Cohen:          Yeah. So, I actually don’t even have the copy yet. Believe it or not, it’s supposed to be coming this week. So, if you quote me, I’m going to try to get as much detail as I can, but I literally was hoping to have the book to give you some real good detail.  But here’s the thing. Children are among the most contaminated of all age groups, and just to start with, because not only do they actually get exposed in utero, in the womb, during pregnancy, which is not intentional, of course, moms don’t want their kids to be polluted, but it’s just because they are exposed to the chemicals that their mother and even their fathers are exposed to, from a genetic standpoint, through the air that mother breathes, and the personal care products, lotions, tampons. Well, not during pregnancy, necessarily, but all of the personal care products, food, cooking, cookware, food chemicals, contaminated drinking water, can expose a growing fetus.

                                Then the kid pops out and you have these babies that are getting perhaps baby food that has a lot of preservatives, chemicals, coloring, glyphosate, some of the pesticides that get into even baby food. And also, where do babies and toddlers spend most of their time? On the floor, right? They’re on the floor, picking up dusty toys, and putting things in their mouths. I have two boys, I know they put everything in their mouths. So, the idea is that they’re getting exposed per body mass index at such a greater degree than even an adult who has detoxification mechanisms already matured, like their liver, and their kidney and other processes of the gut.  So, in other words, they are really kind of the worrisome group that we need to think about, of course, all groups, but definitely starting young with exposures over a lifetime, really can add up to a lot of health conditions, which we can go into.

Dr. Weitz:            Yeah, not to mention some of the chronic conditions tend to happen after longer term exposures. So, if you’re starting to get exposed early in life, you’ve got a longer period of time when these chemicals can eventually have that damaging effect.

Dr. Cohen:          Absolutely. I mean, and we think about our grandparents diet, and our grandparents behaviors, they didn’t have toxic lawn chemicals sprayed everywhere, they didn’t have the plethora of pesticides outside in farmland and on their food and all the manufacturing food chemicals. They had cleaner whole foods that they cooked, not as much processed foods, which have upwards of 3,000 chemicals that are now in the food system in terms of just food additives. Their water may have been much cleaner because they didn’t have a lot of the chemicals that end up on surface bodies of water, lakes and streams, end up in aquifers underneath farmlands that travel into wells and into water treatment plants.

                                So, we’re really getting exposed to a whole different level of chemicals, particularly after 1950s when we really had an explosion after World War II with so many chemicals, and they make a lot of our lives easier. I mean, don’t get me wrong, we have canned foods because they make cans, Naugahyde, rayon, nylon, plexiglass, plastic containers that could store food for longer periods of time. There are benefits to what we’ve developed, especially post World War II, but there’s also we never thought about where they would go after we use them. We had a very specific time period in mind to not have to wash dishes, or break dishes, and now we’re finding that all of these chemicals have been in our soil, in our environment for a very, very long period of time, and they get into our bodies and into the bodies of wildlife, of course.

Dr. Weitz:            Right. Right. Right. So, maybe we should start with chemicals in our food and prob maybe start with agriculture and all the chemicals that are sprayed and dumped onto the produce and in the soil.

Dr. Cohen:          Yeah. So, you can start up really upstream by talking about soil quality. I mean, even just soil quality is so diminished in terms of nutrient value. And the reason that actually matters in terms of chemicals, I mean, separate from chemical pesticides and fertilizers that are pretty harmful to human health, many of them, without the nutritional support in the human body, we can’t even defend ourselves against the chemicals. So, in terms of some of the nutritional value of omega 3’s, and vitamin D, which is so immunologically beneficial, and folic acid, which we know can block the effects from Bisphenol A, and BPA and other endocrine disrupters, which we’ll talk about those chemicals, but nutrients actually block lead contamination, especially in children. Vitamin C can do that. Being anemic or iron deficient actually lowers that ability to manage lead toxicity. So, it’s two-pronged. It’s not just what we’re contaminated with but it’s also the nutrients that we’ve evolved to utilize to protect us from environmental chemicals. So, twofold, it’s pretty bad stuff.

Dr. Weitz:            So, you’re saying we’re getting less of these nutrients because the soil is depleted, that the fruits and vegetables are grown in.

Dr. Cohen:          And our choices of food. We all know how processed foods is overtaking the market, much cheaper, nutrient weak and calorie dense. Processed foods. I mean, look, it’s everywhere and it’s hard for all of us to manage. I mean, I have two kids that love junk food or they love processed foods, and it becomes a battle even with people who feel like they know what they’re doing. It’s just too easily available and it’s cost efficient for a lot of people who can’t afford necessarily whole fresh organic fruits and vegetables. There’s been improvements.  We have frozen vegetables and fruits that you can now get in a lot of big box stores, which is great, and I think that’s been a nice change over the last seven to 10 years, making frozen organics available. They’re less costly than fresh, and to be honest with you, they probably have more nutrient value because they’re flash frozen as opposed to being picked and traveling maybe 10 days to get to a supermarket, or even frozen for six months, which a lot of fresh vegetables and produce are actually done. They freeze them at a temperature where they can kind of tee them up for a year from now, in a way.

Dr. Weitz:            Really? So, your fresh fruits and vegetables can be a year old.

Dr. Cohen:          Well, I would say that I’ve heard up to six months for apples, for instance, apples, particularly. A lot of these big chain stores need to have enough surplus to manage their stocks around the country, and so there are processes by which you pick apples, and they stay in a cooler for certain degree of time before they ripen or before they go to market. So yes, there is a process. I don’t know if I’d say a year, but I’ve heard up to six months, particularly with apples as an example.

Dr. Weitz:            So, the bottom line is, in modern life, our fresh fruits and vegetables are not so fresh, even if we’re trying to do the right thing.

Dr. Cohen:          Exactly. And I think when you lift the cover of a lot of these… The people who are trying to do health and wellness and really trying to make all these efforts, really thinking about what they’re eating and how they’re doing it, they’re doing it but they may not get quite to the where they want to even be better in terms of, for instance, having an organic salad with all the great ingredients, you’re all psyched, but then you might be carrying it or cooking something in a plastic container, or all of our organic ketchup for my kids, or organic condiments are in plastic containers, which sort of defeats the purpose in some ways, right?

Dr. Weitz:            Maybe you can talk about the dangers of plastics.

Dr. Cohen:          Yeah. So, plastics, for instance, are part of chemicals that are used to make either plastic soft or hard. So, for instance, Bisphenol A, which many of your audience members may recall, Bisphenol A or BPA is part of a class of chemicals called phenols, and there’s many of them, but BPA is the most well studied. And BPA was actually taken out of baby bottles in 2012… it made a lot of news… out of plastic bottles in the US because of its ability to disrupt the endocrine system. So, hormones in the human body, very, very, very low levels. And this was a breakthrough, because we normally think of chemicals being worse as the dose or exposure gets higher.  Now, what we’ve now found from international research, World Health Organization, American Academy of Pediatrics, Endocrine Society, is that many chemicals can actually do just as much harm at incredibly low doses as they can at very high doses. In other words, they act almost like hormones or mimic hormones in the body, because that’s how the hormones in the body work.   And so Bisphenol A was taken out of baby bottles. My co-author for both the textbook and my upcoming book, Non-Toxic, which is coming out next week, Guide to Living Healthy in a Chemical World, my co-author was largely responsible for helping to get Bisphenol A out of baby bottles in 2012 in the US.

Dr. Weitz:            But what did they substitute for the BPA?

Dr. Cohen:          BPS, BPFB, BPSIP, …

Dr. Weitz:            Right. Which could be just as bad, right?

Dr. Cohen:          Yeah, it’s a whack a mole. So, they take out one thing that has tons of good data from third party reputable researchers and then they just substitute another phenol in. So, it’s been a real uphill battle in those who study chemicals, on I would say, the good side. Not the manufacturers. Manufacturers do not have to prove safety before going to market.  So you asked me about plastic. So, Bisphenol A was designed to actually make plastics hard. It basically if you think of like a clear aspirin bottle, the clear kind of like a bear aspirin bottle, that was the big discovery in the ’50s actually, so that when you linked BPA molecules together, they actually became a real hard epoxy kind of material, hard.

                                Phthalates, which are another class of plastic chemicals used in millions and millions of products, from cookware, to personal care products, even food ingredients, phthalates are everywhere, they actually tend to make plastic soft. So, I think like an iPhone case, or some kind of cell phone case that makes it squishy soft, or cookware that’s got a kind of a soft grip handle. So, that’s kind of how they’re differentiated in terms of structure. But these chemicals actually can, at very low levels, mimic hormones in the human body. And we now have enough data to show that. Especially phthalates can affect male hormones in a growing fetus and can make some reproductive changes in the fetus of a baby boy, can affect or block testosterone, can mimic estrogen at very low levels.

Dr. Weitz:            In fact, it seems like predominantly these endocrine disrupting substances tend to have more of an estrogenic effect.

Dr. Cohen:          Well, they have both an estrogenic and an anti-androgenic effect, and they also have thyroid effects. So, think about all the hormones that our body uses to signal different physiologic functions: growth, development, fertility, managing insulin. We know that these exposures can actually affect blood glucose levels and also utilization of glucose in the muscles, which you know because of your work. But the idea is that we have so many hormones that affect physiologic processes, and these chemicals mimic them, and that’s why they’re called, overall, endocrine disrupting chemicals.


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Dr. Weitz:         What do you think about genetically modified crops?

Dr. Cohen:          So, genetically modified crops are interesting because it depends on the type of modification where they’re splicing out DNA and inserting different types of DNA into that spot.

Dr. Weitz:            Right. Isn’t it the case that most genetically modified crops currently are designed so that the crop is resistant to roundup or other herbicides, so then they can spray that herbicide on the crops and kill the weed and not kill the crops?

Dr. Cohen:          Absolutely. So, a lot of genetically modified crops, the majority worldwide, are designed specifically by the same makers of those seeds that genetically modified them, such as Monsanto, which was bought by Bayer, they are designed to basically be sprayed with this pesticide that was designed but not die. It would just kill off–it’s an herbicide–and it kills off all the different weeds around it. And what ended up happening, the marketing scheme was that this was going to add food to the world’s food system, and no one was going to starve, and it hasn’t panned out as such. And in fact, it shows that these seeds have shown resistance to the actual pesticides. So now, the weeds are being killed off, and they’re spraying not just once a season, but perhaps even two or three times during a farming season, and they’re sprayed to get the crop ready as a desiccant to dry it, to get it ready to move the farming along in terms of the crop readiness.

                                But the issue with this is that glyphosate, which is the most commonly used worldwide herbicide, we now know has multitude of health effects. Primarily, it’s probably carcinogenic activity, but we also know it has endocrine disruption activities as well. And just to give you a heads up, it’s now what? September… What the date? September 1st right now?

Dr. Weitz:            Yeah, September 1st. Yeah.

Dr. Cohen:          They just banned glyphosate from Mexico very recently, within the last few weeks, they are banning it from every major park, certainly in public parks in Miami, I think they’re looking at it for public parks in New York. Europe is looking at banning glyphosate. I mean, after the million dollar lawsuits that were paid out not that long ago to some of the school lawn keepers who developed cancer, multiple myeloma and some other cancers, I mean, it’s been a windfall. So, so many cases are now coming through the pipeline, and the science is pretty robust showing the pretty terrible harm that comes from Roundup or glyphosate.

Dr. Weitz:            Right. So, glyphosate is the main chemical in Roundup?

Dr. Cohen:          Yeah. Correct. And then there’s also the inert ingredients. So, there’s the active ingredient, which you see on the label, which is Roundup, and then there’s all these what they call inactive chemicals, that actually can be worse than the actual active ingredient, and you’re not privy to know all of those inactive chemicals because they’re proprietary. So, it’s a hot mess, let me tell you.

Dr. Weitz:            Right. Yeah, there’s another sinister aspect to this whole genetically modified crop thing, which is that they also make sure that the seeds can’t reproduce by themselves, so the farmer who buys these seeds has to buy the seeds over and over again, from Monsanto, or whatever company that makes the genetically modified seeds, and then they’re genetically modified to be resistant to a herbicide that they make. So, not only do you have to buy the seeds from them, you have to buy the herbicides from them. And this is especially sinister in the developing world where you have subsistence farmers who normally would harvest the seeds and replant them, and now we can’t do that anymore.

Dr. Cohen:          And I’ll tell you, this is from a very recent personal experience. We live in New Jersey, and New Jersey is the garden state. Okay, that’s just its definition, and every license plate has lots of fruits and vegetables on the license plate. So, we personally live in the corner of a 200 acre preserve farmland area that was bought by a farmer who outsourced it to another farmer that sprays glyphosate 10 feet from my kid’s door, twice a year, once a year. And finally, I worked on this relationship with this farmer and I would drop off articles, and I dropped in chapters off, and I would buy him beers, and I kept break him down. “Just listen to me.”

                                I showed him video of the farm water from the field coming into our driveway. I mean, I don’t know if he thought I was going to sue him, but there’s no lawsuit there. I mean, it’s their land. But the idea was I eventually worked so that he would not spray the season. I even reached out to a wonderful group in Washington, D.C. called Beyond Pesticides, who’s actually in our book, and they’re a wonderful organization that gives lists of all of the herbicides that can be beneficial in farmland, but also even selective ones. So, in other words, what you said where there are selective seeds, there are some herbicides, if you hit them at the right time, these weeds will actually do quite well with these organic or much less toxic sprays. So, there’s a solution to everything, and that’s why we just got to keep working at it.

Dr. Weitz:            Right. So, one of the things in your chapter on food is you talk about the recycled plastic codes on the bottom of the bottles in the triangle. Maybe you could explain what those mean and which ones are the safe ones.

Dr. Cohen:          Yeah. So, I believe it’s in 1988. Again, I have very short term memory because of my children now. So, in 1988, I think it was the Society of Plastics Industry that basically came up with this way of stamping a triangle on the bottom of plastic containers, food storage. I mean, most of us have seen them, maybe now they’ll look even more. Mott’s Applesauce, or my ketchup, or whatever, it’s always on plastic containers. And that triangle actually has value, value to the people who want to use it properly. The Society of Plastics Recycling came up with it just to save money because they wanted to know how they can recoup money from telling people which triangle to put in which trash can for recycling.

                                So, it’s one through seven, in terms of the numbers that go into those triangles, and seven is often Bisphenol A or other, and three is vinyl or polyvinyl chloride, or polyvinyl chloride is essentially what makes up number three triangle. Six is styrene. So, on the bottom of Styrofoam, you’ll see a triangle with six, or take out food. And one and two and five are generally considered less toxic because we water bottles are typically one or two, or five for some foods. So, the idea is that you could literally go on to your Google or Yahoo or whatever and just look up recycling codes, and they’ll tell you the kinds of foods and packaging that’s used for that triangle. And what I would say is avoid three, six and seven. And three is the vinyl, because it’s an endocrine disruptor, PVC, it’s plasticizer, like a phthalate. And six is styrene, because we know styrene is carcinogenic, and seven is usually Bisphenol A or others.

                                So, if you have to choose, try to stay away from three, six and seven. And we go through it in much more detail in the book, but again, the whole book is about practical solutions. It’s about being armed with the stuff to reduce your exposure because we’re all not toxicologists or medical doctors or what have you, we need to have some guidance. That’s all I want to tell you.

Dr. Weitz:            Well, if PVCs are not safe, and pretty much all our plumbing went from lead, which is obviously horrible, and we know about all the issues with lead, then we switch over to copper, and we’ve got issues with copper toxicity, now we’re using PVC. What the hell are we doing?

Dr. Cohen:          Right. Yeah. Which leads me into the next topic, thank you for doing that, that is our water, and the fact that we use PVC piping… And for instance, my company that we use, I think it’s American Water Company in New Jersey, and I visited one of their treatment plants. So, for instance, there are 160,000 water treatment plants in the country in the US, 160,000, which serve about 250 million Americans out of 310 million, right? So, the majority of Americans drink from water treatment plants that are city water. The 20 to 50 million others that are leftover are in wells, they’re usually in wells, and they have their own issues, and they have their own requirements. But the treatment plants, the 160,000, are only mandated to monitor 91 chemicals, 91 nationally, under the Safe Drinking Water Act of 1974.

                                So, what that means is since 1974, they’ve only added… I mean, from then I think it was like 80, now it’s 91. What happens is these folks do their job, and they do it well, but they’re only mandated to calculate how much of those 91 chemicals are over the limit and to remediate it. Now, we have over 90,000 chemicals on the market right now, in everything, even if it gets into the air, the air quality gets into our water, and they all end up going through these water treatment plants. And the water treatment plants aren’t capable, don’t have the infrastructure to manage medications from our sewage.  Yes, sewage does turn into drinking water. It doesn’t have the ability to manage antidepressants, which wouldn’t be so bad, blood pressure medications, oral contraceptives, all of the industrial chemicals, runoff, fertilizer, pesticides, so many chemicals that go through… Microplastics are now-

Dr. Weitz:            To just stop you for a second. So, you’re talking about medication, prescription medications, over the counter that get flushed down the toilet that end up in our water supply. Is there a proper way to dispose of prescription and over the counter drugs?

Dr. Cohen:          That’s a great question. I mean, I guess maybe some of the big box pharmacies probably have some means of doing it, but who knows? I don’t really know where that would go to. It’s not like they just combust into nothing, they have to be somehow destroyed, dissolved. I don’t know. But there’s no great solution for all these chemical… Well, there is a great solution. I’m going to tell you. I mean, worldwide, we have to think about water contamination, but PVC piping takes water from those municipal plants, and ours travels 40 miles to get to our house. I’ve done the drive. I’ve calculated the drive. And so when you’re talking about that much piping, and anything can break the piping, you can get dirt in there, you can get any number of chemicals originally that didn’t get washed out, there’s coal ash, there’s fracking chemicals, I mean the list goes on and on and on, but those chemicals will travel all the way down to your home.

                                And so the solution, which is what we go into in great detail, is to filter the water at the point of us, which is at your sink. So, whether the water comes from below your house at a well, or it comes from a municipal treatment plant 40 miles away, who cares? It had to have chlorine in there to kill off bacteria, it had to have detergents to clean it up, but when it gets to your sink, it’s traveled, it’s done, and you just got to clean it right there before you ingest it or take it with you to work or soccer games or whatever. And then we get into the different types of filtration, how aggressive, the cost.

                                But I’ll tell you the punch line, I think everyone should be filtering no matter what, carbon filter, pitcher, whatever, but RO filters or reverse osmosis are the most aggressive way of cleaning water in this country, and there’s many places you can get reputable RO filters for upwards of 300 bucks max, and they are right under your sink. Not whole house filters.

Dr. Weitz:            And a lot of the big water companies will install it and just charge you a monthly fee like $40 a month or something.

Dr. Cohen:          Well, that’s not how I do it. I say buy the RO filter, have a plumber… We bought ours out of California because we’ve got it off of Consumer Reports, highly certified. You want to make sure it has all the certifications, not outsourced to China, Indonesia. Don’t buy it at a big box store that says Made in America. They often will have parts, especially the filtration portions from other countries. And so you want to research this quite well. I don’t say brands, but I can tell you we do a lot of information to get you to the right product.

Dr. Weitz:            All right. Why not tell us brands?

Dr. Cohen:          Because I’m working to get into Princeton University and all the universities and high schools. My ultimate goal is to have this as a curriculum for high school students. And I’ve been very conscientious of never doing branding, even though I’d love to, but I don’t because my goal is to have a bigger reach than just a one off, and I don’t get paid for any of these remarks, and that’s why I want to keep it so legit and believable.

Dr. Weitz:            Okay.

Dr. Cohen:          But the RO filters are interesting because it’s almost like a dialysis machine. It’s so aggressive. It has to go through three canisters, it’s not that big, but it goes through three canisters and then has to sit in a waiting tank. And our plumber put it in at $150, I think it was, for one hour of work. It should not be three hours. It should be one hour of work for a plumber who knows how to do an RO filter. It’s super easy. I actually order them as wedding gifts because they cost 300 bucks or 250, nice gift, right? And I’ll send them to their house, with their permission, and then they’ll just pay a plumber to put it in for 150 or $130, and they’re done. And then all they have to do is change out the cartridges for about 40 bucks a year or every nine months, depending on how much they use it. But the tank actually has to hold the water. So, it goes through three filtration systems, sits in a tank, comes with its own faucet, that’s just your drinking and cooking water.

Dr. Weitz:            Yeah, that’s what we have.

Dr. Cohen:          Yeah. And so you don’t have to keep paying anyone for anything. I hate the idea of constantly paying for something when you can do it yourself.

Dr. Weitz:            It’s an American way to just keep overpaying.

Dr. Cohen:          I know. I’m always fascinated when I hear these stories about certain water companies, they come in, they tell your water sucks, and then they tell you to buy the best, most expensive thing they offer because you’re scared out of your mind. Of course, you’re going to buy it and be suckered to a whole house $6,000 filter. But I kind of push away from that. I mean, some patients you have-

Dr. Weitz:            I guess the advantage of the whole house is then the water that you’re bathing in or showering in is filtered as well.

Dr. Cohen:          Well, true, and I agree with you. I think if you can afford that, that’s great. I would love people to afford that over a lot of nonsense things in our lives, right? I do nonsense things too, but the idea is that if you’re taking reasonably short showers, nothing excessive, not too many baths, you’re not otherwise having blood testing that shows heavy metals. I mean, I do that routinely. It’s covered by insurance. I would say, six, $7,000 is a lot of money when you could put that into an RO filter, plenty of food, the clean food, maybe a couple yoga classes. I don’t know. I just look at it as more high yield to just get the water that you’re drinking and cooking set up and then think big later.

Dr. Weitz:            Yeah, we don’t find testing for heavy metals often covered by insurance, but again, we’ve got different insurance in California.

Dr. Cohen:          Yeah. I mean, I don’t do a lot of metals, but they’re covered by Quest and LabCorp in New Jersey, with the right coding and it’s inbursed. I’m always fascinated why regular, non integrative doctors don’t just do them, but it’s not typical that they do screenings of a lot of things.

Dr. Weitz:            Yeah. I’m not sure if the testing done from Quest and LabCorp for metals is as accurate as the better testing.

Dr. Cohen:          I agree with you, but for the vast majority of what I see, based on the symptoms, I try really consciously to keep people’s costs down, because to me, I see enough people where they’re working class, they don’t have money coming out of their ears, and I think to myself, “you know what, if the symptoms match, I’ll do some of these basic testing, and if it’s not resolved over some basic interventions, then we’ll move into deeper testing.” But go with what sprays, is what I say.

Dr. Weitz:            Yeah. Are stainless steel bottles and containers safe?

Dr. Cohen:          Yeah, in general, they are, but I’m always leery of anything that says, made in China. I worry about the recycling of metals. I tend to really try to get people to think about US made pans, pots, containers. There’s stainless steel thermoses that are great made in California. So, there’s some really good companies, and it should say 18/8 underneath on the bottom stamped, because it’s basically the formulation of food grade steel. And we talk about that in the book, and of course, I can’t remember the exact numbers. But the idea is that you want to go with everything that touches your lips, your body, hot coffee, hot tea, you want that material to be strong enough so that the matrix of it doesn’t fall apart and get into your body. Glass and stainless steel is what we’ve got.

Dr. Weitz:            So, nonstick cookware has these polyfluorinated chemicals, these PFAS, PFOAs, and we know those are very toxic. But there’s also nonstick cookware made from ceramic titanium. What do you think about that stuff?  It’s supposed to be safe.

Dr. Cohen:          Yeah. I mean, it’s almost, I guess, like a Le Creuset in a pan form or something.  I don’t know. The idea is that I can’t vouch for companies because I don’t do the third party testing.  So, like many other things that we’re not trained to know, it sounds like we’re going with our best guess or estimate. There was a company online that a woman actually, who her whole job has been to look up pans and safety. I don’t know what her background is, but it’s just not an area I’m so familiar with. So, I just go with the old school stuff.  I mean, to me anything that’s marketed as green clean, I get a little nervous, because remember, there is no testing by the US government on these pans to say that they’re not adding PFOS chemicals, or perfluoroalkyls, which is what you’re describing, and that’s what makes these pans easy to cook with.  So, if they’re made in China, they’re marketed really well to be green pans.  And I’m not saying they’re all a problem, I’m saying I don’t know, and so I stick with what I know.

Dr. Weitz:            Right. Why don’t we talk about those PFOS chemicals right now?  So, these are the chemicals that line these non stick pans, like Teflon, they’re also found in a whole series of other products. They’re what are actually sprayed as fire retardants in California, we have all these fires, and planes are coming by and dumping all these flame retardant chemicals.

Dr. Cohen:          Poor California, man. I [crosstalk 00:38:27].

Dr. Weitz:            I just did see though that there’s a bill in California that was just passed to ban these chemicals. Of course, I think they have eight more years to stop using them, but all this crap is seeping into the groundwater. And I had seen reports where these chemicals are literally in the majority of states throughout the country in much higher levels than are safe.

Dr. Cohen:          Oh, sure. I mean, Hoosick Falls in New York is a big battle. Every military base in this country is pretty much almost a super fun site because of all of the unbelievable number of chemicals, PCE that get in there, perchloroethylene, I think it is, PFOS chemicals, which are the ones that are used, like you said, for fire training in fires. Perfluoroakyls, they’re called perfluoroalkyls, it’s PFOS and PFOA, generally speaking, they’re what’s called forever chemicals.  So, these chemicals, unlike many others… like BPA breaks down in six hours. So, if you give up things with BPA like canned foods, or receipts that you touch, which goes through the skin, you will lower your BPA level in your bloodstream, but the PFOS chemicals happen to be a group of chemicals that are forever. I mean, they don’t break down with sun, wind, rain, they get into the soil. And again, everything will always make its way into water, because soil is like tissue paper, and it absorbs and it transfers chemicals for miles and miles away.

                                If anyone wants to read a really good book called Toms River written by a New York NYU Professor, Dan Fagin, I think his name is, fabulous, fabulous read. True story about chemical pollution. It started in Ohio, the company moved to New Jersey, and then you see these wells that basically contaminated miles of surrounding… I should say, contamination pots that really affected the wells for miles around in the Jersey Shore. It’s a true story and it was beautifully written.   But anyway, I learned from that book just how soluble soil is, and how soil, literally like tissue paper when you drop that little corner in the water, it literally goes right up the tissue paper. It’s similar for almost all soil that we’re in, it literally transfers. So, the PFOS chemicals affect human health as endocrine disruptors, they also lower immune system response to vaccinations. So, we now know it blunts the effect. If you’re going to have a vaccine or vaccination, even as a childhood vaccines, it will blunt those effects, especially with immunocompromised folks, it’ll blunt their immune system process. But they’re a horrible group of chemicals. They’ve been banned but they’re still around and they’re making… It’s kind of like DDT. They’re still finding remnants of some of these chemicals that are 30, 40 years old, and I think we’re going to find the same problem moving forward.

Dr. Weitz:            A thought just came into my head. I always get these weird thoughts, is that we’re in the midst of this coronavirus pandemic, and we’re reading reports about how people who’ve been exposed, who’ve been infected, and it’s assumed that with the majority of viruses, you’re going to develop protective antibodies. And what you’re talking about, vaccines, could it be that if our bodies are loaded with some of these toxic chemicals, maybe our immune system is not going to produce the same amount of protective antibodies that would have happened otherwise?

Dr. Cohen:          Well, what’s interesting, and to make that nice segue into COVID-19 and how chemicals actually really cause more problems for people who are exposed to COVID-19, and the fact that environmental chemicals we now know cause inflammation, okay? They cause inflammation, IL-6, IL-18, IL-17, tumor necrosis factor of natural killer cells. All of these chemicals are shown to be elevated with high exposures to every day chemicals, so we know that.   We know that many of these chemicals contribute to chronic conditions like diabetes, right? Because they affect insulin production and insulin resistance in muscle tissue, heart disease, blood pressure, all affected by BPA, plenty of good studies on that. We know that all these comorbidities that we hear about on the news, five months into this pandemic, we know that the people who do worse once infected… Everyone can get infected, right? Everyone can get it. It’s the people that do worse with it, who respond more severely and require ventilation, oxygenation, and some die, of course, many die, are the people that have one or more comorbidity, okay? And as the comorbidities go up in number, the higher your risk of having an inflammatory response to COVID.

                                So again, the number one way I would say is to eat healthy, eat clean, but to really think about chemicals that affect these chronic conditions and inflammation as one mechanism of preventing that inflammatory response if exposed.  Now, I agree, the vaccine is going to be a whole nother discussion. And as an autoimmune disease specialist, as a rheumatologist, I’m particularly sensitive to this whole topic because my patients are either immunocompromised to begin with, or now exposed to chemicals and may have to be in a position for their jobs or school to get a vaccine. So, it’s going to be very tricky, but yes, it can blunt your immune system response to create antibodies, your B cells creating antibodies, which would be protective to future exposures. So anyway, that’s a long winded answer, but yes.

Dr. Weitz:            Yeah, it’s kind of interesting. It could be that people in the United States are less likely to develop natural immunity, herd immunity, whatever you want to call it, or/and maybe the vaccine might be less effective in the United States because of all these chemicals. I really think this whole crisis is a wake up call for people in the United States to get more healthy, because we’re talking about all these chronic health conditions like diabetes, and hypertension, and obesity, just epidemic, so it should be a wake up for that. Maybe this is a wake up call to start paying attention and getting rid of some of these toxic chemicals or trying to reduce them.

Dr. Cohen:          And you’re absolutely right. And obesity is another one of those big como- in fact, probably the biggest comorbidity, especially in children who have a terrible response to COVID are mostly obese.

Dr. Weitz:            And where do a lot of toxins get stored, but in fat cells, so people who are more obese are storing more fat.

Dr. Cohen:          And also when you talk about environmental justice, and health equity, and you talk about who are getting the sickest, we know that many of the minority groups in this country, major cities, people who are underserved, people who don’t have access to health care, they may have higher access to junk food, right? Because they’re in places where there’s food deserts, or healthy food deserts. And so you can start to pick out why it all connects. Our diet-

Dr. Weitz:            And junk food is cheap.

Dr. Cohen:          And junk food is cheap, and it’s, unfortunately, what a lot of people rely on for feeding their families. So, I think the system is really a mess, it’s really broken. And I think we’re also seeing through the pandemic, just how bad the system is for people who really even want to get healthy. And these are people that just wouldn’t like to be necessarily on junk food, these are people who necessarily want to be healthy like everyone else and have the ability to do so. And it’s not just food, by the way, air quality plays a key role in terms of risk for COVID. And we know this because air pollution actually has been shown over the last five months worldwide and when they measured it, it correlates with a worse inflammatory response to COVID. We have a whole chapter on indoor and outdoor air quality and what to do about it. Because again, it’s not just what you eat, it’s what you drink, it’s what you inhale, it’s what you put on your skin, what you put in your body. These things all add up to a picture of contamination.

Dr. Weitz:            And one of the ways people are trying to be healthier is to reduce their carbs, they might be eating paleo, or keto, or carnivore diet, and they’re eating less carbs, or very little carbs, and they’re eating more fat, and they’re eating the entire animal. And you mentioned in your book how eating the fat and the skin from animal products like fish and poultry are going to concentrate more of the toxic chemicals. Not only are they eating the skin and everything else, but they’re eating liver, and these other organs, which even more are going to concentrate these toxins, right?

Dr. Cohen:          Yeah. Well, you did actually read the book. I can’t believe you know so much detail about the book. I’m so impressed. I’m like, “Oh my god, I did write that.” But it is true. The fish, when we eat fish, the skin is the dirtiest part of the whole fish. Fat holds these chemicals, these endocrine disruptive chemicals.

Dr. Weitz:            But I always thought that’s where the omega 3’s are, right? So you want it.

Dr. Cohen:          Well, it’s become a really sad situation where I tell patients, believe it or not, knowing what I now know about chemicals and seafood, wild or farm raised, I recommend only about two or three servings of fish even a week wild caught. Because I think you start to tip the balance between benefit and risk.  And if you’re going to do supplements, which I do believe in supplements, just evidence based, well thought through and really good brands, because brands matter in this country, because everything is a free for all, I say a good fish oil supplement that’s affordable, that’s cleaned for heavy metals and PCBs, that is concentrated so you don’t have to take 10 of them to get the same amount as another one that’s just one of them, that all plays out into cost, to compliance, consistency. And you need a company that actually cleans and looks for those metals and those PCB contaminants, because quite frankly, I think as we move forward, just those chemicals, it’s actually microplastics are getting into fish. I’m sure you’ve read those articles.

Dr. Weitz:            Oh, yeah.

Dr. Cohen:          Yeah, like I said, it’s a pretty daunting conversation, but what we try to do is just give people really simple, “Here’s what we recommend based on the science.” And it’s not a perfect situation. I color my hair. We all have habits that we love, and we have to work, it’s a journey. So, I call myself out on that, but I think I try to give up everything else so I can still try to be a blonde.

Dr. Weitz:            Absolutely, yeah. It’s not a perfect world. It’s a question of doing our best to reduce our level of these toxic chemicals, and then perhaps maybe doing some sort of detox periodically as well.

Dr. Cohen:          Yeah. I mean, there’s nothing wrong with doing detoxes, I just don’t promote a lot of that. In the book, I have a whole chapter. The last chapter, I think is on detox, and it’s really talking about how exercise works anthropologically. I was an anthropology minor in college, I loved it. I loved it, loved it, loved it, because you can look through the world as an anthropology person and you can see how messed up we are these past 200 years. Really, it’s like 200 years, 300 years. I mean, you could argue further, but in terms of chemicals, pollution, lack of community, spiritual, clean drinking water, sleep, we have really screwed a lot of things up that we’ve been evolving to utilize in our lives for millions of years.  So, I really want people to think about the ways to naturally detox that our bodies were designed, like exercise, how it works, why it works? Sleep. How we detox our brains at night. People don’t realize we actually detox our brains at night.

Dr. Weitz:            The glymphatic system, yeah.

Dr. Cohen:          [crosstalk 00:51:00].

Dr. Weitz:            Which happens during REM sleep, yeah.

Dr. Cohen:          Yeah. Yeah. I mean, it’s so fascinating. That’s new science from 2013. We have all the references in there. But there’s just really interesting stuff that if you just learn about it, you’ll start to realize you don’t need any fancy cleanses, and detoxes, and high colonics, and all these cockamamie things that I hear about, you really just need to be consistent with very reasonable behaviors and lifestyle changes, and that will be enough to do it. And I see this because I test myself, I test my patients, so it supersize me. I’m living and trying to make sure I’m pulling as many studies that show that what you do and how you change matters.

Dr. Weitz:            Yeah, firstly, I don’t find that just exercising and eating clean is enough when you’re loaded with heavy metals and some of these toxins.

Dr. Cohen:          It depends on your occupation too, it depends on where you live, it depends on your water quality. There’s so much. So, what doctors and healthcare professionals don’t often do is do an environmental health assessment. When I see a patient, I see them for an hour, my initial visit, and by the time they leave, I know every aspect of their exposures, their lifestyle, their history. You got to know this stuff because you have to figure out how to intervene. And I think that’s what’s missing, is doctors tend to spend about 15 to 20, maybe half an hour with patients, and mostly it’s dealing with the current issues and not the big picture ideas. But everyone’s different in terms of their exposures, so I don’t go nuts in one direction or another. I try to really hone in on that person.

Dr. Weitz:            Yeah. So, let’s see. We talked a little bit about the water and the problems with the water. We’ve got personal care products. So, there’s so many chemicals in these personal care products, phthalates, and benzoates, and there’s so many chemicals. What are the most toxic ones to avoid?

Dr. Cohen:          Well, they all have their own risks, and of course, over time, exposures add up. So, the idea is that look, when I was a kid and a teenager, did I know any of this? No. Did I go to college and sleep on a nasty mattress? Who knows what I was breathing in. I mean, I look back at all the Cheez Whiz and Oreos I ate. I mean, you cannot change your past, you can only change what you do moving forward. And when it comes to personal care products, we’ve been through all of them. I mean, all of us have been through all of them.

                                The idea is whether one class or one chemical is going to get you is hard to even figure that out. What you want to do is try to think globally about, do I need these products? How many do I need? Since they’re completely unregulated. I mean, personal care products in the US are not regulated at all, meaning they’re not required to have testing for toxicity or health issues before they’re added to products that go on to the shelf. And most people can’t believe that. In fact, products that are on the shelf, like shampoo, conditioner, what have you, body spray, if they cause human health problems and enough people complain, the only ones that can take that off the shelf are the manufacturers. Our government cannot pull products from the shelf. So, it’s absurd, but there are many great ways to check your products. And that’s where we talk about Environmental Working Group has a skin deep database where you type in your products. I even have their app on my phone, and when I go shopping, I can actually use the barcode. And they have a rating system, zero to 10.

                                And so we give all that information as to how to just find your personal care products. For teenagers, it’s usually they use about 17 products per day, 15 to 17, which is crazy, but they use the most. Women, on average, use about 12 personal care products a day, and of course, men use about six. But really, once you get those checked out, you’re done, at least until you recheck them. But the idea is to get clean products that you put in, on, and around your body, tampons, feminine care products, especially. And really, it’s not that complicated once you do it. It’s a journey so you have to do one by one and not stress yourself out.

Dr. Weitz:            Right. Yeah. So, use as few personal care products as you can and shop at Whole Foods and try to get the least toxic ones you can.

Dr. Cohen:          Yeah. I mean, Whole Foods does a nice job. I don’t want to give them so many props that it’s all you have to go shop at. I mean, I think you’ve got to be using your app for EWG skin deep database, and you can buy anywhere. I mean, the idea is that you want to check your products and then you can probably find those products in many places. But you want control.   Now, they do a nice screening process, but again, I can’t vouch for all of their products.

Dr. Weitz:            Right. But I mean you have to go to either health food stores or natural stores, I mean-

Dr. Cohen:          Websites.

Dr. Weitz:            … the main stores websites. Yeah.

Dr. Cohen:          Yeah. But you have to do the work. So, when I teach high school, which I do, and that’s my goal, is to get all of this information into a national curriculum. And if you want to hear that story, actually, it’s a TED talk, TEDx talk on YouTube, if you type my name.

Dr. Weitz:            Yeah, I watched it.

Dr. Cohen:          Did you?

Dr. Weitz:            I did.

Dr. Cohen:          Yeah, that was the hardest thing I’ve ever done. It was really quite hard to do, but I’m proud of it. Anyway, so that’s the story of where this whole thing is hopefully going, is getting information such as in the book and what I do with patients into schools. Because if we can’t teach people young before they get sick, then we’re just chasing after it after they do get sick.

                                So, when I teach high school, I will have everyone in the class download the skin deep database app, or the website, and I come in with a bag of stinky junk from one of the big box stores and I toss the tampons at the jocks, and I’ll throw the body spray at the girls, and lipsticks, nail polish, everything, and their job is to actually take the product, look it up, tell me what the rating system is, tell me what chemicals they are supposedly bad in the product, and choose better products.

Dr. Weitz:            But if I’m a young man in high school, and if I don’t use the Axe products, I’m not going to have all those hype chicks chasing me.

Dr. Cohen:          Guess what? There’s different ratings for the different Axe sprays. So, depending on the flavor, it could be a two, or it could be a 10. It’s fascinating. And again, I’m not here to tell everyone, “Listen, don’t do this, don’t do that.” I don’t want to be that person. I want people to have the tools, the fishing rod, to do this throughout their lives, not just listen to a one off. And you’d be surprised about that body spray. That stuff stinks, man, but these kids love it, and at least I can teach them how to find the safer versions of what they love.

Dr. Weitz:            Right. And then we got these flame retardant chemicals in furniture, in carpets.

Dr. Cohen:          Yeah. And it’s a matter of just working your way through the process. I don’t want this to be overwhelming. Look, I came from a place where I didn’t do any of this stuff, I didn’t know anything about, it’s on the TED talk. I learned, as anyone would learn, and I’m considered to be someone who has a background in science or medicine, or what have you, I didn’t know any of this stuff.

                                So, as I learned and my journey kept continuing, I kept on layering what I would tell other people. And that’s what this is the culmination of, it’s like eight years of trying to figure it out on my own. And instead of people spending eight years to do it, now they can just buy a book and read it. You know what I mean? So, I’m very honest about that. It’s a journey, and I’m not there yet. I mean, I’m still doing things that I wish I could change, but I’m doing it slowly. We changed out our couches. Couches are expensive. And so I would stare at this couch as I walked through the kitchen or the lounge or whatever we have, and I would have like a tick, because I knew that it had flame retardant chemicals, but we needed a couch. So, it was so stressful. And the day I got rid of my couch, I took pictures, I posted, I was like, “This is the way you get good ones.” So, I look at it as a win every time you kind of one out.

Dr. Weitz:            What can you do about your car seat, because car seat all have it, right?

Dr. Cohen:          Car seats have them because they’re covered by the Federal Transportation Association or [crosstalk 00:59:44] Transportation. Anyway, so yeah. Flame retardants are part of car seats and the material in car seats. There’s no way around it at this point. But they’ve gotten rid of flame retardants in baby pillows, and a lot of mattresses. Certain states, like California, are much better at this than others. And the rules are changing, but in car seats, because the car can explode, they have not been able to do that. And quite frankly, I’m not sure I disagree, but you can also do a covering to your car seat that can be non toxic. So, there’s that. You can do that with no problem.

Dr. Weitz:            Yeah. Okay, cool. Well, I think we covered a bunch of really useful information.

Dr. Cohen:          Yeah. I had fun. You got my Jewish [crosstalk 01:00:28] drink.

Dr. Weitz:            There you go. So, how can our listeners, viewers get a hold of you, find out about your book?

Dr. Cohen:          Yeah. Well, my practice is in Princeton. I do telemedicine, I see people from all over the world if they need it. That’s just my website for my practice, which is just A-L-Ycohen, C-O-H-E-NMD.com, so alycohenmd.com.    But my baby is The Smart Human. Thesmarthuman.com, The Smart Human on Facebook, Instagram, Twitter. I post Monday, Wednesday, Friday on Facebook, Instagram, maybe three times a week also. But I’m always posting nuggets, nuggets and pictures, and things I’m learning, and changes in the market, breast cancer prevention tips, Alzheimer’s prevention. So, that’s my educational platform. I’m very proud of it. I don’t sell anything, but I will sell the book. I got that right. But after the book, I really don’t sell anything at all. So, it’s squeaky clean and I hope people will go to follow on those different platforms. And check out the YouTube video, the TED Talk called, How To Keep Your Kids Safe From Toxic Chemicals.

Dr. Weitz:            Great. Excellent. Thank you.

Dr. Cohen:          Yeah, my pleasure. Thanks for having me.




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, including sugar and anything else that causes inflammation in the body.

3:45  Dr. Hall describes the process of type II diabetes as there being in each of us “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.”

5:25  The most commonly prescribed drug for diabetes is metformin, which is touted as increasing the cell sensitivity to insulin, but Dr. Hall says that it is not really clear how metformin works and she believes that it damages the mitochondria, which are the energy producing parts of our cells.

7:11  Diabetes is quite prevalent in the US and is increasing.  The standard American diet plays a role, including the amount of sugar intake. Air pollution can play a role, as can mold illness, biotoxins, and genetic factors that affect the ability to detoxify. Obesity can lead to diabetes, as can anything that increases inflammation in the body.

8:18  During the consultation with a patient with diabetes, Dr. Hall will look for root causes for their condition.  She will explore their environment through their history.  Are they a truck driver sitting in smog every day or commuting a long way on the 405 Freeway?  Is it likely that they have been getting exposed to toxins? Where did they grow up? Did they take a lot of antibiotics growing up?  If they have a thyroid problem, this can lead to diabetes and vica versa.  Dr. Hall said that it’s rare to meet a diabetic patient who’s really eating a good diet, but she noted that she does “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. 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 into the blood … its like 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 what’s 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 seem 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 who 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 or the 5 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 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:            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.