Bone Health with Dr. John Neustadt: Rational Wellness Podcast 114

Dr. John Neustadt discusses the Bone Health with Dr. Ben Weitz.

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Podcast Highlights

3:32  The reasons we are having an epidemic of osteoporosis and osteopenia in the US is that we are getting older, according to Dr. Neustadt.


Dr. John Neustadt is the founder and Medical Director of Montana Integrative Medicine and he is the founder and President of Nutritional Biochemistry Inc. (NBI).  He has written four books, including A Revolution in Health Through Nutritional Biochemistry, and he has published over 100 research review articles. 

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


Podcast Transcript

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free eBook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and a review. That way more people will find out about the Rational Wellness Podcast. And for those of you who don’t know, we also have a video version so you can go to my YouTube page, weitzchiro, and watch that and if you go to my website, drweitz.com, there will be a complete transcript and show notes.

Our topic for today is osteoporosis with Dr. John Neustadt. Osteoporosis literally means porous bones, and it refers to a condition in which the bones become fragile and the risk of fracture is increased. In fact, according to the National Osteoporosis Foundation, studies suggest that one out of two women and one out of four men over the age of 50 will break a bone due to osteoporosis. The most common sites of these fractures are at the hip, the spine, and the wrist.  If you have osteoporosis and break your hip, there’s a 40% chance that you’ll be dead within six months. When you look at a bone density scan, if there is a T-score of 2.5 or greater, this is defined as, -2.5 or greater, this is defined as osteoporosis, and a score of -1 to -2.5 is termed osteopenia, which is a loss of bone, though not as severe as osteoporosis. Thanks to a new paper that Dr. Neustadt just sent me, we now know that even patients in the 35 to 50 year old range are suffering with bone loss. In fact, 28% of men and 26% of women in the U.S. in this 35 to 50 range have some loss of bone. As I understand it, one of the ways that we should understand osteoporosis is that throughout our lives we have a balance of both cells that build new bone, osteoblasts, and cells that clear out old, junky bone, osteoclasts. When we are younger, there’s a tendency for the osteoblasts to dominate and we tend to build more bone over the osteoclasts. And then when we get older, there’s a tendency for this to become reversed.

                                        Dr. John Neustadt is the founder and medical director of Montana Integrative Medicine, and he’s the founder and president of Nutritional Biochemistry Incorporated, and also NBI Pharmaceuticals. He’s written four books, including A Revolution in Health Through Nutritional Biochemistry, and he’s published over 100 research review articles. Dr. Neustadt, thank you so much for joining me today.

Dr. Neustadt:                     My pleasure. So great to be talking with you.

Dr. Weitz:                          Excellent. So, why do you think we’re having such an epidemic of osteoporosis and osteopenia in the U.S. today?

Dr. Neustadt:                     Great question. It’s typically understood to be a disease of us getting older, and with the baby boomers getting to 65, 70 year old range the general population United States skewing older, it makes sense that as we get older and we are more likely to lose bone that the prevalence of osteoporosis and the risk of osteoporosis goes up. In fact, the fastest rate of bone loss for women is after menopause, the 10 years after menopause is the fastest, the time when women lose bone the fastest.

Dr. Weitz:                          And that’s because it’s related to estrogen levels?

Dr. Neustadt:                     Correct. Estrogen is considered anti-inflammatory. It also helps to build bone and maintain bone, and when that gets lost, you can get bone loss.

Dr. Weitz:                          Now, you know, we understand that women are programmed essentially for their hormone levels to drop after menopause a lot, their estrogen and progesterone levels, but men are not really programmed for that to happen, so why should men necessarily have a similar sort of risk as women?

Dr. Neustadt:                     Well they really don’t actually, and this new study that you quoted is new research. It’s groundbreaking research. I think there needs to be continuing studies, but it is incredibly alarming. The understanding currently of osteoporosis in men is that it affects about, you know, 20% of osteoporosis cases are in men, and 80% are in women-

Dr. Weitz:                            Oh, okay.

Dr. Neustadt:                     … so, disproportionately women are affected. This new research is very alarming though in that it’s showing first that bone loss is occurring much younger than we had anticipated and thought, and second, that it is occurring potentially at a rate much higher in men than we thought as well. What may be happening is that the rate of bone loss or the risk for osteoporosis, I’m speculating here, based on the research, may be similar for men and women. In the study the loss of bone was very similar in terms of the percentage of men and women in that 35 to 50 year old age group who had lost bone and became osteopenic, had pre-osteoporosis. And then as they get older and into menopause, that you get that drop in estrogen, what may be happening is then women actually start losing bone faster than men because they have, they’ve lost that estrogen, and at that point they’re actually outpacing the men in terms of the rate of the onset of osteoporosis.

                                                And we wouldn’t know if men are more susceptible that younger because all of the research to date has really been with osteoporosis, and in fact, the, not osteopenia. And the screening guidelines the United States Preventative Task Force for osteoporosis doesn’t even recommend that men get screened for osteoporosis because it appears to be, based on the research that they looked at, so infrequent in men compared to women.

Dr. Weitz:                            Well, it may reflect a sedentary lifestyle and poor diet.

Dr. Neustadt:                     Absolutely, absolutely. And there is definitely that component to it. And I think it’s important to note that the most important risk with osteoporosis is not the low bone density. That’s a number on a test, or what’s called a surrogate marker. That’s not clinically the most dangerous thing about osteoporosis, or the most important that people need to worry about. The most important risk with osteoporosis is breaking a bone, as you correctly pointed out. If you fracture a hip and you have osteoporosis then there’s up to a 40% chance that you’re going to be dead in six months. If you happen to survive the first year, there’s actually a 20% chance that you’re going to end up in nursing home care and you’re going to suffer from chronic pain or other complications from that fracture.

                                                So, anything that we do clinically and everything should be interpreted, both the testing and any recommendations, through that lens of how predictive is the test for predicting a fracture? And what does the research show in terms of what my doctor, or what I’m reading, is recommending I do? What does the research show in terms of its ability to actually prevent a fracture, not just change bone density, because since the 1990s we’ve known that a bone density test only predicts 44% of women who will break a bone and only 21% of men, which is shockingly low. It’s neither specific nor sensitive. The World Health Organization, the American College of Obstetricians and Gynecologists, anyone essentially that’s looked at the research has published position statements on this, have correctly concluded that fracture risk depends on factors largely other than bone density.

Dr. Weitz:                            So, what are some of those factors?

Dr. Neustadt:                     Great question. So, medications is a huge factor. We live in a completely overmedicated society. A lot of people don’t know and they’re popping these like candy and taking them for years and years, acid-blocking medications, the Protonix, the Prilosec, Zantac, those were never approved by the FDA for longterm use, yet not only are they being prescribed for years for symptoms of acid reflux to suppress the acid, but now they’re available over the counter without a prescription. The research shows that after four years of taking them, over time the risk continues to increase for osteoporosis and hip fracture, the most dangerous fracture, then after four years of taking them that the risk for a hip fracture increases by 60%.

                                                Another common medication, Prednisone, Oral Prednisone can strip the bone of its minerals, calcium, and cause osteoporosis and increase the risk of fractures. Premenopausal Tamoxifen, if someone’s had breast cancer, been treated with Tamoxifen prior to going through menopause, that’s also a risk. There’s quite a list of medications that can cause that. The number one predictor of a future osteoporosis fracture is if you’ve had one already. So, if you have osteoporosis, you’ve had a previous fracture with osteoporosis, that’s the number one predictor of a future fracture. Medications are an issue. Other diseases that you may have, anything that causes malabsorption, like Crohn’s disease, ulcerative colitis, celiac disease, those are risk factors as well.

                                                So, autoimmune diseases where there’s systemic inflammation, that’s a risk factor as well. And one of the, you know, sedentary lifestyle, not exercising, that’s a risk factor. Poor diet is a risk factor. There’s good research also showing in terms of risk factors for osteoporosis that what we want to prevent is falling because the number one event to occur just prior to breaking a bone typically is somebody falling, right? So, that’s where the sedentary lifestyle, the not exercising, comes in, that if somebody doesn’t have that balance and strength, then they’re more likely to fall and fracture.


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 a right product for the right patient, especially since we do a lot of testing and we figure out exactly what the patients need. So, 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. And now, back to our discussion.


                                                You know, some people say that what appears to be a fall that results in a fracture is actually a pathological fracture of the hip that then results in a fall. Is that true or is that not really true?

Dr. Neustadt:                     So…

Dr. Weitz:                            Does that occur in some cases?

Dr. Neustadt:                     Yeah, the only cases where it’s really noteworthy is when people are taking bisphosphonate medications, right? It’s pretty rare unless you’re running, you have really weak bones, you come down so hard, but most people who fall, they lose their balance.

Dr. Weitz:                            Okay.

Dr. Neustadt:                     There’s no evidence to my mind. It’s sort of a chicken and the egg thing, what came first? It is understood that typically a fall precedes a fracture, and when that doesn’t happen, when the fracture happens first, what we’re looking for is medication-induced fractures, like if somebody is taking Fosamax for example, and that provides the pattern of fracture in a bisphosphonate break is a very specific pattern of fracture, and it’s a non-traumatic fracture so that can be differentiated.

Dr. Weitz:                            So, let’s clarify for people who are listening. Bisphosphonates are a classification of drugs that are prescribed for osteoporosis, correct?

Dr. Neustadt:                     That’s correct. They’re the most prescribed medication. They go by names of Fosamax, Zometa, for example. And like anything, the end goal, hopefully the end, the goal clinically is to reduce fractures, so the question is well, how much do these reduce fractures? The bisphosphonate category medications reduce fractures about 45%. Those are hip fractures with, I mean, vertebral fractures. Vertebral fractures can cause pain, but they’re not going to kill you. It’s the hip fractures that kill you. What’s been shown is Fosamax actually doesn’t even prevent what’s called a primary hip fracture. If you’ve never had a fracture before, it has not been shown to actually prevent a first fracture. And paradoxically, which I think is a little insane, that even though it’s rare, these medication are supposedly are supposed to prevent a fracture actually in rare cases, actually increase people’s risk for fracture. Not something we really want to do clinically.

Dr. Weitz:                            Like unusual fractures like femur fractures?

Dr. Neustadt:                     Correct. It’s called a unicortical break in the femur. Non-traumatic so there are cases in the medical literature of some woman actually, she was watering her plant, she’s on a stepstool and she just, she stepped down, she didn’t fall, she stepped down and twisted a little bit, and her leg just broke. And what happens when somebody is on the medication, and it breaks, it actually reduces their ability to heal from that, so it takes them longer to heal.

Dr. Weitz:                            Now can you explain how these bisphosphonates work, the mechanism of action?

Dr. Neustadt:                     Yes, they poison the osteoclasts. So, as you mentioned, there are two main cells in the bone, and, osteoblasts and osteoclasts. Osteoblasts build bone, osteoclasts break bone down. It’s a process called bone remodeling. And it’s important, it’s necessary. It has to be in good balance to break down old, used up bone and build new fresh bone to maintain healthy bones. That’s important. And what the bisphosphonates do is they poison the osteoclasts so the osteoclasts stop working and so you get a, the osteoblasts keep working and they keep building up bone but it’s abnormal bone, it’s weaker bone.

Dr. Weitz:                            You’re not clearing out the old, junky bone that should be cleared out to make stronger bone.

Dr. Neustadt:                     Correct.

Dr. Weitz:                            Now I’ve heard you talk about the fact that to prevent fractures, you mentioned the fact that bone density tests are not the most accurate tests and that’s because there’s a flexible part of the bone, right, that’s not-

Dr. Neustadt:                     Correct.

Dr. Weitz:                            … measured by the density. Can you explain what that flexible part of the bone is?

Dr. Neustadt:                     Absolutely. It’s the connective tissue in bone. So, bone is a tissue and like all tissues in the body, it’s made up of different substances. The bone density test only measures the mineral content of the bone. The minerals in the bone give bone its hardness, but there’s collagen, bone collagen, that gives bone its flexibility and actually gives bone what’s called its quality, its ultimate strength. If you were to take, and in fact when I was in medical school my histology class, the professor soaked a chicken leg, a chicken bone in acetic acid, in vinegar, and what that does it strips all the minerals away from it. And when all the minerals are gone, all that’s left is the collagen, the connective tissue. And he brought it in, and it’s like it’s a rubber chicken bone. It flexes, it bends, but it doesn’t break. And so that bone collagen, that connective tissue, is crucial and that’s not measured on a bone density test, nor is it taken into consideration typically in the conventional approach to looking at bone health and treating osteoporosis.

Dr. Weitz:                            So, if bone density tests don’t tell us about the true ability of a bone to resist fractures, are there any tests that do? What about urinary tests for bone resorption markers? What about measuring serum osteocalcin or undercarboxylated osteocalcin?

Dr. Neustadt:                     Great question. So, I want to make sure that I’m very clear in what I’m saying, that I don’t completely discount a bone density test. It does have some predictive value, but I think it’s important to put it in its proper perspective and place. It’s one piece of the puzzle. It’s one piece of data to consider, but most times when people come to me with their bone density test, there’s a lot of anxiety. They’ve got the diagnosis of osteoporosis. They’re very scared, and that’s all they’re focusing on. So, it’s important just to step back, and I think put it in its proper perspective, that it is one piece of the puzzle, and by no means is it the most important piece of the puzzle.

                                                Yes, there are other tests that can, that are, again are what’s called surrogate markers. They’re markers that can look at different indicators of potential collagen or connective tissue health in the bone. They go by names that you said, osteocalcin or undercarboxylated osteocalcin, N-telopeptide, which is NTX, or CTX is another one, C-terminal peptide. And the challenge with those and why I don’t test those anymore is because there are no perspective studies showing that changing that value actually changes fracture risk. And in fact, with the undercarboxylated osteocalcin there was an animal study done some years ago in mice, in rats, where there was what’s called a wild type, just a normal rat that produced normal amounts of osteocalcin, and there was a genetically altered rat that was created that didn’t produce the osteocalcin. And after six months the rats that did not have the osteocalcin actually had stronger bones.

                                                And it just shows that the story that we’ve learned about, you know, one marker leading, and one result is maybe too simple when it comes to bone, and we need to look a little more holistically. And why I don’t test is because is doesn’t, the only reason we should test any patient and run any test if it’s going to change our approach to treatment. And what I’ve learned over the years and working with thousands of patients, and doing my research, and lecturing and digging into the research, is that none of those tests except a bone density test will change my recommendations in terms of my approach.

Dr. Weitz:                            One of the companies is offering the undercarboxylated osteocalcin as a functional measure of vitamin K status.

Dr. Neustadt:                     Yes, that is a functional measure of vitamin K status, because vitamin K is required to carboxylate it.

Dr. Weitz:                            So, is it valuable for that purpose or is it valuable to measure serum vitamin K and do you also monitor vitamin D levels?

Dr. Neustadt:                     So, I do monitor vitamin D levels. I don’t typically monitor vitamin K levels. If there is, if they have osteoporosis, they come in with a diagnosis of osteopenia and osteoporosis, and by the way why osteopenia is for me such a huge red flag with that research that we talked about is because there was two studies that came out years ago that showed that people with osteopenia are actually at higher risk for fracture than people with osteoporosis.

Dr. Weitz:                            Really? How can that be?

Dr. Neustadt:                     Well that’s a great question, and people ask me that a lot. I don’t have a definitive answer. I think that there are a couple different potential answers. One is people may not be taking it as seriously. They get the diagnosis of osteopenia so maybe they’re not as protective with their bones, they’re not as proactive with their diet and exercise and maybe dietary supplements, or medications if that’s indicated, than people with osteoporosis are. So, that’s one potential explanation. I think that’s probably the simplest explanation, but I don’t know for certainty that that is the correct one. Nobody has really teased that apart. But with respect to testing, if somebody comes in with osteoporosis I don’t really, the only thing that I would test is vitamin D to see if I need to supplement at a level much higher than I normally would. But vitamin K I don’t test because what I go off of, what do the clinical trials show, are the nutrients that people can take that have been shown consistently to reduce fractures?

                                                So, there are four nutrients that have been shown to reduce fractures and only four in clinical trials. So, calcium and vitamin D have been shown to reduce fractures about 20%, which is okay. The strontium has been shown to reduce fractures about 45%, which is no better, no worse than Fosamax, and I’m not a fan of using strontium as a first line, and I can go into that a little bit if you want after this, I talk about the next nutrient. But my first line therapy is a specific form of vitamin K called MK-4. 45 milligrams per day. That’s been approved as a medication in Japan since 1995 for the treatment of osteoporosis and bone pain caused by osteoporosis. There have been over 7,000 volunteers studied and followed for up to eight years on that dose and higher. People with postmenopausal osteoporosis, osteoporosis from medications like Prednisone, and bone loss in children, people with autoimmune diseases and bone loss, and it’s consistently shown that not only can it stop and reverse bone loss as indicated by a bone density test, but again, that’s not the most important clinical thing, it’s does it reduce fractures?

                                                But repeatedly it’s been shown to reduce fractures by over 80% when combined with the calcium and vitamin D. So, my go-to is that MK-4. There are different forms of vitamin K, but it’s only the MK-4 form of vitamin K that’s been shown to reduce fractures. All forms of vitamin K will change that osteocalcin marker blood test, but again, that’s not the most important thing clinically, it’s what’s been shown to reduce fractures. And it’s only that MK-4 form that’s been shown to reduce fractures and there are over 25 clinical trials on osteoporosis and five of them specifically looked at fracture reduction as the endpoint that they were evaluating.

Dr. Weitz:                            The use of the MK-7 version of vitamin K2 is much more common, more popular in the U.S. right now, and this may be since serum levels of vitamin K stay elevated longer after consuming MK-7 than MK-4. And since MK-7 is converted into MK-4, shouldn’t taking MK-7 be as effective as MK-4?

Dr. Neustadt:                     So, great question. First of all, MK-7 is not converted to MK-4. Vitamin K1 is converted into MK-4 in the body.

Dr. Weitz:                            Okay.

Dr. Neustadt:                     The MK-7 is not produced by mammals, humans. It’s produced by bacteria. So, gut bacteria will produce some amounts of MK-7 and then it gets absorbed into our bloodstream.

Dr. Weitz:                            Okay.

Dr. Neustadt:                     Vitamin K1 can be converted through a specific enzymatic pathway in our body into MK-4 which then gets stored in different tissues in the body throughout the body. I’ve heard that argument before that MK-7 lasts longer in the body. It’s got what’s called a longer half-life, therefore it must be superior, must be better, but again, is that the most important thing with osteoporosis? The half-life of a substance. If that were the case then Fosamax would be the best thing to take because it’ll stay in the bone for years and years. No, the most important thing is does it reduce fractures. And again, MK-7 has never been shown as an endpoint in a clinical trial to reduce fractures. And they are different molecules. They are both vitamin K, but vitamin K is a category, and as different molecules they have a little bit different effect on the body.

                                                MK-4, for example, has been shown as to have anti-cancer effect that MK-7 does not have. In fact, they’re up to phase two clinical trials in Japan with MK-4 45 milligrams and up to 135 milligrams per day for acute myeloid leukemia and myelodysplastic syndrome, blood cancers, also liver cancer. And MK-7 in contrast has been shown, if someone were coming to me and says, “I have coronary artery disease. I’ve atherosclerosis,” and that’s all they were worried about, “Should I take MK-4 or MK-7?”, I would tell them to take MK-7 because the research supports MK-7 more than MK-4 for being able to potentially promote arterial health and decalcify arteries, but with respect to bones and osteoporosis and fracture reduction, the research overwhelmingly supports MK-4.

Dr. Weitz:                            Wow. So, if we really wanted a comprehensive anti-aging program, we should probably be taking K1, MK-4, and MK-7.

Dr. Neustadt:                     You could, but there are other nutrients. You know, the anti-aging program-

Dr. Weitz:                            No, I know. Just in terms of the vitamin K part.

Dr. Neustadt:                     Yeah, it’s a yes. You could, but frankly I think that it’s, to get the clinical doses of all of that gets very expensive.

Dr. Weitz:                            Right. So, in terms of supplementing for osteoporosis, you mentioned taking the MK-4, calcium, and vitamin D.

Dr. Neustadt:                     Correct.

Dr. Weitz:                            What level do you try to get the vitamin D level up to? Do you try to get it up to 60 to 80? What’s your-

Dr. Neustadt:                     I love it. Anything above 60 I think is great. Yeah.

Dr. Weitz:                            Okay. What about adding magnesium? What about adding boron? What about adding strontium, vitamin C, antioxidants?

Dr. Neustadt:                     Great questions. Great, great questions. So, you find a lot of those in bone health supplements. And frankly you find them in multivitamin and mineral supplements too and in a good high quality vitamin and mineral supplements those nutrients should be there in adequate amounts for broad spectrum support.

Dr. Weitz:                            But you don’t get a lot of magnesium in a multi really.

Dr. Neustadt:                     Depends on the multi. The one that I created has 150 milligrams of magnesium per serving. So, I don’t know if that’s a lot to you or not.

Dr. Weitz:                            I guess it’s not, to me, no.

Dr. Neustadt:                     Right. So, it depends on what the target is. But here’s the bottom line, the most important question is has magnesium, boron, the other nutrients that you mentioned, have they-

Dr. Weitz:                            Strontium.

Dr. Neustadt:                     Well, strontium I said has been shown to reduce fractures, but have magnesium and boron, or other vitamins, have they ever been shown to reduce fractures?

Dr. Weitz:                            Right.

Dr. Neustadt:                     The answer is no. They’ve never been shown to reduce fractures. And so for me clinically when I’m working with patients and wanting to use what I think is the highest evidence, which is the randomized, you know, clinical trials, and we can get 80 plus percent fracture reduction verified in multiple clinical trials just with the combination of MK-4, 45 milligrams a day, calcium and vitamin D, and I’m targeting bone health and just osteoporosis. As an osteoporosis supplement, that’s what I would use, and in fact that’s what I created because I needed it to help my patients, and I couldn’t find one that works so I created the product. I couldn’t find, not one that worked, I couldn’t find one that had the nutrients, the combination, the dose of nutrients shown in the studies to work, so I created it.

                                                But, and then the other nutrients that you mentioned, if, I’m a big fan of magnesium, huge fan of magnesium, and I think and the research has shown that, you know, over half of the population don’t get enough, don’t consume adequate magnesium in their diets, that having it as a supplement is important but if we’re just targeting osteoporosis, there’s no research showing that it reduces fracture risk. And so, I like to move people more towards a whole foods diet, magnesium, green leafy vegetables. Every center of the chlorophyll atom has a molecule of magnesium in it so that whole foods, Mediterranean style dietary pattern whole foods diet, very rich in all those nutrients we’ve just mentioned except for the strontium.

Dr. Weitz:                            So, there’s no reason to get two to one ratio of calcium magnesium or anything like that?

Dr. Neustadt:                     So, there’s no study showing that that actually affects absorption that I’ve ever seen. I keep asking people please send me a citation, send me a study. For me, it’s reached the status of myth out there and I’ve yet to have anybody actually be able to send me a study. It’s theoretical that one may compete with the other or you need them in a certain ratio, but in terms of fracture reduction to get that 80 plus percent, it was MK-4, 45 milligrams a day, vitamin D, and calcium, and that’s it.

Dr. Weitz:                            If the key is the collagenous part of bone, if there’s going to be more about supplements, is there any benefit in taking things that are known to help with collagen like glucosamine sulfate, bone broth, collagen protein?

Dr. Neustadt:                     Great question. So, for me the question I’m going to always go back to and that I really work with a lot of people that, osteoporosis-

Dr. Weitz:                            Let me guess, is there any study showing that they decrease fracture risk?

Dr. Neustadt:                     That’s exactly right. That’s it. It’s not complicated in my mind. What are the studies showing it reduces fracture risk? And dietary supplements and taking supplements can get very expensive for people, and so what we know in terms of maximum fracture risk reduction are those three nutrients that I mentioned, medications if necessary. I’m not opposed to them but I think the best fracture reduction on a medication is on Forteo, which is only available by injection, but, you know, what has been shown to reduce fractures, or falls, and fall related injuries in osteoporosis? It’s diet, exercise, MK-4, 45 milligrams a day, calcium, and vitamin D, and strontium, but I don’t like to use strontium.

Dr. Weitz:                            Peptides have become very popular, and there’s one called BPC, Body Protective Compound-157 and that’s been shown to stimulate bone healing at least in some of the animal studies.

Dr. Neustadt:                     I think that’s wonderful preliminary research and I’m definitely open to learning of new things that actually work but as a clinician, I’m going to go back to that same question, you know, just because it’s in an animal study doesn’t mean it translates into humans, and we see that over and over in medical research. And what happens is you see a lot of these companies that are coming out with these raw materials like AlgaeCal, for example, or the MK-7, and they’ll have studies and every time the study will report, you look at it, it’ll report increase in bone mineral density, increase in bone mineral density. Well ask the question has it been shown to reduce fractures? Because we know that a bone mineral density test only predicts 44% of women and only 21% of men who will fracture.

Dr. Weitz:                            Since estrogen is protective of bone, should postmenopausal women take bioidentical estrogen?

Dr. Neustadt:                     I think that if they are showing symptoms of hot flashes and insomnia and other symptoms of low estrogen and issues with that then that is a good clinical indication to potentially supplement them. There is research taking estrogen and what are called selective estrogen response modifier, those category of medications, Evista, for example, is one of them, can reduce fracture risk. So, should they take it? There can be some risks with taking those so that would be something to be decided only in consultation with their healthcare provider who knows their medical history and their risk profile.

Dr. Weitz:                            Since there’s such a problem with these bisphosphonates, what about salmon calcitonin?

Dr. Neustadt:                     You know, salmon calcitonin I’ve used to help people heal from fractures within the elderly, and it’s got some good research on it, but as a longterm solution, the fracture reduction is not great.

Dr. Weitz:                            Okay. One thing I thought that was interesting I heard you say in one of your talks, this is a little bit of a tangent for those of us in a functional medicine space is that if you have a patient who’s in a condition where they’re losing bone, we may see an increase in heavy metals in the blood since some of these metals tend to get stored in the bone, and I think that’s pretty interesting because a lot of us are dealing with chronic patients, some of whom have heavy metal toxicity, and we may find that sometimes their heavy metal toxicity continues even though we’re using some protocols that should be reducing their heavy metals, and we may not be considering the fact that if they’re in a state where they’re losing bone, they may be continuing to liberate more heavy metals into their bloodstream, and so, you know, if we’re dealing with a patient like that, especially with a postmenopausal woman, we might consider the importance of trying to get their bone situation stabilized.

Dr. Neustadt:                     Absolutely. Absolutely. So, and there are risks, you know, for osteoporosis and if somebody does have one of those risk factors even the U.S. Preventative Task Force says any, you know, women under 65 who are premenopausal with risk factors for osteoporosis should be screened for osteoporosis. So, they don’t really, on their radar it’s not the heavy metal toxicity but definitely on mine it is and it sounds like it’s on your radars as well.

Dr. Weitz:                            Yeah. So, what’s the best kind of diet for increasing bone density?

Dr. Neustadt:                     So, the best, over 60 years of research without a doubt the Mediterranean pattern style of eating. And I really, it’s something, it’s referred to as a Mediterranean diet, but I really want people to understand it’s not as if you’re going on a diet, it’s an eating pattern. It has its own food pyramid, and it’s really basically a whole foods diet. Getting those nutrients that we talked about, the minerals, the vitamins, from whole plant foods. Very high in whole grains and at the base of the pyramid, vegetables, like I said, whole foods. As you go up, lean proteins, you know, you’ve got legumes in there, chicken and fish maybe weekly. It’s the opposite of the standard American diet which is a lot of red meat and highly processed foods. And in the Mediterranean eating pattern red meat is consumed, you know, less than weekly, maybe once every couple weeks, and all in moderation. Water, ample water, exercise, it’s really an eating pattern but it’s also a lifestyle.

Dr. Weitz:                            It’s kind of hard to know when you start reading all the articles on the Mediterranean diet, and don’t get me wrong, I’ve seen a lot of positive studies, but there’s a lot of confusion from study to study exactly what constitutes a Mediterranean diet. You mentioned whole grains, you know, how much pasta, how much bread is there? People talk about legumes, you know, is cheese part of it? You know, olive oil, red wine. I’m not so sure it’s that clearly defined a diet, but, you know, I get your general point about it.

Dr. Neustadt:                     I totally agree with you, and you hit such an important point of how confusing this research can be for somebody. So, here’s my, my overall emphasis is that typically people when they come to me and probably you as well, you know, where they’re at in their eating is really far from where it should be. And a lot of it is just starting, people becoming aware of it. And so the first thing I do with people is I have them quantify. I break it down to the number of grams of total fiber and the number of grams of protein they’re getting a day. And that total fiber needs to come from whole foods, not a supplement. So, that would be the green leafy vegetables, that could be some legumes, and I shoot for a minimum of 30 grams of total dietary fiber a day, and they have to quantify it.

                                                And for a couple days without changing their diet, and same with their protein requirement is calculated based on their body weight. And so, over six weeks or so I work them to transition into eating more of a whole foods diet. I’m not a fan of dairy, as you and I discussed prior to the podcast. The biggest reason is I don’t think it aids a great source of nutrients, but there’s so many hormones in there that I don’t think are real, they’re not healthy. And a lot of people react to dairy. They can have allergies to them that they’re not even aware about. They get stuffy nose, post-nasal drip, gas and bloating, that sort of thing.

                                                So, I’m not a fan of dairy, and the dairy in Europe and the Mediterranean’s very different. They have a different regulatory environment for the hormones that they allow, what they allow on their crops. And our crops are, unless it’s organic, are quite poisons with glyphosate pesticides and recombinant growth hormones in the beef, and it gets into the dairy, and so I counsel people eat as organic as possible if you can. If you feel that you can’t afford 100%, you know, stay away from what’s called the dirty dozen, the 12 most pesticide-laden fruits and vegetables. And if you can see what it was-

Dr. Weitz:                            For those of you who don’t know, that’s from the Environmental Working Group publishes a list on dirty dozen of the fruits and vegetables that are most likely to have a lot of pesticides.

Dr. Neustadt:                     Exactly. Exactly. And, you know, and then there are just some general rules of thumb that I guide people on. If you can see, look at it and know where it came from, it’s a whole food.

Dr. Weitz:                            What about soy? Should women be eating soy?

Dr. Neustadt:                     In moderation I don’t have a problem with it. I’m a big fan of moderation. Like, if somebody wants to have a little dairy every once in a while, okay. I’m not really fanatical about most things.

Dr. Weitz:                            Could soy be beneficial because of phytoestrogenic effect?

Dr. Neustadt:                     It can actually. It can. Again, it’s never been shown to reduce fractures, but yes, soy does have some benefits. But then it in the question of how much do you really need to eat to get those benefits?

Dr. Weitz:                            What’s the best type of exercise for improving bone density, improving bone, preventing fracture of bones?

Dr. Neustadt:                     Yeah, great question. The best exercise is one that helps people improve their balance to reduce their risk of falling and fall related injuries. So, a lot of people think that when they get the diagnosis, or they got to start exercising, they have to go to the gym, they’ve got to start pumping iron. And that’s what people want to do, great. But, for a lot of people who don’t want to do that it becomes an impediment to them doing anything because they’re under that impression that that’s what they need to do. But, the research shows that anything you do to improve your balance will reduce the risk of falls and fall related injuries. So, that can be gentle yoga, that can be Qi gong, even going for a walk on uneven terrain where you’re walking up and down, you know, over a curve, you know, anything that sort of improves that balance.

                                                And I love and I read a blog on it what’s called the stork exercise. I love things that people can do in their house. There are ways to work exercises into people’s daily routine so it just becomes part of their life. So, the stork exercise, while you, you know, storks, they stand on one leg, while somebody brushes their teeth, and brushing your teeth should be two minutes a day. While you’re brushing the bottom teeth for a minute in the morning you stand on one leg and you can kind of hold the sink if you want a little bit to balance yourself, but try not to use it as a crutch, not too much. And you stand on one leg in the bottom teeth for a minute and you time it, and then when you switch to the top teeth, if you’ve got a Sonicare or something it times it for you. Switch to the top teeth, you switch legs. And you do that twice a day. And that’s been shown to improve balance. They’re just little things that people can do.

Dr. Weitz:                            But, hasn’t resistance training, weight training, doesn’t that stimulate the muscles to pull on the bones which causes the bones to [crosstalk 00:42:26].

Dr. Neustadt:                     Absolutely. Weight training and that sort of training has been shown to improve bone density and absolutely, it has benefits. And I do encourage people to do that. It can be isometric. It doesn’t necessarily have to be weights. It can be somebody’s body weight as well. But I’m also a fan of trying to meet people where they’re at, and not, it’s, treating the individual because there’s a lot if somebody doesn’t want to go into a gym or maybe they can’t afford it or it doesn’t fit into their day or they’re not motivated enough to do it, there are ways to get them to start doing things proactively that can be incredibly beneficial and then maybe over time, maybe they get the exercise bike and they want to do a little bit more. It’s what I hope. And they can always build on those successes.

Dr. Weitz:                            Great. I think that’s all the questions I have. Any final thoughts you want to leave our listeners and viewers with?

Dr. Neustadt:                     This has been fantastic, lot of fun talking with you, and hopefully your viewers have gotten a lot out of it. I think it really boils down to that one question I kept going back to, and I try and educate people over and over. The most important question, whether, if it’s a test, to ask the clinician is, how predictive it this that I’m going to break a bone? How well does it predict my fracture risk?

Dr. Weitz:                            Right. Oh, you know what, there is one more thing I wanted to touch on.

Dr. Neustadt:                     Sure.

Dr. Weitz:                            The idea of trying to eat a more alkaline diet.

Dr. Neustadt:                     Yeah. So, I’m a fan of that only in the sense that what is an alkaline diet? It’s a whole foods diet. It’s a whole foods plant-based diet. So, if that’s what people like and it’s really popular. They like that you can test it at the pH strip. You can test your urine to see if it’s getting more alkaline. I think that’s great. Whatever’s going to motivate somebody to take charge of their health, to take more responsibility and get excited about eating well. I think it’s fantastic.

Dr. Weitz:                            But is there really something to, if your body is more acidic, you’re going to strip calcium off the bones to balance out the pH in the blood, is there anything to that?

Dr. Neustadt:                     So, there’s research that’s been shown looking at people who consume meat, and meat tends to be rather acidic, and that’ll strip, that’ll increase calcium excretion in the bone.

Dr. Weitz:                            Okay.

Dr. Neustadt:                     But that’s very different from saying you’ve got increased calcium, I mean sorry, it’ll increase calcium excretion in the urine. So, you’re peeing out calcium. But it’s very different to say, there haven’t been studies that I’m aware of at least that make that next connection to say, okay, people eat an acid diet. Their calcium is increasing in their urine. Well, is that because the calcium that they’re absorbing, they’re just peeing more of it out, or are they actually stripping it from the bone, and is it creating osteoporosis? So, if you’re eating that way, regardless of if people want to characterize it as acid or not, which it is if you’re eating a high meat diet.

                                                The research is very clear. That’s not a plant-based whole foods diet. And that is a risk for osteoporosis. Whether the mechanism is the acid or not, I’m not sure. Maybe there are people who are more expert in that that can more definitively answer that question, but the bottom line is that is a dietary pattern that is not a whole foods plant-based diet that has been shown to create osteoporosis, and it could be because of the acid, but it could also be because of nutritional, mineral deficiencies.

Dr. Weitz:                            And you know, besides meat, the other area of controversy, you keep mentioning whole food plant-based diet, or, is like grains and beans.

Dr. Neustadt:                     Correct.

Dr. Weitz:                            You know, grains generally are considered to be acidic.

Dr. Neustadt:                     Correct. Everything in moderation. It’s a balance. I’m not saying eat grains with every meal. I’m not saying eat that, that’s the majority of your meal, or majority of your nutritional source. It should be a balanced diet. So, for me, you know, I love, you know, I’ll have, you know, spinach and green leafy vegetables, and a rainbow of colors from bell peppers and carrots and you know, other fruits and vegetables, and then maybe I’ll also have on there some, a sweet potato, for example, for my starch. Not always a grain. There are other ways to do it. And a lean protein like fish, like soy, tofu or something like that. There are different ways. But there’s also protein and vegetables, and I think people lose sight of that. Vegetables do have protein in them.

Dr. Weitz:                            Okay. Good, good, good, excellent. So, yeah, I think you’ve provided us with a lot of great information to think about in terms of improving our bone density, reducing our risk of fractures, and helping those of us who are practitioners for helping our patients to reduce their risk of fractures. What’s the best way to get ahold of you?

Dr. Neustadt:                     The best way would be through my website, nbihealth.com. NBI stands for Nutritional Biochemistry Incorporated so it’s nbihealth.com if they want to reach me. There’s a contact forum or a toll-free number on there, and they can reach me through the forum or my staff can always forward any messages to me from-

Dr. Weitz:                            Are you still seeing patients?

Dr. Neustadt:                     I do all pro-bono consulting work now by phone with people.

Dr. Weitz:                            Oh, okay.

Dr. Neustadt:                     I’ll see people by phone, maybe two or three a week, to help them, but they’re not officially my patients. I help them understand what questions like this they can go back and ask their doctors. What tests, maybe they’re missing. I synthesize things that have been going on with them, help them understand, reframe what’s going on. I’ll recommend dietary supplements, lifestyle, diet, have them talk about medications or testing further with their healthcare provider.

Dr. Weitz:                            Great. Excellent. Thank you, Dr. Neustadt.

Dr. Neustadt:                     Thank you so much.



Brain Body Diet with Dr. Sara Gottfried: Rational Wellness Podcast 113

Dr. Sara Gottfried discusses the Brain Body Diet with Dr. Ben Weitz.

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


Podcast Highlights

5:16  Dr. Gottfried decided to stop practicing McMedicine when she felt she had hit the wall.  She was practicing in a conventional medical model and she was seeing 40 patients a day and she was trying to incorporate some Functional Medicine concepts that she learned from listening to the audiotapes from Dr. Jeffry Bland. She had a couple of kids in her 30s and she had PMS and depression and had gained weight and was on the path to burnout. And she wasn’t able to practice the quality of medicine that she was trained to deliver.  She had to step away from this insurance-based system, since it had driven up the number of patients doctors have to see each day.  Reimbursement has come down to the point where it is abusive to doctors and it has led to burnout and triple the rate of suicide among US physicians that’s even higher than war veterans!  

10:32  Dr. Gottfried was a practicing gynecologist and her focus was mostly on using bio-identical hormone balancing and she had come to realize that this was just one node in the Functional Medicine matrix, which led her to write this Brain Body Diet book.  She realized that so much of hormonal balance is mediated by the gut and she needed to pay more attention to the microbiome in her patients.  Often they may not have any gut symptoms, but they may have increased intestinal permeability (leaky gut) or dysbiosis and decreased microbial diversity.  Dr. Gottfried does a careful history and asks about exposure to toxins, such as glyphosate.  And she may test for glyphosate with the Great Plains urine test.  Dr. Gottfried likes to look at serum markers of hormones, thyroid, CBC, and glucose metabolism. She also likes to look at the microbiome by running Rob Knight’s American Gut stool test. Dr. Gottfried used to use uBiome, but the FBI just raided them.  She may also do a basic comprehensive stool analysis like with Genova or Doctor’s Data.  Dr. Gottfried also likes to look at functional tests like calprotectin, lactoferrin, and sigA. 

17:15  Dr. Gottfried talks about toxins in her book that affect brain health, including glyphosate, heavy metals like lead (which is a dementogen), cadmium, and arsenic, and EMFs. We know that EMFs are associated with brain cancer and increased oxidative stress.  There is also Bisphenol A, which is an endocrine disruptor, a disruptor of insulin, and an obesogen. Other toxins include household cleaners with phthalates, flouride in toothpaste, flame retardants in furniture, sunscreens with PABA, and mosquito repellants with DEET.  Also that new car smell that comes from pthalates is a toxin.  Pesticides, herbicides, and fungicides in food.  Toxins in our air and our water. 

20:20  In order to help detoxify heavy metals and other toxins, Dr. Gottfried likes to use glutathione to mobilize the toxins and then binders like activated charcoal to bind to the toxins and take them out of the body in the stool.  Modified citrus pectin and chlorella can both also be helpful.  Leeks can help the body with glutathione production and N-Acetyl Cysteine is the precursor for glutathione and is very helpful, including the Metagenics product GlutaClear.

24:28  If a patient comes in complaining of brain fog and memory problems and there are no gut symptoms or other obvious causes, besides gathering a detailed history, what would be some of the lab panels Dr. Gottfried might order?  She said that she always looks at hormones and she will often order a serum panel, but she is now a big fan of the DUTCH (dried urine) panel, which tells you about estrogen metabolism, metabolized cortisol, and the total cortisol load. She also likes to use the Genova NutraEval, which is a really comprehensive Functional Medicine panel that looks at vitamin and mineral status, antioxidants, fatty acids, amino acids, and heavy metals. Dr. Gottfried believes that carefully monitoring glucose is very important since so many patients have disrupted glucose metabolism. But just doing a morning fasting glucose does not tell you the whole picture.  She wears a continuous glucose monitor as a way of measuring abnormal glucose signaling, since she may have good fasting glucose but she may eat a sweet potato and her glucose spikes up to diabetic range, so it gives such a more accurate picture.  She may also order stool testing to map the microbiome and look for dysbiosis. If she wants to focus more on heavy metals, she used to do provocative urine testing for heavy metals [give the patient an oral chelator like DMSA and then measure a 6 hour urine] but now she tends to use Chris Shade’s Quicksilver heavy metals serum panel.

30:54  Sleep is super important for brain health. Dr. Gottfried cited sleep researcher Matthew Walker, who found that it is the deep sleep that’s associated with clearing amyloid beta and other toxins from the brain through the glymphatic system.  Dr. Gottfried describes the gymphatic system as like a shampoo for the brain and she noted that it works best when you sleep on your side, esp. your right side.  Deep sleep is also where neurogenesis and memory consolidation occurs.  REM sleep is very important for emotional regulation and for prevention of depression and anxiety.  She likes to track sleep using an Oura ring.

35:97  Food sensitivities and intolerances can play a role in brain health and gluten and diary are two of the most common sensitivities, though not everybody needs to avoid them.  Dr. Gottfried has used Cyrex food sensitivity testing.  For many patients, food sensitivities are caused by leaky gut, so she usually focuses on improving intestinal permeability, but that is a fairly difficult project.  If you do an elimination diet, one of the difficult parts is when you start phasing foods back in and it is difficult to get patients to do it slow and gradually.  If they add all the foods back in at once that they took out, they are more likely to relapse.

40:05  Hormone deficiencies in menopause increase the risk for dementia and Alzheimer’s in women.  Dr. Gottfried explained that if she is seeing a woman in her 40s with brain fog. She will do a careful history and do some testing to look for nutritional deficiencies and probably put her on an elimination diet. If that doesn’t resolve symptoms, then she will usually look at hormone balance. In the first phase of perimenopause, where progesterone tends to drop first. She will often find that chasteberry is a really good solution.  Dr. Gottfried also likes to do some genetic testing and look at the risk of clotting and of cardiovascular disease. And then she finds that having women start taking bioidentical hormones in their later 40s and early 50s, since cerebral hypometabolism starts in women at this age, and it is more effective and safer than giving hormones later. The Women’s Health Intitiative showed us that giving hormones to women in their 60s, esp. synthetic hormones, increases the risk of dementia and Alzheimer’s Disease. Dr. Goffried tends to prescribe estradiol in the Vivelle patch together with Prometrium, which is most proven.



Dr. Sara Gottfried is an MIT and Harvard trained Medical doctor, a board certified gynecologist, and she is also board certified in Preventative and Anti-Aging Medicine. Dr. Gottfried is also now the Chief Medical Officer of Metagenics. She has just written her 4th NY Times best selling book, the Brain Body Diet, and the book is available here.  Her other best sellers are The Hormone Cure, The Hormone Reset Diet, and Younger.

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


Podcast Transcript

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness Podcast. Bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field.  Please subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free ebook on my website by going to drweitz.com.  Let’s get started on your road to better health.  Hello, Rational Wellness Podcasters. Thank you so much for again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple Podcasts, which replaced iTunes, and give us a ratings and review. That way, more people can find out about the Rational Wellness Podcast.  Also, if you want to see the video version, you can go to my YouTube page, Weitz Chiro, or put in Rational Wellness Podcast into YouTube. And if you go to my website, drweitz.com, you can find show notes and a complete transcript.

Our topic for today is the brain-body connection, which is discussed in The Brain Body Diet, Dr. Sara Gottfried’s latest bestselling book, about how to understand and improve your brain health by improving the brain-body connection.  Brain health tends to deteriorate for women as they age. And this can be related to toxins, gut problems, diet, lack of exercise, sleep deficits, blood sugar imbalances, stress, hormones, nutritional deficiencies, and other factors.  One fact that Dr. Gottfried discusses that I found particularly interesting is that the enzyme that removes beta amyloid from the brain, and beta amyloid, as it accumulates, increases your risk of Alzheimer’s, is the same enzyme that clears out insulin, insulin-degrading enzyme.  So, if you have higher insulin levels due to a lot of blood sugar spikes, your insulin-degrading enzymes won’t be available to break amyloid beta. Dr. Gottfried mentions in her book that a study from Harvard shows that only 13% of women can be classified as healthy agers, which means that they have no impairment of memory, physical fitness, or mental health, and are relatively free of major chronic diseases.  She then lays out a series of steps that women can take to promote healthy aging of their brains and their bodies.

Dr. Sara Gottfried is an MIT and Harvard-trained medical doctor, a board-certified gynecologist, and also board-certified in preventative and anti-aging medicine.  Dr. Gottfried is also now the Chief Medical Officer of Metagenics. She has written her fourth New York Times bestselling book, The Brain Body Diet, to go along with The Hormone Cure, The Hormone Reset Diet, and Younger, her three prior bestselling books.  Dr. Gottfried, thank you so much for joining me today.

Dr. Gottfried:                     Oh, I’m so happy to be here.  That was the most thorough bio I’ve ever heard in my life.  And I love that you took maybe the most important takeaways that I have in my book.  It just warms my heart that you noticed the insulin-degrading enzyme, and this fact that so few women are healthy agers.  I think that’s alarming.

Dr. Weitz:                          It is.

Dr. Gottfried:                     So, thank you. Thank you for your careful intro.

Dr. Weitz:                          Oh, absolutely. I’d actually like to start this interview with a comment. I was preparing for this interview on Sunday afternoon, by reading your Brain Body Diet book, and I was sitting on my deck in my backyard, and I was sipping some organic red wine. And I came to your section on memory, and you wrote, “Alcohol impairs memory, erodes mental function, reduces brain size, and causes brain cell dysfunction. Makes you want to put down that glass of wine, doesn’t it?”  So, if I have any trouble remembering what I want to say today, I have an excuse.

Dr. Gottfried:                     That’s so funny. Well, yeah, I don’t like to start with my feeling about wine, because it’s maybe the least popular message that I have. But let me say this. I think that, based on the epidemiology that we have, on especially red wine, in places like Italy, and Europe, Framingham study, we know that men probably do better with alcohol than women do.  I think there’s certain reasons for that.  Women have different sex hormones, we’ve got a different process in the liver. And I think part of the issue for women is that alcohol raises the bad estrogens, and leads to a greater risk of breast cancer, as well as other things. As little as three glasses of red wine per week.  I think men can often get away with one to two glasses a day, without any adverse outcome. I just want to reassure you that I think you were okay in the backyard.  It sounds like you were getting a little nature, maybe some vitamin D. All those things are good.

Dr. Weitz:                            Thank you. Dr. Gottfried, why did you decide to stop practicing McMedicine medicine, in your words, and switch to Functional Medicine, or integrative approach?

Dr. Gottfried:                     Well, I wish it were as simple as just deciding to stop, because, in some ways, I think I was forced to stop. My body forced me to stop. And I think a lot of clinicians come up against this. I imagine you have some listeners, a listener in particular, who’s got one foot in the allopathic medicine world, and one foot in the functional medicine, holistic medicine world.  Trying to figure out how to reconcile those two worlds can be very tricky. For me, I was practicing some of the concepts that we have from functional medicine. I was listening to the Jeff Bland tapes in the ’90s, and I-

Dr. Weitz:                           I listened to every one of those.

Dr. Gottfried:                     You listened to them too? Yeah, you’re one of the-

Dr. Weitz:                           I had the little cassettes I used to listen to.

Dr. Gottfried:                     Right. I mean, there are people listening to this right now who don’t even know what a cassette is. I’m with you on that.  But what happened for me is that I hit a wall. I hit a wall physiologically. I had so much stress, I had a couple of kids in my 30s, I was seeing 40 patients a day, and it just got to a point where I couldn’t practice the quality of medicine that I was trained to deliver.  And I felt like I was failing my patients. I had patients who were coming to see me, and saying, “This antidepressant isn’t working. I have PMS. It doesn’t make sense to me that I would take Prozac every day.”  Or, “I’m trying to deal with stress, and I’m not just going to go sit in a corner and meditate on a cushion. That’s not going to solve it. What else do you have for me?”

What I did is … I had my own health crisis. I went to my primary care provider, realized that what he was offering was totally wrong. Antidepressant birth control pills, because supposedly that helps with every hormonal imbalance.  And I was overweight. I had issues probably with insulin-degrading enzyme. And so I decided, at that moment, that I couldn’t continue in McMedicine. That I was on this path towards burnout. And so I built a bridge, an 18-month bridge, to get out of there, and to build my own practice, the kind that would really serve patients the way that I felt like they needed to be served.

Dr. Weitz:                          Great. What did that bridge look like, if you don’t mind maybe just taking a minute.  Because there probably are practitioners listening to this who are trying to figure that out.

Dr. Gottfried:                     Sure. Well, the cool thing is, you can start the education while you’re still in that allopathic realm.

Dr. Weitz:                          Of course.

Dr. Gottfried:                     I was listening to Jeff Bland, I was starting to do some of the things he talked about. I was starting to do really basic things, even in a seven to 15-minute appointment, I could talk about the elimination diet. I could order a fasting glucose and a fasting insulin. I could order a hemoglobin A1C. And so I could have conversations about those things, and we all know that something simple, like an elimination diet, which we’ve been using for almost 100 years, that can reduce symptoms, based on the MSQ, by 50%.  It’s a pretty strong tool. So I started to practice in that way with education first, and then I built, with a coach, how to step away from the security of this insurance-based system, to opening-

Dr. Weitz:                          That’s the hard part, is when you’re taking insurance for your medical practice, how do you start building that functional practice, which is not insurance-based?

Dr. Gottfried:                     Well, it’s hard, and in some ways it’s very liberating, because the reality is that taking insurance has become increasingly difficult. It’s driven up the number of patients we have to see each day. Reimbursement has come down. And so it’s not a sustainable model. In fact, I would even say it’s abusive.

Dr. Weitz:                          Yes.

Dr. Gottfried:                     And it’s serious. It’s led to burnout, to the level that we have something like triple the rate of the baseline suicide rate among US physicians right now.

Dr. Weitz:                          Wow.

Dr. Gottfried:                     It’s higher than war veterans.

Dr. Weitz:                          Wow.

Dr. Gottfried:                     We have post-traumatic stress disorder. So we have a real crisis on our hands, and I think that the kind of medicine that we practice, Ben, lifestyle medicine, precision medicine, functional medicine, integrative medicine, whatever you want to call it, this is a solution to the burnout. And it’s also a solution that serves our patients better.  It took me about 18 months to figure this out, to figure out, okay, where’s the location? What’s the minimum, the MVP, the minimal viable product? What’s the pared down number of staff that I would hire? Malpractice insurance, all those kind of pieces, it took a while. It took 18 months to get those together.

Dr. Weitz:                           Okay, cool. Thanks for some of those insights.  I’m sure that could be a long conversation at another time.  Why did you decide to write this new book, the Brain Body Diet?

Dr. Gottfried:                     I wrote it for a couple of reasons. I’m a board-certified gynecologist, from my allopathic days. And so the way that I tend to take care of patients is starting with hormones. The way that … my focus has been, for 20 years, bioidentical hormone balancing. But what I realize is that it’s only really part of the story, especially when you consider the matrix of the Functional Medicine model, and you realize that hormones are just … it’s one node in the matrix.  I realized, based on my own health issues, which always feels like a message from the universe about what I need to pay attention next, I realized that so much of hormonal balance is mediated by the gut. And I needed to pay more attention to it. And maybe most importantly, I realized that my patients who had no gut symptoms, so they didn’t have gas or bloating or constipation, or diarrhea, or irritable bowel syndrome, they had gut issues. They had increased intestinal permeability, they had reduced microbial diversity. And they had dysbiosis, even in the absence of GI symptoms.  This is what got me to pay attention to this.  And as I started to dig deeper, I realized, oh my gosh, the way that we’re treating anxiety, the way that we’re treating depression, the way that we think about cognitive decline, really needs to be reset.  We have to change the paradigm. And we really have to put the gut, microbiome brain access, at the center of this.

Dr. Weitz:                          Yes. That’s great. How do you try to analyze the gut to see what might be going on that might be affecting brain health?

Dr. Gottfried:                     Well, I still think it’s helpful to ask, to do a thorough history and physical. I think you can get a lot from that. I use the MSQ for all of my patients. Do you use it too?

Dr. Weitz:                          Yes, absolutely. It’s incorporated into the initial paperwork, yeah.

Dr. Gottfried:                     I find that so helpful. But when I go back and I look at my patients, so few of them have gut symptoms. So the way that I assess it, in the history, I’m thinking, in particular, about the gut disruptors.  I’m thinking about antibiotics, how many courses have you had?  Because we know, even a single course of antibiotics is associated with a greater risk of anxiety, depression, insulin resistance, obesity, diabetes, learning and memory problems.  And multiple courses, the rate goes up.  I ask about that on history.  I ask about food, of course.  I’ve got a food-first philosophy.  I imagine you do, too.

Dr. Weitz:                           Sure.

Dr. Gottfried:                     And then I also ask about other toxins. Things like glyphosate. Things that disrupt the integrity-

Dr. Weitz:                          Glyphosate’s contained in Roundup, which is an herbicide, a pesticide, that’s often sprayed on foods, and especially in genetically modified crops.

Dr. Gottfried:                     That’s right. And when I started to test my patients for glyphosate, I was really surprised at how many of them had a toxic load of glyphosate, even though they were eating primarily organic food.

Dr. Weitz:                          You use that Great Plains urine test?

Dr. Gottfried:                     I use Great Plains. You asked about assessment.  I start first with some of the blood biomarkers that I think are helpful.  I want to know about stress, and cortisol, and the hypothalamic-pituitary-adrenal-thyroid-gonadal axis, of course, that’s my focus.  And we know that, if you are someone who’s chronically stressed, the high cortisol can poke holes in your gut lining, can disrupt the integrity of your gut lining.  And then I look at other things too. I want to measure inflammation.  I want to look at white blood cell count, I want to look at leukocytes and neutrophils.  I want to look at glucose metabolism, because the gut is so intricately involved in insulin resistance.  I do look at the microbiome.  I think this is somewhat controversial, and a lot of people would say it’s not quite ready for prime time.  But what I tend to use is Rob Knight’s test (American Gut), which also is one of the most affordable.  I previously used uBiome, but the FBI just raided them, so I don’t use them anymore.

Dr. Weitz:                          Really? I didn’t hear about that.

Dr. Gottfried:                     Yes. I do some of the basic, comprehensive stool analyses, like with Genova, or Doctor’s Data. I try to mention at least a couple of labs here, so that I’m not associated with just one. And I like to look at functional tests, things like Calprotectin, as well as lactoferrin, sigA.  I’ve done a lot of testing of intestinal permeability.  I wish we actually had better tests of intestinal permeability.  I end up with a mix, and I want you to answer this question, too.  I end up with lactulose-mannitol as the gold standard, although I wouldn’t really say it’s gold, I think it’s more aluminum or tin.  And then I look at things like zonulin, Cyrex array. But tell me what you do. What kind of testing do you do?

Dr. Weitz:                          A lot of times we’ll do a stool test that includes zonulin. But a lot of times it’s not positive, even when we’re pretty sure that they have leaky gut. In most of the patients who have any kind of dysbiosis, I’m just assuming that they have leaky gut, because it’s so common.

Dr. Gottfried:                     Sure.

Dr. Weitz:                          We used to do the lactulose-mannitol test, but it’s not my priority right now.  So I’d rather know what’s going on in the gut that we can try to rebalance things first.

Dr. Gottfried:                     Absolutely.

Dr. Weitz:                          I’m more interested in doing a good stool test.

Dr. Gottfried:                     I agree with that. I think about the lactulose-mannitol test, and I’ve been using it for maybe 15, 20 years, whenever I first started doing this, and I think about sitting on your back porch, drinking a glass of organic red wine. And I know, if I do the lactulose-mannitol test on you before you have that glass of wine, versus after you have the glass of wine, it’s probably going to be different.  Because we know that alcohol is what we feed animals to test for leaky gut-

Dr. Weitz:                          But I sprinkled some probiotics in my wine.

Dr. Gottfried:                     Oh, good. Okay. You’re well-covered. A little bone-broth chaser.

Dr. Weitz:                          Exactly.  You talk about various toxins in your book that can affect brain health. What are some of the most common toxins that affect brain health that Americans come into contact with?  I know you just mentioned glyphosate. What are some of the others?

Dr. Gottfried:                     Well, unfortunately, the list is very long. I think heavy metals are at the top of the list. We all know about mercury toxicity, that’s something that I’ve talked about a lot in my books. But I was amazed to find, in myself as well as in my patients, higher lead levels, higher cadmium levels, higher arsenic levels. And I think, increasingly, our food and water is exposing us to some of these toxins.  We know that EMFs, for instance, have some modest data. It’s not as strong as I would like it to be, but it’s a little tricky with EMFs. 

Dr. Weitz:                          Right. So you’re talking about the radiation from cellphones, and laptop computers, and wifi in our home, et cetera.

Dr. Gottfried:                     That’s right. That’s associated with a couple of different brain cancers. We know that it increases oxidative stress, especially if you’re holding the phone next to your head. We think that probably increases risk.  Bisphenol A is another one. BPA is brought up anytime we talk about endocrine disruptors. But it’s much deeper than just a xenoestrogen or a disruptor of insulin, which it is, it’s an obesogen that makes you fat, and insulin resistant.  It’s also, it does other things to the brain. In terms of disrupting the hypothalamic–pituitary–adrenal axis. It’s one of the bad players. I’ve got a list. You made me think of the table that I have in my book, where I go through a list of these toxins.  The other thing I think about with lead is that it’s a dementogen. It’s one of those toxins that robs you of IQ points. And we don’t want to be exposed to this, but we know, from the example in Flint, Michigan, that many-

Dr. Weitz:                          Yeah, horrible.

Dr. Gottfried:                     … of us are exposed in our food supply. I found it in my lipstick. So, for those of you who are listening, and you are a woman, or maybe gender non-binary, and you wear lipstick, take a look at your lipstick. Because if it’s not organic, there’s a good chance it contains lead.

Dr. Weitz:                          Absolutely.

Dr. Gottfried:                     I have a few others listed here. Household cleaners that contain phthalates. Fluoride in toothpaste. Flame retardants that are in furniture. Sunscreen that contains PABA. Mosquito repellent with DEET. That new car smell, that’s a toxin for the brain. It disrupts thyroid function, too, which can affect your brain’s ability to focus.  And then there’s a long list of food. But I think water and air are some of the exposures that I think we really need to be thinking about, not in a doom and gloom way, but how do we reduce exposure on the one hand, and then how do we detoxify?

Dr. Weitz:                          How do we detoxify? What’s the best way to get rid of heavy metals, and some of these other chemicals?

Dr. Gottfried:                     Well, this is a great question. This is fun to riff with you, because I imagine you’ve been dealing with this for a few decades.

Dr. Weitz:                          Of course.

Dr. Gottfried:                     And when I first started dealing with it-

Dr. Weitz:                          I’ve been in practice for 30 years, yeah.

Dr. Gottfried:                    You’ve been in practice for 30 years, so longer than me. And I was taught, when I went through my training, to use chelators. And so I had a whole system for how to do that. And what I’ve learned, especially from Chris Shade over the years, is that it maybe be better to focus on glutathione, and to support the detoxification pathways in the liver.  I’ve shifted. There’s still some … there’s a time and a place for chelators, but I have shifted toward really focusing on glutathione as the master detoxifier and antioxidant. But I’m curious what you would say in response to this.

Dr. Weitz:                            Well, no, I totally agree. After finding out about so many patients that we referred for a chelation, who got worse, or had all sorts of adverse symptoms, and even after long courses, that the glutathione, and then binders to capture it, seems a much better strategy.

Dr. Gottfried:                     Yes. I’ve been using his PushCatch quite a bit recently. And I like his binder. I looked at the data on binders, and I wish we had more robust data on the binders. I use them. I think activated charcoal is probably the most proven, but I like his PushCatch system.  I can’t think of an alternative that’s similar to that. There’s lots of companies that make activated charcoal and other binders. Do you have any other supplements that you use for binding?

Dr. Weitz:                          We’ve used modified citrus pectin, I got into a whole discussion with Chris about this. He doesn’t think that’s a very good binder. But Isaac Elias, he has some data showing that it binds lead and certain other heavy metals pretty effectively, so that’s one we’ll throw in there.

Dr. Gottfried:                     Yeah.

Dr. Weitz:                          Chlorella.

Dr. Gottfried:                     Right. Yeah. There’s hope that that makes a difference.  There’s certain foods that I think can really help you with glutathione. I don’t think, for some of us, that it’s quite enough.  I’m someone, I don’t have glutathione S-transferase, and so I just need to take liposomal glutathione.  And I have a fair number of patients … the ones, the canaries in the coalmine, the ones who really have the symptoms from toxic overload, tend to have trouble producing glutathione.  So, yes, you can get it from your food.  Always a good idea to start there first, but I think a lot of people who have to detoxify, need something more.

Dr. Weitz:                          Right.  A lot of people talk about onion, garlic …

Dr. Gottfried:                     Leeks.

Dr. Weitz:                          Leeks, yeah, as being beneficial for stimulating glutathione production.

Dr. Gottfried:                     Right.

Dr. Weitz:                          And of course NAC, which we’ve used for years, which is an amazing compound for so many things.

Dr. Gottfried:                     I love N-acetylcysteine, because it’s got such a great safety profile, and yet it’s so well-proven. This is one of the few supplements that I would say mainstream medicine has actually embraced, because we use it in the emergency room, when someone comes in with Tylenol poisoning, as an example.  So, I think it’s one of the … I’m always looking to, how do we build bridges between the allopathic world, and this more integrative, functional world. And I think, with proven supplements that have randomized trials, like N-acetylcysteine, that’s where we start.

Dr. Weitz:                          Yeah. Well, good luck.

Dr. Gottfried:                     Exactly.

Dr. Weitz:                          I’m sure there’ll be-

Dr. Gottfried:                     How much energy do you have?

Dr. Weitz:                          I’m sure there’ll be a negative study on NAC next week, and then …

Dr. Gottfried:                     Exactly.

Dr. Weitz:                          In the American Journal, in the AMA Journal.

Dr. Gottfried:                     That’s right.

Dr. Weitz:                          If you have a … what would be a set of tests that you might do? Let’s say you have a patient who comes in, they’re complaining of brain fog and memory problems. And you go through their history. What might be a set … we’ve talked a little bit about panels, but I’m wondering, what would be some of your go-to panels?

Dr. Gottfried:                     Sure. Let me just apologize, because I have no air-conditioning, and it’s 100 degrees outside. Because my power just went out, so I’m going to strip here.

Dr. Weitz:                          Oh, okay.

Dr. Gottfried:                     It might make more people go to the video, we’ll see.

Dr. Weitz:                          Exactly.

Dr. Gottfried:                     Maybe not. This is such a good question. Again, I’m a hormone doctor, so the way that I think about this, especially in a woman over the age of 40, is I’m thinking first about estradiol. Because estradiol is the master regulator in the female body. We know that when it comes to perimenopause, even the most subtle, early changes that begin at 40, that there’s a central effect with cerebral hypometabolism, as a result of the loss of estradiol.  And you may not measure it peripherally. You could do a serum test, a blood test, measuring estradiol, and you may not see a change. But there are brain effects that have been documented very well by Lisa Mosconi at Cornell, showing that 80% of women have cerebral hypometabolism, so they start to have the symptoms that you’re describing. Brain fog, they walk into a room, and they can’t remember why. They start to have vasomotor symptoms, maybe sleep becomes disrupted, and it becomes this snowball, that I think leads to much greater health risk as they get older.

What kind of panels do I do? I start with serum panels, because again, that’s part of building this bridge. I think we’ve got good evidence with serum estradiol levels, as well as other hormones, like cortisol, and DHEAS, and testosterone, free and bioavailable, in total. I look at progesterone, and then I’m a big fan of the Dutch test. I wonder if you do this too? I think it gives you so much more information in terms of-

Dr. Weitz:                            Yeah.

Dr. Gottfried:                     … estrogen metabolism, how much metabolized cortisol, the total cortisol load. How do you use that?

Dr. Weitz:                            We just started using it. I was doing the 24-hour urine test, because I like to look at the metabolites, because I think that’s super important for breast cancer risk and everything else. So we just started using the Dutch test more. And I think it’s great, and it’s so convenient, easy for patients to use.

Dr. Gottfried:                     It’s easier than saliva testing. I actually think, at least what I’m seeing in my patients, I think the data is more reliable. And it’s … I’ve just found that it’s been a real game-changer in the way that I take care of patients.  That’s one of the panels. The other basic functional medicine panels that I do, I tend to use a Genova NutrEval. Other people use the ION.  Other people are religious about organic acid testing. I do that as well. But I tend to start with a combination of serum testing of sex hormones, as well as a larger panel.  I always think about glucose metabolism, because we know it’s disrupted in at least half of our patients, if not more. In fact, I wear a continuous glucose monitor, because-

Dr. Weitz:                          Oh, cool.

Dr. Gottfried:                     Because I think glucotype is so important. Our ways of measuring abnormal glucose signaling, I think are 30 years ago. They’re so 30 years ago. Fasting glucose, fasting insulin, hemoglobin A1c, we miss a lot of patients who are like me, who have a sweet potato, and my glucose goes up to the diabetes range. And that’s … I can talk about the reasons for that, but I think understanding how this might map onto symptoms like brain fog, and this gut-brain axis issue, is really essential.  So those are some of the tests that I tend to start with. What about you?

Dr. Weitz:                          That’s great. Yeah, no, I love the NutrEval. I love the fact that it includes organic acids, amino acids, fatty acids, it’s got some heavy metals, it’s got some oxidative stress markers. It’s a really neat, general screening tool. I love that test-

Dr. Gottfried:                    It’s kind of one-stop shopping.

Dr. Weitz:                         Yeah. Yeah, yeah, yeah.

Dr. Gottfried:                    And I like to keep this as simple as possible, and it also, I think, for the most part, for patients who have insurance, it’s well-reimbursed. So they have a good pay assured price.  I like to do that to start with. Often you end up dissecting after a NutrEval. I tend not to do serial NutrEvals. I use that as a screening test. And then, from there, I’ll order organic acid testing, from Great Plains, and then I’ll do some additional stool testing, and I’ll look more at heavy metals.  I tend to use Chris Shade’s quicksilver testing to look at heavy metals.

Dr. Weitz:                            Oh, okay. Have you done provocative urine testing?

Dr. Gottfried:                     Well, I’ve done a lot of provocative urine testing over the years. I do less of it now. I still think there’s a time and a place for it, because I believe in Chris Shade’s science, for the most part. And I think his way of measuring heavy metals makes a lot of sense to me.  There’s mixed data on provoked testing. Here’s where I think it’s helpful. We know, especially for women who reach their peak bone mass at somewhere around 30 to 35, that they tend to store a lot of heavy metals in their bones. And so I think provocative testing, especially in a woman before age 50, can be very helpful to try to unroof some of that heavy metals that are hiding behind the bone matrix. How about you?

Dr. Weitz:                            Yeah, I think that’s actually one of the keys for detox, is if you’ve got a woman who’s losing bone, and she’s liberating more heavy metals, you’re never going to get rid of the heavy metals until you stabilize her bone metabolism.

Dr. Gottfried:                     That’s right. Totally agree.

Dr. Weitz:                           Let’s see, we talked about that. You write about the importance of sleep for brain health. And you write in your book, “Lack of sleep affects neurogenesis, particularly in the hippocampus. You can even develop false memories if you lose sleep.”  So, if you were to stay up half the night tweeting, you might think that thousands people who are protesting you were actually cheering you.  Just kidding.

Dr. Gottfried:                     Oh, that’s very funny. I didn’t realize we’re going to be-

Dr. Weitz:                           No, no, but-

Dr. Gottfried:                     … talking about politics, too. This is going to be funny.

Dr. Weitz:                           No, no, I’m kidding. But can you talk about the importance of sleep?

Dr. Gottfried:                     Sure, sure. Absolutely. I’m also happy to talk about politics.

Dr. Weitz:                           No, no, no, no. I don’t talk about politics.

Dr. Gottfried:                     The power just came back on. So I’m taking over here. I was just listening to a podcast with Matthew Walker, where I felt like he got into the details of sleep in a way that I found really captivating.  What he talks about, he’s a sleep researcher, a PhD, so he doesn’t have clinical experience, but what he believes is that it’s your Deep sleep that’s associated with clearing amyloid beta and other toxins. So we know that the glymphatic system becomes its most effective when you sleep at night, and you have to have that full conversation with the glymphatic system.

Dr. Weitz:                            Can you explain what the glymphatic system is?

Dr. Gottfried:                     Yeah, so the glymphatic system is kind of like a shampoo for the brain, that’s how I describe it to my patients. It’s where the spaces, the interstitial spaces in your brain open up, and this cleansing process happens through your brain.  It’s not the lymphatic system, it’s got a G in front of it. The glymphatic system. And it was only discovered, I think, 10 years ago. It’s a relatively new thing that we’ve found.  The glymphatic system seems to work the best when you sleep on your side, especially the right side, and deep sleep is really essential for this.  I use an Oura Ring to track my sleep.

Dr. Weitz:                            Cool.

Dr. Gottfried:                     And it’s not quite the same as a sleep lab, but I think a sleep lab is often very artificial. And I don’t know that it gives you the best data, other than to tell you whether you have sleep apnea or some other clinical diagnosis.  But for the average person who’s trying to improve their sleep, like their deep sleep and the REM sleep, I think sleep tracking can be very helpful. You don’t have to do it every night. I think just getting a sense of what your issues are, and then working on them, designing an N of 1 experiment, can be very helpful.

And then REM sleep, we know, is really important for emotional regulation, and for prevention of things like anxiety and depression, as well as other what are called mental health issues, and I think are basically health issues.  I think of deep sleep also as that place, as you mentioned, it’s where neurogenesis occurs, and it makes sense to me that not only are you clearing amyloid beta, but you’re also doing memory consolidation, and you’re working on emotional regulation. Those are some of the things that happen with deep sleep.  Do you track your sleep?

Dr. Weitz:                            I have in the past, I haven’t recently, but I definitely … of all the things I do to promote long-term health, it’s the one I’m least good with.

Dr. Gottfried:                     Well, I think it’s close to a panacea as we have. And it’s interesting to me, because I feel like there’s certain topics, Ben, that people’s eyes glaze over when we talk about them. And I would say sleep is one, stress is another, sometimes food. People are just like, “Oh, yeah, yeah, I got that.”  And yet, we know that common sense is not common practice, and so I feel like it’s on us to talk about sleep in a way that really magnetizes people to understand how it’s going to help their health, and what concrete steps they can take to make a change.

Dr. Weitz:                          Right. You mentioned food. What role do food sensitivities play in our risk for diminished brain health? Should we all avoid gluten and dairy?

Dr. Gottfried:                     Well, certainly, gluten and dairy are the most common food intolerances. And I see that all the time in my patients. I don’t know that all of us need to avoid them. I can tell you that I’ve got two daughters, and they both do fine with gluten and dairy, especially the gluten in Europe. They do especially fine with the gluten in Europe.  They don’t have food sensitivities, and I think it’s remarkable, given how stressed teenagers are right now, with social media, and iPhones, and other pressures that they experience.  I find that food sensitivities are incredibly common. The way I think about it is that it tells me that someone has increased intestinal permeability. And so I want to always be thinking of, okay, what’s the root cause? How do I help them with their symptoms? But how do I also address the root cause? How do I improve the integrity of their gut lining?  I’m curious what you would say about this, because I’ve found, over the years, that it’s kind of a big project to improve intestinal permeability. It’s not the kind of thing where you just give them a jar of glutamine, and say, “See you in six weeks,” and they’re done. It’s not like one and done. It’s a much bigger project than that.

Dr. Weitz:                          Yeah, multi phases. You’ve got to try to see what’s out of balance in their gut, and you got to try to reduce the pathogens, and dysbiotic bacteria, and fungal overgrowth, and get the inflammation down, and strengthen the immune system of the gut, and do all those things.  And then you’ve got to try to repair the gut, and then sometimes food sensitivities become a problem, so you’ve got to sort through those. How do you like to sort through food sensitivities?

Dr. Gottfried:                     This is another one of those moving targets, I think.

Dr. Weitz:                          You use Cyrex food sensitivity testing?

Dr. Gottfried:                     I use Cyrex. I sort of, honestly, I somewhat reluctantly use Cyrex. I think it can give me some helpful information, but often, what I find is, it just tells me what I know already, which is that I have to work on a 5-R protocol for the gut, and we have to focus especially on intestinal permeability.  I used to use Alcat. I used to do …

Dr. Weitz:                           There’s many food sensitivity tests out there.

Dr. Gottfried:                     There’s many different food sensitivity tests, and so I used some that were more convenient than others. There’s some that allow you to do home testing. And I’ve found, over time, that they’re less useful than understanding that the patient in front of you has increased intestinal permeability. In pretty much anything they’re eating, they’re going to become somewhat intolerant to.  To me, I think the name of the game is to understand what someone’s triggers are, and to help them, as close to the root cause as you can. But I also am careful not to do what I think of as root causeism, where all we’re doing is addressing the root cause, and we’re not helping the patient feel better as fast as they want to. Because they have to see results to continue to buy in.

Dr. Weitz:                           Yes.

Dr. Gottfried:                     So I think we do have to treat symptoms, along with addressing the root cause.

Dr. Weitz:                           Absolutely. Yup, yup, yup. And then, of course, we always have the elimination diet, which is the true-

Dr. Gottfried:                     And I actually … I’m a huge fan of the elimination diet. I was just looking at some data from so long ago, on rheumatoid arthritis, and the use of the elimination diet. Really strong data showing this is so beneficial. And I read that, and I think, “Oh my gosh, why doesn’t every rheumatologist know this?”  I’m a huge fan of elimination provocation. I think that’s, in many ways, more useful information than an expensive Cyrex array, or some other food sensitivity testing.  The problem is, a lot of patients, by the time they do three weeks, or three months of a food elimination diet, when they’re adding food back in, what I find, time and again, is they are not patient. They don’t do that one dose a day, watch for three days to see the response. They lose their minds, and they have a piece of pizza, and they have gluten and dairy, and tomatoes, and nightshades, and it’s-

Dr. Weitz:                            And they get symptomatic all over again.

Dr. Gottfried:                     And they get symptomatic, and you just lost all that time. So I’m a huge fan of a carefully constructed elimination provocation, where the patient really understands, okay, you have a clean canvas now, at the end of your three weeks or three months. And we need to take our time, and really understand your response to these test foods.

Dr. Weitz:                          Yeah. Let’s talk about hormones, and their relationship to brain health.

Dr. Gottfried:                     Yes, what would you like to know? I can talk about this all day long.

Dr. Weitz:                          I know, that’s your favorite topic.

Dr. Gottfried:                     Yes, it is.

Dr. Weitz:                          Perimenopausal, menopausal women, you’re having symptoms related to hormone deficiencies, estrogen, progesterone. Should we substitute bioidentical hormones? How much is that going to benefit their brain health? Which women should have that done? Should we try other alternatives first?

Dr. Gottfried:                     That’s a great question. The way that I think about this is a pretty simple network medicine, functional medicine, precision medicine formula, which is, I start first with what symptoms she’s having. Maybe it’s a 40-year-old with brain fog.  I’m going to start first with doing testing, and understand what the root cause is, as well as addressing the symptom. I’ll probably put her on an elimination diet.  For me, step one is to fill any nutrient gaps. We may find that she’s a little low on B12, or B6, or folate, and so we may top off some of those nutrients that she’s missing. Maybe she’s low in vitamin C, and so she’s not making enough progesterone. That’s often a low-hanging fruit for someone who’s 35 to 50.

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

Dr. Gottfried:                     Yeah, and then step two, if that doesn’t resolve symptoms, I’ll start to look a little deeper at what’s going on with hormone balance. And what I find, in the first phase of perimenopause, which is where progesterone drops, but estradiol can be fluctuating wildly, what often find is that chasteberry is a really good solution, because it modulates progesterone levels, it’s been shown to raise serum progesterone in randomized trials, and it’s one of the most proven herbs that we have in perimenopause.  It doesn’t work once you stop ovulating, but there’s a window of time where I find it works really well.  And then, if that doesn’t resolve symptoms, then I move on to bioidentical hormones. And I’m someone who’s pretty careful about it. I would say I’m not … on the spectrum of the people who are really heavy-handed with bioidenticals, and use … well, we can get into that topic, versus people who are scared to death of prescribing hormones, I would say I’m in the middle. Where I like to do genomic testing, I want to understand what’s your risk of clotting, what’s your risk of cardiovascular disease? How do we make a risk balance alternative balance sheet for you, and have a sense of here’s what your individualized risk is, and here’s why I am coming out in favor of or against using hormone therapy.  But at the same time, I would say it’s not a yes/no question. I think it often is what type, what dose? What’s most proven?

You asked specifically about the brain, and I know you asked that for a specific question, because we know that … the emerging data is that there’s a window of opportunity for taking exogenous estradiol. And the window is much smaller, I believe, for brain health, than it is for, say, cardiovascular disease.  We know from the Women’s Health Initiative, as well as some other trials, that the window’s about 10 years for cardiovascular disease, and it’s potentially dangerous and provocative to give it beyond that 10 years for menopause, so after age 60, although I have patients who consent to that, they understand the risk.  But I think, when it comes to the brain, there are these subtle changes, the cerebral hypometabolism that I mentioned, that starts in 80% of women over the age of 40, and I think that’s the window for getting estradiol.  I think we have to consider this as more a problem of middle age, a problem of women in their 40s and 50s, and really consider the benefits and the risks of prescribing bioidentical estradiol in that population much earlier.  And we have data on this from women who go through surgical menopause, that earlier treatment makes a big difference in terms of brain health. The problem is, we have the wrong study, which is giving Premarin and Provera to older women over the age of 60, and it increased the risk of dementia.

Dr. Weitz:                          You’re referring to the Women’s Health Initiative, which used these synthetic forms of estrogen and progesterone, and give a lot of them to women who were in their 60s, or 10 years or so past menopause.

Dr. Gottfried:                     That’s right. And what we found is that it actually increases dementia, it may increase Alzheimer’s disease. But I would say the problem is, it’s too late. And we know that when you put estradiol together with neurons, there’s a point, almost like a switch point, where the neurons respond well to the estradiol. We don’t know what that age is. It might be sometime in your late 40s, maybe early 50s.  And then, when you give it after that, it can actually accelerate the decline of those neurons. So there’s this window of opportunity that we have to define better. And as we wait for better data, I can tell you that I prescribe estradiol to my patients. I usually give a three-quarters dose, like a estradiol patch, Vivelle patch, .0375 milligrams is one of my favorites, together with Prometrium, is what I think is most proven. That’s a standard prescription that I give for my patients who are in their 40s.

Dr. Weitz:                           Okay, great. We talked a little bit about nutritional deficiencies. I think that’s pretty much all the questions I had prepared for today.

Dr. Gottfried:                     All right. Well, it was a fantastic list of questions, I really appreciate it.

Dr. Weitz:                           Thank you, thank you. Any final thoughts, or insights for our listeners, about the brain body connection?

Dr. Gottfried:                     Yeah. I’ll finish with a quick story, because I love how Brené Brown talks about how stories are data with soul. In 2017, I took a month of antibiotics. I’d never had antibiotics before. And I turned this into an NF1 experiment, where I measured my microbiome before and after.  But after that month of antibiotics, I had anxiety for the first time in my life, and I gained about 15 pounds. I had insulin resistance, and a lot of trouble with my fasting glucose and fasting insulin.  And so that’s what got me to go to the literature, and that’s where I found this association between a course of antibiotics and the increased risk of anxiety, depression, learning and memory problems, obesity, insulin resistance. And I can tell you, when I went through my medical training, I was never told to give this kind of informed consent.  I feel like this is a real game-changer. And I’ll give you one teeny little piece of data from my N of 1 experiment. When I measured my microbiome before and afterwards, I had an 87% reduction in the diversity of my microbiota. That’s pretty huge. And that’s anecdotal information, it’s only one subject, but it’s a subject who was studied over time in a scientifically valid manner.

And in many ways, what I was taught at Harvard is that randomized trials are really important. But the N of 1 study is even higher in terms of evidential hierarchy, because it allows you to personalize, it allows you to really know the individual, and not base your decisions on a population.  I feel like that’s where we’re heading. That was part of what motivated me writing this book, and really diving into the literature. But I feel like that’s where we’re heading, with the way that we practice medicine, is to understand … we’ve got to think about how to address … the reason why I took these antibiotics after my surgery, there might be a better way to do this that isn’t a nuclear bomb for my gut microbes, and for those of our patients.  It’s not me that’s so interesting, it’s that so many of our patients go through this. I’ve been prescribing antibiotics for 25 years, right? This is news to me, and it really changes clinical practice. I pay attention to those things that have really changed since we went through our medical training.

Dr. Weitz:                          Right. Are you still in clinical practice?

Dr. Gottfried:                     I am. I went on sabbatical, but I have to tell you, I have 10 patients that just would not let me go, so I still have these 10 patients. And then I’m planning to open my practice again next year. We have a clinic that’s opening in Aliso Viejo, kind of a clinic of the future.  So I’m planning to see patients again, starting next year.

Dr. Weitz:                          Okay, great. So how can listeners find out about your book? And find out more information about you, through your website?

Dr. Gottfried:                    Yeah, the best place to go is BrainBodyDiet.com. That’s where we have a lot of information. We’ve got an anxiety documentary coming up. And that’s where they can learn more about the book.

Dr. Weitz:                          An anxiety documentary? Cool.

Dr. Gottfried:                     Yes. Which is basically functional and integrative medicine, to address anxiety, instead of just throwing benzodiazepines at it.

Dr. Weitz:                          Awesome. Thank you so much, Dr. Gottfried.

Dr. Gottfried:                     Thank you. Such a pleasure to be with you, Dr. Weitz.



Acid Reflux with Dr. Steven Sandberg-Lewis: Rational Wellness Podcast 112

Dr. Steven Sandberg-Lewis discusses Gastroesophageal Reflux Disorder with Dr. Ben Weitz.

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


Podcast Highlights

2:57  The more common causes of GERD are SIBO with increased gas pressure pushing things upwards, vagal nerve problems, which results in the stomach not emptying as quickly, problems with lower esophageal sphincter, not having tone and allowing reflux, and a hiatal hernia which affects the ability of the esophageal sphincter to keep things out of the esophagus.

4:35  To distinguish the cause of GERD you might consider having your patient do a barium swallow test and an upper endoscopy that looks at the esophagus, stomach, and first portion of the small intestine. Dr. SSL will also do functional testing for hiatal hernia to see if there is a hiatal hernia syndrome. He will also often do Heidelberg testing, which measures the pH of the stomach.  You might also want to get pH testing of the lower esophagus, and manometry, which measures the pressure. And SIBO breath testing. 

6:06  Dr. SSL finds that with his patients with Reflux, 75% tends to be associated more with too little HCL and 25% are associated with too much acid.  Dr. SSL also points out that you can have two types of hypochlorhydria on a Heidelberg. One version the patient will have a pH of 5 or 6 and this is frank hypochlorhydria. There is also hidden hypochlorhydria.  We do a series of challenges with a super-saturated bicarbonate and see how long it takes to reacidify. If after the second or third challenge, it takes much longer to reacidify or doesn’t do it at all, then that means that the stomach is not able to produce enough acid to digest a meal, which is what we call hidden hypochlorhydria.  Then we can give the person some herbal bitters or some betaine hydrochloride.

10:15  The reasons why so many patients have low stomach acid includes that the patient may have a chronic state of disease or they may have autoimmune disease, such as autoimmune gastritis, where they have antibodies to their parietal cells or they can have anti-intrinsic factor antibodies, which means they can’t absorb B12. These patients will tend to be chronically anemic with a macrocytic, large cell type anemia, not the iron deficiency anemia, though they can have both. With other, more common autoimmune diseases, such as lupus, they can also have low stomach acid.

12:20  SIBO can be a cause of GERD due to pressure from the hydrogen or methane or hydrogen sulfide gas pushing upwards and pushing food and acid up into the esophagus.  Methane especially seems to be associated with reflux because it slows down intestinal motility and the normal peristaltic movement downwards.  You can have bile reflux as well as acid reflux due to decreased tone of the pyloric valve, allowing bile to reflux up into the stomach and then into the esophagus and this is very irritating to the esophagus and may be a key factor in the cause of Barrett’s, which can progress to dysplasia and eventually to cancer of the esophagus.  Proton pump inhibitors may increase the risk for bile reflux and there is a Danish study that shows that patients who took PPIs for their Barrett’s esophagus were more likely to develop esophageal cancer and possibly stomach cancer.  Here is the study: Proton pump inhibitor use may not prevent high-grade dysplasia and oesophageal adenocarcinoma in Barrett’s oesophagus: a nationwide study of 9883 patients.  According to Dr. SSL, while the American College of Gastroenterology is not ready to accept the concept that PPIs increase risk of esophageal cancer, their new guidelines published two years ago state that PPIs should only be used with patients with Barrett’s to control symptoms and they should not be used to prevent cancer. 

18:07  H. Pylori infection in the stomach is often discussed as being a factor in the etiology of reflux.  Dr. SSL said that this is wrong.  There is a meta-analysis showing that having H. Pylori in your stomach is protective against reflux, protective against Barrett’s esophagus and esophageal cancer.  100% of the world’s population used to have H. Pylori and it is an ancient dominion organism, as Martin Blaser points out in his book, Missing Microbes.  H. Pylori is also protective against Crohn’s disease, hay fever, asthma, eczema, laryngeal cancer, reflux, Barrett’s esophagus, and cancer of the esophagus.  But less than 10% of Americans have H. Pylori in their stomach, since we’ve been testing and killing it since the 1990s.  In fact, if you have reflux and you test for H. Pylori and you treat it, it makes the reflux worse, according to the research.  In fact, it would probably be a good idea to take H. Pylori probiotics, if they existed.  Here is a meta-analysis paper showing that eradication of H. Pylori is linked with lower–not higher risk of GERDHelicobacter pylori infection in gastroesophageal disease in asian countries.

We have been describing in general what happens with H. Pylori.  To add another layer of detail, which unfortunately complicates the story, of the folks who have H. Pylori, if the H. Pylori colonizes the entire stomach, pangastritis, these people will have about a 1% risk of developing cancer of the stomach, though they will get all of these immune strengthening benefits just mentioned.  People who have colonization of the only the bottom of the stomach with H. Pylori, antral gastritis, are the ones who tend to get hyperchlorhydria and might end up with ulcers in the stomach or the duodenum.  Thus, H. Pylori can either produce hypochlorhydria, when it’s pangastritis, or H. Pylori can produce hyperchlorhydria, when it’s antral gastritis.

24:49  The reason so many people no longer have H. Pylori is that by age 20 the average person in the US has had 17 courses of antibiotics and by age 40 they have had 30 courses, on average. 

29:08  We have all heard about leaky gut, which describes hyperpermeability of the small or large intestine. But there is also leaky stomach and leaky esophagus and leaky mouth and leaky brain. In the esophagus, this is called Dilated Intercellular Spaces, which is present in most cases of reflux as well as in about 30% of patients who don’t complain of reflux. But it is not seen on a biopsy, so it’s often not looked at.  It is also common in almost all cases of eosinophilic esophagitis and allergic esophagitis.  Research has shown that leaky stomach is increased by taking proton-pump inhibitors and its found a lot of autoimmune conditions. 

31:01  To fix GERD, we have to treat the cause.  We should start with a low carbohydrate diet or a low fermentation diet, like Norm Robillard talks about with his Fast Tract Diet.  If there is SIBO we need to treat the SIBO, especially methane.  You can normalize hiatal hernia by doing visceral manipulation and putting the stomach back into its place.  You can improve the lower esohageal sphincter by cutting out the CRAP. C stands for chocolate, coffee, cola drinks, and caffeine in general. R is for refined carbohydrates and for Rx or prescription medicines, such as medications that slow down the gut and contribute to reflux.  A is for acid and certain kinds of highly acidic foods that aggravate patients with reflux, and aspirin and NSAIDs, which we know can cause reflux and ulcers.  If you have a patient who has hypchlorhydria, then you can treat with bitters or apple cider vinegar before meals or betaine hydrochloride with meals.  If they have too much acid, you can use a H2 antagonist like ranitidine (aka, Zantac) or you can use a natural product with melatonin, with B6 and other B vitamins, and zinc. Some products also contain D-Limolene.  One of the products he likes is Endozin by Klaire Labs, which contains zinc carnosine and L-glutamine. Dr. SSL also likes a product from Vital called Heartburn Tx, which contains zinc, L-glutamine, glycine, N-Acetyl Glucosamine, DGL, and Aloe.  He recommends his patients take a teaspoon 2-3 times per day before meals.

37:15  The best way to heal the damage to the mucosa in the esophagus is to treat the cause of the GERD.  Also, avoid alcohol, which can be very toxic to the entire GI tract.  You can also take something like aloe vera and zinc carnosine, or use that Heartburn Tx and make a slurry of it, and swallowing it and not drink any water afterwards, so it coats the esophagus. That way you get both some topical as well as systemic treatment. 



Dr. Steven Sandberg-Lewis is a practicing Naturopathic physician for nearly 40 years and he teaches at the National University of Natural Medicine and he wrote a medical textbook, Functional Gastroenterology, now in its 2nd edition. Dr. SSL (as he is often called) practices at 8 Hearts Health and Wellness in Portland, Oregon.

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes, and YouTube, and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness podcasters, thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and review. That way more people can find out about the Rational Wellness Podcast. Also, if you want to see the video version go to YouTube, weitzchiro YouTube page. If you go to my website, DrWeitz.com, you can get a complete transcript and show notes. So I’m very excited that today we’re going to be talking about a very important topic, gastroesophageal reflux disorder with a very prominent functional medicine doctor, Dr. Steven Sandberg-Lewis.

                                Gastroesophageal reflux disorder is a very common gastrointestinal condition occurring in up to 20% of Americans. GERD, also known as acid reflux, also known as reflux, is a condition where the contents from the stomach come back up into the throat resulting in a burning or acidic taste in the mouth. Burning in the chest, it could be vomiting, breathing problems, a chronic cough, you could be chronically bad breath, chronic laryngitis, and erosion of the teeth.      This can eventually lead to chronic inflammation of the esophagus, it can lead to esophageal strictures, which is a narrowing of the esophagus, and it can lead to Barrett’s esophagus, which is a pre-cancerous condition and eventually can even lead of esophageal cancer. I’m very pleased that we have one of the top functional medicine doctors in the country to join us for a discussion of this important topic, Dr. Steven Sandberg-Lewis.

                                Dr. Steven Sandberg-Lewis (Dr. SSL) has been a practicing Naturopathic physician for nearly 40 years, and he teaches gastroenterology at the National College of Natural Medicine. He wrote an awesome medical textbook, Functional Gastroenterology, which is now in its second edition. And he lectures all around the world. Dr. Sandberg-Lewis, thank you so much for joining me today.

Dr. SSL:               You’re welcome, it’s good to be here.

Dr. Weitz:            Is it okay if I call you Dr. SSL?

Dr. SSL:               Yeah, everybody does, it’s good. It’s shorter.

Dr. Weitz:            Exactly, exactly. So, what are some of the causes of GERD? How should we understand this condition?

Dr. SSL:               Well, I’m currently writing a book on it, and I’m trying to take a really complicated topic and not make it more complicated, trying to make it simpler. Let me say some of the more common causes are issues with SIBO, and increased pressure in the abdomen, pushing things upward. Problems with the vagus nerve, and the emptying of the stomach, because if the bag stays full longer, it’s more likely to go up instead of down. That’s related to a lot of different conditions.  Problems with the lower esophageal sphincter, not having the tone, and allowing reflux. Then, issues that, probably one of the most common reasons, is hiatal hernia, a sliding hiatal hernia, which pretty much takes the normal connection of the diaphragm muscle, and the lower esophageal sphincter and moves the lower esophageal sphincter by two to three centimeters, or occasionally more, so that these muscles aren’t working together the way they’re supposed to. That changes the ability of the sphincter to keep things out of the esophagus. Those are some of the most common issues.

Dr. Weitz:            So, when you get a patient with these GERD symptoms, how do you work it up? What are some of the things you look at? What are some of the tests that you do to try to rule out one of these causes over another?

Dr. SSL:               So, a lot of the people that I see have already had imaging either barium swallows, upper endoscopies showing the esophagus, stomach and the first portion of the small intestine. So I might have a lot of information already from those reports, but in addition I do functional testing that doctors can do to check for hiatal hernia, what we call hiatal hernia syndrome if we don’t have imaging. The treatment is the same whether it’s a true hiatal hernia, or what we’re just calling a syndrome.  We might also do Heidelberg testing, which we do in our office, which directly measures the pH of the stomach. We sometimes refer patients for pH testing that actually looks at the lower esophagus, to see if the pH is changing, there’s true reflux coming up into the esophagus, and the pressure of that fluid. Manometry, which measure the pressure. These are all things that we might use as well as testing for SIBO.

Dr. Weitz:            Okay. Do you think reflux tends to be associated more with too much hydrochloric acid, or too little hydrochloric acid?

Dr. SSL:               So that’s the interesting piece, is that when we check people with Heidelberg testing, you know, it’s a certain group, most of the people have reflux. I would say about-

Dr. Weitz:            Most of these patients that come in that you’re testing, are they on PPIs already?

Dr. SSL:               Many are. And they either want to get off of them, because of chronic side effects or risks, or they’re not working very well. So, what we’ll do is not have them take it the morning of the test, and then we’ll measure. What we find is probably a good average is about 25% of the people that we test that have reflux actually have too much acid. They have Hyperchlorhydria, and probably somewhere between 50% and 75% either have too little acid, or normal acid, both.

Dr. Weitz:            Now, I’ve heard you say that before, I listened to an interview you did on Nirala’s podcast. And that number differs from A, what most traditional gastroenterologists think, and I’m friends with Dr. Rahbar and he does a lot of Heidelbergs too. He sort of sees the opposite.

Dr. SSL:               So Rahbar is seeing a lot more hypochlorhydria?

Dr. Weitz:            Hyper, yeah.

Dr. SSL:               Oh, hyper.

Dr. Weitz:            Yeah.

Dr. SSL:               Okay. Yeah, I’ve heard that. But the thing is that maybe it’s a different patient population.

Dr. Weitz:            It might be.

Dr. SSL:               But there are two types of hypochlorhydria that we might see on a Heidelberg. One is the patient swallows a capsule, it sends out the pH measurement directly to the computer, and you see right away what it is. And if the pH is five, six, you know right away the person has frank hypochlorhydria. If it’s six and a half, you might even call it achlorhydria, meaning no acid production at all. That’s kind of rare. But then there’s also what we call hidden hypochlorhydria. That’s when we do a series of challenges with a super saturated bicarbonate solution, the patient, it’s a very small amount, like five cc’s of this solution, neutralizes their stomach acid, and we see their pH go, you know if it’s already acid at the beginning of the test, we’ll see the pH go up to close to neutral, six, six and a half.  Then we measure how many minutes it takes for it to come back down to acid, so to reacidify. We’ll do up to three of those reacidification challenges in the hour that the patient’s being tested. Then we see, does it take 12 minutes every time? That means they just have pretty normal acid production. If it takes 12 minutes, the second time it takes 15 minutes, the next time it never comes back down, that’s a typical thing we’ll see, never meaning we wait 25 minutes and it’s still not coming down. So the stomach is not able to produce enough acid to reacidify.  That’s sort of mimicking a meal. Because we can’t put food in there during the test, it’ll gum up the capsule. So we use this to mimic a meal. So if it’s getting longer and longer like that, we call it hidden hypochlorhydria. Then, we can give the person some bitter herbs, or some betaine hydrochloride, and see if that brings it down. See what works.

Dr. Weitz:            Interesting. So, why would a lot of these patients, up to 75% of patients that you see, why do they have low stomach acid?

Dr. SSL:               Reasons why people will have low stomach acid? In general, I think it has to do with a chronic state of disease. I think in many chronic diseases, just as we see hypothyroid function in many chronic diseases, even if it’s a functional conversion issue. I think we see those same people tend to have hypochlorhydria.  Autoimmune diseases, very common. There’s a whole host of common conditions.

Dr. Weitz:            How do autoimmune diseases result in hypochlorhydria?

Dr. SSL:               Well, there’s true, what we call, autoimmune gastritis, I don’t think that’s as common.  But that’s a condition where people actually have antibodies against their own parietal cells, which are, of course, the cells that make acid and make intrinsic factor to absorb B12. Or they’ll have other kinds of antibodies that also will affect the parietal cells indirectly, like anti-intrinsic factor antibodies. So those people, you’ll generally find them to be chronically anemic with a macrocytic large cell type anemia, not the iron deficiency necessarily, although they can have both. They will tend to get a thinning and a decreased mass of parietal cells, and they just can’t make as much acid.  So I think chronic disease in general as well as autoimmune disease, we know lupus tends to have that, it doesn’t have to be just pure autoimmune gastritis, it can be with other autoimmune diseases.

Dr. Weitz:            So you mentioned SIBO as the cause of reflux, can you explain how that happens?

Dr. SSL:               We think that the major mechanism is whenever, you know, the abdominal cavity separated from the thoracic cavity by the diaphragm, normally we expect to have more pressure in the thorax, in the chest, than in the abdomen. When you have 50, 80, 100 parts-per-million of gas, extra gas production with SIBO in the abdomen, that’s going to increase the intra-abdominal pressure. That’s going to tend to move things upward. So we think that it’s kind of a pressure differential issue. There may be other instances-

Dr. Weitz:            The pressure from the gas is produced by SIBO, like the methane and the hydrogen, they’re pushing up on the esophageal sphincter.

Dr. SSL:                 Or hydrogen sulfide.

Dr. Weitz:            Or hydrogen sulfide. The new gas on the block.

Dr. SSL:                 Yeah. But then it could also be that methane, especially, really slows down the normal peristaltic forward movement, and I think methane, especially, seems to be associated with reflux, with biliary problems, just slowing down all the pipes.

Dr. Weitz:            Yeah. How often is reflux really bile reflux as opposed to acid reflux?

Dr. SSL:               That’s another one. So here we’re talking about the pyloric valve instead of the lower esophageal sphincter, having decreased tone and allowing bile to reflux back into the stomach. Of course that bile could then further reflux into the esophagus if you have both types, causing a very irritating type of reflux. Personally, from all the research I’ve looked at, I think that this may be the key piece with Barrett’s esophagus. A lot of people with reflux, chronic reflux, don’t get Barrett’s esophagus, and it doesn’t progress further into dysplasia, severe dysplasia, or cancer of the esophagus.  I think it’s when people, the people that actually have bile reflux, and that’s refluxing up into the esophagus. We know bile, secondary bile acids are carcinogens, and so I really think that that’s part of the piece of Barrett’s esophagus. It’s interesting too, one study showed that people who didn’t have bile reflux, but had reflux, normal reflux, and took proton-pump inhibitors, 12% of them developed bile reflux as well. So proton-pump inhibitors may actually increase this.  There’s a huge Danish study that was done that found that the more assiduously the patients take proton-pump inhibitors for their Barrett’s esophagus, the more likely they are to have more advanced dysplasia and cancer of the esophagus. The same thing was true with stomach cancer in patients that were taking proton-pump inhibitors.

Dr. Weitz:            So, in terms of where we are, and in terms of the current research on PPIs, do we think that that’s a conclusion we should be drawing or not yet?

Dr. SSL:               Well, let’s put it this way. The American College of Gastroenterology came out with new guidelines about two years ago for proton-pump inhibitor use in Barrett’s esophagus. What they said was, “Don’t use it with every patient with Barrett’s, don’t tell them this is a way to prevent cancer of your esophagus, only give proton-pump inhibitors if it helps relieve symptoms in patients with Barrett’s.” So it’s for symptomatic relief only according to the experts at The American College of Gastroenterology.



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Now, I’m so excited that they have just brought out the new Keto Before 6 product to make it easier to get into ketosis while following a ketogenic diet, which I have just started to use, and I can tell you it really works.  Also, listeners can get 10% off their first Quicksilver Scientific order if they use the code BEN10, that’s B-E-N 10, and now back to our interview.



Dr. Weitz:             How often is GERD associated with H. Pylori infection?

Dr. SSL:                 I’m so happy you brought that up. You know, I didn’t list H. Pylori as a cause of reflux, and the reason is, everyone agrees to this meta-analysis show that having H. Pylori in your stomach is protective against reflux, protective against Barrett’s esophagus, and esophageal cancer, also Crohn’s and a whole host of other things.  So, nowadays, less than 10% of Americans have H. Pylori in their stomach since we’ve been killing it, testing and killing it, since the 1990s.

Dr. Weitz:            Isn’t it a question of how much though rather than having it or not having it?

Dr. SSL:               That’s a good question-

Dr. Weitz:            Right, because isn’t H. Pylori a normal “commensal” of the stomach?

Dr. SSL:               Yes. I highly recommend the book Missing Microbes, which is written by Martin Blaser, who is the Director of the Microbiome Research Center at NYU. Really a great book, well written, fun to read. But really lays out the research that shows that H. Pylori is an ancient dominion organism, as he calls it, that it belongs in the stomach, 100% of the world’s population used to have it. Now we’re down to maybe 7% of Americans, and even fewer kids in America, because they can’t get it from their parents who don’t have it.  We think, according to the research, that it’s increasing the risk of all kinds of allergic conditions and autoimmune conditions such as Crohn’s disease, hay fever, asthma, eczema, laryngeal cancer, reflux, Barrett’s esophagus, and cancer of the esophagus. So it’s protective against all those things. One thing I try to talk people out of, if they got tested for H. Pylori because they have reflux, it makes no sense to treat it, because it just increases the risk of all the complex complications and sequela of reflux, it makes reflux worse, according to the research.

Dr. Weitz:            Interesting. Because the theory that was told was originally we thought you couldn’t have bacteria in your stomach, because of all the hydrochloric acid, then we were told that this H. Pylori was this bacteria that screwed itself into the wall of the intestine, so were somewhat protective and that it leads to ulcers because the body has to secrete hydrochloric acid to try to get rid of it, and it can’t get rid of it because it’s buried into the wall, and that’s why you end up with hyperchlorhydria, which leads to GERD, and so, therefore getting rid of H. Pylori would reduce the hydrochloric acid secretion, and that would fix your GERD.

Dr. SSL:                 The thing is, again, I said it’s a really complicated topic, and I’m going to try to not make it … complicate and try to make it less complicated. But the bottom line is when people initially get H. Pylori colonizing in the stomach, they will, according to the research, they will have hyperchlorhydria, for at the least the first three months. H. Pylori then either tends to predominate down in the antrum, the bottom of the stomach, that’s called antral gastritis, or the entire stomach, which is Pangastritis.  People who have colonization of the entire stomach, Pangastritis, are the ones that have about a 1% risk of eventually developing cancer of the esophagus … a cancer of the stomach, excuse me.  And H. Pylori has a risk of that. But it’s been a 1% risk in the people that have Pangastritis. That’s probably the most common type of H. Pylori gastritis. This gastritis in itself isn’t harmful. Gastritis sounds like it’s a disease, but it’s really just the H. Pylori kind of upregulating the immunity in the stomach, which is what it’s supposed to do when you’re a kid, so you won’t develop all these immune diseases.

Dr. Weitz:             Why do we have less H. Pylori? Why do so many people not have it at all?

Dr. SSL:                Let me just mention the antral gastritis first. The antral gastritis, we think is a much smaller percentage of people, where it’s just in the bottom of the stomach. Those people actually produce more acid. Those are the people, 5% to 7% of the population, that might end up having ulcers in the stomach, or the duodenum. It’s very much, you know, it’s coordinated with that antral type gastritis, but that’s the rarity. But yeah, those people are more likely to get not the stomach cancer, but the ulcers.

Dr. Weitz:             And that was the original story about H. Pylori was this was the way to fix ulcers.

Dr. SSL:                Yeah. And it is. In that small population. That’s why even though 100% of the world’s population, before we started killing it, had H. Pylori in their stomachs, still ulcers were only 5% to 7% of the population. It’s because it’s when it’s that antral type gastritis. But when it’s the whole stomach, it tends to reduce acid production. This is one way to get hypochlorhydria is H. Pylori. You might call H. Pylori Pangastritis nature’s proton-pump inhibitor. But it’s all a matter of balance.   If people also have chronic degenerative diseases, and autoimmune diseases, and other factors, they may develop more severe deficiencies of acid production. So, just to let you know, H. Pylori can either reduce acid or when it’s down in the antrum, increase acid. I can explain why, but you probably don’t need to explain that right now.

Dr. Weitz:             Okay. So why do so many people not have H. Pylori, is it because of the antibiotic use?

Dr. SSL:                Yeah. So we are now in the fifth generation of antibiotic use. Average person by age 20 has had 17 courses of antibiotics. By age 40, 30 courses. That’s just average. You and I both see patients who’ve had more than that. And that’s just one factor. But we know that no single antibiotic will eradicate H. Pylori, there’s always a triple therapy with a proton-pump inhibitor and at least two antibiotics that’s used.  But research by Blaser and his associates at NYU have shown that repeated courses of antibiotics can definitely weaken or kill H. Pylori, 17 courses over 20 years can do that.  Also, say that’s for the adults. But for the newborns, if fewer than 10% of grownups have it, the newborn is not going to get it, because you get it from your mom and your dad, and your brothers and sisters. If you have big families where the kids are all sleeping in one bed, in one room, and they’re crowded, you’re more likely to get H. Pylori when you’re a kid. So you’re less likely to end up with autoimmune and allergic disorders and certain types of cancer.  Also, we have cleaner water now, water is a way to get H. Pylori, that’s a good thing. But we’re not getting it from other sources as well. But sometimes antibiotics-

Dr. Weitz:             So we need H. pylori probiotics.

Dr. SSL:                 … yeah. So Martin Blaser, at the end of his lectures and the book, am I giving it away? Spoiler alert, he says that he thinks in the future, when the FDA is not so freaked out about the word H. Pylori, maybe 20 years from now, we will have multi-strain probiotics that are multi-strain H. Pylori, we’ll give that to the newborns, because the parents don’t have it.  Maybe we’ll treat it with triple therapy when they get into their 30s or their 40s if they develop ulcers, or lymphoma of the stomach, or a gastric adenocarcinoma, which are known diseases that can be associated, as people get older, with certain strains of H. Pylori.

Dr. Weitz:            If we see H. Pylori on a stool test, should we not treat it?

Dr. SSL:               So, I have a lecture called H. Pylori, The Only Good H. Pylori Is a Dead H. Pylori, right?  So you asked the perfect question.  My feeling is that doctors who do stool panels that include H. Pylori, unfortunately, are screening patients that we really don’t want to test.  And you’re finding commensal H. Pylori and then killing it.  I think it’s really best only to test patients for H. Pylori if they have diseases that are associated with it, and you really don’t want to pick up on the commensal and kill it, because there’s no reason to, in itself it’s not dangerous, unless the person is developing one of these diseases.  I think we’ll get better and better about doing this right over the next 10 years or so, but right now there’s just so much, the rule of the land is test and treat.  So anyone you test, you treat. So I’m just saying, be careful about who you test.  If someone just has reflux, don’t test them.  If they just have Barrett’s, don’t test them.  If they never had an ulcer, they don’t have stomach cancer, or they’re not developing that, you know, if they’ve had Barrett’s esophagus, they’ve had their stomach biopsied already, and you know if they have dysplasia in their stomach or not. So yeah.

Dr. Weitz:            Okay. I’ve heard you mention leaky stomach and leaky esophagus. Can you explain briefly what these are, and what role do they play in GERD?

Dr. SSL:               Yeah. A lot of people have seen the research on small intestinal hyperpermeability, and large intestine hyperpermeability.

Dr. Weitz:            That’s what we typically call leaky gut.

Dr. SSL:                Right. But the truth is, it’s everywhere. So I’m sure dentists will find there’s leaky mouth syndrome, and it’s probably already been shown, but I have-

Dr. Weitz:             We have leaky brain barriers.

Dr. SSL:                 Oh, we know that, yeah, yeah, as well. So, in the esophagus, the research calls it DIS, or Dilated Intercellular Spaces. That’s not something you get from a biopsy because you need electron microscopy to do it, so it’s not looked at. Just like we don’t look at microvilli on a biopsy of the small intestine, because you need electron microscope for that, typically not done. But DIS, or the leaky esophagus so to speak, is present in virtually all patients with reflux. And about 30% of patients who don’t complain of reflux.  So it’s a very common thing, and seems to be present in most reflux and in almost all cases of eosinophilic esophagitis, allergic esophagitis, and other conditions like that. Also, research has shown that taking a proton-pump inhibitor increases the permeability of the gastric mucosa, so leaky stomach is increased by taking proton-pump inhibitors. And it’s found in a lot of other autoimmune conditions as well.

Dr. Weitz:             So how do we fix GERD?  How do we help our patients heal?

Dr. SSL:                You fix GERD by treating the cause. So first you have to figure out what’s the cause. We know that low carbohydrate diets, and low fermentation diets in themselves can be a perfect fix for reflux, and Norm Robillard with his diet, Fast Tract Diet, has really shown that.  Norm and I were on the same panel at a recent SIBO Conference.  As we were talking about all this, he sounded like a one-trick pony.  He just kept saying, “It’s all about fermentation.  It’s all about carbohydrates.”  And you know, by the end of our talk, I kind of felt like he was right.  Like every mechanism, the lower esophageal sphincter tone, all these things, they seem to be, let’s say 80% of GERD seem to be related to fermentation.  So, he kind of made me a believer, at least I’m entertaining that idea, I think that’s a great way to start.

Dr. Weitz:            Yeah, I’ve had Norm on the podcast. So, what other things do we treat?  How else do we heal, besides … so if they have SIBO, we were going to use these SIBO protocols, which is probably another whole podcast. But-

Dr. SSL:                 Yeah, so you treat SIBO, especially methane. You normalize hiatal hernia syndrome by doing visceral manipulation, different kinds of treatment that can put the stomach back in place, and you teach the patient how to reduce the intraabdominal pressure, so it doesn’t recur, less likely to recur. Then you also improve the tone of lower esophageal sphincter, there’s this idea of cut out the CRAP, C-R-A-P, that comes from the book No More Heartburn. C stands for chocolate, coffee, cola drinks, caffeine in general. Sometimes those, the use of those things is a real key piece for people with this problem.  R is for refined carbohydrates. It also stands for Rx, or prescription medicines, because we know a lot of medicines that relax spasms, and pain in the gut, and slow down the gut, can cause reflux. A is for acid. Some people, certain kinds of highly acid foods aggravate them, and it’s also for aspirin and NSAIDs.

Dr. Weitz:            So, on the acid thing, let’s say we have a patient with low stomach acid, what do we do?

Dr. SSL:                Well, if you have a patient with low stomach acid, and you know that from either a trial with vinegar, or betaine hydrochloride, or doing a Heidelberg test, then you can actually treat reflux by using bitters, apple cider vinegar before meals, or betaine hydrochloride with meals. That can be a treatment for hypochlorhydric reflux. So yeah, just depends on the case. There are some patients that using pancreatic enzymes will get rid of the reflux. Maybe because they’re digesting carbohydrates more effectively, brush border enzymes, breaking down their carbohydrates better and that way they’re not getting as much bacterial overgrowth.

Dr. Weitz:            How about if they have too much stomach acid?

Dr. SSL:                That’s the trickiest one. If they have too much stomach acid, I will admit, I will have a patient at least use, in many cases, at least use a H2 receptor antagonist, such as ranitidine, which has a much lower side effect profile than the proton-pump inhibitors, and we’ll just use the minimum dose that controls it. If we can’t control it by normalizing all the plumbing, and the fluid, and the pressure.

Dr. Weitz:            What about natural PPIs? There are some products on the market that contain melatonin, B vitamins, methionine.

Dr. SSL:                Melatonin is a really great thing to try. Yeah, that study that used melatonin with B6 and other B vitamins, and zinc, definitely worth the trial. And there’s lots of good products, some in powder form, some in capsules that incorporate a lot of these treatments including D-limonene sometimes in itself just really helps to normalize biocidal protection, normalize the esophagitis.

Dr. Weitz:            Do you have a preferred product for that?

Dr. SSL:                Am I allowed to say products?

Dr. Weitz:            Sure.

Dr. SSL:                I really like either Endozin by Klaire Labs, which has a tiny bit of glutamine, and mostly zinc carnosine. D-limonene, I don’t really care where it comes from, seems to be good.  But there’s a powdered product from one of these companies, I think it’s either Pure Encapsulations, or I think it’s Pure Encapsulations, which is called Heartburn Tx. And it has gamma oryzanol, and Acetyl-Glucosamine, glutamine, zinc, carnosine, DGL, and a few other, aloe vera, and it’s a really nice mix. And people can take around a teaspoon twice or three times a day before meals, and I think it really gives therapeutic doses of those things.

Dr. Weitz:            So, if they have damage to their esophagus, like we were talking about this leaky esophagus, or they have Barrett’s, what’s the best way to heal that?

Dr. SSL:                I think the best way to heal it is treat all the known causes that you have that you can come up with.

Dr. Weitz:            Yeah, so let’s say we’ve reduced their reflux, but now they still have damage.

Dr. SSL:                Yeah. I’m a big believer in the fact that don’t push the river, it flows by itself. So if you fix the cause, you get rid of that chronic inflammation from that reflux, I think you give it some time. Studies show, for instance, patients who … By the way, when we were talking about the C-R-A-P, A also stands for alcohol. For some people, their reflux is caused by alcohol. So studies have shown that-

Dr. Weitz:            How does alcohol cause reflux?

Dr. SSL:               How?

Dr. Weitz:            Yeah.

Dr. SSL:               Alcohol is toxic to the entire GI tract, the mucosa throughout the entire GI tract, and is a risk factor when used daily, even social use, there’s a risk factor for SIBO.  So, I don’t think you have to look too much further than that, but-

Dr. Weitz:            What about alcoholic containing..

Dr. SSL:                 …alcoholic gastritis as well.

Dr. Weitz:            What about alcoholic contained in mouth washes?

Dr. SSL:                I hope people aren’t swallowing those. But yeah. I mean, alcohol in mouth wash has been shown to be a carcinogen in the mouth. For squamous cell carcinoma, so they’re tending to remove that from mouth washes these days.

Dr. Weitz:            Then, you throw in some antibiotic, and throw in some fluoride…

Dr. SSL:                Yeah. I mean, again, if you’re trying to heal a leaky esophagus, I think that using something like aloe vera, and zinc carnosine, or that Heartburn Tx, making a slurry of it, and swallowing that and not drinking any water afterwards, just let it coat the esophagus. That’s a really nice way to get direct treatment right there, and then they’re swallowing it, so it gets systemic as well.

Dr. Weitz:            That’s cool. What about food allergies?

Dr. SSL:                Food allergies are a big issue. Food allergies is a big issue for all of these conditions. So, you may need to do individual sleuthing to figure out what foods the person is sensitive to, so that you’re not upregulating their immune system constantly.

Dr. Weitz:            What’s your favorite form of sleuthing?

Dr. SSL:                Well, I don’t do a lot of the IgG, IgA, IgE food testing. I do it when patients ask for it. If I do decide to do it, I tend to use IgG, IgA, unless the patient has classic allergic triad, like eczema, asthma, and hay fever, and then I might do the IgE, IgG. But mostly I’ll use-

Dr. Weitz:            Which testing companies do you like the best?

Dr. SSL:               I think we tend to use Doctor’s Data.

Dr. Weitz:            Okay.

Dr. SSL:               Genova does a good test as well. But mostly what I tend to do is use Dr. Siebecker’s SIBO specific diet, and then we have what we call the high five. If they’re not getting significant relief in their reflux from that low-carb, low fermentation diet, I’ll talk to them about the high five, that’s eggs, dairy, even lactose free dairy, the third would be raw fruits and vegetables, the fourth would be too much honey, or sugar from fruit, and the fifth one would be nuts and seeds.  So one at a time, they’ll take those things out in addition makes the diet a little more restrictive, but they can find out if any of those particular things is causing their reflux.

Dr. Weitz:            Interesting. Can you just repeat those again?

Dr. SSL:               The high five?

Dr. Weitz:            Yeah.

Dr. SSL:                So, the high five, I got this actually from the guys at SCD Lifestyle, they call it the four horsemen of the apocalypse, but I added a fifth, I call it the high five. The first one is eggs, common foods people react to. The second is dairy products, even lactose free dairy products, like 24-hour yogurt. The third one is nuts and seeds. The fourth one would be raw fruits and vegetables, because some people, the fiber is just too much for them initially, especially if they have ileocecal valve syndrome, which is another valve. And the fifth one would be too much honey or fruit.

Dr. Weitz:            I’m surprised you don’t have gluten in there.

Dr. SSL:               Gluten is already gone on that diet.

Dr. Weitz:            Okay.

Dr. SSL:               All grains are already gone.

Dr. Weitz:            Oh, so they’re already on the low-carb, low fermentation diet.

Dr. SSL:               Yeah. First they just do the general SIBO specific diet, and if they’re not having dramatic improvement, then we look at the high five.

Dr. Weitz:            I got it. I got it. Good, excellent. Okay, Dr. SSL, I think that’s all the time I have today. This was great, I really appreciate it. How can listeners get a hold of you, or your courses, or your books?

Dr. SSL:               My book, right now, I have one textbook, I’m working on a few others, is on Amazon.  So if you just google Steven Sandberg-Lewis on Amazon, or Functional Gastroenterology, which is the name of the book.  It’s available there.  I’m just developing a website I have, I had one for years, but I never did anything with it.  Currently, you can find a link to all my articles, Townsend Letter, I have a near monthly column there, which I really like to share with people.  Where my current private practice is at 8 Hearts Health and Wellness, you can go to 8, the number 8, Hearts.org, and that website links you to all my articles if you look under my bio.

Dr. Weitz:            Are you still accepting patients?

Dr. SSL:               Yeah. Yeah. I mean, we have a bit of a waiting list, but I have other doctors that work with me that kind of can speed up the process. I would say too that if you go to the SIBOcenter.com, I believe it is, which is the SIBO Center at NUNM, National University of Natural Medicine, I’m affiliated with them too, and you can find my articles there, and blogs and things as well.

Dr. Weitz:            Awesome. Thank you so much for spending the time with us.

Dr. SSL:               You’re welcome, it was fun. Nerding out on GERD.



Keto Diet with Dr. Christopher Shade: Rational Wellness Podcast 111

Dr. Christopher Shade discusses Keto Diet with Dr. Ben Weitz.

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


Podcast Highlights

1:06  The topic is how the ketogenic diet, fasting, and calorie restriction can have benefits for longevity. This is through stimulating AMPK and inhibiting the mTOR pathway and stimulating autophagy, which is the process by which cells break down and digest old, damaged parts of cells and proteins and debris.

8:04  Dr. Christopher Shade is especially well known for developing liposomal forms of nutritional supplements like glutathione to increase absorption rates.  A liposome is is a spherical vesicle made of a lipid phospholipid bilayer.  Dr. Shade explained that “You have to design these shells and you have to get them exactly into the right size and you have to have exactly the right chemistry in the middle to hold the whole nutraceutical you’re going to bring. There’s two basic kinds, there’s the hollow water-filled ones for taking water solubles and that’s called Liposome. There’s the solid, oil filled ones for bringing oil solubles like we have in the Keto Before 6. We’re doing things like Berberine and Resveratrol, those are called Nanoemulsions.  You have to get the right ratios of all the phospholipids in the membrane. You have to have the right size, you have to have the right ratios in the water, the glycerin, the ethanol, the different oils in there.  When you do that and only when you do that do you have this enhanced uptake.  In fact, you start absorbing these little spheres right through the oral cavity, right into your blood.  You can see this stuff in the blood in as little as two minutes.”

10:10  The Ketogenic Diet is very low carbohydrate, low to moderate protein, and very high fat.  It relies mostly on fat and vegetables, which mimicks some of the aspects of fasting.  Dr. Shade said that the key is going back and forth between the fed state and the fasting state. During the fed state you are in fat storage, lipogenesis state, and when you do keto, you turn on the lipolysis, fat burning state. You switch back and forth from glycogen storage to glycogen burning. You upregulate your glucose transporters. You block mTOR and you go into autophagy where you recycle your proteins by breaking down dysfunctional parts of organs, like burning the fatty deposits in the liver and breaking down damaged mitochondria.  You need to break down these damaged mitochondria to restore cellular function. This happens during the fasted state through the activation of AMPK, which cascades into blocking mTOR, the activation of PPAR-alpha and the activation of PGC1A.  When you burn up the old mitochondria and synthesize new ones you can create higher mitochondrial density.  You also have a change in the ratio of NAD+ to NADH. This fasting/keto state also probably effects the Sirtuins and the FOXOs, which stimulate growth factor release out of stem cells. 

15:19  Exercise has some of the same beneficial properties as fasting.  Exercise converts ATP to ADP to AMP and when the ratio of AMP to ATP goes up, it gives you a 10x upregulation of AMPKinase. Then if you phosphorylate this threonine residue on the alpha sub unit, that gives you another 100x upregulation, which means that you now have a 1000x upregulation.  This is especially the case when you work out after an overnight fast. 

17:42  One of the challenges of a ketogenic diet are that it is very difficult to be super low carb all the time.  Dr. Shade explained that “We’ve designed our Western civilization around the all-mighty carb.  We’re now reaping the diabesity reward of our own old food pyramid that was all carb.”  When you go out to socialize, it is very difficult to avoid all carbs.  Also, there is a benefit to switching back and forth between periods of low carbs and periods of higher carbs. He mentioned that Joe Mercola is a friend and he was doing very strict keto for quite a while with low protein as well and he had shrunk down to nothing.  He had gone too far. Now he cycles back and forth between keto/fasted and fed and he looks much better. Back and forth between super low carbs and higher carbs. Dr. Shade developed his KetoBefore 6 product so that no matter what you ate the night before that between the overnight fast and you take a teaspoon of this and in 90 minutes you get blood ketones.  He explained that if you are using urinary ketone strips, you will see ketones for the first week and then when you are fat adapted, you will not see ketones in your urine anymore because now you are burning the ketones.  Urinary ketones are just when you haven’t adapted all of the transporters and enzymes. But if you measure the blood, you will see the ketones.

22:32  Dr. Volter Longo at USC has been doing a lot of research on fasting and longevity.  Dr. Longo is recommending what he calls the Fasting Mimicking Diet, which is a 5 day calorie restriction program that he recommends doing intermittently, such as once per month.  But this program is essentially a plant based, Mediterranean style eating plan (Dr. Longo calls it a Pescatarian diet plan) and it is being sold in a box by a company called Prolon that Dr. Longo started.  Dr. Shade explained that Dr. Longo is not into low carbs but more into calorie restriction and Dr. Shade said that the approach is so low calories, that it’s essentially fasting.  Dr. Shade said “You look at these people that Valter Longo was interviewing, and they’re like these little skinny, little people up in the mountains. They’re like, ‘How are you alive? ‘Because, I’ve never had any fun.’ They’re like toothpicks, and I was like, ‘No, I don’t think that’s the way I want to go.’ … We want to look maybe a little grayer, but we want to have mass and strength and we want to have a good robust life until the end here.”

28:23  Dr. Shade told the story how he came up with the idea for his new Keto Before 6 product.  He was at the Paleo f(x) conference and Dr. Joe Mercola squeezed his love handles and taunted him about his level of visceral fat that would end up killing him.  Then Dr. Mercola encouraged Dr. Shade to do 4 days of water fasting, that was to be part of a 30 day intermittent fast and Dr. Shade was not happy about the program.  He did some reading and put together some ingredients that he figured out were natural mTOR blockers and he drank it and the he picked up a keto strip and peed on it and it was black, indicating that he was in ketosis.  He realized that this could be a biohack to get himself into fat burning more quickly.  Dr. Shade explained why he chose the nutrients in his Keto Before 6 product–DIM, Quercetin, Milk Thistle, Resveratrol, Berberine HCL, and Cinnamon bark oil–because these nutrients can help induce ketosis more quickly than just following a ketogenic diet can. Resveratrol is an AMPK activator and its also a Sirtuin activator.  Berberine is nature’s Metformin and it is an AMPK activator and also helps with insulin resistance.  Silymarin from Milk Thistle is also an activator of AMPK and it helps to seal up leaky liver.  Leaky liver upregulates Canalicular trafficking, which affects bile flow.  Quercetin is a PGC1A upregulator, it turns up mitochondrial function, it’s a very strong AMPK activator, and it also boosts NAD+ levels in the cell by blocking NADase, which then further induces Sirtuins, which further activates AMPK.  All this in addition to the overnight fast results in ketone formation in only about 90 minutes. 

33:08  Ketone salts can be helpful for brain health, esp. for patients with Alzheimer’s, MS, or other neurological dysfunction. 

37:30  Dr. Shade talked about Keto flu, which is when some people get flu like symptoms when starting a ketogenic diet may be partially related to water and mineral depletion, like a lot of people talk about.  But the core of Keto flu is that you are detoxing and as you burn fat, you’re releasing fat soluble toxins.  The best thing to do is take binders, like the Quicksilver Ultrabinder. You can also take a bitter’s formula, some PC binders, and some glutathione to support detoxification.  Embrace the Keto flu because it means you are getting rid of toxins. 



Dr. Christopher Shade is a PhD researcher and the founder and CEO of Quicksilver Scientific, which offers his patented mercury speciation process as part of its heavy metal testing offered to practitioners. Dr. Shade has also developed some of the most advanced detoxification systems using unique combinations of nutritional supplements in specialized nanoparticle and liposomal delivery systems for higher bioavailability.  If you go to Quicksilver Scientific you can register as either a practitioner or a patient to buy the nutritional products.

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to Rational Wellness Podcast on iTunes and YouTube and sign up for my free eBook on my website by going to drweitz.com. Let’s get started on your road to better health.   Hello Rational Wellness Podcasters, thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and review.  That way, more people can find out about the Rational Wellness Podcast. Also, you can check out the video version on YouTube and if you go to my website there’ll be show notes and a complete transcript–that’s drweitz.com.

Our topic of conversation today is how the ketogenic diet, fasting and even calorie restriction can have benefits for longevity. We’re going to be talking to Dr. Chris Shade, one of my favorite people. Both of these types of programs, ketogenic diet, fasting and even just calorie restriction have been advocated by various doctors, scientists for reducing diabetes, other chronic diseases and also to promote longevity.  The ketogenic diet is a very high fat, medium protein and low carb diet that originally was found to be helpful for Epilepsy. The drug Rapamycin, which inhibits mTOR, mTOR actually stands for the mammalian target of Rapamycin, also prevents the development of Epilepsy.  mTOR is a cell signaling pathway and both fasting and the ketogenic diet have been shown to inhibit this mTOR pathway.  They promote longevity by inhibiting this mTOR pathway because mTOR regulates and stimulates… regulates autophagy.  Autophagy is a process by which cells break down and digest old damaged parts of the cells and proteins and debris.  By reducing mTOR you stimulate this rejuvenation process that’s really beneficial for cells and for living organisms.  Increased AMPK is another molecule that helps to decrease mTOR and stimulate Autophagy.  The first drug that was found to inhibit mTOR is this drug I mentioned called Rapamycin.  Now this drug was originally isolated from a bacterium found on Easter Island and the natives call this island Rapa Nui, so that’s how they came up with the name Rapamycin. It was originally developed as an antifungal drug but then was found to have immune suppressing properties and so it was really an anti-rejection drug. Now Rapamycin is being used off label by some anti aging doctors as an anti aging drug. mTOR is really a nutrient sensor that detects if there are enough nutrients available for cell growth and if there’s no food such as while fasting, then the cells go into an energy conservation, no growth, dormant state for the sake of survival.

Dr. Chris Shade is one of the most brilliant PhD researchers working in the field of nutritional supplements, and he’s the founder and CEO of Quicksilver Scientific. Quicksilver Scientific is known especially for its heavy metal testing and detoxification systems and products and its unique liposomal supplement delivery systems. Dr. Shade has developed a new supplement to help patients more easily get into ketosis while following a ketogenic diet, Keto Before 6.  Chris, thank you so much for joining me today.

Dr. Shade:           I’m happy to be here. I always like talking to you Ben. I always like rolling on about these subjects, because they’re fascinating and incredibly helpful.

Dr. Weitz:            And we all want to live a long time.

Dr. Shade:           Yeah, that’s it. And live really well. We want the health span to be super long.

Dr. Weitz:            Exactly. We want to rectangularize that curve and live a high level of function and then drop off at the end, the last day.

Dr. Shade:           Yeah. Just go screaming right into the end.

Dr. Weitz:            Can you tell us a little bit about your background and how you became involved in Functional Medicine and in the nutritional supplement field?

Dr. Shade:           Yeah. It’s a funny sort of cyclical path here, winding and cyclical. I was originally… I was a son of a professor. I was a nonbeliever in natural things. All of a sudden I’m in college, you take certain things and you open up your mind a little bit. I got into organic farming and I became an organic farmer. It was before USDA Organic.  Things were really hardcore soil ecology back then.  I really got involved in because first I was involved in environmental science and I saw environmental science as a profession is just running around behind the polluters making them feel good about things and making it public like you’re actually doing something but it was bullshitI got deeply involved in food supply and health from food supply.  Real organic farming is like I said, is deeply ecologic and there’s all this interaction between the microbes and the organic matter and the mineral matter inputs.  This whole food web that’s going on in the soil to feed this food web that’s coming up above the soil.  It’s only now that we’ve gotten so sophisticated about GI and digestion that we see it in a similar way that we used to look at soil.

I joked that I went out of business in organic farming the year that Whole Foods came along. I was early for the whole thing. I left school where I left the farm, and I went back to school, and I was looking at environmental chemistry again, and looked at metals, toxic metals.  Then I developed that testing for looking at very small specific amounts of mercury in the environment and how it moves up the food web.  I wanted to get back directly into working on health.  I took the patent for that testing and all the knowledge that I had from that I came back into integrative and Functional Medicine and I brought forth these tools for evaluating toxicity.  Then with that I had to develop tools for alleviating toxicity.  Those were the detox systems I developed and in order to do that I needed to break this bioavailability barrier that surrounded glutathione.  I had to be able to get glutathione in, which would normally be broken down by your digestion and that led me to Liposomes.  I tried a lot of them out there, and most of them were just a lot of hype and not really a lot of action.  I got really good at making my own Liposomes.  It was so amazing what it can do for bioavailability that we started looking at all the other holes in Functional Medicine and then which compounds really need this kind of help. We started developing out a broader range beyond just detoxification.

Dr. Weitz:            By the way, what exactly is a Liposome?

Dr. Shade:           A Liposome, it looks like a little cell. It’s a spherical vesicle or a carrier made of a lipid phospholipid bilayer. Phospholipids are the same things that make up your cell membranes and they’re used for phospholipid therapy-

Dr. Weitz:            It’s a lot more complicated than just combining a nutrient with Phosphatidylcholine or Lecithin right?

Dr. Shade:           No. You have to design these shells and you have to get them exactly into the right size and you have to have exactly the right chemistry in the middle to hold the whole nutraceutical you’re going to bring. There’s two basic kinds, there’s the hollow water-filled ones for taking water solubles and that’s called Liposome. There’s the solid, oil filled ones for bringing oil solubles like we have in the Keto Before 6. We’re doing things like Berberine and Resveratrol, those are called Nanoemulsions.  You have to get the right ratios of all the phospholipids in the membrane. You have to have the right size, you have to have the right ratios in the water, the glycerin, the ethanol, the different oils in there.  When you do that and only when you do that do you have this enhanced uptake.  In fact, you start absorbing these little spheres right through the oral cavity, right into your blood.  You can see this stuff in the blood in as little as two minutes.  It’s good for something like vitamin C or B vitamins.  It makes them more bioavailable but it’s amazing and it’s a game changer for stuff that otherwise isn’t bioavailable like glutathione or like in the Keto Before 6 you’ve got Berberine, Resveratrol, Quercetin, Silymarin.  All these things that have all this promise for what they can do to your biochemistry, but it’s very unrealized promise generally because of their bioavailability issues.  That was the whole trick, is to get around this bioavailability and then make it more like an injection and really get the deep rewards of our natural medicine cabinet.

Dr. Weitz:            Cool. Let’s talk about the ketogenic diet and what benefits are attained in this way?

Dr. Shade:           Absolutely. Ketogenic you see that comes on the heels of the Paleo.  Paleo got big but not huge.  Keto got huge and it’s because it works on so many different issues that it was applied to.  Probably the biggest medicinal, the biggest pathology it was used for was around Type 2 Diabetes and insulin resistance, metabolic syndrome, those kinds of things.  Paleo was very low carbohydrate, it’s still very low carbohydrate, but Paleo tended to accentuate the protein aspect of it. Where Keto now limits the protein, not like it as much as it limits carbohydrate but it limits protein, and then it really relies on fat and vegetables.  This is a really big thing because it really is mimicking a lot of the aspects of fasting.

All of this is a roll, a back and forth pendulum between fed and fasting.  Fed means you have access to carbs specifically. When you have access to carbs now talk like the Paleo guys like way, way back and evolution.  You didn’t have that access to the carbs.  When you did, what you did was store this surplus energy that you are getting and it would turn you, it would make you store energy as glycogen.  You would store energy as fat.  You would actually take that, you would synthesize all these carbs together in the fat, store fat or any fat that you’re eating in you would store instead of burning it.   In these periods of abundance when you come upon the trees that all the fruits are coming out, the berries that are coming out of the bushes, the grains are coming out.  You can eat a lot, and you’re going to store it like a bear’s fat.  Now in the fasted state, when you don’t have those carbs, now your blood sugar is going to drop and more importantly the insulin is going to drop. Then you switch to this fasted state where you go back into all that stuff and you start burning it all.  You switch from lipogenesis which is building fat on, to lipolysis, which is burning fat. You switch from glycogen storage to glycogen burning. You even upregulate your glucose transporters so you can more effectively burn what’s there for you.  Coming along with all this then is the blocking of mTOR and that shift inward instead of protein synthesis, you go into autophagy where you recycle protein.  This is really important because it’s at that point you go inward and you take all of the dysfunctional parts. That could be whole cells, dysfunctional parts of organs, and probably the most notable for this is the liver, like burning the fatty deposits in the liver.  In the cell, I think Mitochondria, they get damaged. You can throw all the CoQ10 and all the mitochondrial supplements you want at that damaged mitochondria.  It’s only when you really break that down and rebuild it that you’re going to restore function.

mTOR forward is protein synthesis.  It’s fat synthesis.  It’s laying down mass. This is important when you’re young you’re laying down mass all the time but when you get old you got to go in, you’ve got to clean up what’s going inside. That happens during this fasting period through this activation of a factor called AMPK.  Then that cascades from there into the blocking of mTOR, the activation of PPAR-alpha, which PPAR-alpha stimulates burning of fat.  With that also comes the activation of PGC1A to another nuclear transcription factor like PPAR-alpha but this is signaling for mitochondrial biogenesis.  While you’re burning up the old mitochondria, you’re synthesizing new ones. If you do this right, you can restore the cell door higher mitochondrial density. You also have a change in the ratio of NAD+ to NADH.  More NAD+ which gives you more oxidative potential to burn things up and that drags with it the Sirtuins and what are called FOXOs. Sirtuins and FOXOs are both pro longevity genes.  This keto diet is this and there’s Keto is… let’s just call it the keto state is burning efficiently, clearing, clarifying, and regenerating.  It also has effects probably through the Sirtuins on turning up growth factor release out of the stem cells.  So it’s a really a wonderful, wonderful tool.

Dr. Weitz:            Doesn’t exercise have a lot of these same properties because I just want to… when you work out, you’re breaking down your muscles, you stimulate your… getting rid of, you’re stimulating a lot of these different factors. You’re burning your glucose, you’re causing your body to utilize fat.

Dr. Shade:           It’s the AMPK, during the exercise. AMPK is interesting and it’s a little counterintuitive how some of these supplements work on it. AMPK is AMP Kinase.  AMP is the downstream from ATP.  ATP adenosine triphosphate has the most stored high energy phosphate bonds.  It’s donating those bonds to drive cellular energy processes.  It loses one and then it becomes ADP and then it’s still got two and it loses another one it becomes AMP. AMP can’t do anything, it’s the end of the line there and it’s got to be recycled back.  When the ratio of AMP to ATP changes so AMP is higher than ATP that is the activator. It’s one of two activators for AMPK. Just that one there will come from exercise that’ll activate AMPK and it’ll start you going into your stores and starting to burn things up and it’ll give you a lot of this cleanup. Now that AMP:ATP gives you about a 10x upregulation of AMPK. But then, there’s a side shot on to the three… there’s three sub parts of AMPK and to get anything to happen you need this AMP:ATP ratio to change and AMP sticks into that, that activates 10x.  Then if you phosphorylate this threonine residue on the alpha sub unit that gives you another 100x upregulation and that takes you to 1000x upregulation. That will come during deeper aspects of calorie deprivation.  If you’re really well fed and you’re exercising, you might get that small AMP bump but you won’t get the whole thing.  It’s why fasted workout will get you even more, especially fat burning than a fed workout will.

Dr. Weitz:            Interesting. What are some of the challenges that people have tried to follow a ketogenic diet and actually get into ketosis? Because from my experience working with clients, it’s very difficult, the ones that test to actually be in Ketosis.

Dr. Shade:           Yeah, exactly. This is the whole trick as you have to be on this really low carb, high fat thing for a long period of time.  We’ve designed our Western civilization around the all mighty carb.  We’re now reaping the diabesity reward of our own old food pyramid that was all carb. There’re carbs that are really snackable, they’re really easy to deal with and it’s what’s going on out there.  There’s this aspect of shutting yourself away from some of the social experiences that are going out there.  That are going on out there especially around dinner where there’s drinking, there might be beer, there might be wine.  There’s chips and little crunchy things and there’s pasta basis, there might be everything.  You’re going to be like, “No.”  To all of that.  That’s a real pain and you’ve got to stay days like that to get into ketosis.  Finally, you get that ketosis going and one night you break down to eat that stuff and boom, you’re off the wagon and you’re no longer in ketosis.  That was the big hack for us here was the ability to have these nutraceuticals connected to a real high bioavailability delivery system, coming super fast and hard and hit both of those two triggers on the AMPK, both the AMP:ATP and phosphorylation of the threonine residue.

When you do that, so you wake up in the morning, you have this, regardless of what you ate the night before.  It doesn’t matter how many french fries and beer you ate last night in the morning, just that period of fasting overnight, you take a teaspoon of this in an hour and a half, boom, you got blood ketones.  It’s interesting how fast you fat adapt on this because if you’re using urinary ketone strips, you’ll start showing ketones the first day and for about a week you will, and then by the next week you’re not seeing any ketones anymore.  Then you’re like, “Oh my God, I can’t believe I’m out of ketosis.”  You measure your blood and boom, there they are.  That’s all fat adaptation.  Urinary ketones are just when you haven’t adapted all of the transporters and enzymes to use all of that food.

One of the things that the guys who are doing keto just continuously and especially like Mercola and some of his buddies were trying to really strongly block mTOR. They weren’t just doing keto, they were doing keto with just a few grams of protein a day and they were really worried about what nut they ate and stuff just to keep the protein really down. Those guys shrunk down to like nothing. I remember looking at Joe and I was like, “God, what did you do?” Then, I see him a couple months later and he’s back to Joe. In fact, it was the best he ever looked and he was like, “Yeah, I went a little too far there.” So, now these guys cycle.  Think of it like fasted and fed and there’s a little dowel symbol in between and you got to go back and forth. There are so many good things that happen when you do eat the carbs. There’s a lot of growth that happens. There’s so many good things that happen when you’re in the fasted state. Now these guys would go like fat side for like three, four days and then they’ll take complex carbs for another three days. They’ll swing back and forth.

Dr. Weitz:            It reminds me of what I used to do back in the old bodybuilding days when we’d be doing competitions and go super low carb and then carb load right before the shows.

Dr. Shade:           Yeah, yeah. Bulk up. First cut, cut, cut and then bulk up and that stuff takes a toll.  One of the things that we did with this, intermittent fasting, there was always intermittent fasting but nobody can do intermittent keto because you couldn’t generate ketones in one day.  So, we call it Intermittent Cyclical Keto because the reason it’s called Keto Before 6 is because you could be keto all day and then at 6:00 PM we’re calling dinnertime, you can go back on onto carbs.  You have this cyclical intermittent keto where you keto up, keto all day again and at night you go back to the carbs. That’s how I work now and every day I work like that, I just give myself fat all day and then at night I eat whatever there is.  My wife is French-Italian, so there’re carbs a lot and I feel freaking great.  This is the best I’ve ever felt, all day long you’re banging with energy and then at night you rebuild and you sleep like a baby.

Dr. Weitz:            Now you know Valter Longo, who’s doing this Fasting Mimicking Diet and claiming all the same benefits.  He’s been doing a lot of research but his program is not really… it doesn’t seem to be a high fat diet.  It’s a low calorie, vegetarian sort of thing.

Dr. Shade:           Yeah. He’s the ultimate… he’s not a biohacker guy, he’s not trying to get the best of all worlds in one shot.  He is the ultimate spokesman for the traditional Paesan, which means Peasant, Mediterranean Diet.  He’s like these guys who had no money, ate twigs and berries and a little bit during the day live pretty long. Now they also found that once you get past a certain age, you’ve got to start stuffing the body full with protein and carbs or you die really quick but up to like 65 living on a calorie restricted diet makes you live better.  That’s the Valter Longo approach is you have to… he’s not low carb. He’s like, “Yeah, you eat spaghetti.  You just eat a little, little, little bit.”  He’s just a calorie restriction guy with a varied diet and then fasting a couple times a year.  They call it Fasting Mimicking.  It’s freaking fasting. “Have a bottle of water with a couple of nutrients in it.”  That’s fasting.

Dr. Weitz:            A little powdered soup, you put water in, and put it in the microwave.

Dr. Shade:           Yeah. This is like, this is not jiving with the rest of the naturopathic, Mediterranean thing.

Dr. Weitz:            Interesting. You mentioned Sirtuins, and I remember David Sinclair who was doing a lot of the anti-aging research and he was trying to figure out that. He found that calorie restriction stimulated the Sirtuins and then he found out that he was trying to figure out a way so you could get the benefits of calorie restriction without actually doing calorie restriction for years and years. He was playing with Resveratrol and there was a thought that that was going to be the magic anti-aging nutrient but it didn’t quite work out as well as he had hoped.

Dr. Shade:           Yeah. There’s a couple things that go into that, one is bioavailability.  These things that we’re supposed to do Sirtuins and that kind of activation. That would be Resveratrol, Pterostilbene, Quercetin, even Silymarin, Berberine have a lot of those same aspects. You could see an AMPK activation which ones hit from which direction and which ones invoke Sirtuins and which ones don’t. It’s all coming down to a couple of key pathways.  Here’s the deal, it comes down to this dietary. It’s not… they’re trying to have one thing you do all the time. They’re not having that rhythm and that pacing through the day where all you need is a really long intermittent fast or that intermittent keto where all you’re doing is fat feeding yourself, couple that to a bioavailable fat or nutrient like that and boom, you have all those things.  In the next phase of this, in the next year or so I want to get together with some of those guys who did that work and see, “Hey, if we do it this way, do we get all of those benefits without that constant calorie restriction?”  It’s just like it’s a calorie differential. You put them into a different bucket during the day just in a fat derived calories to drive the system all day and then you replenish with the broad spectrum at night.  I’m certain that you’re going to get all those benefits all together and there’ll be little things that we tweak in, and we’re got to look at the total calorie usage.  But, just from seeing the ketones turn on like that you know that you’re hitting all of those switches.

Dr. Weitz:            Yeah. It seems to me that there’s got to be this balance that, part of an anti-aging strategy has to be not just clearing out old cells and debris and stuff, but our cells break down, and we have to rebuild, and the ability to rebuild and create new neurons and new cells. So, while it may be beneficial, it seems to me to go into this fasted state where you maybe have lower IGF-1 levels and lower growth. Long term, that’s probably not a good idea, it seems that probably following a keto diet for too long because you’re inhibiting the regeneration of all those cells. That’s got to be an important part of anti-aging as well.

Dr. Shade:           Yeah, and of our health span. You look at these people that Valter Longo was interviewing, and they’re like these little skinny little people up in the mountains. They’re like, “How are you alive? “Because, I’ve never had any fun.”” They’re like toothpicks, and I was like, “No, I don’t think that’s the way I want to go.” It’s the old alchemy is solve the coagulum, dissolve and then re-precipitate, dissolve, re-precipitate. That’s what we want to get to. We want to look maybe a little grayer, but we want to have mass and strength and we want to have a good robust life until the end here.

Dr. Weitz:            Right. We’ve got to be able to regenerate our cells,

Dr. Shade:           Exactly.

Dr. Weitz:            We have to go through periods of growth in and reformation of new neurons and connections 

Dr. Shade:           You’re not going to have that power without putting the calories in.

Dr. Weitz:            Why did you choose these particular nutrients?  In particular, I noticed that you have Berberine, and I find that as a super interesting nutrient because there’s been research on using Metformin for its anti-aging effects to be able and Berberine has been shown to have some of the same benefits.

Dr. Shade:           Yeah.  It’s the nature’s Metformin.  Metformin is just a killer AMPK activator, but it’s not like Metformin is pharma’s version of Berberine.  It was a natural compound now they just synthesize it.  I forget, which plant they extracted it from but it was a natural compound. It’s a killer AMPK activator. I remember the first time I heard Terry Grossman say to me, “Everybody should be on Metformin, everybody over a certain age.”  I’m like, “Huh?”  Then I looked into it, yeah it’s an AMPK activator.  It’s an under have two up regulator.  It hits all these switches.  Now, why did I use all the ones that I did? Let me first tell you where this all came from. I’m at Paleo f(x) and Joe Mercola comes up to me and he squeezes my love handles and taunts me and he goes, “Chris, all this visceral fat is going to kill you badly.”  I’m like, “Shit. I know.”  He had to school me for the next week on the phone every day and I have to do this 30 day intermittent fast.  Then I got to do four days of water fasting.  I get a week into that and I’m like, “The hell with this.”  I started pulling together stuff that I know are mTOR blockers from my minimal reading on this.  I start stacking them together, and I’m taking them, and I picked up a keto strip and I peed on it and it’s black.  I’m like, “Jesus Christ.”  I looked into this more and I realized that I was shifting myself deep into fat burning in no time at all.

What do you have in here? All right, you got Resveratrol. We just talked about that as it’s an AMPK activator, it’s a Sirtuin activator. It helps bring up NAD.  Berberine, nature’s Metformin. It’s another Metformin it’s what it is. It’s a strong AMPK activator. It’s great on insulin resistance.  It’s known for all these metabolic aspects. Silymarin, from Milk Thistle.  People don’t know that’s also a really good one.  It’s one of the activators that gives you the hyper charge of the AMPK.  Once you’ve got the AMP in there, I mentioned that there’s this 100 fold activator.  It goes through this trigger called the Liver Kinase B1 which is in the Liver.  It was first seen as a tumor suppressor gene and because all this stuff is tumor suppressive because they’re mTOR blockers and they enhance autophagy and that’s this downstream cleanup thing.  Milk thistle is really good to that direction and really good at activating this stuff in the liver.  One of the things that it does as I look more into this AMPK activation in the liver seals up leaky liver. Have you ever heard of leaky liver?

Dr. Weitz:            No.

Dr. Shade:           You hear of leaky gut but sure enough there’s leaky liver too. It upregulates my favorite word Canalicular trafficking. Arresting canalicular trafficking, what’s there, right? Bile flow.

Dr. Weitz:            You must have practiced that word.

Dr. Shade:           This is… it’s high bile flow, and it’s repairing all these parts in your liver. I’d read before about it stabilizing bile flow under stress and this is a part of it through activating it this way. Then you’ve got Quercetin. Quercetin, yeah some people say it’s PGC1A up regulators it supposed to turn up mitochondrial function. Yeah. But, it does that because it’s a very strong AMPK activator, and it is separately and Sinclair showed this a booster of NAD levels because it blocks NADS called p38, that breaks down NAD. It raises NAD+ levels in the cell, which then further induce Sirtuins which further activate AMPK, and the whole thing drives together.  One is just, so I could get that many AMPK activators together but another is because they hit these, some of them actually transiently block ATP synthase to bring AMP up to fit into that hole while others hit that threonine to hyper charge it. They’re coming at the situation from a couple of different aspects. Some are a little bit more focused on one organ over another, but the whole spread together gets me enough of a punch of the AMPK activation then I have that ketone information in an hour and a half.

Dr. Weitz:            What about ketone salts and people advocate those as being beneficial?

Dr. Shade:           Yeah. I was just over in Switzerland and I was talking to… looking for her name. Elaine, this is really cool because now ketone salts don’t fix everything at a cellular level, but they are amazing for energies especially in the cases of like Alzheimer’s where there’s not enough energy in the brain. I don’t find her name on here but her name was Elaine and she has a company called KetoSwiss and they’re using very specific salts of ketones or Ketone esters. I forget which one, but they figured out exactly how to get them and to have a steady ketone level throughout the day. That application is towards Alzheimer’s because the brain can only use two forms of fuel, glucose and ketones.  When you have what’s called Type 3 Diabetes, which is part of the pathology of almost every Alzheimer’s patient. You can’t use the sugar. You can’t get it in. Ketones rescue the whole system, but it’s not bringing with it the shift into fat burning. It’s not bringing with it the autophagy, it’s not bringing with it the mitochondrial biogenesis, all these metabolic shifts that happen don’t happen. All you get from that is energy.  The best application of the ketone salts is into anyone with a neurological dysfunction. They’re probably going to find they’re really good for Parkinson’s and MS and some of these other neurological ones but certainly in Alzheimer’s it shows it. They claim that it gets you more keto and fad adapted quicker but why don’t I just go with the real thing?

Dr. Weitz:            What period of time do you think it’s probably safe to stay on a keto diet? I’m particularly worried about negative effects on the microbiome.

Dr. Shade:           Yeah. Now that’s interesting. Interestingly, AMPK activation, remember I said it seals up leaky liver. It also seals up leaky gut.

Dr. Weitz:            Okay.

Dr. Shade:           It’s enhancing tight junction integrity in the GI tract, and it’s lowering the immune activation that’s happening during the leaky gut, and it’s pacifying that whole situation. It also has some effects on stabilizing, letting the immune system help stabilize the microbiome and making the immune system better at dealing with bad guys by increasing the immune system’s ability to digest and recognize bad invaders.  On the other hand, if you’re not eating enough fiber with this then you can starve your microbiome. This is the Paleo thing that happens, too much meat not enough fiber.  As long as you do a lot of fiber, don’t worry about the carbs in a leafy green salad.  There’s some in there, but not a whole lot the carb problem is more like the sweet potatoes. Your recipe for keto sweet potatoes, no, that’s not true.  You got to get a lot of fiber and even if you’re doing things like gums and psylliums those will help that whole issue.  The core question was how long should we be on these keto diets?  I believe in cycling in and out of them, pretty much for the rest of our life, this is going to be a way that we eat, and a way that we do things.  Doing it dead on for a couple of months if you’ve got cardiovascular issues, if you’ve got a lot of excess weight, if you’ve got diabetes, obesity, insulin resistance, metabolic, that could be months where you’re resetting all of that stuff.  Once you get the stability go back and forth, maybe halfway, half the time one way, half the time another.  The way I do it now is basically I’m keto by day and I’m omnivorous by night.

Dr. Weitz:            Good, good, good. Okay, I think that’s the main questions I had. Anything else you want to leave our audience with?

Dr. Shade:           Yeah. Keto flu.

Dr. Weitz:            Okay.

Dr. Shade:           Keto flu. Yeah, there’re aspects of water and mineral retention, I just started going through it.

Dr. Weitz:            Okay. Let’s define what the Keto flu is. People on the ketogenic diet and then they have these symptoms like the flu, right?

Dr. Shade:           Yes. You know what people say when they go and do a detox. You get flu like symptoms. In the Keto dialogue they’re saying, “Well it’s a water because you’re burning your glycogen. You don’t have enough water stores and your minerals are coming out with that. It’s water and minerals and you just take salt and water.” That’s also what you do when you’re detoxing too hard.

See, as you go into lipolysis, and you’re breaking down your fat you’re releasing fat soluble toxins. You have a big toxic load going on through the body. Now, one of the ways you deal with the negative symptoms in a toxic load is dilute out with water and when you take a big dose of salt, you actually shut down detoxification. You shut down and then boom, they’re out of the tissues it makes it a little bit easier.

You’re doing the same thing there because the core of Keto flu is really toxins. It’s not going to be a better with this, in fact, it might be worse because there’s a lot of liver generators in here. There’s a lot of detox generators in here. The key around it is the use of a good binder through that first two weeks when you’re doing that. I don’t have a bottle here but our Ultra Binder as Charcoal Zeolite, Acacia gum, IMD our metal binder and Chitosan in it. All those are different toxin binders. When we had a cohort of people go through the Keto Before 6 protocol, a couple of them went into that Keto flu, I gave them binders. Susan went on that, everything went away and everything was stabilized.

Detoxification is an inherent part of going into this keto stage and this is when you get the fat soluble stuff out. When you do that you need to be able to support detoxification. Absolute minimum is a binder if you don’t have something there are bitters in here, but I would get if you’re not going to do this. Get a bitter’s formula, some PC binders, maybe some glutathione and support that whole detox, embrace what’s happening there when you feel that Keto flu.

Dr. Weitz:            That’s great. That’s great. How should we find out more about the Quicksilver products?

Dr. Shade:           Come to quicksilverscientific.com and you can see all the products there. Register either as the practitioner or a consumer and also you can learn a lot more, there’ll be some webinars there on the site and then on YouTube we have a Quicksilver Scientific YouTube page where all of our last 30 webinars are posted up there. If you register on our site, you’ll get our newsletters. You’ll get all the information of when we’re doing webinars and talks and just join in with this whole process here you will not regret it.

Dr. Weitz:            Excellent. Thank you, Chris.

Dr. Shade:           Thank you so much, Ben.



SIBO with Dr. Allison Siebecker: Rational Wellness Podcast 110

Dr. Allison Siebecker discusses Small Intestinal Bacterial Overgrowth with Dr. Ben Weitz.

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


Podcast Highlights

2:20  Dr. Siebecker got interested in digestive disorders and SIBO in particular because she had IBS since she was five years old.  She started getting constipated and bloated and it got her interested in researching about health and medicine.  This also led to her starting her website 14 years ago, SIBOinfo.com to provide a comprehensive source for information on SIBO. 

4:45  If SIBO is the cause of IBS in 70% of cases, what about the other 30% of patients with IBS?  IBS has a set of non-specific symptoms that include bloating, constipation or diarrhea, or a mixture of the two, and abdominal discomfort or pain, at the minimum.  Figuring out the causes of IBS besides SIBO is where the differential diagnosis comes in and the causes include about 40 different conditions, including yeast overgrowth, parasitic infection, large intestine overgrowth or infection, H. pylori infection, celiac disease, non-celiac gluten intolerance, inflammatory bowel disease, IBD, carbohydrate malabsorption, like lactose or fructose, food intolerances, histamine intolerance, salicylate intolerance, hypchlorhydria (too little stomach acid), cancer of the adbomen, pancreatic enzyme insufficiency, diabetes, hypo or hyperthyroid, insufficient chewing, gastroparesis or stomach emptying, bile acid malabsorption, VIPomas, or Zollinger-Ellison Syndrome, any kind of obstruction in the small intestine, Parkinson’s, scleroderma, systemic sclerosis, Ehlers-Danlos Syndrome, mast cell activation, MCAS, mast cell activation syndrome, POTS, Lyme and co-infections, various immune deficiency diseases, and endometriosis.

8:35  And some of these can be co-existent with SIBO, which is why it may be a good idea to have patients with gut problems to do both SIBO breath and stool testing.  And for many patients who have several different conditions co-existing, like SIBO and candida, it is part of the art and science of medicine to figure out if you treat one first and then the other or try to treat both at the same time.

11:11  It is often thought that in SIBO you have an overgrowth of bacteria from the large intestine into the small intestine, made possible by decreased motility.  Dr. Siebecker thinks that while this is possible, she’s not convinced that this is what happens most of the time. She said that it is possible that the bacteria come down from above, up from the bottom, or that the bacteria that are already growing in the small intestine overgrow.  We have to keep in mind that we have bacteria entering into us constantly every day at all times, swallowing, eating, etc.  Dr. Siebecker mentioned that she spoke to Dr. Pimentel about this and he did say that the bacteria that are down in the large intestine do also exist there in the small intestine in very small amounts, and they could just be overgrowing right there. Dr. Siebecker suggested that if they are normal to the small intestinal microbiome, then we should stop thinking about them as large intestinal bacteria. 

16:05  There are bacteria that normally line our digestive tract, though the small intestine is supposed to be relatively free of bacteria (only small amounts of bacteria) since this is where much of the absorption of nutrients from our food occurs.  There are a number of mechanisms that have been discussed in the scientific literature that are supposed to help keep the bacteria count in the small intestine down: 1. Hydrochloric acid, 2. Bile, 3. Pancreatic enzymes, 4. Intestinal motility through cleansing waves via the Migrating Motor Complex (MMC), 5. the immune system centered around the digestive tract (the Gut Associated Lymphatic System, the GALT), and 6. the Iliocecal valve, which is supposed to prevent the bacteria from the large intestine from going backwards up into the small intestine.  I asked Dr. Siebecker which of these mechanisms she thought was most important and she said that the motility is most important, based on the scientific literature, which agrees with what Dr. Pimentel said in his interview.  Dr. Rahbar recently told me that with some of the difficult cases of SIBO, he believes that we are dealing with a dysfunction of the immune system.  Dr. Siebecker said that after motility, any physical obstruction of the intestines, such as scar tissue from trauma or previous surgery, can increase the likelihood of bacterial buildup. She said that after motility and structural, the immune system would be the number three factor resulting in SIBO.  We know that patients with immunodeficiency disease have an 18% increased risk of SIBO, while patients with HIV have a 88% increased risk of SIBO and there is a significant risk of SIBO with a number of other immunodeficiency diseases.  A lot of Functional Medicine practitioners when they see low IgA on a saliva or stool test will assume that this contributes to risk of SIBO and it probably does, but we don’t really know to what extent.  We also know that Lyme is an underlying cause for SIBO and this may be because it can result in nerve damage or because of the immune system deficiency that tends to occur.  Dr. Siebecker said that we don’t know much about the impact of digestive enzymes or of bile.  Hydrochloric acid is hotly debated in the scientific literature with some studies showing that the use of proton pump inhibitor drugs like Prilosec increase SIBO and other studies showing that they don’t.  She feels that PPIs must be a risk factor.  Dr. Siebecker feels that inadequate amounts of HCL allow excessive bacteria to grow in the stomach and some of this bacteria may spill over into the small intestine.  With respect to the importance of a properly functioning ileocecal valve in preventing SIBO, Dr Siebecker said that this too is very controversial.  She pointed out that there are patients who have had their ileocecal valve surgically removed when removing part of the intestine due to cancer or inflammatory bowel disease and they don’t necessarily get SIBO, as long as they have a functioning Migrating Motor Complex and their motility is intact.  They can also surgically create a fake valve and this has been shown to reduce SIBO. 

27:22  Dr. Siebecker often recommends specific herbs for treating hydrogen and methane gas forms of SIBO.  Berberine is one herb that’s often effective, but she recommends a higher dosage than many Functional Medicine doctors recommend–5 grams per day of berberine, split into several different dosages, which could mean taking 9-11 pills per day rather than the 2 or 3 pills per day sometimes recommended.  Dr. Siebecker usually recommends using two different individual herbs and the next herb she will often use for hydrogen SIBO is neem, specifically a product called Neem Plus from Ayush herbs.  She usually recommends six pills of Neem Plus per day. Another herb she will use is oregano, though she tends to use one that does not contain oil in a capsule, since oregano in oil in a capsule can sometimes be hard on some patients mucus membranes. She will tend to use ADP from Biotics at a dosage of 6 per day.  For methane SIBO one of the herbs will tend to be allicin, which is the active ingredient in garlic. She will usually use a product called Allimax Pro at a dosage of 6 per day.  She will use either a Berberine/Neem or Berberine/Oregano or Oregano/Neem for hydrogen SIBO and for methane one of the herbs will be Allimax or Atrantil.   

31:37  The Elemental Diet can also be very effective for SIBO and Dr. Siebecker said that she will typically see a reduction of gas of around 70-100 parts per million of gas lowering in a two week course. She prefers the dextrose version, since she has seen very sensitive patients react to maltodextrin. However, the exception is that this is not good for patients with yeast. 

34:00  Dr. Siebecker said that she finds patients often develop antimicrobial resistance to herbs and she will use different herbs for successive rounds of treatment, so she will usually not use the same herb for more than 6 weeks.  This is also why she likes to use single herbs, so she can reserve some herbs for later use, whereas with combination products that contain many herbs, she may not be able to use any of them for additional rounds of treatment. 

36:14  The most effective natural prokinetic formulas include MotilPro, Motility Activator, Prokine, SIBO MMC, and Bio.Me.Kinetic from the UK.  All of these contain ginger and some other products that are designed to stimulate the migrating motor complex.  As for the best dosage, Dr. Siebecker said that you can experiment with different dosage, but she says you should not go above 2000 mg of ginger per day, esp. since the ginger can burn the throat or cause reflux.  Then we have Iberogast. You can also consider combining them. The prokinetic pharmaceuticals include low-dose erythromycin, procalopride, and LDN, low-dose naltrexone.  The biggest challenge is that we have no way to gauge if the MMC has been stimulated or not by either natural or pharmaceutical agents.  The only way to test the MMC is with antroduodenal manometry, which is costly and invasive and not practical to use in clinical practice.  Taking charcoal and watching how long it is pooped out measures bowel transit, which is different than the MMC.  Several years ago Dr. Pimentel was working with a group that was developing an acoustic test for the MMC, but they decided not to use the device for this purpose, so it’s not available.  How quickly a patient relapses is probably a good way to gauge that their MMC is not working properly. 

44:17  There are some techniques for stimulating the vagal nerve, including manual techniques, which should help the MMC.  Dr. Siebecker said that she experimented with Dr. Kharrazian’s recommendations to gargle and to stimulate the gag reflex and she found no benefit.  There are some doctors who claim that you can use infrared laser and chiropractic adjustments to stimulate the vagal nerve.  Dr. Siebecker mentioned that the medication Prucalopride is a prokinetic that helps to regenerate the nerve.  Since the nerve damage in SIBO is coming from autoimmunity, LDN might help. Dr. Mona Morstein uses Acetyl-L-carnitine to help regenerate nerves, since it has been shown to help regenerate nerves in diabetic neuropathy.  Lion’s mane mushrooms might also help. Frequency specific micro current has been claimed to help. 

47:32  Some prominent Functional Medicine doctors use probiotics for patients with SIBO, often citing the antimicrobial effect of probiotics, while other doctors feel that is a bad idea to add bacteria when you are trying to get rid of too many bacteria in the small intestine.  Dr. Siebecker said that specific probiotics have been shown to help motility and most of the studies on SIBO and probiotics have been positive.  Dr. Jason Hawrelak has shown which specific strains are beneficial for reducing methane or for improving motility or for other effects.  Unfortunately, some of the specific strains he mentions are not available in the US. Dr. Siebecker explained that some Functional Medicine doctors say that no SIBO patient should take probiotics because you don’t want to add more bacteria. Other Functional Medicine doctors say that all SIBO patients should be given probiotics because they help to decontaminate the bad bacteria. Dr. Siebecker says that she is in the middle, a probiotic moderate. She has not really seen probiotics decontaminate the gut like some of the studies say, but she thinks that they could be helpful in some cases.

Dr. Siebecker said that she does not like using the 4 “R” program, since she does not think it’s a good idea to wait until the SIBO has cleared before starting probiotics.  The 4 “R” is a classic Functional Medicine protocol for treating gut disorders where you start with the Remove phase (kill the bad bacteria and parasites and remove foods that cause sensitivities), then Replace (pancreatic enzymes, hydrochloric acid, etc.), then Reinoculate (with probiotics), and finally Repair (using L-glutamine, aloe vera, colostrum, and other gut healing herbs and nutrients).  Probiotics could make some SIBO patients worse by the fact that probiotic bacteria make acids and then the bacteria in the small intestine can take those acids and turn them into gas. So if you wait to recommend probiotics until after the SIBO has cleared and the patients is finally symptom free, esp. after a long course of treatment, you could trigger a relapse.  You should be especially cautious about using prebiotics, so you should make sure that the probiotic product does not also contain a lot of prebiotics, since these can aggravate SIBO, esp. in large amounts.  But if you incorporate probiotics while you are using antimicrobials in the treatment phase and they aggravate the patient, you can stop and the herbs will help to check the symptoms.  Dr. Siebecker mentioned that she has recently started using serum bovine immunoglobulin, which she has found very helpful for her patients to repair the gut.



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

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


Podcast Transcript

Dr. Weitz:                   This Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please subscribe to Rational Wellness Podcast on iTunes and YouTube, and sign up for my free eBook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness Podcasters. Thank you so much for joining me again today for another episode of the Rational Wellness Podcast. For those of you who enjoy listening to this podcast, please go to iTunes and give us a ratings and review. That way more people can find the Rational Wellness Podcast. Also, there’s a video version on YouTube and if you want the show notes, and a complete transcript just go to my website drweitz.com.

Our topic for today is small intestinal bacterial overgrowth, which is the main cause of irritable bowel syndrome in approximately 70% of the cases. Today we plan to focus on how best to understand some of the mechanisms, the latest diagnostic methods, and to hopefully gain some new insights on which integrative treatments strategies work and don’t work. And to help us to take a deep dive into SIBO then with our special guest, Dr. Allison Siebecker, the Queen of SIBO. I feel so fortunate that I recently had the opportunity to speak to Dr. Pimentel, the King of SIBO, and now I get a chance to speak you.

Dr. Allison Siebecker is a Naturopathic Doctor and acupuncturist, and she’s very passionate about education. She specializes in the treatment of small intestinal bacterial overgrowth, and she teaches advanced gastroenterology at the National University of Natural Medicine. She also lectures all around the world at conferences, and she is the most incredible resource of research articles and information about SIBO on her website siboinfo.com. Allison, thank you so much for joining me today.

Dr. Siebecker:          Thanks, Ben, so happy to be here.

Dr. Weitz:                 How did you get interested in digestive disorders and SIBO in particular?

Dr. Siebecker:          Like so many people, it’s because I have the problem. I think, as far as I’ve known, I could recall I had what I now know to be IBS, since I was about five. It was interesting because I wasn’t born with it. My parents and family tell me I had normal function, like normal bowel movements and things like that. But after, somewhere around five or six, I became constipated and also had bloating. I never knew what it was. No one in my family knew what it was and I spent this whole time trying to figure it out. It’s not really why I went to medical school, but it certainly is what steered me in this direction.  I read various things and then I came upon the term, SIBO, and it just all clicked. But there was barely any information out there at the time. This was like 14 years ago or something like that. I can’t remember exactly how long ago. Then I just started researching and researching. Then that’s when I made my website, because when you would Google, or search, nothing would come up. There’s one Medscape article and there was … where you could get the test came up on page four. Then I made my website. Now, of course, my website is like, “Is it even needed?” Because everyone and their brother and their cousin has a site on SIBO. But it’s done its job. It helped people during the pinch when there was no info.

Dr. Weitz:                  No, it’s still a great resource, especially when you update all the most recent studies.

Dr. Siebecker:           Yeah, I’m so glad that you use that, because I work really hard on that. It’s very interesting to me. Every quarter I go through and anything new that’s been published on SIBO I put on my site. Especially, my favorite part of the associated diseases page.

Dr. Weitz:                  Right.

Dr. Siebecker:            God, you just wouldn’t believe the studies. Things you’d never even think of, like acromegaly being associated with SIBO and a study on it. It’s like, “Wow, okay.”

Dr. Weitz:                   Yes. Skin disorders, epilepsy, I had a woman who had seizures, she lost her driver’s license, and you fix the SIBO, and she’s better.

Dr. Siebecker:            Wow.

Dr. Weitz:                   I mean, it’s great. To start off with, I want to take a little bit of a side turn for a second. In 70% of the patients who have IBS, which is caused by SIBO, I wonder what about the rest of the other 30% or so. What do you think is probably the cause of their IBS?  Or is it SIBO that we haven’t been able to diagnose because we don’t have the new breath test, the hydrogen sulfide. Do you speculate about the other 30%?

Dr. Siebecker:            That’s such a good point that you bring up. The other 30% is the differential diagnosis, which just for any lay person listening, that just means what else could it be. This is what we have to go through in our heads. The differential diagnosis for IBS, irritable bowel syndrome, is huge. That’s because the symptoms are what is called, non-specific. The symptoms are bloating, constipation or diarrhea, or a mixture of the two, and abdominal discomfort or pain, at the minimum. At the minimum, right?

Dr. Weitz:                   Right.

Dr. Siebecker:            What causes that? Like so many things, right?

Dr. Weitz:                   Right.

Dr. Siebecker:             Right now, I just brought up in front of me, on my screen, just to remind myself the list that I compiled of the differential, and it’s got 40 conditions on it. I’ll just read a few of them.

Dr. Weitz:                  Sure.

Dr. Siebecker:           And some of them could be causes of SIBO, but some of them they might not be causing SIBO. They just have similar symptoms. We’ve got things like yeast overgrowth, parasitic infection, large intestine overgrowth or infection, H. pylori infection, celiac disease, non-celiac gluten intolerance, inflammatory bowel disease, IBD, carbohydrate malabsorption, like lactose or fructose. I mean people can have that and not have SIBO, and causes the exact same symptoms. Food intolerance, which most people typically think of as a protein type allergy, but there’s also histamine intolerance, salicylate, on and on. General hypochlorhydria, too little stomach acid that can be caused by 15 to 20 things just regardless of SIBO. Pancreatic enzyme insufficiency, diabetes, hypo or hyperthyroid, these have the same symptoms. Something as innocuous as … This does need to go on the differential for IBS, insufficient chewing.  I have all these dietician friends that tell me that’s the first thing they do when someone has IBS symptoms. They coach them on how to chew their food well, and be able to do that. Because, instead you just have the impulse to swallow real quick. And that a large proportion of their patients to IBS, so to speak, is solved by proper chewing. Then all the way on the other side of this differential diagnosis, we have got cancer, any kind of cancer of the abdomen, could create the same symptoms. And we’ve got, from the innocuous, to the very serious. There’s things like gastroparesis or stomach emptying, bile acid malabsorption, VIPomas, or Zollinger-Ellison Syndrome, any kind of obstruction in the small intestine, Parkinson’s, scleroderma, systemic sclerosis, Ehlers-Danlos Syndrome, mast cell activation, MCAS, mast cell activation syndrome, POTS, these are the New Kids on the Block. Everyone’s like, “Whoa, complicated patients might have these.”

These have the same symptoms. Lyme and co-infections, various immune deficiency diseases actually have the same symptoms, and endometriosis that’s a really common one. Lot of patients with SIBO will have that as their cause, the endometriosis, but even if you don’t get SIBO from endometriosis, it has extremely similar symptoms: swelling, bloating, pain, diarrhea, you can vomit from the pain. There you go. That’s not the complete list, but it’s just a massive differential.

Dr. Weitz:                  Right. And, of course, these can be coexistent with SIBO at the same time. You can have several layers of problem dysfunction.

Dr. Siebecker:            Most patients, that I see, have more than one thing wrong.

Dr. Weitz:                   Right.

Dr. Siebecker:            Same with you? Have you ever seen anyone with just one thing wrong?

Dr. Weitz:                  Sometimes, yeah.

Dr. Siebecker:           We have to keep that in mind.

Dr. Weitz:                  Right.

Dr. Siebecker:           The patients, a lot of times, are like, “What’s the one thing?” And it’s often more than one.

Dr. Weitz:                  Right. Yeah, I try to get all the patients with gut disorders, at the very least, to get a stool test and a breath test.

Dr. Siebecker:           Excellent.

Dr. Weitz:                   So we can start to put a couple of layers together.

Dr. Siebecker:            Excellent. The thing about this is that what I think happens to a lot of people with IBS, unfortunately, is it’s not investigated at all. Like this differential I was just reading, which SIBO would be on with the 60 to 70% prevalence. Than all these would have 30 to 40% prevalence. No one looks at any of them or, maybe, they look at one thing. Maybe the doc is advanced enough to check for SIBO, but if that was negative, then they don’t look at all these other things. So it’s, “Oh, you just have IBS.”  I guess the thing is, what really is IBS? I my mind, the way I think about it is, that it’s what would be left if absolutely every single one of these 40 plus things was ruled out. Which, of course, then that’s a burden on everyone, the system, and tests. It might not be practical to rule out all these things, but I’m just saying philosophically what is it? It’s still just a name for when you looked at everything and you don’t know what is causing these symptoms.

Dr. Weitz:                   Right. Then, of course, if you do find several different things, it’s a question of what do you prioritize? If there’s SIBO and there’s blastocystis hominis, or there’s candida, or there’s dysbiotic bacteria, or there’s worms. What do you treat first?  Do you treat both things simultaneously?

Dr. Siebecker:             Questions, just big old questions there.

Dr. Weitz:                   But that’s something that would be interesting to have some guidelines as a continuum, as to, “Okay. If it’s a parasite, treat that first. Then SIBO. If it’s you know.”

Dr. Siebecker:            Yes.

Dr. Weitz:                   But that’s part of the art and science of practice.

Dr. Siebecker:             Yes.

Dr. Weitz:                   When I was speaking to you at the Integrative SIBO Conference in Seattle, you said that you thought that we generally think that the bacteria in the small intestine have overgrown from the large intestine. That’s especially the story that Dr. Pimentel tells, because of a decrease motility and then you get this backwash. You said to me that you think that’s not what happens in a lot of cases. That the bacteria come down from above, is that right?

Dr. Siebecker:             Yeah. I don’t know, it’s just that I’ve read so many articles on SIBO, obviously. I’ve got two file cabinets full. I’ve read them all multiple times. It’s just that there’s this … Something hasn’t made sense to me, and I get a picture in my head. What seems likely to me is that all three things are possible in terms of top-down, bottom-up, or just from the small intestine itself. I do think it’s possible we can have a back migration, but I think it’s just as likely, if not even more likely, that the normal bacteria that are in the small intestine are simply not moved down and are overgrowing. And, also, we have bacteria entering into us constantly every day at all times, swallowing, eating, everything. They’re in the atmosphere. They’re everywhere.

Basically, think about it. How did our large intestines get colonized with these bacteria? Some say from vaginal birth. What if you weren’t vaginally born? They’re going to come from, somehow, the top-down and they’re going to be passing through us. What if then those bacteria just didn’t get the chance to move all the way down? What most experts say is that the way you say it’s SIBO is that the types of bacteria that are in the large intestine are now in the small intestine. That is a very strongly held opinion, but it is debated. It is debated. There are articles currently, in fact, just our symposium, our integrative conference in New Orleans, which was a year ago, we had two researchers discussing that. Discussing the oral upper respiratory bacteria. That being a form of SIBO as well.

Even though it’s what is generally held, I just want people to know that there are other people thinking other thoughts and publishing on that as well. I did talk to Dr. Pimentel about this, and ran some of my suspicions or thoughts by him, and he did say that the bacteria that are down in the large intestine do also exist there in the small intestine in very small amounts, and they could just be overgrowing right there. That’s an odd thing, because they’re really large intestine bacteria but then if they’re always there in the small intestine in small amounts, are they just large intestine bacteria?

Now, he’s just come out … Digestive Disease Week is occurring right now, a big gastrointestinal conference. He’s just come out with a full sequencing of the small intestine microbiota. He’s been working on new technology, and I quickly looked at those articles, but they were abstracts, so I don’t have the full information. Maybe this will become a little bit more clear now.

Dr. Weitz:                  Yes, yes. I had the opportunity to interview him, and he was telling me about that. That he’s mapping the small intestine microbiome.



I’ve really been enjoying this discussion, but I’d like to pause for a minute to tell you about our sponsor for this podcast. I’m proud that this episode of the Rational Wellness Podcast is sponsored by Integrative Therapeutics, which is one of the few lines of professional products that I use in my office. Integrative Therapeutics is a top-tier manufacturer of clinicians designed cutting edge nutritional products with therapeutic dosages of scientifically proven ingredients, to help our patients prevent chronic diseases, and feel better naturally.

Integrative Therapeutics is also the founding sponsor of TAP Integrative. This is a great resource for education for practitioners. I’m a subscriber to TAP Integrative. There’s videos, there’s lots of great information constantly being updated, and improved upon, by Dr. Lise Alschuler who runs it.  One of the things I really enjoy about TAP Integrative is that it includes a service that provides you with full copies of journal articles, and it’s included in the yearly annual fee. If you use the discount code Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99 for the year. And now, back to our discussion.



Dr. Weitz:                   There’s a number of factors that have been discussed in the literature that help to keep the small intestine relatively free of bacteria. As most of our listeners probably know, your colon is backed with tons and tons of bacteria, and there’s bacteria throughout our digestive tract, and in most of the mucosal surfaces of our body. But the small intestine is supposed to be relatively free of bacteria, because that’s where most of the absorption of nutrients occurs. So getting too many bacteria becomes problematic. There’s a number of mechanisms by which the body typically keeps the small intestine from having too much bacteria, and those include hydrochloric acid secretion, digestive enzymes, bile, motility, the migrating motor complex, the ileocecal valve, which, if it maintains its integrity, prevents the bacteria from the large intestine from growing in. And then 80% of our immune system is focused around the gut. That’s referred to as the GALT, and that also helps to keep the small intestine clear of bacteria.  I asked Dr. Pimentel about this and he’s a big believer motility is pretty much the main factor. He doesn’t think that the others are really important factors. I also spoke to Dr. Rahbar recently and he thinks that a lot, especially the problematic cases of SIBO, were really dealing with this function of the immune system, and that’s one of the underlying problems. What do you think? Do you think these factors can all play roles and which do you think are the most important?

Dr. Siebecker:                      Yeah. I think certainly what everyone else thinks, and what the literature supports, is motility and the anatomy or the structure of the body. The migrating motor complex probably being number one, and number two being the anatomy of the intestines allowing for the passage of bacteria down. The number one problem that would happen there would be obstruction, some kind of partial obstruction. If those things fail, we know it’s really high likelihood someone will get SIBO. That’s very well accepted.  But then when we look at all these other factors, there’s not a lot of studies to support, or there’s a lot of contradicting evidence. I also agree with Dr. Rahbar that, I think, the immune system would be number three, coming after structural and motility, as a very important factor. How important, I’m not sure. I actually brought up a chart. I want to give you the rates I have in one of my slides. The rates of SIBO immunodeficiency that have been published. We don’t have a ton of articles on this.

Dr. Weitz:                   Right.

Dr. Siebecker:                     We’ve got anywhere from about 18%, that’s for common variable immunodeficiency disease, up to 88% for HIV. That’s pretty extraordinary. If a person was to go and look at this article that was written on SIBO and HIV, one thing you would need to keep in mind is that the positive value for … They used culture. They used culture test for the diagnosis. The positive value for that has changed. This article says that it’s not very associated, because it was using the old standard, which was 10 to the fifth, or 10 to the sixth. Now, it’s been lowered to 10 to the three. So taken into account the 10 to the three is 88%.  Then we’ve got chronic lymphocytic leukemia 50%, actually, high. And various immunodeficiency diseases in children 41%. The thing about this is that these are all frank immunodeficiency diseases. I think what a lot of people wonder about is, what about when you see, like on a test, you see low IGA on a saliva test or stool test? What about that? And we just don’t know. I think what we can say is, “Yeah, I think it would be a risk.” I think it would. How much? We don’t know. At least, when we have these frank immunodeficiency diseases in our mind, these percents, we can maybe put it into perspective. But, for instance, with Lyme. We know that Lyme is an underlying cause for SIBO and there’s various theories as to why. One of them is the nerve damage that occurs, probably, from one of the co-infections. But the other is the immune system deficiency that occurs. And I think it’s an important factor.  I would put that as number three, after first motility, and then structural and, particularly, partial obstruction.

Now, bile enzymes, hydrochloric acid, these are … Not much is known about the bile and the enzymes. Hydrochloric acid, that one’s hotly debated. Really where it’s debated is with proton pump inhibitors. Deficiency of hydrochloric acid is actually well documented in studies. That it leads to an overgrowth of bacteria in the stomach, itself. That’s where the acid is missing. For me, the concept with how it would then lead to SIBO is then that overgrowth would just move on over, spill over, into the small intestine. If the migrating motor complex would be working, it could clear it out. We actually have studies that simulate this, where tubes have been put right into the upper small intestine with fetal bacteria, like an FMT type of situation, but those people have been shown to have a functioning migrating motor complex, and all the bacteria was cleared out and they didn’t get SIBO.  That’s the concept, I think, we’re working with here. Therefore, how much would hypochlorhydria effect? I think it would be a significant risk factor, if someone also had deficient motility. I could imagine a scenario like this. You have some deficiency of motility, maybe, not enough to give you SIBO, but you’re heading in the direction. You’re like, “You’re at risk.” Then you have the low hydrochloric acid. Together, it gives you SIBO. See, that’s what I would imagine.  Now, with the proton pump inhibiting drugs being such a highly popular prescribed drug, they, on purpose, create hydrochloric acid deficiency, and that is hotly debated back and forth, back and forth. For every article that comes out saying that they’re a risk factor for SIBO, another one comes out saying that it’s not. Just now, Dr. Pimentel’s team came out at DDW with one saying it’s not. I feel like this is going to go on forever. To me, if you’ve got half the articles saying it’s a risk factor, and half saying it’s not, I don’t know, to me, I feel there’s a risk factor there. I believe it’s a risk factor.

Dr. Weitz:                   Right.

Dr. Siebecker:             It puts at greater chance that’s all.

Dr. Weitz:                   Right.

Dr. Siebecker:             I don’t think it’s a major underlying cause.

Dr. Weitz:                    I spoke to Dr. Rezaie, who’s one of Dr. Pimentel’s associates, who spoke at one of our functional medicine meetings, and he discounted it as a possible factor, because he said that once the hydrochloric acid gets into the proximal part of the small intestine, it gets flooded with bicarbonate, so it would have no effect in the small intestine anyway. In other words, it gets neutralized.

Dr. Siebecker:              I remember you told me that and I thought that was so interesting, because I think he was thinking of a different mechanism here for how it would cause a problem. For me, I’m thinking of actual spillover.

Dr. Weitz:                    I was thinking it had an antibacterial effect.

Dr. Siebecker:              Yeah, right. I wasn’t thinking of it in that way. I had a different concept. But let me just think if there’s anything else. The ileocecal valve, now, that one’s also very controversial, because … You brought that up, right?

Dr. Weitz:                    I did, yes.

Dr. Siebecker:              Okay. Because I actually have … It might be interesting, if I bring this up. Let me just see here. There have been a lot of studies. Well, not a lot, but some that maybe show it’s not so obvious that it is, for sure, a problem. Again, I think what we’re looking at here is the migrating motor complex having the ability to compensate. We actually have some studies like that, where people have their ileocecal valve removed. But they have intact migrating motor complex, and they don’t get SIBO.

Dr. Weitz:                    These are people who had part of their intestine removed due to cancer, or IBD, right?

Dr. Siebecker:                      Exactly, exactly. Let me see if I can bring up the one. There was one that they had controls. Let me just see here. I want to see if I can find it. I’ll just read you what I have, because it’s kind of interesting. In a study of 17 children with bowel surgery, they found that the loss of the ileocecal valve was not associated with an increase risk of bacterial overgrowth. And another study looked at 40 patients with SIBO and concluded there was no significant difference between patients with, and without, SIBO and the presence of the ileocecal valve. Then there was this one that was … Let me find it. Eight resection patients … The ileocecal valve was removed because of cancer. This was the one, they had eight controls. They found then the distal small intestine, ileocecal valve, and proximal large intestine were removed, but the transit was normal. The small intestine transit was normal. The same as the healthy controls. There was no reflux from the large intestine into the small intestine, the remaining aspects.

Now, they didn’t look at SIBO, they looked at reflux, but they did not see it back migrating, and the motility was normal, and there’s more. There’s studies on children and everything. This is not to say it isn’t a risk factor. I believe it’s a risk factor, but I guess the concept to get across here is that risk isn’t a guarantee. It’s that it increases chances somewhat. Here are people that have their whole ileocecal valve removed and they didn’t get SIBO, but then other people do. I have patients who they have an absent ileocecal valve and they have continuous chronic SIBO.

It’s interesting, what they did find, actually, in the study with one of the children’s studies, was it had to do with the length of the small intestine that was removed. The more small intestine that was left in the body the lower the chance of SIBO. And, again, they didn’t say it, but my thought here is because then it could perform the migrating motor complex. It has the chance to do a clearing downward sweeping action. I would say for anyone who’s needing to have their ileocecal valve removed, there’s a couple things to ask for, and that’s to leave as much a small intestine as possible. And, also, there’s studies done where they reconstruct and create a fake valve. That actually also helps. Then there’s studies on which fake valve works better than the others.  If somebody is listening, and heading towards that in surgery, they can look into this.

Dr. Weitz:                    Interesting. Which are the most effective antimicrobial herbs for SIBO, hydrogen methane, hydrogen sulfide, et cetera?

Dr. Siebecker:             Well, there’s a whole bunch that we use that seem to have equal effectiveness. We use berberine containing herbs. You can buy products that just say berberine or berberine complex, things like that. But the herbs that have it are goldenseal, Oregon grape, things like that. That’s an excellent one.

Dr. Weitz:                   Does it matter if the product is from all those variety of different berberine containing herbs, or has the complete herb, or just a berberine extract? Do you think those are equally effective?

Dr. Siebecker:            I do. I’ve tried single herbs and I find them to be just as effective as a combination. The only difference, for me, with a combination is some people are quite sensitive. A lot of people with SIBO are very sensitive to really anything that comes in. So sometimes it’s nice to use just one item and not multiple herbs, because then if they become reactive you just have one thing to remove and figure it out. So that’s excellent. One thing I want to mention about that is that the dose for berberine, I have found, at least in my patient population, which is a bit more of a challenging, we need a pretty high amount. I use, and my colleagues use, five grams a day.

Dr. Weitz:                   Five grams, okay.

Dr. Siebecker:            In split dose, yeah.

Dr. Weitz:                  I was in milligrams.

Dr. Siebecker:            That’s it. It winds up being anywhere from nine to 11 pills. Now, a lot of my colleagues say three grams, 3,000 milligrams is plenty. But, I guess, the key thing I want to get across is, two pills a day, three pills a day, isn’t going to do it.

Dr. Weitz:                  Is that the same if you’re using it with one or two other herbs?

Dr. Siebecker:           It is.

Dr. Weitz:                  Okay.

Dr. Siebecker:            It is. Then the next one would be neem, N-E-M. The one we tend to use a lot is called, Neem Plus, I guess it has Atripla in it, which is really a mild prokinetic. Again, we’re adding extra things here, but people tolerate it very well. We use about six pills of that one a day. Then oregano. I tend to use one that’s not an oil in a capsule, because I find the oil in the capsule is a bit more caustic. Sometimes oregano is hard on people’s mucus membranes and it can hurt. Other people do fabulous with it, no problem. But the one that’s in a dry tablet seems to be tolerated by more people. Of that one, I use it in my-

Dr. Weitz:                  Which product is that?

Dr. Siebecker:            I use Biotics A.D.P. for oregano.

Dr. Weitz:                  Okay.

Dr. Siebecker:            We use six a day, again, of that. Then there’s allicin, the antibacterial aspect of garlic. The product we use is called, Allimed. It’s also sold as Allimax Pro. But that allicin company, they have three levels. They have Allimax, which is the lowest, Alliultra is middle, and Allimed is the highest. So we use the highest one, and that we use six a day of that. Now, that one is the one, the allicin, is specific for methane. The other three work beautifully on hydrogen. And, actually, the Allimed works well on hydrogen, but we don’t typically start with that because it’s more so for methane.

For myself, I will use two herbs at once. I would do berberine neem, or berberine oregano, or oregano neem for hydrogen. And then, when someone has methane, I will choose one of those three, and I will add Allimed. Another one we can use for methane is Atrantil. I can use that one alone sometimes, or I’ll just use it like the Allimed. Those are our main workhorses, and I find them all to have equal effectiveness. But I do just want to say, another point here is, a lot of docs, particularly those who are more primary care physicians, they’ll use combination formulas that also have herbs that work on yeast, and parasites, and viruses, big antimicrobial formulas. I talk to them, and they report good effectiveness with that. I just don’t go that way, because I’m not seeing that population. I’m seeing people that have already failed and I’m getting a bit more specific. But either method works well.

Dr. Weitz:                   What about the elemental diet? Have you found that to be effective either, by itself or in combination?

Dr. Siebecker:             Well, we don’t use it in combination. I mean, I guess there are some people that do, but that’s against Dr. Pimentel’s recommendation. He’s the doc who came up with this as a treatment for SIBO. It’s highly effective, highly, highly effective. I feel, in terms of killing, I guess it has equal effectiveness to herbals or pharmaceutical antibiotics. But it has that one advantage, which is that it can kill more in the same time period. So we’ll typically see somewhere around 70 to 100 parts per million of gas be lowered in one two-week course, a huge amount. It’s a special treatment, because it can safe time. Because a key thing to know, like the little gold piece, I figured out very soon into my SIBO specialty practices that both, herbs and pharmaceutical antibiotics, seem to lower gas, on average, around 30-ish parts per million per treatment course.   A treatment course for a pharmaceutical antibiotics is two weeks. A treatment course for herbal antibiotics is four weeks. It takes longer with herbs to get the same effect. Within those time periods, we tend to get around a 30 part per million decrease. It’s all they can seem to do. I mean, occasionally, of course you get something fabulous and through it. But elemental diet, on average, lowers about 70 in two weeks. It’s not a very pleasant treatment. A lot of people don’t want to do it, but you really have to think about this because if you’ve got high gas, that could be what could convince you. Then you just do that elemental diet.

Dr. Weitz:                  Do you prefer the dextrose or the dextrose free version?

Dr. Siebecker:           I like to use dextrose. Now, this is not for a patient that has yeast, obviously, or a strong history of yeast. This could be problematic. But the only reason why is because I have a lot of sensitive patients, and I’ve had a lot of patients who reacted poorly to the maltodextrin. Most formulas either have maltodextrin or maltodextrin with dextrose, which is glucose. I think those are all wonderful, but if you’re just truly asking … If I was going to pick on out of everything, I would probably pick a dextrose simply because I’ve had a lot of patients react.

Dr. Weitz:                   Right. Do you find some patients are developing antimicrobial resistance the way patients can develop bacterial resistance?

Dr. Siebecker:            You sent me this question ahead. This is to herbs, right?

Dr. Weitz:                  Yeah, to herbs, yes. They can’t tolerate oregano anymore, or they don’t react to it the way they used to.

Dr. Siebecker:            I find this in just about every patient I see. It is absolute norm. Now, this could be, of course, because I’m seeing people farther down their journey and they’re harder cases. So everyone I see is going to have this kind of thing. It is expected and the norm. I see it all the time. I constantly have to rotate my herbs, and this is another reason why I don’t like to use these huge formulas. Because then I’m exposing them to everything. I want to pick and choose, and I want to reserve herbs aside for future use, because most people need multiple rounds because of this high gas.

Dr. Weitz:                   And is the rate around four weeks, six weeks, eight weeks?

Dr. Siebecker:            Yeah, as I mentioned, for pharmaceuticals it’s two weeks, elemental diet it’s two weeks, herbal antibiotics it’s four weeks. Of course, we can stretch that out a bit, so we can go to three weeks for elemental diet, which isn’t the most pleasant, and pharmaceutical antibiotics, and six weeks for herbals. The question here is, well, why not just keep going and get the thing done? It’s because I find that it peters out. I’ve seen this over, and over, and over, and particularly for herbal antibiotics. I will see patients actually start to relapse while they’re taking the herbal antibiotics usually in around six to eight weeks. So I don’t usually go past about six weeks.  I know a lot of docs, standardly, will just give an eight week. In my patient population I can’t do that, because they actually begin relapsing. I certainly have seen some cases where people have been on three months of pharmaceutical antibiotics and it was still working and lowering, but that is not the norm. That is a rare circumstance. You just seem to not get anymore effect. You have point of diminishing returns after about three weeks for pharmaceuticals and six-ish to eight on herbals.

Dr. Weitz:                  What are the most effective natural pro-motility agents?

Dr. Siebecker:           Well, for the natural prokinetics … By the way, a funny thing here is a lot of the SIBO patients have diarrhea, so I specifically don’t say, “Promotility agent,” because they’re going to go, “I can’t take it.”

Dr. Weitz:                  Of course, exactly.

Dr. Siebecker:            Prokinetic, I like to use that term instead, and always try to tell the patients that have had diarrhea, or still do, that they can take it, because it’s not a laxative. It’s possible that it might give them a worsening of diarrhea, because pretty much anything you give could and certainly, as you’re stimulating the upper small intestine motility, it might. But, in general, we don’t see that it does that. For the natural ones, I don’t really see one of our options being more effective than another. I see it’s … We have ginger, which if you just use that alone, ginger root, it would be 1,000 milligrams at night before bed. Then we’ve got all these ginger containing prokinetic formulas. There’s MotilPro. There’s Prokine. There’s SIBO MMC. There’s Motility Activator. And from the UK there’s Bio.Me.Kinetic. Am I forgetting any? Did I get them all? I hope I did.

Dr. Siebecker:            Well, anyway. We’ve got all of those. Then we usually have things like fine HGT and a few other things that can help potentially stimulate migrating motor complex. Then we’ve got Iberogast. I would say they’re pretty equal. Mostly, we just really have the Iberogast, and then ginger or ginger containing formulas. For the pharmaceuticals we have … The main ones we use are low dose-

Dr. Weitz:                  Let me just ask you another question.

Dr. Siebecker:            Yeah, sorry.

Dr. Weitz:                  How easy … It seems to me that with the natural prokinetics, it’s hard to gauge their effectiveness, and a lot of patients don’t necessarily feel anything. I often wonder, “Should I be going up on the dosage?” Especially, maybe you have a 240 pound patient. What do you really think are … Take some of the popular ones, like Motility Activator, or MotilPro, what do you think is the most effective dosage?

Dr. Siebecker:            Well, it’s the same issue with the pharmaceutical prokinetics. No matter what, whether it’s natural or pharmaceutical, how do we know it’s working? This is so frustrating.

Dr. Weitz:                  We need a way to test motility.

Dr. Siebecker:            Yes. Very unfortunately there was this … Fortunately and unfortunately, there was this machine that was being developed. Right when I first talked to Dr. Pimentel, he was helping them run some tests on it. It wasn’t his development, but he was helping and it was acoustic. It was meant to be able to tell us about the migrating motor complex. I spoke to them, and they just decided not to use it for this purpose, at all. Apparently, it’s not even available. Honestly, I haven’t checked back and I should. We were all waiting for this. It was like, “This will be the way. We’ll be able to take a baseline, then give someone a product and check them again.”  Right now, the only way we would be able to know is two ways. One, you would send them for the costly, invasive, have to travel to it, antroduodenal manometry test, which is the way you test for the migrating motor complex. Then that’s performed as a functional test, at least the way Dr. Pimentel does it. You would test the baseline, then you would give them the product. Then you would test again. Can it make the migrating motor complex? Well, obviously this is not very realistic, right? Then what’s the other way we would know? We would know from watching how they relapse. How frustrating, right? When do they relapse? I mean, the best thing I can say about this is I would say for patients that are not doing badly, they probably-

Dr. Weitz:                  What about having them eat some charcoal and see how long it takes to come out in the stool?

Dr. Siebecker:            That’s transit. That doesn’t really have anything to do with migrating motor complex.

Dr. Weitz:                   Okay.

Dr. Siebecker:             Yeah. You’ve got several regions, very different motilities. Anyway, I would say that your relapse rates … If a person’s doing pretty good, they’re probably in the four, to six, to eight month range of relapse, even after a year. When a person is a chronic patient, they often will relapse at about a month or two months. You have to judge like that. If your patient is relapsing, they get better, and then they relapse at two months, that’s pretty average. Now you know, I got to try, and do something to make this better. Then you might increase your dose. You might add a second prokinetic. All the prokinetics, and I didn’t mention the pharmaceuticals, so just quickly, low-dose erythromycin, procalopride, and LDN, low-dose naltrexone. These are the main ones we use.

All of these, that I’ve mentioned, have different mechanisms of action and, therefore, can be used together. One thing, you just want to be very careful erythromycin, because it can prolong QT. But with these particular prokinetics, they can go together. But just anything you’re going to add with erythromycin, check it. Then I will do that. Then I might combine two. To your question, what about if somebody’s heavier weight, should you go up? You can go up. I wouldn’t go higher than 2,000 milligrams in a day of ginger. That’s just from reading studies. And for the low-dose that we use for pharmaceuticals, I wouldn’t go above the standard dose. But for erythromycin, the thing is, with that one, it’s the low-dose that really has the prokinetic effect. When you start going higher it actually doesn’t work as well as a prokinetic. I wouldn’t go above, probably, 100 milligrams two to three times a day on erythromycin.  For the ginger-

Dr. Weitz:                    Has anybody experimented with red yeast rice? Because I know Dr. Pimentel was talking about using low-dose statins, at one time.

Dr. Siebecker:             Yes. That’s different. What that’s about is not as a prokinetic. That’s about inhibiting methane gas formation. Then the idea would be your motility … Because methane gas causes constipation. It slows motility. This is a different mechanism, but people have and when I first did it, it was a little like I had some positive I thought. Then I had some negatives. Then when I really followed it out, I really didn’t have those positives. You know how when you do something, and you’re like, “Oh my God, it’s working.” Then there’s confounding factors. Then as you trace it through you’re like, “Wait, that wasn’t it.”

Dr. Weitz:                   Right.

Dr. Siebecker:             I actually feel better about the Atrantil for this purpose than the red yeast rice. Back to the question of, should you increase your motility activator? You can, just check that dose of ginger, and don’t go above 2,000. Yes, you absolutely can do that. One problem with those is that the ginger often burns people’s throats, so that can be a limited factor or causes reflux. In many patients I’ve had, they just want to drink water, because they like the effect of it. One last thing on this. There are patients that are sensitive enough that they can actually sense and feel a prokinetic working. And it’s an odd thing to describe, but, I wonder, you might have had some patients give you this feedback. It’s different from when somebody has a really excellent bowel movement, and they feel all cleared out, and they’re like, “Wow.”  But, yet, patients will say, “I feel cleared out,” but it’s not like a bowel movement. It’s like an upper clear out. And they’ll say, “Things feel different. Things feel like they’re working better.” It’s like the upper abdomen region and they get a good feeling, some patients. The vast majority, they can’t tell a thing. And one last thing, patients will often confuse this with bowel movement, and they’ll say, “Well, I’m not having a bowel movement anymore than I was before, so my prokinetic isn’t working.” It’s not supposed to give you a bowel movement.

Dr. Weitz:                   Right. Have you experimented with any of the manual or other techniques for stimulating the vagal nerve?

Dr. Siebecker:             I haven’t. Well, actually, I did experiment with gargling and gagging, like the classic from Dr. Kharrazian. And I found no benefit, at all, which has been confounding to me, because Dr. Kharrazian reports these amazing case successes, and I was dejected. It was like, “Why aren’t I seeing this?” Now, I did hear a lecture recently by Neil Nathan. He just came out with the book, Toxic. He was talking about polyvagal syndrome and various vagal issues. He did make this one comment that depending upon the reason of what’s wrong with the nervous system, and the vagus, and everything possibly those exercises just might not be targeted enough. There might be some more targeted treatments that would help. That’s about the extent of my experimentation.  Do you want to make a comment on this?

Dr. Weitz:                  We’ve experimented a little bit with using infrared laser, and chiropractic treatment, sometimes to the thoracic spine or the cervical spine. I’m not really sure if it helps or not.

Dr. Allison S.:             Well, if we’re on the subject of what could help nerve repair. I think there’s a few things that I would be aware of, and you might have others to offer. One is prucalopride, it is a neuro regenerative. That’s the prokinetic. That’s probably my favorite prokinetic that we have to offer, because of this. It actually protects nerves from damage and regenerates them. Then it also stimulates the migrating motor complex. I like that one. I think doing things that help protect from autoimmune damage, because a lot of people are having SIBO from autoimmune damage to nerves, like in the case of food poisoning, the most common cause of SIBO. That’s the mechanism there. Anything we can do to calm down autoimmunity, LDN, that’s another one of our prokinetics could help that. But then my colleague, Dr. Mona Morstein, she uses aceytl L-carnitine. She specializes in SIBO, but also diabetes and that’s been proven to help regenerate nerves in diabetic neuropathy, so that would be another option.  Then myself, and Mona, also have both spoken about Lion’s mane mushrooms has been shown to help do some nerve regeneration.

Dr. Weitz:                  Interesting.

Dr. Siebecker:            Yeah. Then, lastly, frequency specific micro current is something I’ve just recently been learning about. They have an enteric nervous system healing protocol and also a vagal healing protocol. They can heal a lot of tissues with frequency specific micro current. That’s one I’m getting very excited about.

Dr. Weitz:                  I’m loving this conversation, but I think only have time for one more question.

Dr. Siebecker:            Really, only one more? Come on.

Dr. Weitz:                   Unfortunately, the last question is going to be a big question. Probiotics, do you ever use probiotics, part of your treatment protocol, or after the treatment protocol?

Dr. Siebecker:            Yeah.

Dr. Weitz:                  I know it’s controversial. There’s a thought that any kind of probiotics is adding bacteria, and we’re trying to get rid of bacterial overgrowth. It’s a bad idea. There’s some prominent functional medicine doctors who feel like probiotics should be a frontline treatment because of the antimicrobial effects. Some functional medicine doctors say, “Well, I use probiotics, but I don’t use those. I just use soil-based, or I just use saccharomyces.” What are your thoughts about that?

Dr. Siebecker:            Exactly. Dr. Hawrelak, he’s wonderful on showing what strains have been studied, and he’s got some strains that … Or he’s educated an awful lot. Some bring down methane. There are other studies that show probiotics help motility and, maybe, even the migrated motor complex. It is really confusing. I am absolutely not opposed to probiotics. Most of the studies on SIBO and probiotics are positive. They show, actually, probiotics decontaminating, like decreasing the rate of SIBO due to antimicrobial aspects. I can’t say I’ve seen that in my patients. This is a case where, for me, the studies don’t match clinical. Although, I haven’t exactly tried the same strains, because a lot of them in the studies aren’t available, at least in the US.  That’s one of Dr. Hawrelak’s arguments. He’s always arguing for strain specificity and that you can’t just generalize, and say, “Well, I tried probiotics.” You have to try the exact thing that was in the study. I guess what I can say is this, I am not of the belief of one way or the other. There’s some docs who say, “No one with SIBO should have … There should be no probiotics used with SIBO.” And others say, “Everyone should use them.” I’m in the middle, because I just like to go by the case of the person in front of me and ask, because so many patients are very aggregated by probiotics. And my explanation for this with SIBO, would be cross-feeding, because when you give a probiotic it makes acids. Then other bacteria can then take those acids and turn them into gas.  I think that it’s possible for probiotics, through cross-feeding, to increase gas. And it’s the gas that hydrogen, methane, or hydrogen sulfide that causes the symptoms, primarily. You have other pathophysiology stuff, the number one. Sometimes it’s just going to be too aggravating. What I do is, I just ask, “How have you done with them.” I take a look at the brands they’ve had. I always want to see if they had one with a lot of prebiotics in it. Prebiotics can very much aggravate symptoms, especially if there’s a large amount.  I think, also, we can, on a side note here, we can use prebiotics. Certainly some are better handled than others and, especially, if you start very slow and go lowly high … bringing it high up slowly.  But, I guess what I would want to say about this is, my preference is to try probiotics while a person still has SIBO, while you’re giving antimicrobials. Because, if there is a real problem, you can be simply correcting with the antimicrobials. The other reason is because, in the past, I followed the classic thing that everybody does where you-

Dr. Weitz:                    The four “R” …

Dr. Siebecker:              Yeah, right. You mentioned this to me, where you give the probiotics when you’re done. I have a lot of problems with that. I seemed to relapse a lot of my patients. I didn’t forget it.  I felt so horrible and it isn’t my preference to wait and try probiotics after everything’s perfect.  I do not like to rock the boat, because these people are sensitive.  It took us a long hard time to get their tests cleared and get them feeling … I’ve challenged my … We work like eek, eek, eek to get them. Now, you’re at 80%. Now, you’re at 90. We got you to take all this time. I don’t want to rock that boat.  I would rather rock the boat when we’re in the middle of treating. That would be my personal recommendations. Try probiotics when you’re still treating. Of course, you can try them at anytime, but I’m just sharing what happens with me.

Dr. Weitz:                    So, basically, you’re saying the four “R” approach, which is almost like a Biblical verse in the Functional Medicine world. Probably first taught to us by Dr. Jeffrey Bland, maybe, the father of Functional Medicine. That, basically, we want to remove, replace, reinoculate, and repair. That protocol probably isn’t great for SIBO.

Dr. Siebecker:             I don’t think it exactly fits, but it’s not awful. Obviously, we’re doing the remove or the reduce.

Dr. Weitz:                   Right, with that microbials or antibiotics.

Dr. Siebecker:             The replace, I feel, a lot of people can start with the replacement right up front, because it helps the symptoms anyway. You don’t have to wait. I mean, but it’s still good. Then does everybody need that? Also, no, not everybody needs HCL, or the bile, or the enzymes. Again, you can just try, and see. Then the reinoculate and repair. Reinoculate, again, I might like to give that a test a little earlier. Then repair is nice too. The interesting thing is that there was these two studies done on SIBO and leaky gut. What they both showed … They both actually showed about a 50% rate of leaky gut and SIBO, which is surprising. I think most people would think it would be like 100%. I tested a bunch of my patients, and I also found a 50% rate. If we believe our tests.

Dr. Weitz:                  What test do you do for leaky gut?

Dr. Siebecker:            I was doing the Cyrex test, Array2.

Dr. Weitz:                   Okay.

Dr. Siebecker:            Because there’s issues if you use lactulose. That’s funny, because it’s the same test used for SIBO.

Dr. Weitz:                   Right.

Dr. Siebecker:            So you could get a false negative. But, anyway … All right. Anyway, then what these two studies showed is that they did nothing other than clear the bacteria. Then they retested one month after the bacteria was gone, the SIBO was negative. And close to 100%, in one study it was 100%, another it was like 80%, of the patients had their leaky gut … They were now healed. What this really shows us, if you remove the cause, if you really did identify and then remove the cause, the body heals, unless you some wound healing issues it should be able to handle it. Do we have to go in there and throw in all these repair elements?  On the other hand, if we get a cut and we put aloe on it, it heals faster. So, okay, I guess it’s just for discussion, right?

Dr. Weitz:                   Right.

Dr. Siebecker:            But I do think some repair things are nice. And I just want to share one of the ones that I’ve been liking the most recently, because I’ve tried so many things with my patients is actually the serum bovine immunoglobulin.

Dr. Weitz:                  Okay.

Dr. Siebecker:            I used to use colostrum all the time, and I’m finding that the IGG, that a purified IGG, is more effective. One thing colostrum has that purified IGG doesn’t is it has epithelial growth factors. And, honestly, that’s what I was really after with the colostrum. But I’m more excited right now about IGG than the whole product of colostrum. Just thought I’d share that.

Dr. Weitz:                 Okay, awesome. Unfortunately, I have a patient coming up here.

Dr. Siebecker:           Well, fortunate for them.

Dr. Weitz:                 How can our listeners and viewers get a hold of you, or find out about your programs?

Dr. Siebecker:           Yeah, so just my website is siboinfo.com. I would highly encourage signing up for the newsletter, because that’s where I put all the … It comes up quarterly, and then with event updates. Whenever there’s classes, or conferences, or something. That’s where the newest news comes.

Dr. Weitz:                  Awesome, awesome. Thank you so much, Dr. Siebecker.

Dr. Siebecker:            Thank you, Ben.

Dr. Weitz:                   Okay, talk to you soon.



The Skin Gut Connection with Jennifer Fugo: Rational Wellness Podcast 109

Jennifer Fugo discusses The Skin Gut Connection with Dr. Ben Weitz.

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


Podcast Highlights

1:48  Jennifer got interested in the nutrition field when she got sick. She had gut issues for many years and then she developed rashes, brain fog, and fatigue in her early 20s. She was told by doctors that nothing was wrong, so she went to see a nutritionist, who determined that she had food sensitivities to gluten, dairy, eggs, cruciferous vegetables, and cashews. She had come to accept that having chronic diarrhea and horrific smelling gas was normal.  She decided to go into nutrition and when she went for a Masters in Clinical Nutrition at the University of Bridgeport, she developed dyshidrotic eczema on her hands and the skin on her hands was so flared up that her hands would burn even running them through water.  She had to wear disposable gloves on her hands and the dermatologist told her to use steroid cream and vaseline and that she would just have to live with it.  The toolbox for conventional dermatologists is incredible limited.  She had already been gluten-free, dairy-free, and egg-free, so she decided to figure out how to rebalance her skin and cure herself, which she did and then she started the Skinterrupt website and The Healthy Skin Show podcast to spread the information she learned.  Part of it was that she was incredibly stressed at the time.

4:58  Some of the underlying, root causes of skin conditions start in the gut.  Jennifer explained that you have to not only make sure that you have good digestion and absorption of nutrients from food but you also have to balance the microbiome and makes sure that the gut is not inflamed or that you are not absorbing fats, since vitamin A is so important for the skin. You want to remove infections and correct gut dysbiosis.  It is also important to make sure that the hormones, like thyroid, are balanced.  Environmental allergens, food allergies, and food sensitivities are also important triggers, as are drug triggers.  There are increasing number of drugs, like Atenolol, that can trigger skin rashes like psoriasis.  There are even psoriasis drugs that can trigger psoriasis flares. Here’s an article that Jennifer wrote about Medications That Worsen Psoriasis. Other triggers for skin problems can be heavy metal toxicity, liver detoxification challenges, and trauma.  There are also genetic factors that can predispose you to certain skin conditions, esp. those with more of an autoimmune like psoriasis, vitiligo, and scleroderma.  Jennifer says that there are 16 different possible root causes.

9:31  Jennifer does not consider food sensitivities other than gluten to be a root cause. They are more of a symptom of an underlying gut problem such as leaky gut or poor digestion or dysbiosis of the microbiome.  She cautions patient against thinking the only reason they are sick is because of food and to go from one restricted diet to another. Patients can spend years with an increasingly shrinking diet that causes them to become malnourished and feel worse and worse.  Jennifer cautions against using an elimination diet as the number one cause of Functional Medicine. 

12:44  Jennifer explained that she has a number of patients who have skin rashes but no gut symptoms and you do a stool panel and they have infections and dysbiosis. She said that Kiran Krishnan told her about the connections between short chain fatty acids produced in the gut by bacteria, like buyrate, and skin conditions, and sometimes supplemental buyrate can be helpful.  But Jennifer cautions patients against doing this on their own. They should really be working with a Functional Medicine practitioner. 

18:55  Even though Jennifer has written a blog post about how some patients react to nickel in foods, she does not recommend following a nickel-free diet. She did mention that some patients are having histamine type reactions, such as developing hives or having itchiness or waking up at night, they may have trouble breaking down histamine in their gut and they may benefit from taking supplemental Diamine Oxidase, which is the enzyme that helps break down histamine, in addition to the digestive enzyme they are already taking.  Histamine intolerance can also be related to gut infections or it can be due to cortisol elevations.  They may also benefit from a low histamine diet by limiting fermented and pickled food, including vinegar, ketchup, and mustard.  Other patients may benefit from a low salicylate diet, since their diet may have difficulty processing salicylates.  Nutrients like glycine, magnesium, and vitamin B6 can all be very helpful in supporting the liver, as well as glutathione, and these can help the liver to process salicylates.

24:42  Even though coconut oil is very popular today, Jennifer does not recommend using coconut oil on the skin, and she notes that it can even cause skin rashes.  The main reasons for not using coconut oil on your skin are 1. coconut oil is too anti-microbial and it wipes out the good bacteria on the skin and some with skin conditions already are having problems with skin microbiome. 2. coconut oil is too saturated and such long chain fats are difficult to be absorbed, so it just sits on the skin like Saran wrap. 3. It’s too alkaline and your skin’s pH needs to be acidic with a level of 4.5 to 5.5, while coconut oil has a pH of around 8.  Jennifer says that jojoba and olive and avocado and sunflower oil are much healthier for your skin than coconut oil.

30:27 There currently is no accurate way to analyse the microbiome of the skin, the way we can analyse the microbiome of the colon with a stool test, though companies are working on it.  One company has a sensor you wear on your arm. There are a lot of skin care products with probiotics in them. like Mother Dirt. One complicating factor is that the microbiome on your skin varies by location, so the microbiome of the front of your thighs is different than what’s in your armpit.  Jennifer has had good luck with applying some olive oil on her skin where there is a rash and then sprinkling some MegaSpore probiotic and let it sit for a few hours.  She has also had luck with clients who have had good luck with taking a swab from their cheek and dabbing it into the areas where there is an issue and then applying some oil over that.  For Jennifer, when she had her severe skin issue, it took 6 months of this type of protocol just to stop the flares and another six months to get the rashes to stop.  The rashes were gone but she till had dry skin that cracked and messed up nails and it took another 3-6 months for the skin to even out and the nails to come back to close to normal.  So patients need to know that it will take a lot of time to heal difficult skin issues.

34:50  The bacteria on the skin are lipid-loving, which means they consume fat, so they are different from the bacteria in the colon. The microbiome of the skin has been called a lipidome, except for the skin around the mouth, where oil is not a good thing to apply to rashes there.

35:50  Small Intestinal Bacterial Overgrowth is the underlying cause of Irritable Bowel Syndrome in the majority of cases and it is sometimes associated with rosacea and other skin conditions. Dr. Leonard Weinstock wrote a paper describing this SIBO and Rosacea connection:  Rosacea and small intestinal bacterial overgrowth: prevalance and response to rifaximin. While there are more and more topical rosacea products on the market, few dermatologists consider the SIBO connection or attempt to address it. 

42:24  Jennifer explained that producing enough hydrochloric acid is very important for proper digestion and a lot of people who have been chronically ill don’t have enough stomach acid.  Many patients are taking drugs to reduce stomach acid (Proton Pump Inhibitors like Prilosec) to help with their stomach and digestive problems, but they may actually have low stomach acid, not high.  Jennifer she has a simple test for assessing stomach acid levels. You simply mix baking soda and water and drink it and wait to burp in about 10-15 minutes.  If you have sufficient acid you will want to make a big belch, a burp.  If you don’t have enough stomach acid, you won’t belch or you will only have very tiny little burps.  Jennifer Fugo’s Low Stomach Acid Test. Here is the link to the eguide to the low stomach acid test.  If you don’t have sufficient stomach acid, you won’t be able to break down your proteins and you’ll lack vitamin B12.  Jennifer will recommend her clients take a digestive enzyme that also contains some betaine HCL and some ox bile prior to meals.

45:55  Thyroid function is also connected to skin and patients with hypothyoid, will tend to have chronically dry skin.  When there is not enough thyroid hormone, your cells don’t turnover as quickly and there tends to be poor circulation to the skin cells.  You want to measure not just TSH, but also Free T3, Free T4, Reverse T3, and the thyroid antibodies.  If the patient has Hashimoto’s, you want to make sure over time that you see an improvement in antibody load. Jennifer also finds that many of her clients have low vitamin A, which is important for thyroid function.



Jennifer Fugo is a clinical nutritionist with a focus on skin and gut problems. She has a masters in Human Nutrition and is an Amazon best-selling author of The Savvy Gluten-Free Shopper: How to Eat Healthy without Breaking the Bank, and the host of a popular podcast, the Healthy Skin Show.  Her website is Skinterrupt

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


Podcast Transcript

Dr. Ben Weitz:                   This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please, subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign-up for my free eBook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness Podcasters, thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and review, that way more people can find out about the Rational Wellness Podcast. For those of you who are only listening on your phone with the audio version, I just want to let you know that there is a video version if you go to the YouTube page, the WeitzChiro YouTube page, there are additional videos that are not on the audio version. You might want to check that out and subscribe.

Today we’re going to talk about how to improve your skin with Jennifer Fugo, and what to do with … about all these skin conditions that so many of us are dealing with. Jennifer Fugo is a clinical nutritionist with a focus on skin and gut problems. She has a Masters in Human Nutrition, and she’s an Amazon best-selling author of The Savvy Gluten-Free Shopper, How to Eat Healthy Without Breaking the Bank. (Don’t go to Whole Foods.) I was just kidding, and the host of The Healthy Skin Show. Jennifer, thank you so much for joining me today.

Jennifer Fugo:                   Well, thank you so much for having me. I really appreciate it.

Dr. Ben Weitz:                   Good. How did you get interested in the nutrition field?  Tell us a little bit about your personal journey.

Jennifer Fugo:                   Well, I got sick. I think that’s one of the commonalities for most people, is you get sick and you end up thinking, “There’s got to be something else out there.” I had gut issues for probably over 15 years since I was a kid, and rashes, brain fog, and really bad fatigue in my early 20’s, and it got to the point where I was told by doctors that nothing was wrong. I found a nutritionist and she’s like, “Hey, I think you have some issues here.” We determined that I had food sensitivities to things like gluten, dairy, eggs, the cruciferous family, the cashew family, and I had no idea what a food sensitivity was, what that meant. I had no clue, I just thought that having chronic diarrhea, and horrific smelling gas was normal.  I got into nutrition that way because I came to realize that there was this whole other side of nutrition, and helping people improve the quality of their daily life by changing food and whatnot, but eventually I came to realize that there’s only so much you could do with food. There are some things that go above and beyond what we can oftentimes do in the kitchen.  It’s not to put that down, food is certainly medicine, but there’s a lot of other things that I found to be helpful because of clients that I was dealing with who were chronically ill, and had autoimmune disease and whatnot.

I went back for a Masters in Clinical Nutrition at the University of Bridgeport, I finished that up a couple of years ago, and actually this sort of leads into my story of how I ended up interested in skin issues. My final year in my Masters Program I developed dyshidrotic eczema on my hands, and it got to the point where it was so flared that I was wearing blue gloves that I would buy–these disposable gloves that I could get at Home Depot–just to protect my hands because I couldn’t even run them under water. It burned so badly. I tried topical steroids. I went to the dermatologist, and they’re just like, “I don’t know, just use a steroid cream and put some Vaseline on top to keep the moisture in, and you just have to learn to live with it.”

Dr. Ben Weitz:                   I remember Woody Allen’s sketch where he said dermatologists are dealing with 5,000 different skin conditions, and they only have four creams.

Jennifer Fugo:                   That’s a good way to put it, and that’s kind of what it feels like. Their toolbox is incredibly limited. I said, “Look, I’m gluten-free, dairy-free, egg-free,” like I had been that for years, eating a more, not restrictive, I didn’t consider it restrictive, but I had had these restrictions in my diet. It wasn’t like I had to then take them out, I was already like that and I developed this condition, and a lot of it had to do with the amount, the sheer amount of stress that I was under at the time.  Anyway, the point where I hit rock bottom, my husband had said to me, “Well, what would you do if somebody came to you and said, could you help me with this?” I was like, “I don’t know. I never thought of it.” I started doing research and came to discover that there really weren’t good resources out there. A lot of the information was super generalized or it didn’t really work after I tried it.  I just started playing around, I thought, “Well, I’m my own best experiment, if I screw up I only have myself to blame.” Eventually I did actually figure out how to correct and rebalance my skin issues so that I no longer have eczema at all. I haven’t had it in probably well over a year and a half. I started the website Skinterrupt, and The Healthy Skin Show Podcast in order to share the information that I just … people aren’t telling the patients who are stuck in these chronic skin rash conditions, and all the other options out there aside from those four creams, and maybe some biologics, and immunosuppressants and such.

Dr. Ben Weitz:                   What do you think are some of the underlying root causes of skin rashes? What are some of the most common triggers?

Jennifer Fugo:                   Well, the first thing I will tell you is absolutely gut issues. I’m sure for anybody listening to this who is a practitioner is like, in the functional, integrative realm you’re like, “Duh, sure. Yeah, of course, Jen, you’re not sharing anything that isn’t obvious.” But here is the thing, what a lot of people discount is that you have to balance your digestion and absorption with what’s going on with the microbiome, both are equally important, and you can’t just do digestive enzymes and be like, “Oh, that will take care of the problem.” You have to look and make sure that the person has enough stomach acid, that they have a gall bladder.  Is there too much inflammation for example, where the … there is such a thing where we see that when somebody’s gut is very inflamed their body has a hard time absorbing fats.  We know that the cellular membrane is made up of lipids, and if you’re not able to absorb lipids, especially Vitamin A is vital for the skin, the thyroid, your eyes, your eyesight, you have a real problem.  Again, you got to balance that with what’s going on with the microbiome. We can certainly talk about that in a little while, because dysbiosis and infections are both two problems, as well as the amount of acidity in the colon, which I’m sure we can talk about too.

I’d also say hormones, thyroid is really important. You can have genetic factors that can predispose you to having certain skin conditions, specifically those with more of an autoimmune like psoriasis, vitiligo, scleroderma, however with eczema it’s a little trickier, there’s a lot more factors involved in it unfortunately than some of the other conditions. Because sometimes we can have things where you’ve got more histamine-dominant, you’re looking at environmental allergens, environmental triggers, food allergies, food sensitivities, but I consider those a symptom. Your thyroid has to be balanced, I will say that.  The other piece to this is drug triggers. You have to also do a really good … You have to actually ask people what drugs they’ve taken in the past, because believe it or not the research that I’ve done shows that there are increasingly number or increasing number of drugs that are prescribed by doctors, like Atenolol for example, that can trigger skin rashes. Atenolol for example can actually trigger psoriasis. There’s also-

Dr. Ben Weitz:                   Interesting.

Jennifer Fugo:                   Psoriasis drugs that can trigger psoriasis flares, which doesn’t make any sense whatsoever. Those are some of the key pieces that you could be looking at heavy metal toxicity, liver detoxification challenges, trauma, and trauma as in maybe you experience something like your father passed suddenly when you were a child or you’re in a horrific car accident or like I lived in New York City when 9/11 happened, that was a terrible thing, or it could be small traumas, like you go to work everyday and your boss is incredibly abusive. There’s a whole litany, I consider it to be about 16 different root causes, but those are probably the most common that I see.

Dr. Ben Weitz:                   Which psoriasis drugs trigger psoriasis flares?

Jennifer Fugo:                   I have to look that up for you. I got an article for you on that.

Dr. Ben Weitz:                   I am sorry, I didn’t mean to put you on the spot.

Jennifer Fugo:                   No, that’s okay. It’s a good question. I don’t know offhand, I just don’t remember offhand, but I’m-

Dr. Ben Weitz:                   That’s okay.

Jennifer Fugo:                   We can certainly share that if you want to share that in your Shownotes. I could send you that link.

Dr. Ben Weitz:                   Yes, sounds good. You can e-mail me that.

Jennifer Fugo:                   Absolutely.

Dr. Ben Weitz:                   What’s your take on food sensitivities triggering skin rashes?

Jennifer Fugo:                   Food sensitivity, I don’t consider to be a root cause as I was saying, I consider them to be a symptom, and this is an important distinction that I think has gotten very muddied in functional medicine. We fixate so much on taking foods out, and the first … You should remember, when people have chronic skin problems they come out of the dermatologist, the first thing they do is go, “The dermatologist hasn’t told me everything, maybe it’s something in my diet.” They start reading online, and they see all these information, there is something called the eczema diet, there is also something called the psoriasis diet. They will begin seeing as they join Facebook Groups the people who’ve taken out increasing number of foods, and what happens is they end up on a smaller and smaller diet. They oftentimes don’t feel better, and a lot of times people who do things like the eggs in the diet or the psoriasis diet sometimes will get better, but then cannot add those foods back in without triggering flares, and it becomes an incredibly frustrating state.

My thing is like, “Hey, you know, food doesn’t cause leakiness throughout the gut.” It really doesn’t. Gluten is the only protein that has been clinically proven through studies to have that capacity, so we can’t blame all foods. You can’t blame eggs. You can’t blame dairy. You can’t blame all these other food groups that we keep telling people, “Oh, you should avoid them because they’re bad for you.” I’m not saying that everyone should eat all of these things or that they’re going to work for everybody, but the thing is they’re not the reason that the gut ultimately became leaky to the point where it can no longer find it’s sense of tolerance again. It’s lost that tolerance for those gut junctions to be closely sealed.

The thing from having done so many interviews and talked to so many microbiome experts, it’s really a state of, A. Are we digesting our food? Are we absorbing it? Because that impacts the microbiome. What then is the state of the microbiome? Do we have infections present? Do we have, say too much e-coli? Even though it’s an opportunistic bacteria and should be there or candida, which it’s an opportunistic yeast, and it should be there to some degree in the gut, but is it in too much of a quantity? That’s where usually, I mean stress certainly plays a role, NSAIDs can play a role, but we’re so fixated on food we don’t realize that as practitioners what we do is we make people afraid of food. They get to a point where they are thinking that the entire reason they’re sick is just because of food, and they spend years with increasingly shrinking diet that causes them to become malnourished and feel worse, and worse, and worse.  That’s why I think food sensitivities are important to identify, but we can’t rely on an elimination diet to be the number one tool of Functional Medicine. That really confuses me because all the clients that I see who have chronic skin conditions have done all of these like sugar-free, dairy-free, egg-free, salicylate-free, nightshade-free, and they’re not any better.

Dr. Ben Weitz:                   Well, I think where it comes from is so many … like yourself, who is maybe seeing the really advanced cases, once the patients go down this chronic gut road, and they’ve layered one diet on top of the next, the FODMAP diet, and the no-histamine diet, and the no-this diet, and there’s nothing left to eat, and then they’re afraid to eat anything. For those patients it’s definitely not a good idea to start talking about eliminating any foods. Then you do have some of these patients who don’t really have any gut problems, and they’re coming to you for something else, and then they get a skin rash and you take out one or two common foods. You take out gluten and it’s gone, and they eat it again, and it comes back. We know there’s some relationship, but-

Jennifer Fugo:                   Absolutely. I’m not saying there is none, and actually the one thing that I do ask people regardless of what their gut circumstance is, I do ask them to take gluten out because of that increased leakiness. However, I will share this, and I don’t know how many people listening to your podcast are practitioners, but pretty much every single chronic skin client, they’ve got eczema, psoriasis, whatever, those who have no gut symptoms, like literally I’m asking and I’m digging, no gut symptoms. Completely fine, they poop like a champ, one to three times a day, no straining, no diarrhea, no gas, no bloating, whatever. When we do a stool panel they either have dysbiosis or they have infections.  You can’t say that just because they don’t have any gut symptoms that there’s no problem with the microbiome. One of the reasons why that a lot of people don’t know about, this blew my mind, I learned about this last summer from Kiran Krishnan, was that butyrate.

Dr. Ben Weitz:                   I’ve had him on the podcast before, he’s really good.

Jennifer Fugo:                   He’s a genius. Man, I love talking to Kiran. I always learn like 20 million things every single time. The one thing that he had shared with me was about a bunch of studies that had been done looking at the different … the importance of short-chain fatty acids in the gut, and how that communicates with the skin. I was like, “What? What are we talking about here?” I go and look it up, and lo and behold there were some really incredible research of linking the acidity essentially of the colon to establishing this healthy microbiome balance, because dysbiosis of the skin is one significant problem or challenge that a lot of people with skin rashes have, and butyrate specifically … for those of you who are like, “Butyrate?” Well, it’s a small, short-chain fatty acid that these bacteria, the healthy gut bugs produce when they munch up your fiber basically.  Butyrate is really important to help maintain that healthy microbiome balance on the skin. If you do, say like a GI effects, and you discover that they have low butyrate, that’s a problem if that person we already know has dysbiosis of the skin because they’re missing this important link between the two.

Dr. Ben Weitz:                   Right. It brings up the issue of fiber, which is such an important issue, and we have patients with chronic gut problems who get flared with fiber, but yet fiber is a prebiotic, and can help the growth of those bacteria in their colon. It can be beneficial and not beneficial, and sometimes it depends on the type of fiber.

Jennifer Fugo:                   There’s also too, now there are butyrate supplements that you can try.  I’m actually testing them out in some clients, and I can’t speak about it extensively and say, “This works,” but in the clients that I’ve tested this out with, who have issues with dysbiosis of the skin, using supplemental butyrate has actually really helped them.  I would just say if you’re not working with a practitioner I wouldn’t recommend you doing this by yourself, but if you’re working with a practitioner or you are a practitioner it might be something to look into.

Dr. Ben Weitz:                   In some conversations with some other practitioners a lot of people seem to like this one product that has a combination of butyrate, acetate, and propionate, which are three of the short-chain fatty acids.





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, it’s not just a quality product, 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 5mg, 10mg, and 25mg dosages in both 60 and 180 capsules per bottle size, which is extremely convenient. Now back to our discussion.




Dr. Ben Weitz:                  In one of your blog articles I noticed you mentioned foods that are high in nickel, which I have never heard before. I find that kind of interesting. I’ve had several patients where we ran like the NutraEval, and they’re high in nickel, and it’s like, “Where did I get nickel? I don’t know.”

Fugo:                                 Yeah, there’s foods, and actually a lot of them unfortunately are gluten-free foods.

Dr. Ben Weitz:                   Which foods are high in nickel?

Jennifer Fugo:                   Well, I’m going to tell you this much, I actually don’t recommend the nickel-free diet. One of the reasons why is in having done my research, and actually talked with a bunch of dermatologists, Dr. Peter Leo for example, he’s been on my podcast, he …

Dr. Ben Weitz:                   Wait a minute, would eating nickel foods help to prevent breaking the bank?

Jennifer Fugo:                   Basically the problem is that there’s such little nickel in food that for those who actually have a sensitivity to it sometimes this becomes too much of a challenge, and not actually worth it. While it may be something where people say, “Hey, if you have a really extreme nickel allergy,” I mean you’ve got to get tested by somebody. I think it’s more than just like, “Oh, I wear a piece of cheap jewelry, and my skin reacts to it,” but in his clinical experience, because I was one … I was kind of on the fence about whether it was even worthy to suggest it, because that’s a problem I recommend people go gluten-free, but a lot of the gluten-free grains, a lot of gluten-free foods have some level of nickel in them. He just said that in his clinical practice, and he is up at Northwestern University I believe, that they found it to be of almost no benefit to have people fixate on removing nickel foods, that they found other things to be more important in helping them.  There is a lot of other diets that can be, I think helpful to some degree, but I think one thing that people oftentimes confuse is if you have an issue with histamine for example, like you’ve got a lot of itchiness, and you’re waking up at night or you become incredibly itchy at night or you’re developing hives, that can be caused sometimes by infections, gut infections. It can also be issues due to cortisol elevations. We also see sometimes that people have difficulty breaking histamine down in the gut, and they may require a DAO supplement in addition to any digestive aid that they’re taking, that can sometimes help.

Dr. Ben Weitz:                   That’s diamine oxidate.

Jennifer Fugo:                   Correct. Also, too, limiting their diet in fermented foods and cured foods, and pickled foods as well, and all types of like … and that includes vinegar. A lot of people don’t realize that, they go, “Oh, well, I don’t really eat a lot of fermented foods.” I’m like, “Do you eat ketchup? Do you eat mustard?” They’re like, “Oh.” That can be something that can sometimes be helpful. Some people will also focus on low salicylate foods, but here is the thing with that, you don’t have a sensitivity to salicylate foods, your liver has difficulty processing salicylates, which is basically a chemical, a naturally-occurring chemical that exists in certain foods to help preserve them. It’s Mother Nature’s brilliance at work, but it’s just your body for whatever reason has difficulty, and using something else-

Dr. Ben Weitz:                   By the way it’s the active ingredient in aspirin.

Jennifer Fugo:                   Yes, exactly. Well, that’s what got me thinking, I’m like, “Why does everybody think they’re sensitive?” Because it doesn’t make any sense, salicylates are processed in the liver, it’s not a gut problem but we position them as if it is a food problem in it of itself, and it’s not. Things like glycine, B6, magnesium can all be very helpful in supporting your liver, as well as glutathione in making sure that your liver has enough of it’s, I like to call them ingredients that they requite in order to do their jobs. But specifically glycine and B6 are necessary because that’s the pathway, the glycine pathway is where salicylates are processed.

Dr. Ben Weitz:                   Great, interesting. In one of your articles you talked about the difference between food allergies, food sensitivities, and food intolerances, and I think there’s a lot of confusion about that. Can you help clarify that?

Jennifer Fugo:                   Food allergies are typically described as an IGE response, you could think of the E as emergency, like throat swelling closed, eyes are closing, if it’s really bad you could die, whereas a food sensitivity is an IGG reaction, it’s a different type of immune cascade that’s happening, typically not life-threatening, and it could be delayed as well, you might not experience something for a number of days. Another reason why I’m not the biggest fan of relying on extensive food sensitivity testing is sometimes they’re kind of transient, and they can change with time depending on what you’re eating and exposed to, whereas food intolerances are an entirely different piece, it just means that you don’t have an enzyme in your system that’s capable of breaking down that particular thing like histamines. Histamine-intolerance is a thing, where’s you’re not … there’s no histamine sensitivity, you’re missing that DAO enzyme in the gut that’s necessary to break histamines down, and so it’s an intolerance, like lactose-intolerance you’re missing lactase, the enzyme.  They’re very different, and people like to interchange those terms and it’s very incorrect, and it’s also confusing to me as a practitioner. I have to question when people say, “Oh, I have this allergy to this,” I’m like, “Okay, could you describe that? Did you go to an allergist? Do you have an allergy panel?” “Oh, no, no, I had a food sensitivity test.” I’m like, “Okay, that’s not an allergy, it’s a different response.” I think we have to, as practitioners have to get a little clearer with people. I know that it’s easy because that’s what they’ve read about, but it also is our job to make sure that they understand what’s actually happening to them, not just making it super easy so we can breeze through the appointment.

Dr. Ben Weitz:                   In one of your articles you talked about the fact that a lot of people see coconut oil as a super healthy oil, really good for us, and people use it in cooking, and people put it on their skin, but that’s probably not the best idea, right?

Jennifer Fugo:                   No, as far as skin rash conditions are concerned. Initially when I wrote the article I was very much just focused on people with skin rashes, but I’ve noticed recently that we’ve had more and more people who were using it, and then developed skin rashes as a result of using coconut oil. This may be a heads up to those of you who don’t have issues, and are using coconut oil as your lotion, but there’s three reasons why, well four, but the fourth reason is basically there are way better options out there than coconut oil to be using as part of your moisturizing regimen, but basically coconut oil is way too anti-microbial. For those who have skin rashes, you’re basically wiping out everything that’s on the skin, and if you’re already struggling, and you’ve got this tug of war going on, on the skin and say you don’t have enough butyrate in your gut to help establish that, you’ve got gut infections, you’re wiping out everything, and then the bad guys rush back faster. It’s not a good situation in that front.

Number two, it’s also too saturated. I’m not going to get into the debate about how coconut oil is really good for us, we need these medium chain triglycerides, blah-blah-blah, our digestive system is much different than our skin, they’re not the same thing. I know it’s a part of the body, but for your skin to properly absorb those lipids they have to be smaller. A lot of times people will notice that coconut oil feels like it’s just laying on your skin, it’s not being absorbed, and that’s the reason why, it is not being absorbed, the molecules are too large. For some people that it feels almost like the skin is being covered in Saran wrap, and at times almost feels like the heat from the body is being trapped as a result of that. That’s not good.

Last but not least, it’s too alkaline. Your skin environment actually needs to be on the more acidic side. I know everybody loves alkalizing everything, that’s like a big thing in nutrition, but the problem is that your skin’s ph to be healthy needs to be around 4.5 to like 5.5 on the ph scale, that’s acidic. Unfortunately coconut oil is around 8, it’s much more alkaline than your skin is, and as you apply that to what should be a more acidic environment you’re causing the ph to go up, and what happens is the ph is really important. You might think like, “What does it matter?” But the ph helps, it’s basically one of the chemical waste that your body prevents microbes that shouldn’t be there or shouldn’t be there in the quantity that they end up being there. It’s a control mechanism, and when you start manipulating the ph from what it should be you’re inviting in problems.

Those are three reasons why, the fourth is just basically like if you want something that’s closest to your natural sebum it would be jojoba, but olive oil is a great choice, even sunflower oil. Believe it or not there’s some great research for eczema that sunflower oil … not the cooking stuff, the stuff that’s meant for your body. Avocado, I’ve heard great things about, and especially testimonials from people who have given that a shot. Olive oil, avocado, jojoba, even sesame oil can be a good option, it just has a pretty strong odor that some people find a bit of a turnoff.

Dr. Ben Weitz:                   Right, interesting. This alkaline thing, it’s very common in the Functional Medicine world to eat a alkaline diet, there’s alkaline water, and people say a high alkaline diet as being better for hormonal balance, for cancer prevention, for all these different things.  But I think number one, people forget about the fact that our body needs, it prefers an acidic environment, especially in the stomach, especially in the large intestine colon, where I think everybody assumes that your intestinal tract is supposed to be more alkaline, but don’t forget about those acid-loving acidophilus, acid-loving bacteria that need a somewhat acidic environment in the colon.  I think there’s a lot of hype associated with these alkaline diets. I’m not so sure that they’re beneficial for the reasons people think they are, number one. It’s my take that probably the fact that they’re eating more green vegetables, and maybe cutting back on their grains, they’re getting some benefit from it, but probably not because of the alkalinity.

Jennifer Fugo:                   I totally agree with you, and plus, you don’t want an alkalized stomach, you can’t digest anything, your stomach has to be very, very acidic in order to appropriately break proteins down for example. It’s complete, I mean it flies in the face of human physiology that every part of your body needs to be alkalized, that’s ridiculous and that’s not based on science.

Dr. Ben Weitz:                   By the way I think you’re pissing in the wind if you think that drinking some alkaline water is going to suddenly turn the environment in your stomach into this alkaline state anyway.

Jennifer Fugo:                   No.

Dr. Ben Weitz:                   You were talking about the microbiome of the skin, it’s interesting, is there any way that you assess the microbiome of the skin?

Jennifer Fugo:                   I wish. I really wish there was one test.

Dr. Ben Weitz:                   Right, that you could just take a skin.

Jennifer Fugo:                   I know.

Dr. Ben Weitz:                   Test, and send it in like you get a stool sample, that would be cool.

Jennifer Fugo:                   There’s this one test that I found that they did that, but I don’t think it’s actually being utilized anymore. I know that a lot of companies, big companies, pharmaceutical and skin care companies are really driving in full steam ahead into the more probiotic microbiome realms. We are going to see more and more products coming out that actually have … that have the microbiome in mind. There is actually a sensor I believe, that I can’t remember whether it’s L’oreal or who is making the sensor that you would wear on your arm, I think it’s a patch, and it will tell you what the ph of your skin is. There’s a lot of creams now that have probiotics infused into them, how well they work is questionable.  A lot of people also want to believe, and this is the other piece, I mean I love products like Mother Dirt. It’s nice because it’s helping to replace some of the microbiome, the good bugs that help establish that healthy balance, but the thing is if you’ve got really bad rashes it’s probably not just one thing, like one cream. You’re not one cream away from being fixed. I think unfortunately that’s the mentality, and it’s not, and here is the other piece, the microbiome on your skin actually varies upon location. What’s going on the front of your thighs is very different from what’s going on in the armpit.  There’s different regions, and it varies, but some things that are interesting is that you can apply probiotics topically. I’ve had really good luck with MegaSpore for example, and you apply your olive oil, not coconut oil, to that area, and then sprinkle lightly some MegaSpore on and let it sit for a couple of hours. I wouldn’t do this during the day when you’re at work, probably wait until you get home, and that can help rebalance the skin microbiome. I’ve also had some great luck with people just saying that they’ve taken like a swab from say their cheek or some place that has no rash whatsoever, and then dabbing it into the areas where there is an issue, and again applying the oil and whatnot, and they’ve had some luck with that.  Those are two things that can be helpful, but again if you’ve got a lot of stuff internally that’s out of balance that might help some, but again you’re not one step away from getting your skin rashes figured out if you’ve had them for a long time unfortunately. I wish it was simple, and this is the thing with the gut world, and the chronic health world we’re like, “Oh, if you just take this one supplement, if you just do this protein powder, if you just do this you’re going to be better. You’re going to have all these energy.” Like we’re super hype-y about it, but with skin it’s so complicated because the skin is the lowest on the totem pole, and nobody tells you that.

For me, the thing I didn’t actually tell you in the beginning, it took six months of consistently taking action on the protocol that I built for myself in order to stop just the flares. I still had rashes. I still had cracked, dry skin. My nails were all messed up, and it took another six months to finally get the rashes to stop. I still had dry skin that cracked. I still had messed up nails, it took another almost three to six months to finally see then that the skin evened out, and the nails were pretty close to being back to normal. It takes time because the rest of the body needs attention before the skin unfortunately. I think when we don’t appropriately provide people that expectation of what’s ahead it is a long journey, especially if you decide to go the natural route it’s a scenic route. Think of it as taking a scenic route, it’s going to take a while and you have to be mentally prepared for that journey. You’re not going to get better in a month, if you do I’m happy for you, but that’s not most people’s experience.

Dr. Ben Weitz:                   Do we know about which organisms are present on the skin compared … are they similar to the bacteria that are present in the colon?

Jennifer Fugo:                   There is a little bit of a similarity, but the bacteria on the skin are actually lipid-loving, which is different from what goes on in the colon. They call the microbiome on the skin a lipidome, and they actually consume fat. For most skin conditions they do … You’re okay, you’re good with using oils, the only one that I know of, and I mean I’m not necessarily an expert in every single chronic skin condition, but if you do have peri-oral dermatitis where it affects right around the mouth, oil is usually not a good thing to apply to your rashes. I don’t know why, it’s one of the most frustrating, difficult conditions to work with unfortunately.

Dr. Ben Weitz:                   Good. I just came back from this Integrative SIBO Conference in Seattle this past weekend, and a condition I often see in my practice is small intestinal bacterial overgrowth, which is the underlying cause of irritable bowel syndrome in quite a number of cases. Can you talk about how this can be related to skin conditions?

Jennifer Fugo:                   Absolutely. One of the really interesting things that I’ve been reading up on, I mean, A. It’s gut, right there you know that if we’ve got SIBO for example that’s a problem. However, there’s a really interesting connection to rosacea that a lot of people don’t realize. What’s fascinating to me is it was an incredible study done back in 2013 by Dr. Weinstock, who discussed and looked into this because he is a GI doctor. He started to notice this interesting correlation between both ocular and skin rosacea, and what was going on with the use of Rifaximin in treating the SIBO, and that once they did that treatment a lot of times rosacea would clear up.  It’s staggering to me to think after all this time they’re coming out with more and more rosacea products, more and more, and yet why is this research that’s been out there for a while, I mean it’s six years, why isn’t that something that’s used in clinical practice. I can’t even tell you how many times I’ve said, “Go back to your dermatologist. Talk to your dermatologist about doing these tests.” The dermatologist don’t want to do any tests. They say that’s not their responsibility, that you have to go see a primary care doctor, and I’m like, “You know you’re a doctor too, you’re allowed to run labs.” I’m confused. They don’t see any-

Dr. Ben Weitz:                   I can tell you it doesn’t fit into the model.

Jennifer Fugo:                   No.

Dr. Ben Weitz:                   It’s basically since everything’s dictated by the insurance companies the conventional docs are limited to short office visits, if they’re going to go out and start testing your gut, and these tests are really complicated to understand and to interpret. Then you have to put people on complicated protocols, and then it takes a period of time, and they have to watch your diet, and it just does not fit into the model.

Jennifer Fugo:                   No, not at all. It’s really sad. Even my father who is an ophthalmologist, he’s in his 70’s, he was just like … I was like, “Dad, did you see this? Have you heard of this, like ocular rosacea SIBO?” He’s like, “What’s SIBO?” I explained it to him and he was like, “Can you send me that? That sounds fascinating.” Because apparently ocular rosacea tends, if you do have rosacea, and you end up with ocular rosacea usually the ocular form will show up first before it results in the skin, at least that’s my understanding.  I just think it’s a shame that we’re not … We talk about all the research being done, but I think people, they are only looking at certain areas, and we don’t realize that medicine is evolving, but the way that it’s being handled and done is really only evolving at the pace of drug companies. Because now on the TV you see all these ads for Dupixent biologic drug for eczema, and that’s considered, I read an article, it’s considered to be one of their next blockbuster drugs because of how much money it’s going to make them, and all it does is suppress the inflammatory, one of the inflammatory pathways, and that’s it.

Dr. Ben Weitz:                   This unfortunately is the story of why so many of the drugs that have come out for a lot of chronic conditions, just look at the Alzheimer’s Research, they’re trying to find the one pathway, and the drug that blocks that one pathway, and that’s the end of the story. Unfortunately there’s many pathways, you have to look at a number of things and address a number of days if you’re really going to get success, but that’s just not part of the model.

Jennifer Fugo:                   No.

Dr. Ben Weitz:                   That’s what’s going on with the skin too, they want to find this one inflammatory pathway, how do we block that one pathway with this one particular product that blocks it, and that’s what fits into their model.

Jennifer Fugo:                   Well, and I’ll say this much to anybody who is listening who’s like, “Wait, I’m on one of those drugs or I’m considering one of those,” I’m non-dogmatic. Listen, you have to make the decision within your values, and what’s going on in your life, and where you are with things about what your choices are, because it’s your choice in the end, but I personally think that you as a patient, you as a steward and caretaker of the one body that you have in this life, you should do your research. You should decide if that 2% or 1% risk is worth it for you, because there are risks of cancer. There are very serious complications that can occur, and you can have bad reactions to those drugs. I had worked with people who have had bad reactions to them, and so you shouldn’t assume it will never be you, but at the end of the day I don’t think you should throw the baby out with the bathwater and say that all pharmaceutical drugs are necessarily bad.

There’s a time and a place for everything, but I think you as the patient, again that steward type position, you have to do your research and be comfortable with the decision that you’re making. Go in with your eyes wide open, and know what the potential issues and hiccups could be, and especially too the thing that’s nice is if you combine complimentary and the conventional together … I still used steroids when I was going through my journey. I had to use topical steroids.  I had to keep the … I couldn’t even touch a stinking knob on the door.  I couldn’t open a door.  I had to do what I had to do to get through daily life, but in the meantime I was working on all the other stuff under the surface.  You can find a way forward that meets your needs and values, and I just want to encourage people to know that it’s okay, and you should never feel bad or ashamed for whatever your decision, but just own it, and make it with eyes wide open.

Dr. Ben Weitz:                   I want to clarify, I’m not trying to bash pharmaceutical companies for trying to help people with medications, and I don’t want to tell people to stop taking their medications, especially if they’ve been helping them.  But they need to understand that there’s underlying reasons for this conditions, and simply blocking the immune response long-term is not going to be the best answer.

Jennifer Fugo:                   Absolutely. I mean that’s what I said, go to the simple things, look at … The first thing to do no matter where you are in your journey, I would say the first thing I ask people to do honestly is to check their stomach acid level. Because if you’re not able to properly digest your proteins, number one, for example B12, which is a really important nutrient is actually connected in foods to proteins.  If you don’t have enough stomach acid you’re never going to break that apart, number one.  Number two, if the proteins aren’t broken down into their smallest little building blocks, I like to think of it as like Legos, they’re not going to be able to be absorbed.  As they head further down stream they feed the gut bugs, which is not necessarily a good thing, and then you’ve got some very expensive poop on your hands, which nobody wants because you want to absorb that expensive food, you don’t want to be pooping that out. You don’t want to be feeding bad gut bugs either.  I typically recommended people check the level of stomach acid that they have because we want an acidic stomach acid environment, we want to make sure we’re producing enough stomach acid. It’s a really simple and easy test, to be able to do that you’re basically just combining some water and baking soda. I don’t know if you are open to sharing the resource that I have, it’s just a really simple direction of how to actually do that test at home. It doesn’t cost anything, and it will get you-

Dr. Ben Weitz:                   Is this the test where you start taking hydrochloric acid tablets?

Jennifer Fugo:                   No, no, you actually just mix baking soda and water.

Dr. Ben Weitz:                   Then what?

Jennifer Fugo:                   You wait to burp, about 10 or 15 minutes, it’s really simple. The thing that’s nice is that the hydrochloric acid, that test makes me uncomfortable because-

Dr. Ben Weitz:                   The hydrochloric acid challenge test…

Jennifer Fugo:                   Yeah, it just makes me uncomfortable. I’ve had really good luck correlating this with actually doing like a GI effects, and also taking a look at the products of protein breakdown and whatnot. You can really see that there is some great correlation even if you don’t have GERD or any heartburn issues. A lot of times people who have been chronically ill don’t have enough stomach acid, and just that alone can really start to alleviate some of the issues immediately, because you’re feeding the gut bugs that you don’t want to be feeding. That’s not a good situation right there. We start to right the shift, and obviously if you don’t … if you discover, basically you want to burp. You want like a big, big belch, like when you’re a kid and you drink a lot of soda, and if you’re not belching or you have the little tiny, little burps, that basically means that you don’t have enough stomach acid present.  Then the next thing to consider is do you have a gall bladder? If you don’t, you really need to supplement ox bile for the rest of your life, and that’s before every single meal. Then consider, I like to do usually a full spectrum digestive aid, it will typically be between HDL, ox bile, and digestive enzymes. That way we’re making sure that all pieces are supported, because if you’re really not well it’s just, “Let’s try and do our best to help your body, let’s make it easy,” but again it’s just a really simple, easy, free thing to do, and get some answers quickly.

Dr. Ben Weitz:                   That’s great. What’s your resource for patients to go to your website and find out about the acid, stomach acid test?

Jennifer Fugo:                   I will be honest with you the link is a little tricky. I can certainly give it to you, and make sure that you have it, if you will put it-

Dr. Ben Weitz:                   Well, you know what, we’ll just put it in the Shownotes.

Jennifer Fugo:                   That will make it super easy for people because the link is … I don’t think anyone would get it from me. They’d be like, “What?”

Dr. Ben Weitz:                   There’s so many things we can talk about, I like to hit on one more thing.

Jennifer Fugo:                   Sure.

Dr. Ben Weitz:                   I know you’ve talked about thyroid and the connection with skin, can we talk about that for a few minutes?

Jennifer Fugo:                   Absolutely.

Dr. Ben Weitz:                   Give me everything you know in the next three minutes.

Jennifer Fugo:                   I would say this, you should make sure that your thyroid is optimized, the function is optimized, because we know for sure that in people who have hypothyroidism and Hashimoto’s, a lot of times some people don’t realize that they’re … Hashimoto is a low thyroid state, and that chronic dry skin is one of the symptoms, and one of the reasons why is that thyroid hormone helps tell your cells what to do, how fast to go. It’s part of your whole system of homeostasis, and so when you don’t have enough appropriate thyroid hormone the cells don’t turnover as quickly. It also, from what I understand in talking to a lot of thyroid experts it causes there to be a poor circulation out to the cells of the skin, and we’re seeing less removal of waste as a result, and as an end you’re seeing less nutrients getting out to those cells.  Optimizing your thyroid and making sure that you’re seeing optimal levels of T3, T4, TSH, that the reverse T3 level is in balance with T3, and I’ll just say this too, always make sure that your T3, T4 are that you’re looking at the free values. That is important, and that you’re also making sure that there are no antibodies or that you’re slowly with time, seeing an improvement in antibody load if you do have Hashimoto’s for example, but that’s a really important part to the piece. Again, Vitamin A, I can tell that pretty much everybody that I talk to and I work with has low Vitamin A, and low Vitamin A is really important to improve because your thyroid needs it, your skin needs it, your eyes need it. I think there’s just some very basic things that we should look at, that way we can just make sure to support the body as a whole.

Dr. Ben Weitz:                   That’s great. Thank you so much for providing us with a lot of interesting information about the skin, and what we could do to improve our skin. How can listeners find out about you, and the things that you have to offer?

Jennifer Fugo:                   You can visit me over at skinterrupt.com. This is basically the words skin and interrupt slammed together, and then basically also if you love-

Dr. Ben Weitz:                   Can you spell that? Can you spell that out?

Jennifer Fugo:                   Yes. S-K-I-N-T-E-R-R-P … U-P-T, there we go. I know it’s a little tricky, that’s what I say, it’s skin and interrupt slammed together. If you certainly search my name it will come up with very easily. You can also check out the healthy … just healthyskinshow.com, and that will bring you to my podcast, which we’re on most of the podcasting platforms. It’s a twice a week podcast where we’re delving into all the different areas of chronic skin conditions. I also have inspirational stories, looking at research, we even answer listener questions. It’s a great resource for people. Those are really the two spots you can find me, and I’m on Instagram, I do a lot of stuff on Instagram too.

Dr. Ben Weitz:                   Wow, twice a week podcast.

Jennifer Fugo:                   Yes.

Dr. Ben Weitz:                   I know how hard a once a week podcast is, that’s great to be able to do that. Okay, thank you, Jennifer.

Jennifer Fugo:                   Thank you for having me, I really appreciate it.



Fertility and Sexual Intimacy with Denise Wiesner, LAc: Rational Wellness Podcast 108

Denise Wiesner, LAc discusses Fertility and Sexual Intimacy with Dr. Ben Weitz.

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


Podcast Highlights

2:14  Denise Wiesner’s practice has a focus on women’s health and fertility.  She found that a lot of couples that are having trouble conceiving having problems with their sexuality and intimacy and their doctors were not offering any help with those problems.  In fact, their doctors do not get a lot of training in sexuality and did not really feel comfortable even talking about such issues.  This is why Denise felt the need to write this book.

5:43  Denise discusses some Chinese medicine and Taoist concepts (Taoist tradition is the precursor to Chinese medicine) in her book and she pointed out that the Taoists had this really equal relationship between yin and yang, male and female, and they would actually prescribe certain sexual positions to help patients cure certain problems.  Denise also has chapters in her book on orgasm and foreplay and stress in her book.

7:37  Denise includes a discussion of the Chinese five elements of wood, water, earth, metal, and fire.  In Taoist tradition, the earth is the center and this is about digestion and if you don’t feel good, it gets in the way of intimacy for men and women. This also includes the microbiome in your gut, your mouth, your skin, on the penis, and in the vagina. If a woman is trying to get pregnant, its not good if she has yeast and other infections in her vagina, so we want to have that balanced.

9:21  The vaginal microbiome is really important and we’re just starting to understand it. The vaginal pH is supposed to be acidic and it starts becoming a little more alkaline around the time of ovulation, so the sperm can live in the cervical fluid and they can swim up to meet the egg.  If the vagina becomes too alkaline, a woman will get more yeast overgrowth.  The vaginal mucous membranes are very permeable, so you want to make sure that if you use a lubricant that it does not contain preservatives, like parabens.  Only a few lubricants have been approved for fertility by the FDA.  A lot of lubes have a high osmolality, which means that they have the ability to pull water from the tissues and this makes their vagina very wet, but it is not so healthy for the tissues. It is better for the woman to produce more cervical mucous, which can be facilitated with acupuncture and herbs and even something like N. Acetylcysteine can thin out the cervical mucus and this can be helpful. Denise mentioned that a lot of people like to use coconut oil. But ideally it is best if a woman produces her own cervical fluid and this can be facilitated with proper diet and more time spent on foreplay. She said that it often takes women 20-45 minutes to become aroused, so you have to give them more time.

14:00  Functional Medicine can help with fertility by looking at the hormones, like the thyroid to make sure that it’s working properly. Traditional MDs usually only look at the TSH, so we should also look at T3 and T4 and the thyroid antibodies. If they have very high levels of antibodies, this means that they have a lot of inflammation and we need to help them to bring this down with diet and look at a stool test and see if there is dysbiosis, which is part of the Functional Medicine approach. 

15:32  Electronics, laptop computers, and cell phones can decrease fertility. If you keep your phone in your pocket next to your scrotum or your laptop on your lap, it can decrease sperm counts and electronics in the bedroom can interfere with intimacy.  So we should keep electronics out of the bedroom.  And with 5G coming, we will have even higher levels of magnetic radiation entering our homes.  Also, pesticides, pthalates, fire retardants, Teflon pans, all are estrogenic and can interfere with testosterone levels in men.  So some detoxification can be helpful for fertility. When women are going through an IVF they will be taking high levels of synthetic hormones, so afterwards, some detoxification can help to make sure they get rid of these hormones.

18:14  Being on birth control for women can be very effective in preventing unwanted pregnancies, but after being on them for years and decades, some women have a tough time getting their periods back.  It can be a struggle to reestablish their normal hypothalamus/pituitary/ovarian axis.  Birth control is chemical castration and their bodies stop producing hormones naturally.  It can take some work to get their natural hormone production restored. 

19:52  Men and women often have sexual problems that a play a role in their difficulty in getting pregnant. There are a number of men who have been avoiding ejaculating in a woman for years to prevent a pregnancy or they may have ejaculatory problems due to masturbation to porn or due to the side effects of SSRIs. Antidepressants known as SSRIs (like Prozac, Zoloft, and Lexapro) make it difficult for men to ejaculate and make it difficult for women to reach orgasm.  It’s hard to make a baby if no one’s orgasming or ejaculating.  Another issue is women wanting to have sex while they are ovulating and men having trouble performing on demand. Denise suggested that men may not need to know when their wives are ovulating and they can just focus on having intercourse more often. There are some women who have pain with sex who may need a pelvic floor physical therapist.

23:38  The benefits of orgasm is that your brain stops thinking and you reach an enlightened or spiritual state.  Sex actually strengthens our immune system.  People today are so busy due to the modern work schedule and culture that there are couples that don’t even have time to see each other very much, except on weekends. 

26:58 When men have issues with low sperm count or sperm that don’t swim as well, Denise will use a Functional Medicine approach and prescribe a fertility formula that contains CoQ10, vitamin E, selenium, zinc, L-arginine and L-carnitine.  Herbs like ashwaganda, rhodiola, Siberian ginseng, cordyceps, and horny goat weed can also be helpful. 

31:33   Denise mentioned that sexuality after menopause can also be a significant problem for some couples and women.  Some women in their 50s continue to have a very active and happy sex life. One of the problems is that women may be in the same relationship for so long that everything has become so predictable and boring.  Men and women need to spice things up and men need to make sure that they take plenty of time with foreplay.



Denise Wiesner is a licensed acupuncturist, herbalist, and certified sex coach. She is the founder of Natural Healing and Acupuncture in West Los Angeles, where she sees patients 310-473-7474, and her website is DeniseWiesner.com and her clinic website is  NaturalHealingAcupuncture.com.  She has recently published a book on Fertility and Intimacy, Conceiving With Love: A whole body approach to creating intimacy, re-igniting passion, and increasing fertility.

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe the the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free e-book on my website to going to DrWeitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you enjoy listening to the Rational Wellness Podcast, please go to iTunes and I’ve us a ratings and review. That way more people can find out about the Rational Wellness Podcast. For those of you who’d like a video version, go to the YouTube page, WeitzChiro, search for Rational Wellness Podcast and please subscribe there. And also I provide a full transcript of every podcast, and it should be connected with the iTunes link, or you can go to my website at DrWeitz.com.  Great, so we’re going to get started.

So our topic for today is how to increase fertility by addressing issues about intimacy, as well as overall health and wellness, with Denise Wiesner.  Denise is a licensed acupuncturist and an herbalist, and the founder of Natural Healing and Acupuncture in West LA. She’s certified by the American Board of Oriental Reproductive Medicine, she’s a certified sex coach, and she’s also a faculty lecturer for the Doctorate Fertility Program at Yo San University. And we’ll be talking about her new book, great new book, which will available very shortly, right? And you can pre-order right now on Amazon and Barnes & Noble. Conceiving With Love: A whole body approach to creating intimacy, re-igniting passion, and increasing fertility.  Denise, thank you so much for joining me.

Denise:                Thank you so much, Ben. Looking forward to it.

Dr. Weitz:            So how did you become so interested in fertility, and the second part is why did you decide to write this book?

Denise:                I got interested in fertility when I was having sort of my own fertility challenges, trying to have my second child. And what happened was I noticed that it was just becoming a chore and I wasn’t having, being able to conceive, and I was pulling my hair out, and very upset, and I was going to all sorts of different kinds of healers.  And one of the acupuncturists I went to actually kept wanting to treat my breathing, and she didn’t want to treat my fertility, and I was like, “I don’t care about my breathing, just put a baby in me.”  So I kind of really understand the struggles that my patients go through in trying to conceive.

Dr. Weitz:            Which is why a lot of patients literally go and have an embryo stuck in them, you know?

Denise:                Right. Yes. Absolutely. So I appreciate it, and so my practice became primarily women’s health and also fertility.  So I treat both men and women going through, trying to get pregnant naturally, and also using Western reproductive medicine. So that’s part one.  And part two is that, you know, as I’m treating all these fertility patients, I’m noticing that people are starting to talk to me about, that conceiving is a chore. And they’re starting to tell me all these kinds of issues, like men who aren’t able to ejaculate in their wives, so they’re now turning to reproductive medicine like an IVF in order to make a baby. And when I ask them if they spoke with their doctors about it, they told me they said something, but nobody gave them any kind of help.  And that made me really want to look at, you know, is there help out there? Are there people talking about sexuality and intimacy and conception? And I found that there wasn’t. So I decided to write a book.

Dr. Weitz:            No, it’s great. I think there’s a number of issues like that, you know? Doctors just not comfortable talking to their patients about sex, and their sex life, other than in a very cursory way, or just handing them a drug or something.

Denise:                Yeah. No, it’s happening a lot in my practice, where nobody’s really talking. When I look at like, MD’s, and how many hours they get learning about human sexuality, I think it’s like 20 hours or so.  And therapists get about 10 hours talking about, learning about sexuality, unless they go on to become specialized in sexuality.

Dr. Weitz:            Yeah, no, I think many of the most important human concerns are sort of treated summarily like that.  Depression, here’s a pill. You know, what about the end of life? You know, doctors don’t even talk about a patient’s undergoing cancer treatments, they’re just taking these treatments a lot of times, which really aren’t even designed to save them, because doctors don’t want to talk about that, have those difficult conversations. And so this is great that you’re breaking this ground, this is very important that health practitioners either learn and become comfortable talking to their patients about this, or be able to refer to somebody like you, who is comfortable about it.

Denise:                Yeah. I think it, was it death, sex, and taxes are really hard to talk about?  Something like that? Yeah, so and it’s funny because …

Dr. Weitz:            You know, I’ll never show my tax forms…

Denise:                Yeah. That’s a whole other conversation. Whole other podcast.

Dr. Weitz:            So, in your book, you bring in a lot of Chinese medicine, and I was reading about some of these concepts of the wood, and the air, and the water, the energy, things like that.  Maybe you can explain, you know, how Chinese medicine can help us understand some of these issues.

Denise:                Yeah, okay. So in my book I have a lot of chapters. I mean, there’s chapters on fine tuning the engine, there’s chapters on orgasm and foreplay, and stress, and all sorts of things. But in this fine tuning the engine part, I really talk about the Chinese five elements. There’s wood, water, earth, metal, and fire.  So in Taoist tradition, earth is the center. And it’s really about kind of your digestion, really.

Dr. Weitz:            By the way, what’s Taoist tradition mean?

Denise:                Oh, Taoist tradition is really where I base a lot of my stuff. Because way back before … Taoist tradition was the precursor to Chinese medicine.

Dr. Weitz:            Oh, okay.

Denise:                Really what’s incredible about the Taoists is that they have this really equal relationship between yin and yang, male and female. So actually sexuality, and sexual positions were given to patients if they had issues. Like, “Oh, go do this position and that’ll cure this problem,” right? So the Taoists had a really great relationship to sexuality, which has since changed in our modern society, right? We have a lot of shame around it. So there’s a lot of Taoist breathing exercises that I brought into my book. But anyway.

Dr. Weitz:            But is there a double blind placebo controlled randomized clinical trial that shows that position is of clinical benefit?

Denise:                I think Masters and Johnson started doing that research, right? They had all that research on sexuality that came. I don’t know if it was … they were the ones who really founded a lot. Kinsey. They did research.

Dr. Weitz:            Right.

Denise:                But lab research is a little different than actually what happens in person, right?

Dr. Weitz:            Right.

Denise:                 So the earth element is kind of like the center, and digestion, and it’s important because right if you’re felling funky in your body, if you don’t feel good, you’re not gonna wanna make, you don’t want anyone to touch you, right?  That really gets in the way of intimacy for both men and women.  If they’re not healthy, if they’re not feeling good, right?  So earth element, we deal a lot with the center.  And that also includes the digestion, and your microbiome, right?  How that’s a big buzzword, right?  You talk a lot about microbiome.

Dr. Weitz:            Yes.

Denise:                 Yeah. So making sure … because there’s not only a microbiome in your gut, right? There’s one in your mouth, and on your skin, and there’s actually on on the penis and there’s one in the vagina. And we want that to be healthy. We don’t want a woman to have yeast infections and all sorts of infections, which women do get. And we want to have that balanced. So that’s kind of part of the earth element, is learning about the center.  And Chinese medicine is funny, because it just doesn’t look at digestion only, it kind of looks at emotions. So there’s this saying that overthinking and over worrying damage spleen and stomach, which is digestion. Right? And we know that doesn’t happen for anybody in this society anymore, right?

Dr. Weitz:            Yeah.

Denise:                 Yeah. So.

Dr. Weitz:            Everybody’s so highly stressed and overworked and trying to fit everything in, and yeah. Absolutely.

Denise:                Right, like eating in your car? I’m trying not to do. But like, shoving in the food as fast as you can, right? There’s no digestion happening, no enzymes.

Dr. Weitz:            Absolutely. And it facilitates eating of fast food because so many fast food items come in wrappers that you can hold in one hand, and shovel in.

Denise:                While you’re driving and talking on the phone.

Dr. Weitz:            Exactly. So you mentioned the vaginal microbiome, and that’s a really interesting topic. We’ve have some women use probiotics vaginally to help with yeast infections, and that’s something we’re just starting to understand.

Denise:                Yeah. No, it’s really important because what happens with a woman during her cycle is her pH for her vagina, which is supposed to be acidic, starts changing around the time of ovulation because the cervical fluid that she produces becomes a little more alkaline, so the sperm can live in the cervical fluid, right?  So they can swim up to meet the egg.  If a woman is not acidic, she’s more alkaline during the month, she’s going to produce more yeast, right?  Because you really want an acidic vagina. So there’s all sorts of lubrications that people use out there, and I had spoken to lots of lube companies and got a great education on lubrication, and really more than I wanted to, but I learned a lot.  Because you know, unlike our mouth, when we digest something, we have a lot of acid in our stomach which breaks things down and gets rid of bacteria, right?  But we put something in our vagina, the mucus membranes, it absorbs. It’s much like our rectum, as well.

So when you go to use a lubrication, you want to make sure that it doesn’t have preservatives in it, like parabens.  Which the FDA has said is fine, but I don’t think is fine. So no parabens. And then there’s also this thing called osmolality of lubricants, which means the ability of it to pull out water from the tissues.  So a lot of lubes, the reason why women get very wet is because it pulls out the water from the tissue and that helps, it really dehydrates the tissues.  It’s not good for the tissues, and there’s a lot of lubes that have this high osmolality.  So with lubes like, there’s lubes that are good for fertility around that ovulation window because they’re a little more alkaline, they say they don’t kill sperm. There’s only a few that have been FDA approved, the FDA now approves them for fertility, believe it or not.

Dr. Weitz:            Huh.

Denise:                Yeah. So there’s a few of them have …

Dr. Weitz:            Is there a natural type of oil or other fat that makes a good lubricant?

Denise:                Yeah. I mean, I think like, I personally think coconut oil is great. I mean obviously if you’re trying to protect, using a condom it’s not good because it’ll just eat up the latex. But in terms of, you know, hopefully women, truthfully if women are healthy, and their cycles are really good, and they haven’t had surgeries on their cervix, they should be producing a lot of cervical mucus.  And that’s kind of what my job is as an acupuncturist and herbalist is to kind of help women to produce more cervical mucus.  And even something like N Acetylcysteine, right? It thins out mucus, right? It’s an antioxidant. But I give it sometimes for women because it actually thins the cervical mucus as well. Right?

Dr. Weitz:            Interesting. Now coconut oil’s a little alkaline, right?

Denise:                 You know, I don’t know the pH of the oils. Do you know the pH of them?

Dr. Weitz:            You know, I just recently interviewed Jennifer Fugo and we’re talking about the gut skin connection and she was very outspoken about the fact that, I haven’t posted the interview yet, so it’ll still be several weeks away, but she felt that coconut oil was too alkaline and the skin needs to be more acidic. So she didn’t think coconut oil should be used on the skin.

Denise:                 That’s really very interesting since everybody uses coconut oil everywhere these days. But the thing about it is is really, truthfully, women who are trying to conceive, really should produce their own cervical fluid.  If you’re not producing, you’re dry, then there are things that we can do the help make that by giving women herbs, and nutrition, and looking at everything.  Looking at their whole body.  And that’s really the truth, unless a woman has had like, surgery.  So I sort of steer away from the lubricants, because, “OK, here’s another thing.” This is in my book, and a lot of times women will become, because we have all these glands that secrete lubrication, right? If a woman’s not sometimes making her own lubrication, not only can it be from just maybe her diet’s not good, but it can also be from not enough foreplay. Which, you know, people don’t know, but it takes women like 20 to 45 minutes to really become aroused. And if you give a woman enough time, she will be.  And when you’re doing baby making, a lot of that time map goes out the window, so a woman’s uncomfortable and it’s painful. So that’s just one thing.

Dr. Weitz:            Interesting. What role can Functional Medicine play in understanding fertility, and in helping a couple improve their ability to conceive, and have a healthy baby?

Denise:                I mean, Functional Medicine is much like Chinese medicine, right? It’s looking more in depth at like, what’s out of balance in a patient’s body, right? So Functional Medicine is great because it’s really looking at the systems, like doing blood. You know, making sure, obviously the thyroid’s working efficiently. Thyroid has to function for fertility, and there’s actually lower ranges for fertility. Doctors want your TSH 2.5 or less. But what happens with doctors is they just do a TSH, and they don’t look at like, antibodies, TPO antibodies, TGB antibodies, and some women have very, very high levels. That’s where the functional medicine do look at those things, and therefore are interested in why someone would have high inflammatory markers, and try to get the inflammation down.  So you know, if I have women that has high TPO antibodies, we’ll be doing some type of antioxidants to help bring down this high level of inflammation. And also looking at their diet, like functional medicine does, right? Are they eating an inflammatory diet? Are they eating a lot of grains? Are they eating dairy?  And so Chinese medicine has similar kind of ways that we look at things, but functional medicine brings in the actual lab values, the actual stool test, the actual hormone test, and we can look at those in a much more in-depth level than just … or sperm, for that matter. You know? Yeah.

Dr. Weitz:            Good. Can electronics like laptop computers and cell phones affect fertility?

Denise:                 Yeah. You know, I treat a lot of men, and I’m pretty lucky that way. And it’s amazing how many men carry their cell phone right next to their scrotum. And it’s, you know, electronics are heating, and there’s research about even just talking on the phone can increase your chance of having lowered sperm counts. So I really do try to discourage use of electronics.  And electronics in the bedroom get in the way of making babies. ‘Cause when everyone’s like, on their, checking their email and doing all this, right? There’s no intimacy. So one of my big things is trying to get electronics out of the bedroom, I’m probably guilty of that too. But yeah. So …

Dr. Weitz:            And you know, with 5G coming, we’re going to have even more higher levels of magnetic radiation entering our homes through our electronic devices, etc.

Denise:                 Yeah. You know, it’s very scary. My son’s a computer science major, and he’s always like, “That doesn’t matter,” whatever, he’s like, “Show me the research.” But I think it does interfere. I mean, what’s going on with our society that men’s sperm counts are so much lower than they’ve ever been? What’s going on when I see these men who have unexplained low sperm counts? Like, the doctor can’t find anything wrong genetically, and they don’t know why. That’s very interesting to me.

Dr. Weitz:            Yeah. Literally from the small sample we’ve had of the men we tested for hormones, 80% or more have low free testosterone, so it is truly getting to be really common. And part of the problem has to be some of these estrogenic substances that you mentioned. Pthalates, and there’s a whole series of this in a way, pesticides, fire retardants, Teflon, etc., etc.

Denise:                 Right. That’s sort of that idea, you know, about detoxification, right? And we have that, that’s functional medicine, it’s also Chinese medicine. It’s the liver, and we have to be able to detoxify. So oftentimes I’m testing and also putting people on detoxification. Especially if they’re going through an IVF and they’re taking a ton of hormones. I mean, these women have estrogen levels really, really high. And I will afterwards just tell them to do a little bit of a liver detox.  Because I know that, you know, we’re not supposed to have those superhuman levels of estrogen in our bodies, right? And then they pee that out, and you wonder where does that estrogen go? Right?

Dr. Weitz:            Yeah, I mean, speaking of hormones, what does being on birth control for years and even decades do to a woman’s ability to become pregnant?

Denise:                 Some women who are on birth control pills, some women don’t get their periods back. It’s very interesting, I have to work very hard to reestablish the HPOA access. You know, the hypothalamus pituitary ovarian access. Some women do get their periods with a little coaxing. I think, you know, they give birth control pills oftentimes without really checking women. I mean, they don’t check to see if women clot. Have any kind of clotting disorder. It’s interesting, and then they find out like, “Oh, I had a clot on the airplane,” and it’s like, “I’m on birth control pills. Whoops, I shouldn’t be on them.”  But they don’t do a lot of testing, they hand them out like you said. They just sort of hand them out to everyone.

Dr. Weitz:            And essentially it’s a chemical castration. These women are artificially having their menstrual cycles stop with chemicals for years and years, and so their body’s not naturally producing these hormones.

Denise:                 Right. And there’s a difference between the synthetic hormones that you get, and the ratios of them, and how they’re pulsed, right? We take, hormones all pulse in a certain way, and you take a pill it’s not quite the same. So I think it must have some impact, and I don’t know there’s a lot of research on that, I’d have to really look stuff up, it’s a very interesting thing. I’m not a big fan, but for those who have unwanted pregnancies I do see that birth control pills are the best form of birth control at this point in time.   So it’s a hard call for women. It’s a hard thing, what to do. You know?

Dr. Weitz:            Yeah. No, I understand. Can you talk about some of the sexual problems that men and women have that they often don’t want to talk about and why don’t they talk about these?

Denise:                 Yeah. This is my favorite thing to talk about, actually. Really because it just let’s people know they’re not alone. So I have men who have difficulty perhaps ejaculating in their wife, and I have a lot of men that are really shamed around that, because they’ve not ejaculated in a woman for years because they were trying to prevent pregnancy, so they didn’t learn how. And maybe they’re masturbatory style is very different than when they make love to their wife, and so it’s just a different sensation.  And so it’s learning how to re-do that style so that they can ejaculate. And there’s many reasons for why men can’t ejaculate in their wives, right? Fear of making a baby, or sometimes … you know, what’s really interesting is there’s a lot of SSRI’s, and one of the side effects of SSRI’s is they have like, it’s hard for men to ejaculate, and it’s hard for women to reach orgasm. And I actually interviewed somebody that was a psychiatrist in functional medicine, Hyla, Dr. Katz.

Dr. Weitz:            Oh, yeah.

Denise:                 Yeah, I interviewed her because we were talking about what can these people do? Because they’re given SSRI’s and maybe that’s not the best thing in order to make a baby because no one’s orgasming and no one’s ejaculating.  So that’s a problem, so that’s one of the things. And then I also have, men can’t get an erection when there’s pressure. Like, when they know their woman’s ovulating, and they all of a sudden have to perform, you know, that moment, and the woman’s like, “Okay, now honey.” Men sometimes just can’t really perform on demand, right? And so my book is really this idea of maybe men don’t need to know when their wives are ovulating. Some men like to know, but maybe it’s this idea of having intercourse more often, having connection more often so it’s like your having it and you’re also having it during baby making time. It’s not just, “Okay, this window we have to do it now.” And then men are like, “Ah!”

So I see those things in men, and I see some sexual pain in women. That they don’t tell anybody. That like, it actually hurts, and they don’t know why. And you know, oftentimes my job as a a Chinese medicine practitioner and sex coach is to like, “You know, you need to go to a pelvic floor physical therapist. Your pelvic floor is like, ripping.” God, I had a woman who couldn’t have intercourse because every time she had intercourse with her husband she’d get a UTI, urinary tract infection. And so it started becoming, she had vaginismus, her muscles started closing down, and they couldn’t have intercourse for a long time, ’cause of the trauma of thinking like, “Every time we have intercourse I’m in pain.”  So unraveling that takes a few people, right? Takes like the physical therapist, and some emotional support, and I can help, and so it’s really pointing people in the right direction.

Dr. Weitz:            Yeah. Probably could use some cranberry D mannose to coat the urinary tract to make bacterial less likely to adhere.

Denise:                 Right. So it’s really addressing, exactly. It’s addressing it in many different avenues, not just the pelvic floor physical therapist, but it’s also looking at how to relax the woman, and how to prevent UTI’s. Like, what’s going on that she keeps getting UTI’s? And you know, help the gut function, and exactly what you’re saying. Perfect.

Dr. Weitz:            Yeah, and those antidepressants are handed out like candy. And then there’s a series of other drugs. So for example, some of the drugs that men take to try to increase hair growth, like Propecia also affect erectile dysfunction.

Denise:                Oh my god, and toxic to fertility. So not good for, yeah. All those things, right?

Dr. Weitz:            Right.

Denise:                Yeah.

Dr. Weitz:            So when you, in your book you talk about the benefits of orgasm in sex besides, you know, being able to conceive.

Denise:                Oh yeah. It’s orgasm, but you know what? It could be like a deep hug, it’s oxytocin. It’s the hugging drug, right? And it’s like 30 seconds, 20 to 30 seconds of like that deep embrace, and you produce these chemicals, and orgasm is the best. Because orgasm, there’s something that happens where your brain, it just stops and you don’t think about anything, it’s this moment that’s really beautiful for men and for women, and it’s sort of an enlightened state. I mean, it’s a state where you can really ascend, it can be a very highly spiritual state. It’s not just about like, gotta have an orgasm, but it’s this connected, beautiful moment in time where all these feel good hormones are in your body and we want more of that.  Because those help our immune system, actually. Like, sexuality is good for our, it helps our immune system. And that’s a very important fact that people forget because they’re so busy.  People are so busy at work, and so stressed out, that they like, they can’t, you know, the idea of taking an hour to like, have lovely, slow connection with a partner doesn’t happen.  I mean, I have people that don’t even have date nights.  They see each other very little, maybe on the weekends only.

Dr. Weitz:            Right. It’s interesting that this problem of, you know, if you call it a problem, right? I think it is, of people having less sex and having less babies is actually something that we see throughout the western world, and you see it in a lot of these countries in Europe, etc., where the native population is becoming a minority partially because they’re not having a lot of kids.  And in some of the Scandinavian kids, they actually have commercials on TV encouraging people to have sex.

Denise:                Yeah, you know …

Dr. Weitz:            Government incentives and stuff for them to conceive.

Denise:                Yeah. It was kind of scary because I attended a reproductive endocrinology lecture and the doctor, a reproductive endocrinologist, was talking about he thinks that one day it’s just going to be like you go to get an IVF to conceive your baby, and sex is only for fun, and it’s not used for fertility anymore, for making a baby, you just sort of do it in the lab. And I thought, “Oh no. That’s such a scary … is that what’s going to happen? We’re going to all have these like, designer babies?” To me, that’s a scary thought, you know?

Dr. Weitz:            Yeah. We should be way more connected to the earth than we are, and that’s like the most extreme example, you know? Yeah.

Denise:                Yeah. I mean, when healthcare dictates that.  You know, right now IVF is, some insurances cover it, but you have to have money.  And it’s really unfortunate, because there’s some people that really need IVF.  I have men who sometimes have, have had … I have testicular cancer guys, like quite a few in my practice.  And their sperm counts sometimes aren’t as good to make a baby naturally, so they need the help of IVF.  And that’s what IVF is for.  I’m not anti-western medicine, it’s just that some people rush to it when they don’t really need to. ‘Cause of the fear, and the anxiety we have in our society, and maybe they’re having relationship issues as well.

Dr. Weitz:            Right. When men have issues with sperm count, or swimming ability, etc., what are some of the things that can be done to help?

Denise:                So glad you asked that. You know, in Chinese medicine … okay, first of all. Western medicine. There’s a lot of, or I should say Functional Medicine, there’s a lot of nutritional substances that we give men. We give men fertility formulas that contain CoQ10 and Vitamin E, and selenium, and zinc. Zinc is very important. L-Arginine is good, L-carnitine, those are sort of standard in men’s fertility formulas. But then there’s actually specific herbs that men can take to help their libido and help sperm, but it really depends on what’s going on.  So a man who maybe has a low sperm count due to maybe a varicocele, so it’s like a varicose vein in his scrotum, he in Chinese medicine would need more cooling of his testicles and more blood flow and cooling herbs. We might have him just put an ice pack actually, to cool them down and take herbs for blood flow, which would be different for a man who has a low sperm count due to, we call like, low kidney energy in Chinese medicine. Or maybe he’s over stressed, or he’s over exercising or something of that nature.

So herbs like, I was just pulling them up actually, looking at my book. One of my patients who had testicular cancer, a doctor told him he should take ashwagandha, and he called me. “Doctor says I should take ashwagandha. What do you think?” And I thought, “Yeah. Ashwagandha.” Ashwagandha is a great adaptogenic herb, it’s shown to like, improve sperm, interesting enough. And it’s calming, so it would be a great herb for him because he was sort of anxious.  And I also give cordyceps, it’s a fungus, it lives on caterpillars, but they make it.  Cordyceps also helps sperm, and it also helps egg quality. And it also helps, good for stress, good for your adrenal glands to be good for them.  So that modulates. And then there’s things like, we call yin yang huo. Horny goat weed. Horny goat weed is an herb that helps libido, there’s a bunch of them.

Dr. Weitz:            Yes.

Denise:                And what I want to say is like, ashwagandha. Okay, you can take ashwagandha singly, but there’s these amazing formulas that have all the adaptogens. Like, rhodiola, and ashwagandha. You know, and Siberian ginseng. And I kind of like to take herbs in formulas as opposed to just single herbs. It’s how the Chinese do it, and I find it’s much more effective to give a formula for a man than just a single herb.

Dr. Weitz:            As a provider, how do you bring up questions about sexuality with the men and women you’re seeing?

Denise:                That’s a great question. I have a form that they fill out, and one of the questions is about libido. Because it’s part of who we are as humans, right? It can tell us a lot of about what’s going on, if there’s deeper issues.  I mean, I had a man who couldn’t get an erection, and really, he ended up having a heart attack because it was blood flow issues. So I think it’s a really important question that we need to ask for providers, our patients, yeah? We shouldn’t eliminate that question. So basically they put a check on my form, and a lot of women, really I would say 98% of my patients that are women check the low libido box.

So I basically ask them, “Hey, you checked the low libido box, and I want to know what’s going on.” And really just try to find out, libido is really complicated. It’s complicated for women, maybe less so for men, but it’s complicated for women. Like, is it stress, is it past trauma, what’s going on? So we go a little in there, and then men oftentimes, on their checkbox, if they have erectile dysfunction, they check it. Believe it or not. So I just say, “Hey, you checked the box with low libido, erectile dysfunction, what’s going on?” And believe it or not, people really wanna talk about it.  Because nobody asks them. And they don’t know what to do about it, and they don’t know who to go see, and it’s just this sort of shame that they live with, and I’m really encouraging more providers to talk about this area. You know, and also refer out, let them know that there’s therapists that actually specialize in sexuality. That you can talk about these things to, if there’s trauma, or past issues with this, right? And I just feel like it’s important for people to be empowered around this topic.

Dr. Weitz:            Yeah, no, I think this very important book, and by the way I think your next book should be about sexuality after menopause, ’cause that’s another whole set of issues.

Denise:                Oh, yeah. I also treat that. That’s a whole, or sex after kids. Right? Where everybody’s like, scrambling around, you remember that. You know, everyone’s like, “Oh my gosh, I need to sleep, don’t touch me.” So yeah, sex after you have the baby, or in menopause. But you know, there’s an interesting …

Dr. Weitz:            Sex after your hormones fall off a cliff.

Denise:                Tank, yeah. I think that you know, and just to mention that, that’s not in my book, but just to say that because you know, yes. Menopause. I know that intimately. It’s not, I think it doesn’t have to be a tank. And if you ask some women in their 50’s, they’d say they have the best sex that they’ve ever had in their entire life. So this idea that everything has to tank, sometimes it’s just that women have been in the same relationship for a really long time, and everything’s very predictable and everything’s kind of boring. And remember I mentioned that like, 30-45 minutes of foreplay? That’s not usually happening.  And so maybe if there’s a way to spice things up or recreate things, or … women, surprisingly enough, maybe can change. So women think, “Oh, no, it’s very common that a woman in menopause, her husband will be like, ‘Hey, let’s have sex,’ and the woman’s like, ‘Ugh, god, I don’t want to.'” But if a man were to really arouse, and I don’t mean like just touching, maybe a woman would be in the mood. So I just got a rose today from one of my colleagues, and these rose petals are super amazing. You could just take a rose petals, lie them on the bed, and just do a touching exercise with rose petals. I mean, when do we do that? Who has time for that anyway?  But it’s just to remember these kind of small things can really wake people up and that even though a woman’s in menopause, maybe she hasn’t been touched by rose petals in a very long time in her life. And maybe that would be the thing that would kind of light her up to really back into her moment. So I’m not sure, I’m not wedded to like, it’s only because women’s hormones drop. You know? I see plenty of women who don’t have hormones, who have a fine sex drive. So that’s a whole other topic.

Dr. Weitz:            That’s great. So one more question since we seem to be in a marijuana revolution in this country, and we live in California where marijuana is now legal and it seems like everybody’s starting to experiment with CBD oil in healthcare practices for every possible condition. How do these affect fertility?

Denise:                 We see CBD everywhere. First of all, marijuana is not good for sperm. Sperm slow down, and it’s not good. So if your man is smoking marijuana, or ingesting with edibles, or whatever, I would say give him 70 days of no edibles. Because it’s not good for sperm counts. That’s just …

Dr. Weitz:            Sperm slow down, they just want to sit on the sofa and not go to work.

Denise:                 Yeah. Not so good. Yeah, sperm, it’s just not good for sperm. And that’s, I’ve interviewed enough urologists, reproductive urologists, and they’ve told me firsthand, “Please don’t, no marijuana for sperm counts.” We don’t know, I don’t know there’s any research on egg quality, but I imagine if it’s not good for sperm, it’s probably not good for eggs. We just don’t know enough about that. That’s just THC, right?  But then there’s CBD. The problem with CBD is that we don’t know enough about CBD. So there’s CBD from hemp, and there’s CBD from, with THC in it, and we don’t even know. There’s no quality control with CBD at all. So you take CBD you don’t even know what you’re getting. Every vendor wants to sell me CBD, and I don’t know really how much is in it. Do you find the same thing?

Dr. Weitz:            Yes. I think there’s a lot of confusion about it. I think there are some specific rules as far as, if you want to sell CBD it has to have less, a certain amount of THC, and if it has more then it has to be … it’s all legal, but …

Denise:                 You know what? No, but there’s CBD from hemp, and there’s CBD from cannabis. Right? The CBD that’s made from hemp has no THC in it. And the CBD from cannabis I think maybe does or doesn’t or I’m not really sure. And there’s so much debate about that. I’m not anti-CBD, I see it do some good things, I don’t think it’s the do-all end-all, I think it’s just the rage right …

Dr. Weitz:            People use it for sleep and relaxation.

Denise:               Yeah, yeah. And I’m not anti-CBD at all, I actually have used it myself and think it’s really good and I love the CBD ointment for pain, I think that’s great, and inflammation. But I think if you’re trying to have a baby, until we know more, it’s just hard to say because I don’t know that there’s any research. I do have a colleague that did a lot of CBD oil in her 40’s and did get pregnant. So that’s just kind of a funny aside, but I don’t know and I don’t recommend it because I don’t know enough research about it.

Dr. Weitz:            Right. Great. So any final thoughts for our listeners? And maybe you can tell us how viewers and listeners can get a hold of you and where they can pre-order your book?

Denise:               Okay. The final thing I wanna say, and we’re so focused sometimes on you know, on money-making, and busy, and lab tests, and health, that we forget to kind of drop into the place in our hearts where the love lives, and it’s always a good reminder to really live in that place of love. You know? We can live in fear, and there’s enough of it in our society right now, but just be in gratitude and love is the best place we can arrive to. So that’s really my, that’s why I think conceiving with love, it’s all about the love.  All about the love. That’s my final thought. And then if you want to get a hold of me, I have a website that’s my name, DeniseWiesner.com, and there’s a lot of information about me and what I do, and it also links to my clinic, and my book is available through Amazon. It’ll be available pre-order and out May 28th. And it’s also I think in Barnes & Noble, and it’s also, it’s published by Shambala so you can also get it on their website as well.

Dr. Weitz:            Awesome. Thank you Denise.

Denise:               Thank you, Dr. Ben Weitz. You’re the best.



Ketogenic Diet with Dr. Josh Axe: Rational Wellness Podcast 107

Dr. Josh Axe discusses The Ketogenic Diet with Dr. Ben Weitz.

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


Podcast Highlights

5:05  One of the biggest benefits of a ketogenic diet is balancing insulin levels. And insulin imbalance causes inflammation, PCOS, Alzheimer’s disease, negatively affect brain health, and cause hormonal imbalances.  It also is very effective in helping clients/patients to lose weight. 

7:25  The main components of a ketogenic diet involve a macronutrient breakdown of about 70% fat, 20-25% protein, and about 5% fat. When your body starts burning fat instead of carbohydrates, you are said to be in ketosis.  This diet was created by Johns Hopkins researchers to fight epilepsy and to mimic fasting. Dr. Axe does not believe that the keto diet should be done for too long a period of time. It should be done for 30-90 days, like a long term fast or cleanse. And it can take 4-6 days of being on the ketogenic diet till your body truly gets into ketosis. Drinking matcha green tea, using adaptogenic herbs, keeping stress levels low, taking exogenous ketone supplements and taking other herbs that support thermogenesis like ginger and cayenne can help getting into ketosis.

9:33  If you are highly stressed, your cortisol levels will cause your body to produce more sugar from protein.  If the person has thyroid or adrenal fatigue and they are highly stressed and go on a ketogenic diet, they likely won’t do well on it.

10:18  Dr. Axe usually has his clients on keto consume 30 grams of carbs per day or less.  He does not like counting calories, so he will tell them that they can only have one serving per day of carbs and it’s either blueberries, beets, or carrots and that’s it for carbohydrate rich foods per day.  The carbohydrate rich foods are grains, legumes, fruits, and the starchier vegetables, like beets, carrots, potatoes, yams, butternut squash, etc.

13:15  Dr. Axe said that exercise is not required to follow a ketogenic diet and you can lose weight following a keto diet without exercising.  But exercise will help to lower stress, increase your metabolism, burn up carbs, and help you get into ketosis more easily.

14:23  Dr. Axe explained that it is o.k. to have small amounts of alcohol while following a keto diet, such as a 3 1/2 oz glass of dry farmed red wine once or twice a week.

14:58  Dr. Axe pointed out that there is a right way and a wrong way to follow a keto diet. He said that he saw the ultimate keto recipe posted on Pinterist and it involved taking conventional shredded cheese, fried in butter, with bacon in the middle, and then you more cheese fried on top, and you have a keto quesadilla. But that is not healthy on any diet. Dr. Axe recommended eating real, healthier fats like avocados, coconut, tahini, almond butter, grass fed butter. ghee, olives, etc.  Dr. Axe goes through a 30 day keto meal plan and has lots of recipes in his Keto Diet book that make it easier to follow a keto diet. 

16:51  A ketogenic diet will not be detrimental to your microbiome if you do it the right way with lots of fermentable fiber and fermented foods. If you do keto with loads of vegetables and you include some nuts and chia, flax, and pumpkin seeds, and berries, you will be getting plenty of fiber. You want to include some fermented foods like sauerkraut. You also want to include plenty of spices and it can be helpful to include matcha green tea, turmeric, ginger, and the supplement, triphala.  Dr. Axe pointed out that some ancient civilizations, like Eskimos and the Hadza lived on a keto diet and they had very diverse microbiomes.

19:00  The most beneficial nutritional supplements to take while following a keto diet are: 1. Probiotics, esp. Soil-based Probiotics, 2. Collagen protein or bone broth protein for tissue regeneration, 3. An organic green powder, 4. Adaptogenic herbs like ashwaganda, 5. Exogenous ketones, and 6. A multivitamin/mineral or drink celery juice or some other green vegetable juice.

22:18  The ketogenic diet is difficult to stay on long term, so Dr. Axe recommends doing it for 30-90 days and then adding back in some healthy carbs, say 30-40%.  That’s about 100 gms of carbs per day, which would be a serving of blueberries, a half a sweet potato, and one serving of rice.  Some people also do well cycling keto, such as doing keto and then adding some additional carbs every third day.


Dr. Josh Axe is a Doctor of Chiropractic, a certified doctor of natural medicine, and a clinical nutritionist. He has the No. 1 natural health website, Dr. Axe.com, with over 17 million monthly visitors, and he created a supplement company, Ancient Nutrition. He has written several best-selling books, including his new book, Keto Diet, and Eat Dirt.

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with The Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research, and by interviewing the top experts in the field. Please subscribe to The Rational Wellness Podcast on iTunes and YouTube, and sign up for my free e-book on my website by going to drweitz.com. Let’s get started on your road to better health.  Hey. Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to The Rational Wellness Podcast, please give us a ratings and review. That way, more people can find out about The Rational Wellness Podcast. Also, check out the YouTube page where we have videos that are not included in the podcast.

Our topic for today is ketogenic diet with Dr. Josh Axe. The ketogenic diet is a high-fat, medium protein and very low-carb diet. By severely restricting carbs, your body gets used to burning fat for energy instead of carbs. And this can facilitate the loss of body fat. When your body is burning fat, it produces ketone bodies in the process. This means that your body is in ketosis. Dr. Josh Axe is a doctor of chiropractic, certified doctor of natural medicine, and clinical nutritionist. He has the number one natural health website, draxe.com, with over 17 million monthly visitors. He’s written several bestselling books including his new book, Keto Diet, Your 300-Day Plan to Lose Weight, Balance Hormones and Reverse Disease, which is what we’ll be speaking today.  Dr. Axe, thank you so much for joining me today.

Dr. Axe:               Awesome. Hey, thanks for having me Dr. Ben.

Dr. Weitz:            Excellent. So, Dr. Axe, can you tell us how you became interested in a Functional Medicine approach to health?

Dr. Axe:                Yeah. So for me, I got into the natural medicine space through a health crisis in my family. My mom growing up was always into fitness, but we were never into nutrition or natural health. And so she was surprisingly diagnosed with cancer at 40.  We lived in that medical model.  We were always getting put on medications, and my mom decided to go through all the conventional medical treatments.  So she had a mastectomy.  She went through rounds and rounds and rounds of chemotherapy. And I remember her losing all of her hair. Just being so sick.  And she went through all those treatments, and then she was diagnosed as being cancer-free and healthy but really, after that, she seemed sicker than ever.  She got diagnosed with chronic fatigue syndrome, depression, anxiety, got put on multiple medications.  And she was just sick and tired all the time.

And that’s really, essentially, what inspired me to become a Functional Medicine doctor and a chiropractor, and nutritionist, and want to learn natural medicine. And so, I went to school, started studying to become a doctor. And about a year before graduation, get a call from my mom, and she says, “I’ve got bad news. I’ve just been diagnosed with cancer again. What do I do?” And I said, “I’ll be home.” I flew back from Florida back to Ohio where I grew up. We sat down and prayed together. And we felt led to take care of her all naturally. And so, she started juicing vegetables every single day. We started doing natural remedies like reishi mushrooms, and turmeric, and vitamin D. She started getting chiropractic adjustments every week. And using essential oils like frankincense.  And also doing positive affirmation.  We worked on her spiritual and emotional health.  We followed this plan for about four months.  We went back to Columbus, Ohio and redid a CT scan with her oncologist.  And they called us the next day and they said, here’s what their exact words were, “This is highly unusual.  We don’t typically see this, but your tumors have shrunk by more than half.  We want to see you again in nine months for another scan.”  She went back nine months later, complete remission.  And now, my mom’s in the best shape of her life.  She just turned 67, and she’s running 5Ks, and she water skis, and feels better now in her 60s than she did in her 30s.  And so for us, that’s a big part of what inspired me to start practicing natural medicine.

Dr. Weitz:            Just out of curiosity, did the oncologist ever call you and say, “Hey, Dr. Axe, what did you do?”

Dr. Axe:                No, no. Of course not. Well actually, on that call, they kind of said, “What have you been doing?” And their long-winded response was, “Hmm.” Was what it was. And at the time-

Dr. Weitz:            They really thought about it deeply.

Dr. Axe:                Exactly. Now another thing what my mom was doing as the time though diet-wise, all the vegetables she did were green vegetable juices, she was sort of doing a form of the keto diet. We removed all sugar, all grains from her diet. Her only source of carbohydrates was, she was doing about a half a cup to a cup of blueberries a day, some beets and carrots, and that was really it in terms of carbohydrates. And so, that was another thing that we felt like was pretty important as part of her treatment plan.

Dr. Weitz:            Great. So what is some of the primary benefits to following a ketogenic diet?

Dr. Axe:               So, the keto diet, big benefit there is balancing insulin. And most people, of all the macronutrients we eat, we overconsume sugar and carbohydrates are the most. We know different organ systems have to deal with different macronutrients, and so your kidney and your stomach, and to a degree, your liver, have to do with protein digestion. We know that fat digestion’s primarily your liver gallbladder, but your pancreas, in a big way, is responsible for carbohydrate digestion. And so for that, most of our pancreases are just worn out. So, when you can balance insulin… When people think of insulin, they tend to just jump to diabetes and think that’s what it does, or if it’s imbalanced that’s the disease it causes.

The truth is, research today is showing insulin imbalance causes severe inflammation. It causes PCOS, that’s polycystic ovary syndrome. In fact, Alzheimer’s disease is called type three diabetes because of insulin issues. And so, and then most hormonal issues, whether it be cortisol or progesterone or estrogen or testosterone, those hormones, a lot of times are at certain levels because of where insulin is at. And so, again, I think it’s really critical that we keep insulin balanced. But again, the benefits can be especially neurological in brain health. It can be big for that. Digestive health. Certain types of hormonal health, especially PCOS and fertility. And weight loss, of course. Probably of all the things, probably it’s most well-known for its ability to help people lose weight and fight diabetes.

Dr. Weitz:            I just did an interview with Dr. Bob Rountree, and he was talking about fatty liver disease, which is also related to insulin sensitivity. And that’s a tsunami of problems that’s coming down the pipe that is going to be the leading cause of liver transplant.

Dr. Axe:                Absolutely. So again, as you can… insulin resistance is a huge… And most people don’t think, unless they have diabetes, they think, “Oh, I don’t have insulin resistance.” Most people are sitting in that sort of syndrome X, that level of not full-blown diabetes, but most people, if they’re carrying an extra 20 pounds of body fat especially, there’s a great chance that they’ve got insulin issues.

Dr. Weitz:            Absolutely. So what are the main components of the ketogenic diet?

Dr. Axe:                So, a keto… Now, here’s the other thing too. There’s a right way and wrong way to do keto. So, keto tends to be about 70% fat, 20-25% protein, and about 5% carbohydrates. That gets your body in state of ketosis, where your body starts burning fat for energy because it doesn’t have carbs to burn for energy. And the other thing important to note about keto is, is that it was created by John Hopkins Medical researchers to fight epilepsy. And to mimic fasting. So think about it like that. The keto diet, for me… By the way, the keto diet is not a lifetime diet.  The keto diet is a long-term fast or cleanse. That’s why most of the time it can be done for 30 days or up to 90 days. Most people, unless somebody has maybe MS or Alzheimer’s or certain forms of cancer, those people may do it for longer periods. Or severe obesity. But for most people, if somebody’s looking to lose 20 pounds, or somebody’s looking to get rid of diabetes, for most of those people, the keto diet should be done 30 to 90 days. And then transitioning into just generally adding some good healthy carbohydrates back in. But it’s really meant to be like a long-term fast or cleanse. But the key is, your body’s getting into ketosis where your body breaks down body fat. That body fat is turned into ketones, which then your brain and other parts of your body can use as fuel.

Dr. Weitz:            From what I’ve seen, it’s not easy to get into ketosis.

Dr. Axe:                No. It does take typically four to six days for a lot of people to get in. There are secrets and ways I cover in my book, Keto Diet. Some ways to get into ketosis faster, such as using certain types of healthy caffeine like matcha green tea, using adaptogenic herbs, keeping stress levels low, keeping those cortisol levels low, taking exogenous ketone supplements, taking other herbs that support thermogenesis like ginger and cayenne. So there are ways to get into ketosis faster, but it does take at least four days for most people, if not six days, to get into that state.

Dr. Weitz:            I think if your cortisol levels go up because you’re stressed, that’ll cause your body to produce more sugar from protein.

Dr. Axe:                Absolutely. And that’s a huge deal. The people that I see that don’t do well on the keto diet, are the people that have… At the same time they’re keeping their stress hormones are very, very high. And, because I had somebody ask, “Is the keto diet good for people with thyroid disease like hypothyroidism?” The answer is, it depends. For the people that are to, with the diet, keep the stress hormones low, yes. Those people will do well on keto if they have thyroid disease. But if somebody has thyroid or adrenal fatigue, and they’re doing keto and they keep stressing out that entire time, they’re just going to create more problems for themselves.

Dr. Weitz:            So, do you have people actually count a specific number of grams of carbs? I saw in your book you said 5%, but that’s kind of hard to figure. How did they determine how many carbs they should be on?

Dr. Axe:                I have most people do 30 grams or less a day. Some people, if they’re athletes, can do 50 grams or less a day. But I… it tends to be… I’ve never been one into counting the calories. It’s more eat these foods. And eat some of them liberally. Eat your avocados liberally. Eat your coconut liberally. So, that tends to be how more I have had patients do it in the past. I found that hey, you add an extra stress on weighing everything, measuring everything, journaling everything. Some people want that. 20% of people may like to do it that way. But 80% of people, they just want to know what foods can I eat and not eat. Or I tell people, “Don’t eat carbs. You can have one serving of carbs a day, less than 30 grams and it’s either blueberries, beets or carrots. Outside of that, just don’t eat any carbohydrate-rich foods.”

Dr. Weitz:            And basically, carbohydrates are grains, legumes, most fruits and the starchier vegetables, right?

Dr. Axe:                You got it. And some squashes I think are fine. I think if somebody’s doing some spaghetti squash like a serving of a cup, that’s going to be fine for most people on the diet, versus if somebody’s doing butternut squash or sweet potatoes, of course. That’s going to get them out of ketosis for sure. Just too carbohydrate rich.



Dr. Weitz:                          I’ve really been enjoying this discussion, but I’d like to pause for a minute to tell you about our sponsor for this podcast. I’m proud that this episode of the Rational Wellness Podcast is sponsored by Integrative Therapeutics, which is one of the few lines of professional products that I use in my office. Integrative Therapeutics is a top-tier manufacturer of clinician-designed, cutting edge nutritional products with therapeutic dosages of scientifically proven ingredients to help our patients prevent chronic diseases and feel better naturally. Integrative Therapeutics is also the founding sponsor of Tap Integrative. This is a great resource for education for practitioners. I’m a subscriber to Tap Integrative. There’s videos. There’s lots of great information constantly being updated and improved upon by Doctor Lise Alschuler who runs it. One of the things I really enjoy about Tap Integrative is that it includes a service that provides you with full copies of journal articles and it’s included in the yearly annual fee. And if you use a discount code, Weitz, W-E-I-T-Z, you’ll be able to subscribe for only $99 for the year. And now, back to our discussion. Here is the link to TAP Integrative.



Dr. Weitz:             How important is it to exercise while you’re following a ketogenic diet?

Dr. Axe:                It’s not. It’s really not important. I mean, people may expect me to say it’s very important. Listen, I believe everybody should be moving. Everybody’s healthier doing some form of exercise, whether it be intensity, high-intensity interval training, or yoga or Pilates or barre or weight lifting or cardio, whatever it is. But what I encourage people to do is just move 20 minutes a day. If it’s that’s walking, that’s fine. But what I tell my keto… people I care for, is “Hey, just move 20 minutes a day.” But I don’t… I think people could lose lots of weight if that’s their goal, or balance their blood glucose levels and insulin levels very easily, even if they aren’t exercising if they’re doing keto the right way.

Dr. Weitz:            But doesn’t exercise make it easier to get into ketosis?

Dr. Axe:                It does. Yeah, absolutely. So again, I think movement is going to support your body in doing that. In fact, movement helps all kinds of things from lowering stress hormones to elevating your metabolism, to start to burn up any of those carbohydrates that might be in your diet. So, yes, it definitely can.

Dr. Weitz:            Good. So, can you drink alcohol while you’re following a keto diet?

Dr. Axe:                You know what, you can in small amounts. And it depends on the type of alcohol. Beer, absolutely not. Maybe some dry farmed red wine. Probably one glass or less a few times a week.

Dr. Weitz:            Now what if the glass is about this big, and you fill it to the top?

Dr. Axe:                Right. So we can stay, I think the-

Dr. Weitz:            Have you seen some of the sizes of some wine glasses?

Dr. Axe:                I have. So we’ll say three and a half ounces or less.

Dr. Weitz:            There you go. So what are some of the biggest problems people have trying to follow a keto diet?

Dr. Axe:                Well one, knowing what… Let me say this. I think one of the things people have to know too, and I alluded this earlier, there’s a right and wrong way to do keto. I was on Instagram and I saw somebody post the… Or maybe it was Pinterest. They posted the ultimate keto recipe. And they said you take conventional shredded cheese, you fry it in butter, put bacon in the middle, and then you fry another shell on top, and you have a keto quesadilla. That’s not healthy on any diet.

Dr. Weitz:            Right.

Dr. Axe:                It’s pure conventional beef and butter. That’s… No, that’s not good. Versus eat real, healthy fats. Eat avocados. Eat coconut. Eat tahini. Eat almond butter. Eat grass-fed butter. Do ghee. Eat olives.

Dr. Weitz:            Can you fit some hummus in there?

Dr. Axe:                Yeah. I think a little bit of the hummus is fine. People do fine if they’re just eating that with their vegetables. But I think that’s a big thing to know is that you got to get a lot of these sources of healthy fat in your diet. And that’s what’s important. So knowing, and in my book Keto Diet, I go through a 30 day meal plan of what a keto breakfast looks like, keto lunch, keto dinner, keto desserts, keto snacks. And so we have all those recipes in the book as well. But I think if you have the recipes in the 30-day meal plan like I have in my book, it’s actually… I don’t think it’s that difficult to follow then.

Dr. Weitz:            No, I appreciate the fact that you emphasize the importance of doing it a healthy way with avocados and vegetables, because that’s one of the things that really turned me off to the whole idea of the Atkins diet which was kind of the progenitor of the keto diet, which people are eating bacon and cheese and all this unhealthy food. And I just, it was like, I get it. I understand how fat could be healthy, but there’s just no way that eating pork bacon can be good for you.

Dr. Axe:                Totally agree. And it’s not. In any setting.

Dr. Weitz:            So, will a keto diet be detrimental to your microbiota?

Dr. Axe:                So the answer is, not if you’re doing it the right way. It’s important to remember, certain civilizations lived on keto. Eskimos lived on a keto diet. Sometimes the Hadza possibly did. We know sometimes people lived on keto diet. But the thing is, you got to be getting the right fermentable fiber in your diet. That’s key in probiotic rich foods. So when you do keto, you got to get fiber. So again, one serving of berries a day, and then loads of vegetables and some nuts and seeds like chia and flax, pumpkin seeds, almond. But getting the fiber in your diet, and then getting some of those fermented foods like sauerkraut in there, and all the vegetables. If you’re doing loads and loads of vegetables, and then herbs or spices. Doing matcha green tea. Doing tumeric. Doing ginger. Doing supplements like triphala which is an ancient Ayurvedic yoga gut digestive support.  But doing those types of things, your microbiome will be healthier than ever. In fact, there’s an animal model study for people with ASD, autistic spectrum disorders. And they found that actually, their gut microbiota dropped especially the bad bacteria which improved behavioral outcomes, their overall digestion, their memory, their focus. So, if anything, it’s actually going to have a great benefit on the gut microbiota if people are doing loads of vegetables, herbs and spices and fermented foods.

Dr. Weitz:            Cool. Do you have people measure to see if they’re in ketosis? Use those urine dipsticks?

Dr. Axe:                Most of the time I don’t have people do it. Now if somebody’s having some issues, absolutely. And if somebody loves to measure things, that’s great. What I’m looking for is how you’re feeling. And are your symptoms changing? How do you look? And so people noticing, oh, I can tell my face is leaning in. I can tell I’m leaning out here. I can tell my energy now is better. I can tell my hormones are… I have people more so listen to their body than I do using the strips. But I think using ketone strips can be great.

Dr. Weitz:            What are some of the most beneficial supplements to take when following a ketogenic diet?

Dr. Axe:                I think number one would be making sure that we’re getting plenty of probiotics. So getting quality probiotics, especially the soil-based organisms, those SBOs. So I would look for a good quality soil-base probiotic supplement that also contains herbs and spices like triphala and ginger that support digestive health. But a probiotic supplement would be number one. Number two, collagen. I think collagen is critical for tissue regeneration. When people go keto, I not only want them to balance insulin and to lose the extra body fat, I want them to regenerate and heal. And so in that case, I’d say number two would be a collagen protein or a bone broth protein. Bone broth protein’s probably even the best, because that also has hyaluronic acid and glucosun and a chondroitin. So a scoop of that a day in a smoothie.

Dr. Axe:                The third supplement I would say would be… I think you want to stay alkaline. I think doing lots of greens. So something like chlorella or spirulina or organic super greens powder of some sort could be great for people. Just a couple more. I think taking adaptogenic herbs can be good. I think ashwagandha is one of those that can be very good to help keep those cortisol levels lower. And for some people, exogenous ketones, if somebody really wants to amp up the weight loss and get into ketosis faster. For a period of time, I think that’s another good one that people can consume.

Dr. Weitz:            Probably minerals too, right? Because there’s a lot of electrolyte imbalances that result from a keto diet.

Dr. Axe:                That’s the other thing I was going to say. In fact, one of the things I have a lot of people do when they’re on the keto diet is drink loads of celery juice. But celery juice to get the minerals. Lots of steamed spinach.

Dr. Weitz:            The cure for everything. Celery juice.

Dr. Axe:                Listen. I do want to say this. I’m not… And by the way, I’ve never met the guy, Medical Medium. He seems like… Obviously a lot of his stuff has a very, just polarizing effect in terms of the way he markets.

Dr. Weitz:            My wife read it. Had her first dose of celery juice, got sick as a dog, concluded this must be good for me. So now every time I go to the market, I have to call ahead and have them stock up on celery.

Dr. Axe:                I was actually recommending celery juice before that guy ever came out with the celery juice book or whatever he came out with. Which at least it’s better than the book before, not by him. Two years ago, it’s the grapefruit juice diet. At least this time it’s celery. So, but I do think some vegetable juice that’s mineral rich, especially celery, cucumber, spinach, ginger, lemon, that sort of… I think can help. But, you’re right, a multi-vitamin mineral can also be great for people that are looking to… That they’re on keto.

Dr. Weitz:            Now, you talk about using the keto salts. But isn’t the whole idea to get your body to produce those ketones?

Dr. Axe:                Yeah again, I’m not… Anytime I’ve done keto in the past, I’ve never used the salts or the exogenous ketones. Again, it’s just a supplement there for people if they want to see, get into ketosis faster, or they’re going to do it for 30 days and want to sort of reap the ultimate benefits. I think it’s fine thing to take. But do I think it’s number one on the list? No, by any means, in terms of supplements. But again, a lot of people I have do it without it.

Dr. Weitz:            Now since the ketogenic diet is hard to stay on long-term, once your recommendation for them to do it for 30 or 60, 90 days is over, what should they do then long-term?

Dr. Axe:                So, I recommend eating a healthy amount of carbohydrates. And so I think, realistically, now what we think of as normal is not normal. I think what the normal amount of carbohydrate consumption is probably close to, let’s say, 30% maybe. Maybe 40. But it’s not 50, 60 or 70.

Dr. Weitz:            You mean Big Mac, fries and Coke is not a reasonable way to eat?

Dr. Axe:               That’s not it. That’s definitely not it. So, I do think that keeping that protein around 25%, keeping the fat around something like 40%. What does that leave? 35% probably for carbohydrates. So, I do think about a third of your diet at carbohydrates is fine. It’s probably 100 grams or less is probably going to be about 100 grams a day for most people is great, and that’s three. It’s a serving of berries. It’s a half a sweet potato. It’s one serving of rice. It’s the right amount.

Dr. Weitz:            And I saw in your book you also talk about keto cycling as a way to sort of integrate some keto diet into your-

Dr. Axe:               I think for some people if they sort of liked being on keto but they wanted sort of a break, to be able to go out with friends and be able to do something long-term, keto cycling can be great. It’s sort of carb cycling meets keto diet. My wife actually did this. I hadn’t thought of it necessarily until my wife said, “Hey, I’m going to try this.” She did keto 30 days and then she started doing sort of these just a carb day every third day. And she said she actually felt better doing that than actually full-on keto, and she actually, the result she saw were just as good and long-term, better. She noticed, and my wife is a chiropractor. She’s a fitness instructor, yoga instructor. She’s super healthy. But she ended up losing just a few… Just leaning out a little bit more and getting her body to kind of ideally where she wanted it to be doing that. So I think the keto cycling as we cover in my book, is a great thing for a lot of people to do.

Dr. Weitz:            Cool. Well, thanks for the interview, Josh. How can our listeners get a hold of you and find out about your books and your supplements?

Dr. Axe:                Sure. Well, you can follow me on Instagram, Facebook and draxe.com. Here’s the new book that just recently came out, Keto Diet. You can see it here. You can buy it on amazon.com. In fact, it’s been ranking as one of the top-selling health books the past three months. International best seller. But in this book, we have 80-plus recipes, 30-day meal plan, and also a keto cancer plan and others. So people can check out this book here, and check it out on Amazon, read some of the reviews there we have. And then-

Dr. Weitz:            No, I read it.

Dr. Axe:                Awesome.

Dr. Weitz:            It’s an easy read. It’s great.

Dr. Axe:                Awesome. And then draxe.com. It’s D-R-A-X-E dot com, my website. But I want to say, Dr. Ben, thanks so much for having me on your show.

Dr. Weitz:            Thank you so much, Josh, Doctor Axe.

Dr. Axe:                All right, God bless.



Cancer Related Fatigue with Dr. Lise Alschuler: Rational Wellness Podcast 106

Dr. Lise Alschuler discusses Fatigue in Cancer Patients with Dr. Ben Weitz.

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


Podcast Highlights

1:45   Fatigue in cancer is under reported, underdiagnosed, and undertreated.  That’s because cancer doctors tend to focus on patients pain and tend not to pay attention to fatigue even though many patients report that the fatigue is their most distressing symptom. 

3:33  Cancer related fatigue is a very severe fatigue and not the kind of fatigue that you can sleep off or easily recover from. 80% or more of cancer patients suffer with this type of fatigue. Dr. Alschuler explained that “from a functional perspective, we would think of this kind of fatigue as the fatigue that is happening on a cellular or even mitochondrial level and, has really gotten to a point where it’s influenced our endocrine system. So, it’s obviously going to take quite some effort to get people out of this type of fatigue.” And for up to 50% of these patients will have this fatigue for years after the cancer is gone, and this where a Functional Medicine approach can be helpful.

5:22  Dr. Alschuler feels that most of the fatigue is related to the cancer more so than the cancer treatment, though the treatment adds to it. The mechanism is the release of inflammatory cytokines by the cancer cells or the stromal response around those cancer cells, like Tumor Necrosis Factor alpha (TNFalpha) and Interkeukin 6.  This is the initial cause of the fatigue and one of the next phases of cancer related fatigue is the circadian rhythm disruption and the hypothalamic/pituitary/adrenal access dysfunction that occurs.

7:06  Sleep is very important in being able to recover from cancer and many patient have their circadian rhythm and their normal sleep cycle disrupted, so you want to help the patient to reinstate their circadian rhythm and their normal sleep pattern.  We’ve discovered clock genes, which occur in every cell in our body and they are tied to our circadian rhythm.  These clock genes are also involved in really important things like cellular repair, cell cleanup, autophagy, so we want to have our circadian rhythm in tact. Dr. Alschuler will often measure the adrenal stress profile with the cortisol awakening response.  She will also measure cytokines, including C Reactive Protein and Interkeukin-6, which are acute phase reactants, 11-Dehydrothromboxane B2, which is a measurable metabolite of the arachidonic acid LOX and COX pathways, and 8-hydroxy-2-deoxyguanosine, which is a good indicator of oxidative stress.

12:46  Cancer and chemo both result in a lot of oxidative stress on the body, so everybody who goes through cancer and cancer treatment will be depleted of antioxidants. They need some antioxidant repletion either from antioxidant supplements or from a good plant based vegetable and fruit diet. The oxidative stress contributes to the HPA hypothalamic/pituitary/adrenal/circadian rhythm dysfunction, as well as a contributing factor to mitochondrial dysfunction, both of which are related to fatigue.

13:45 It is understood that chemotherapy and radiation use oxidative stress (free radicals) to kill cancer cells and we need to be careful about recommending antioxidant supplements while treatment is occurring.  We now have a lot of data to be able to determine which particular nutritional supplements might help or interfere with specific chemo drugs.  But it is a different story with the newer targeted drug therapies of cancer, like the molecular based, antibody based, or immuno therapies and new drugs are being released quite often. And we are still learning whether there might be interactions with natural therapies. We need to understand how each of these drugs work and how they are metabolized and then try to figure out if there is a likelihood that there might be an interaction between a given supplement and a targeted treatment. 

21:44  The best type of diet for patients with cancer is the one that is going to lower inflammatory cytokines. Intermittent fasting for 13 hours helps to lower inflammation. Fasting for a day or two before, on the day, and the day after chemo infusions helps to minimize toxicities, esp. to the digestive tract, and may improve their energy a bit.  While cancer patients should avoid a high carb diet, they shouldn’t necessarily follow a ketogenic diet.  But should make sure that they get plenty of healthy fats like omega 3 fats, though one recent study found that soy oil was better than fish oil in reducing cancer related fatigue:  Multicenter randomized controlled trial of omega-3 fatty acids versus omega-6 fatty acids for the control of cancer-related fatigue among breast cancer survivors.  Coconut oil and MCT oil also reduce cancer-related fatigue. The effects of virgin coconut oil (VCO) as supplementation on quality of life (QOL) among breast cancer patients. Dr. Alschuler also recommends that cancer patients consume high quality proteins like legumes, tofu, seeds, nuts, eggs, grass fed or wild meats, fish, and organic poultry.  When it comes to consuming legumes and seeds, one prominent Functional Medicine doctor–Dr. Steven Gundry–has been claiming that the fact that these foods contain lectins is a problem for our health.  In advocating consuming legumes and seeds I asked Dr. Alschuler if she worries about lectins and her response is “You know, there’s many thing’s we can worry about but, no, lectins hasn’t made my list recently.”  Dr. Alschuler also recommends branched chain amino acids, which have been used in several studies that show benefit for cancer-related fatigue. 

27:18  Recommended nutritional supplements for cancer-related fatigue include:  1. Panax quinquefolius (American Ginseng) when taken at a dosage of 2 gms per day during cancer treatment and continued for 8 weeks after reduces cancer-related fatigue.  2. Rhodiola rosea is an adaptogenic herb that makes cancer patients more energetic. 3. Ashwaganda is also an adaptogenic herb that may be helpful. 4. CoQ10, esp. the ubiquinol form helps with mitochondrial support, 5. Reduced Glutathione can help support the mitochondria, 6. L-carnitine helps with fatigue at a dosage of 4 gms per day, though if the patient is on ataxane chemotherapy it can make peripheral neuropathy worse and 7. Acetyl L-Glutathione may be better for both fatigue and also cardiovascular support. 

32:14  Exercise is important in rebuilding the mitochondria and their functionality.  Exercise also helps to increase hypothalamic/pituitary/adrenal resilience and reinstate the normal circadian rhythm.  It is beneficial to do a combination of aerobic and resistance exercise for at least 45 minutes per day at a level that is moderately strenuous.

34:02  Some organic coffee with caffeine or green tea can stimulate sympathetic nervous system responsiveness and help reinstate normal circadian rhythm and enhance cognition.  And both coffee and tea are inversely associated with cancer risk.


Dr. Lise Alschuler is a Naturopathic Doctor with board certification in Naturopathic Oncology and she was past president of the Oncology Association of Naturopathic Physicians. She is the executive director of TAP Integrative, a nonprofit educational resource for integrative physicians. If you use the discount code WEITZ you can subscribe for only $99 for the year.  Dr. Alschuler wrote The Definitive Guide to Cancer and The Definitive Guide to Thriving After Cancer. She sees cancer patients in Scottsdale, Arizona and is a sought after speaker at conferences around the world and she co-hosts a ratio show, Five To Thrive Live! on the Cancer Support Network. Her website is DrLise.net.

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


Podcast Transcript

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness Podcast. Bringing you the cutting edge information on health and nutrition from the latest scientific research and, by interviewing the top experts in the field.  Please subscribe to the Rational Wellness Podcast on iTunes and YouTube. And, sign up for my free ebook on my website by going to doctorweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcasters. Thank you so much for joining me again today, and for those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and review. That way more people can find out about the Rational Wellness Podcast.

Our topic for today is fatigue and cancer with Dr. Lisa Alschuler. The National Comprehensive Cancer Network says that, “Cancer related fatigue is a distressing, persistent, subjective sense of physical, emotional and, or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.”  Pain is very common in cancer and, up to 80% of patients receiving chemotherapy or radiation and, cancer survivors report that fatigue is a disruptive symptom months and even years after treatment ends. I meant to say, fatigue is a common symptom in cancer. Fatigue in cancer is under reported, underdiagnosed, and undertreated.  That’s because cancer doctors tend to focus on patients pain and tend not to pay attention to fatigue even though many patients report that the fatigue is their most distressing symptom.

Dr. Lise Alschuler is a naturopathic doctor with board certification in naturopathic oncology, she was past president of the oncology association of naturopathic physicians, she’s executive director of TAP Integrative, a non-profit educational resource for integrative physicians, which I use regularly and very, very helpful.  They have tons of great educational videos and other information, and the service also includes free retrieval of full journal articles all for the price of the annual membership, which I take full advantage of.  Dr. Alschuler wrote, The Definitive Guide To Cancer and, The Definitive Guide To Thriving After Cancer, and The Definitive Guide To Cancer is just an amazing resource and, anybody who sees cancer patients, you have to have that book as a resource.  Dr. Alschuler sees cancer patients in Scottsdale, Arizona, she’s a sought after speaker at conferences around the world, she co-hosts a radio show, Five To Thrive Live on the cancer support network and, she’s also a cancer survivor herself.  Dr. Alschuler, thank you so much for joining me today.

Dr. Alschuler:                     My pleasure, Dr Weitz. It’s nice to talk to you again, its been a while so, looking forward to it.

Dr. Weitz:                          Absolutely.  So, what are some of the reasons that cancer patients get fatigue?

Dr. Alschuler:                     You know it’s a really, first of all, I want to just emphasize the introduction that this kind of fatigue is not the kind of fatigue that maybe we all think of. Like, the fatigue that we get when we’re working too hard and, we just need to sleep in on the weekends and then, we kind of wake up rejuvenated. This is not a fatigue that people can sleep off, it’s not something they can recover from, it’s a very debilitating fatigue and, it’s associated, actually, with anxiety, with depression, with cognitive dysfunction. It’s a very, so, it’s a very deep seated fatigue.  I think, from a functional perspective, we would think of this kind of fatigue as the fatigue that is happening on a cellular or even mitochondrial level and, has really gotten to a point where it’s influenced our endocrine system. So, it’s obviously going to take quite some effort to get people out of this type of fatigue.  But, so I just wanted to really emphasize this type of fatigue is quite different and, as you said, the majority of people going through cancer and treatment, upwards of 80% have this kind of fatigue. It may not be severe, it may be sort of mild but, even mild cancer related fatigue is pretty significant and, some people fortunately probably over half do kind of spontaneously, as we would say, their innate healing process takes over and they can overcome the fatigue, maybe six months out from their diagnosis but, the rest can have it for years and, years and, years.  So, this is something, I think, our prime opportunity for integrative practitioners to really jump in on. And now that I’ve taken us on this tangent, I don’t even remember your question.

Dr. Weitz:                          That’s great.  How much of fatigue do you think is related to the cancer versus the cancer treatment?

Dr. Alschuler:                     Yeah, I think that the majority of fatigue is related to the cancer and, I think that the treatment is basically jumps onto that.  The reason I say that is, because there seem to be some emerging underlying mechanisms that are becoming commonly accepted. So, one is, that there’s clearly a cytokine aberration in cancer related fatigue. We think that it probably is, that sort of the main culprit is high levels of Tumor Necrosis Factor Alpha and, then along with that, of course, that Interleukin six, those two, when they’re in high levels, the classic symptom is fatigue.  So, there’s definitely something to do with cytokines and cancer when you have the malignancy, there is cytokine aberrations as a result of the malignancy, either the malignant cells are secreting these cytokine’s in high levels because of up-regulated NF Kappa B in those cells or, and, or the stromal response in and around those cancer cells, there’s a high level of inflammation.  So, I think it’s mostly the cancer but, you take that kind of inflammatory, simmering mix and, you throw some chemo in there and, you’re just going to aggravate those inflammatory cytokines.  One of the next phases of cancer related fatigue then is, the circadian rhythm disruption and the hypothalamic/pituitary/adrenal access dysfunction and, that system, as we know, is also very sensitive to cytokine induced oxidative stress. So, I think that that’s kind of a secondary event in the continuum of cancer related fatigue. 

Dr. Weitz:                           So, you mentioned the circadian rhythm and, cancer patients often have trouble sleeping, either as a side effect of treatment or, due to stress or, due to other factors. What role does sleep play in this?

Dr. Alschuler:                    Yeah, it’s a really important point.  So, as I mentioned earlier, if somebody has cancer related fatigue and, they just say, “Okay, I’m just going to sleep for eight hours a night,” they still may have cancer related fatigue if the mitochondrial dysfunction is not addressed, if the inflammation isn’t mitigated and, if the circadian rhythm isn’t reinstated.  That being said, all those three things won’t do anything for somebody if they’re not sleeping so, sleep is essential, it’s an essential component to recovery and, as you mentioned, a lot of people go through this disease and treatments because their circadian rhythm is so disrupted and, so shifted their sleep cycle gets very disrupted as well.  So, one of the key cornerstones, if you will, of addressing recovery and survivorship is to reinstate circadian rhythm and, as a component of that, sleep.

Dr. Weitz:                            So, let’s say the person normally wakes up every day at 6:00 or 7:00 or, 8:00 in the morning, goes to work, goes through their day, et cetera, et cetera. Now they get cancer and, maybe they’re off work and, their schedule changes so, it kind of throws their circadian rhythm off. Is it better for them to just go back to waking up every day at 7:00 and, having their regular schedule? Is that something that’s beneficial?

Dr. Alschuler:                     Yeah, I think it is. There’s, you know, now that we’re learning more about the circadian rhythm, I think that we understand how sensitive it is to what I call, ritual and rhythm and, the more ritual and rhythm we have in our day-to-day lives, the easier it is for us to have a healthy circadian rhythm.  And, remember, that even within the last 10 years, we’ve just now discovered clock genes, which occur in every cell throughout our body, are directly tied to the circadian rhythm. They only function or turn on in accordance with the circadian rhythm and, most of the genes controlled by clock genes are involved in really important things like cellular repair, cell cleanup, autophagy, so we want to have our circadian rhythm in tact for lots of reasons, that being the primary one.  So, yes, to go back to your question, if somebody had kind of a rhythm, ideally a rhythm that were used to, now they’re off work, their rhythms kind of all crazy, it would really be helpful to try to go back as closely as possible to what they had before, assuming that that rhythm was optimal for them.

Dr. Weitz:                            When you’re treating a patient who has cancer related fatigue, do you, when you work them up, do you try to sort through which, you know, what are some of the causes of the fatigue?  Like, for example, do you measure cytokine’s, are there certain questionnaires you use?  Do you try to figure out how much is hormonal, how much is related to different factors in coming up with a treatment plan?

Dr. Alschuler:                     Yeah, I often do.  You know, not 100% of the time if I have a good kind of, I don’t know if it’s intuitive hit or, just having done this for a while hit but, if I’m really wanting to be very precise then, yes.  So I’ll do an adrenal stress index test and measure cortisol at four points over the 24 hour period. Get a really good sense of their cortisol awakening response, as well as their full circadian rhythm and then, I do often …

Dr. Weitz:                            That’s just, that’s the new part of the adrenal stress test, is the cortisol wakening response where you are measuring how their cortisol changes in the first 30 minutes after awakening.

Dr. Alschuler:                     Yeah, haven’t seen a normal one yet but, I’m still holding out for it.  But, I think it is important, this is really actually a pretty substantial body of literature just on cortisol awakening response in relationship to depression and, anxiety and, all sorts of things.  So, yeah, adrenal function, for sure. I do measure cytokine’s for this purpose and also, just as a way to assess, to some extent, what’s the milieu of this person like so that I have a, kind of I can determine whether or not they are more or less at risk for occurrence.  So, for cytokine’s, I will most commonly measure include C reactive protein as an acute phase reactant, Interleukin 6, I definitely look at and, those two alone are usually enough to do it. There’s another inflammatory test that I have started to use quite a bit, it’s a urine test and, it measures 11-Dehydrothromboxane B2, which is a measurable metabolite of the arachidonic acid LOX and COX pathways.  So, it’s a very important way to assess the eicosanoid side of inflammation, and then the CRF and the IL-6, sort of measure the genetic side of the inflammation, the NF Kappa B, up regulation side so, all that together can give me a pretty good sense of what’s going on.  And then sometimes I might also look at, see if there’s any evidence of oxidative stress, which would be another indication of the fact that there’s up-regulated inflammation so, looking at 8-hydroxy-2-deoxyguanosine would be kind of my go to.

Dr. Weitz:                            Okay so, oxidative stress means that there’s not enough antioxidants to block some of the excessive oxidative stress.  And, of course, oxidative stress is often part of the chemotherapy if they’re getting chemo.

Dr. Alschuler:                     Yeah, most everybody who goes through cancer and its treatments will be depleted from an antioxidant perspective at the conclusion of that treatment.  So, typically, some degree of repletion is necessary.  It doesn’t necessarily have to be supplementation, a good plant based vegetable and fruit rich diet can restore people’s antioxidant capacities but, yeah, it’s very common and, that oxidative stress is a contributor to the HPA hypothalamic/pituitary/adrenal/circadian rhythm dysfunction, as well as, a contributing factor to mitochondrial dysfunction, both of which, as we talked earlier, are related to fatigue.

Dr. Weitz:                            I know we’ve discussed this in the past but, where are we in terms of the use of antioxidants during cancer treatment?

Dr. Alschuler:                     You know, again, I think that the controversy, I will say is a little bit muted right now and, maybe because we’re starting to get a little bit more savvy and realize that when you say, antioxidants, we’re talking about such a large and diverse group of compounds, some of which are problematic with certain chemotherapy agents or, certain radiation treatments, some of which are actually very helpful.  So I think we have to sort of say, the question shouldn’t be, are antioxidants safe or not? The question should be, can I use X, Y or, Z?

Dr. Weitz:                            Right.

Dr. Alschuler:                     Then we have data now to answer that very specific to the actual treatment that somebody’s getting, the cancer type even and, figure out, yeah, you were a prime candidate for using this antioxidant or, nope, this is not good for you.

Dr. Weitz:                            Okay, good, good, good.  And, does that apply to the newer drugs, the targeted drugs?

Dr. Alschuler:                     So, you know, as you mentioned, cancer treatment is changing and, hopefully, some day, chemotherapy will be a thing of the past but, we’re not quite there yet.  But, more and more we’re moving towards molecular based therapies or, antibody based therapies or, immuno therapies so, these all target tumors in one way or another by either, capitalizing on a genetic aberration in the cancer and targeting that very precisely or, by stimulating our own innate healing mechanisms, like the immuno-therapies are essentially un-breaking the immune system to attack.  And, we’re getting a lot more sophisticated with all this now. Because this is all new and, it’s happening so fast and, there’s new drugs in trial all the time, we, in the integrative space, are playing catch up, for sure and, we just are really in a place of trying to understand what we have that’s helpful, not contraindicated.  Generally speaking, this is an area where it would really be important to be under the care of an integrative practitioner with an expertise in integrative oncology because, like even me, when I had a patient that, and that’s all I do is, integrative oncology and, when I have patient, I get patients every week with new drugs I haven’t heard of so, I have to go, I have to research the drug and, really understand its mechanism, it’s metabolism and then, I have to apply that with a knowledge of it’s side effect profile, figure out what I have to use, see if there’s any potential for a reaction and, be very cautious around that whole thing. So, it takes a lot of time and effort so it’s not, you know, we’re still learning, that was a long-winded answer.

Dr. Weitz:                            You know, I was looking at some studies on some of this stuff and, a couple of the papers were mentioning the part of the cytochrome P450 pathway that this nutrient affects and that could interfere with this drug. And you start going, oh my God, you can’t take this, you can’t take that and then you start looking at the drugs and you realize that this cocktail of cancer drugs are actually interfering with each other.  And, you know, nine other things that they’re taking to control their blood pressure and, everything’s interacting on these cytochrome P450 pathways and so, it occurs to me that, if you use that as the basis for not eating something, it’s way to complicated to use that as a rule out, don’t you think?

Dr. Alschuler:                     Well, I think, so eating for sure but, I think that with supplements the challenge is that, so, yeah so, first of all, a good practitioner, conventional practitioner will do a drug/drug interaction check when they’ve introduced chemo to make sure, because, and sometimes I’ve seen patients get pulled off of pre-existing antihypertensive drugs, or whatever, because of potential interaction.  That being said, there are some that are left but, the degree of the interaction can really vary so, it may have a little reaction but, it’s not clinically significant. So a lot of the nutrients in herbs, the data we have is pre-clinical and, that has almost no relevance to what happens in the human.  So, really, I look for human pharmacokinetics studies so that I can see, is there really a potential for interaction here?  And, that being said, if somebody’s on a small targeted molecule type of therapy, which has a very small dose and, a very narrow, kind of a very, the blood dose, the concentration that is targeted is very narrow, I don’t want to mess with that because, if I mess with that, I could run the risk of increasing side effects and, you know, who knows what.  So, you know, in general it’s best to be cautious with drugs that have a high percentage of toxicity.

Dr. Weitz:                          Right, okay.  So, back to the fatigue. What role does anemia play, which is a common side effect of a lot of chemo?

Dr. Alschuler:                     Yeah so, it’s a really good point.  So, generally speaking, when we’re talking about care to related fatigue, that’s, in medical kind of perspective, that has the assumption that we’ve ruled out known causes of fatigue.  So, if somebody comes to treatment, I’m tired, you need to check, are they anemic, do they have thyroid dysfunction or, are there any other obvious causes of fatigue and, obvious nutrient deficiency, for example? Address all that and, if that takes care of the fatigue, we’re good, if they’re still tired, then they have this cancer related fatigue.

Dr. Weitz:                            Do you have a certain panel you like for assessing nutrients because, there’s a lot of controversy as to the best way to assess nutrients because, a lot of times just serum levels are not indicative of tissue levels, et cetera.

Dr. Alschuler:                     Yeah so, I don’t run serum vitamin levels except for vitamin D and, vitamin D deficiency is associated with fatigue so, that’s one that we want to check.

Dr. Weitz:                          Right.

Dr. Alschuler:                     I do look at red blood cells zinc, red blood cell magnesium, I think those are very accurate and nice reflections.  To get at B vitamins in general, I typically run a urinary organic acids test.

Dr. Weitz:                          Okay.

Dr. Alschuler:                     Yeah, which kind of looks at the metabolites from the TCA or the Krebs cycle where, we use the vitamins to make energy so we can tell by the ratio of metabolites whether we’re lacking certain B vitamins or, we have kind of a blockage in that pathway.

Dr. Weitz:                          Yeah.  Have you used the NutrEval? Do you like that test?

Dr. Alschuler:                     I have ordered that on occasion and I think that it is, it provides a really broad view of nutrients, nutrients status so, I think it can be helpful.  I’m not 100% sure and, this could just be my ignorance, the data but, I’m not 100% sure that that snapshot in time is truly representative of an ongoing functional deficiency that’s related to symptoms or, pathology.  So, I’m not sure how actionable some of that information is. And there’s always a range so like, what’s really the cut off? You start to, what indicates, yes, we need to give this person this supplement.  So, I still have some questions around that but, I think it could be a guide.

Dr. Weitz:                          Yeah, because it includes an organic acids and then, there’s also some red blood cell minerals and so, throw in some other stuff.  So, what type of diet?  So diet is very controversial when it comes to cancer and, when we have patients with cancer with fatigue, you want to make sure they’re getting the right nutrients to give energy. We often think of carbohydrates for energy but, these days, one of the more popular strategies for dieting cancer is to use a lower carb approach, a ketogenic approach, maybe intermittent fasting.  What’s your take on that?  How does that interact with fatigue?

Dr. Alschuler:                     Yeah, excellent question.  So, with cancer related fatigue, again, because it’s primarily a cytokine disorder, the diet interventions that are going to lower inflammatory cytokine’s are going to be the ones that would be most effective.  So, for example, intermittent fasting, we know lowers CRF, sorry, high sensitivity to reactive protein. So, we know that when we intermittent fast, we lower inflammation in the body so, that’s a perfect dietary strategy for somebody with cancer related fatigue. My goal is 13 hours as an overnight fast, anything above that, bonus but, 13 hours is kind of the magic number from a research perspective. And then, beyond that …

Dr. Weitz:                          What about fasting, some clinics are recommending fasting the day of chemo, maybe the day before, the day after or, some level of complete fasting all centered around when they get their chemo.

Dr. Alschuler:                     Yeah, so that’s kind of a separate strategy in terms of minimizing some of the toxicities from the chemo, particularly to the digestive tract.  It does appear, maybe, in some people to also improve people’s energy a little bit within the time of getting chemo, whether that has any impact on post treatment, cancer related fatigue is, to my knowledge, not known. I haven’t personally observed a strong correlation there. But, it may, I don’t know.

Dr. Weitz:                          Okay. I’ve thrown you off track.

Dr. Alschuler:                     Yeah, no, that’s fine.  But, yeah, post treatment, I think, intermittent, overnight fasting, definitely. I would not go for a high carb diet unless you’re talking about complex carbs from vegetables through whole grains but, simple carbs, although they give us immediate energy, are very oxidative over time.  So, that’s going to worsen the cancer related fatigue. So, really what’s more important is, two things. Number one, fats and, it doesn’t have to be necessarily a ketogenic diet but, we know that omega three fatty acids and, actually there was a very recent study that somewhat surprisingly found that soy oil was more effective than fish oil in reducing cancer related fatigue.

Dr. Weitz:                          Really?

Dr. Alschuler:                     Yeah, which is kind of crazy that they attributed that to the soy oils content of omega six and omega nine.

Dr. Weitz:                          What?

Dr. Alschuler:                    And that that had a decreasing effect on tumor necrosis factor alpha.  Kind of interesting, I don’t know, its just sort of an outlier for me but, I think really what it speaks to is, we need good fatty acids, that our body needs.

Dr. Weitz:                          Was that study funded by the American Heart Institute?

Dr. Alschuler:                     No, I don’t think so.

Dr. Weitz:                          Okay.

Dr. Alschuler:                     And, the other things so, fatty acids so, fish derived fatty acids for sure.

Dr. Weitz:                          Coconut oil, MCT oil.

Dr. Alschuler:                     Coconut oil, yes.  I think that, actually, has been studied and seems to improve cancer related fatigue.  And then, protein, you know, people really need a lot of protein. The range, generally is, just for an average person is like point 0.6 to 1.2 kilogram or, grams of protein per kilogram of body weight so, after treatment, I go to the high side of that. 1.2 grams of protein per every kilogram of body weight and, try to get people eating really high quality protein.  And so, high quality protein, high quality fats, overnight fast, from a dietary perspective, are kind of the keys and then …

Dr. Weitz:                          When you say, high quality protein, you’re advocating animal products, right?

Dr. Alschuler:                     I’m fine with animal products, you know, I think that if so, high quality proteins for me, for my vegetarian perspective include, legumes, tofu, seeds, nuts, eggs. And then, from my non-vegetarian perspective, grass fed or wild meats, fish, organic poultry.

Dr. Weitz:                          Okay.  You worry about lectins?

Dr. Alschuler:                     You know, there’s many thing’s we can worry about but, no, lectins hasn’t made my list recently.

Dr. Weitz:                          You mentioned protein, I saw one of the studies used branched chain amino acids as part of the protocol.

Dr. Alschuler:                     Yes. I think branched amino acids are really helpful for cancer related fatigue and, I think that that’s probably where supplementation is the easiest way to get that in.  So, getting a protein powder with a good whey or, amount of branching amino acids, people can really subjectively feel the difference pretty quickly with that.

Dr. Weitz:                          So, which nutritional supplements can be beneficial for patients with fatigue, cancer related fatigue?

Dr. Alschuler:                    So, from a, there are many, first of all and, the first thing that comes to mind, of course, when we’re thinking about circadian disruption are, adaptogenic herbs. And there was actually a really nice study that was done using Panax quinquefolius so, American Ginseng, specifically on cancer related fatigue and, they started the Panax quinquefolius, it was, I think two grams a day during the treatment, and then they continued it beyond treatment for eight weeks and, there was a substantial reduction in the degree and, the severity of the fatigue and people taking the Panax quinquefolius and so, that really just speaks to the role of preserving the circadian rhythm, which is one of the things that these adaptogenic plants do.  So, I use Panax quinquefolius, American ginseng, often. I also use an adaptogen called, Rhodiola rosea, which is, although adaptogens aren’t sort of like energy pills, there are some adaptogens, which are a little more energetic than others and, so Rhodiola is one.  It just really increases people’s physical stamina, their mental clarity so, I find that very helpful.

And, there’s also adaptogenic blends, which work beautifully for people. If people are really depleted, really depleted coming out of therapy, I’ll probably start a little more gently, something like, ashwagandha and, you often dose that at night because, it has a little bit of a sedative effect to it.  So I definitely use that. Then I think about mitochondrial support and, you know, mitochondrial support can get very complicated but, I think, fundamentally, CoQ10 is critical and, I happen to favor, ubiquinol as the form of CoQ10 and, I dose it pretty aggressively so, I’m giving people 100 milligrams, two or three times a day to really try to get their CoQ10 levels up and, to try to improve their mitochondrial health. Because, the mitochondria themselves become oxidized and, they need to get that redox balance back.  Along those same lines, I’m also a fan of glutathione and I will use glutathione, reduced glutathione post treatment.  That’s not something I use concurrent with treatment but post treatment, to help replete people’s redox potential or, antioxidant levels. Typically dose that in the morning and, that can be quite helpful for people too. And, that supports, of course, mitochondrial function.

Dr. Weitz:                          You like a liposomal form?

Dr. Alschuler:                     You know, I don’t need a liposomal form, actually, there’s some good data by a researcher, by the last name of Ritchie, at Pennsylvania, Hershey State, the University of Pennsylvania, I can’t quite get his university quite right but, he really eloquently demonstrated that glutathione is very well absorbed orally and, it increases glutathione levels in various bodily compartments in accordance with the dose. Doesn’t need to be liposomal.  Liposomal, I think, probably does enhance the glutathione absorption even more so, especially if there’s compromised intestinal integrity, which often is another sequelae of chemo, for example or, radiation, then liposomal might be even better.  But, you know, it’s a cost issue, whatever, I think just straight up, reduced glutathione works well.

Dr. Weitz:                           L-Carnitine?

Dr. Alschuler:                     Yeah so, L-Carnitine’s a good one, you know it’s been studied and it for sure reduces fatigue, particularly kind of muscle fatigue.  And it’s particularly good for people who have had radiation and, L-Carnitine is effective but, it needs to be dosed the four grams a day. Anything less than that just doesn’t work.  The challenge with L-Carnitine is that, if somebody’s had ataxane chemotherapy, it can make peripheral neuropathy worse. So it’s contraindicated in people who have had ataxane chemotherapy.  Other people seem to do fine with it.

Dr. Weitz:                          Is that just Acetyl L-carnitine or, does it not matter?

Dr. Alschuler:                     No, it’s all of it, all carnitine and acetlyl L-carnitine.

acetlyl L-carnitine is the one that I use when I want to address the fatigue and I’m also concerned about heart function, which I didn’t really speak about, it can be another contributor to fatigue. There are some cardio-toxic both chemo’s, some radiation and, even in these targeted therapies or, hormonal therapies that can make it a little harder for the hear to function optimally.  So, supporting heart with CoQ10, acetlyl L-carnitine can be very effective.

Dr. Weitz:                            Good, interesting.  What about exercise recommendations?

Dr. Alschuler:                     Oh, I’m so glad you asked.

Dr. Weitz:                            I remember going, I met you at that 2010 Institute of Functional Medicine conference about cancer and, I think Keith Block showed a video of patients rollerskating attached to their getting their chemo infusion at the same time and, he had a treadmill in his office and the patients were on the treadmill getting their infusions.

Dr. Alschuler:                     Yeah so, exercise is absolutely critical.  So we know that exercise rebuilds mitochondria and rebuilds their functionality. We also know that exercise helps to increase hypothalamic/pituitary/adrenal resilience or, reinstate circadian rhythm. So, I’m very specific about my exercise recommendations for cancer related fatigue.  So, most people are very tired and it’s hard to exercise so, I talk to them about figuring out where their fitness level is, being right on the edge of their fitness, exercising at that edge and then, continuing to move that edge out so that they’re getting more and more fit.  But they have to be reasonable, start where they are and then just keep pushing.  So, that exercise, as I say, should always be fun and never really easy.  And, what we know from a data perspective is that, people who exercise aerobically and, actually a combination of aerobic and resistance exercise, it seems to be for at least 45 minutes a day, at a level that’s moderately strenuous or, strenuous to them, at least five days a week, have a much lower duration and severity of cancer related fatigue.  So, exercise is absolutely an evidence based, very effective recommendation.

Dr. Weitz:                          Great.  What about a little bit of caffeine from organic coffee or, green tea?

Dr. Alschuler:                     Yeah, I’m all about it.  Not only because caffeine in, as you said, a little bit so, you know, in the morning, not kind of getting too much stimulation to the nervous system towards the end of the day but, in the morning, caffeine not only helps to in some ways actually reinstate circadian rhythm by creating that sympathetic nervous system responsiveness but, caffeine and coffee, both and, tea, are inversely associated with cancer risk for almost every cancer that we study.  So, coffee drinkers have a lower risk of occurrences, therefore and, plus, from a botanical perspective, coffee has been used to address people with mental fuzziness so, it’s a cognitive enhancer and, that’s one of the symptoms of cancer related fatigue.  So, coffee’s also going to help stimulate cognition.  So, yes, I think it’s actually very medicinal suggestion.

Dr. Weitz:                          Great so, thank you so much for spending some time with us, Dr. Alschuler. How can listeners get a hold of you to find out about your programs?

Dr. Alschuler:                     Yeah.  Well thank you for having me, first of all and, I’ll give a couple of things for listeners.  For practitioners, you mentioned TAP Integrative, I really encourage you to check it out. TAPintegrative.org. And, if you use the code, WEITZ, then you get your membership for only $99.00 which is an awesome deal.  Clinical protocols and all that stuff and, Dr. Weitz doesn’t make any commission on that, just so you know, it’s just, it’s because we love him.  So, yeah, TAPintegrative.org, you can send, find me on that site as well. There’s place to shoot an email there.

And then, for patients, I think you mentioned our radio show, which is, Five to Thrive Live and, that’s now streamed on iHeart and, Spotify and, so that’s easy to find.  And then we have a personalized online cancer survivor program, which I really encourage people to check out. It’s actually available now through AICR, which is really cool and, you can also find it directly on, ithriveplan.com.

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

Dr. Alschuler:                     Thank you.



The Mitochondria in Complex Illness with Dr. Eric Gordon: Rational Wellness Podcast 105

Dr. Eric Gordon discusses The Role of the Mitochondria in Complex, Chronic Illness with Dr. Ben Weitz.

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


Podcast Highlights

2:07  According to Dr. Gordon, understanding chronic illness requires a larger perspective than the traditional one of finding the triggering event, removing it and then the body heals and we’re back to health. Chronic illness is not often an isolated response to a toxic exposure or an infection. Chronic illness is more a stuck note in a complicated sonata of the interaction between the triggering event and the complexity that’s you. Dr. Gordon explained that complex chronic disease is indeed complex it is difficult to understand for doctors who are trained to find the simplest explanation for a given problem. In philosophy, this is known as Occam’s Razor. Interestingly, Dr. Lawrence Afrin, a former oncologist who’s practice is now focused on patients with Mast Cell Activation, wrote a book on Mast Cell disorders called Never Bet Against Occam.  But when you deal with patients with complex chronic illnesses, there often is not a simple cause. In fact, there may be 10, 20 or even 50 causes.  

8:08  Dr. Gordon explained that the way he got involved with treating patients with complex chronic illnesses is that he tends to believe his patients. Dr. Gordon often sees patients with chronic fatigue (myalgic encephalitis is a preferred term) and with chronic inflammatory response syndrome, which was termed by Dr. Shoemaker, or chronic Lyme Disease. The body ends up in a state of chronic inflammation.

11:58  A number of years ago patients with chronic disease were being diagnosed with hypoglycemia and then it was hypothyroid and then it was adrenal fatigue and then it was candida and then it was Lyme Disease, etc.  Dr. Gordon explains that in these complex, chronic diseases the body is stuck in a pattern of response. This same kind of stuckness also exists at the mitochondria level.

16:37  We’ve always been taught that the mitochondria are the energy producers, but they are also the main modulators of the immune response, which Dr. Robert Naviaux has been writing about.  Dr. Naviaux has written several landmark papers on the cell danger response, which is that cells will turn down the energy production for survival purposes when they sense danger.  If the cells sense that there is a virus in the cell and the virus is starting to reproduce, the cell will turn down energy production and  they will use less oxygen, which means that there will be more oxygen in the cytoplasm, which helps kill the virus. Dr. Gordon pointed out that many of the herbs that we consider antioxidants, like resveratrol and curcumin, are actually pro-oxidants which cause stress to the body and make it stronger. This is in a similar way to how exercise tears down your tissues and then your body rebuilds them to be stronger.  There is a cycle of stress and response.

20:14  I pointed out with all this talk about how fasting creates autophagy, we have forgotten that one of the best ways to create autophagy is with exercise.  Dr. Gordon pointed out that “when the body is in a fed state, it wants to build tissue and when its in a less fed state, like at night when you are sleeping with the fast, your body works at breaking down old tissue and using those parts to rebuild with. But as we get older, if all we keep getting is the signal of fedness and is that we keep old half dead cells alive and we wind up with a whole body burden of half, like people are talking about zombie cells.  Basically, they are cells that are growing and living but they really are not communicating well with each other and they’re not doing the cellular function. Like the liver, they’re in your liver and they’re alive but they are not processing chemicals like they should be. They’re just busy trying to stay alive and so when you exercise, you stress them but if you want to stress your liver cell, you’re better off doing it by not feeding it for awhile.” 

22:22  If you have a patient with adrenal fatigue or hypothyroidism and you support them with dietary changes like getting off gluten and nutrients and possibly hormones, they can get better. If their mitochondria are just not working well, then you can give them mitochondrial nutrients like CoQ10 and carnitine and they will get better. But in these cases of complex, chronic illness, like chronic fatigue, the mitochondria have turned themselves down and changed function and giving them more raw materials to make energy doesn’t work.  The mitochondria have reprogrammed themselves to modulate your immune response.  To stimulate change we can look at it from different perspectives, such as the structural component with chiropractic and bodywork, and the cranial mechanism and the vagus nerve.  In the Functional Medicine world we are trained to figure out what some of the triggers are, like Lyme or HH6 [aka, Human Herpes virus 6, aka HHV-6] or EBV [Epstein Barr Virus] or other viral infections or heavy metals or toxic load, etc. and treat them, and this may help to some extent, but many of these chronic complex patients don’t respond as well as most other patients would.  80% of patients will respond to this type of care, but the chronic, complex cases will not as well, since in some of them the trigger is either gone or not as important anymore.  We have to look at how to treat these patients from different perspectives. Because these chronically unwell patients don’t respond like other patients do to the same treatments, they are often labelled as having psychological disorders, as being depressed. 

32:47  We do not understand these chronic patients and we need to focus on why particular individuals get such severe and long term reactions to some of these diseases like Lyme, which Dr. Gordon feels is ubiquitous, or herpes, which nearly everybody has.  But most of us with exposure to Lyme or herpes don’t get sick.  Everybody gets exposed to mold and heavy metals at some point, but depending upon your biochemical individuality, some people detoxify them, while others get sick.  The challenge is how to analyse each person to see how their genes are being expressed.  We are getting closer to being able to measure a person’s expression of their genes (transcriptomics) and which proteins they are making (metabolomics), so we can see which pathways are most stressed and need supporting.  There is hope for many of these patients but there is no on easy answer.




Dr. Eric Gordon is a the Medical Director of Gordon Medical Associates, a medical practice focused on serving patients with complex chronic illness in Santa Rosa and San Rafael, California.  According to Dr. Gordon, understanding chronic illness requires a larger perspective than the traditional one of finding the triggering event, removing it, and then the body heals and we are back to health.  Chronic illness is not often an isolated response to a toxic exposure or an infection.  Chronic illness is more a stuck note in a complicated sonata of the interaction between the triggering event(s) and the complexity that is you. His website is GordonMedical.com and he has started to see new patients again.

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition. From the latest scientific research and by interviewing the top experts in the field. Please subscribe to Rational Wellness podcast on iTunes and YouTube and sign up for my free e-book on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness podcasters! Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness podcast, please go to iTunes and gives us a ratings and review, that way more people can find out about the Rational Wellness podcast.

Our topic for today is a complicated one. We’re going to talk about the role of the mitochondria in complex chronic illness. The mitochondria is the organelle that’s most responsible for cellular energy and it plays a crucial role in chronic diseases. Every cell in our body contains several thousand mitochondria and mitochondria produce 90% of the energy our body needs to function. Mitochondrial dysfunction is understood as a decline in the ability of the electron transport train to generate high energy molecules like ATP and this is often seen with aging and virtually all chronic diseases. Including neurodegenerative diseases, heart disease, diabetes, autoimmune diseases, autism, bipolar disorder, cancer, chronic infections, chronic fatigue, and fibromyalgia.

Dr. Eric Gordon is the founder and medical director of Gordon Medical Associates. A medical practice focused on serving patients with complex chronic illness in Santa Rosa and San Rafael, California. According to Dr. Gordon, understanding chronic illness requires a larger perspective than the traditional one of finding the triggering event, removing it and then the body heals and we’re back to health. Chronic illness is not often an isolated response to a toxic exposure or an infection. Chronic illness is more a stuck note in a complicated sonata of the interaction between the triggering event and the complexity that’s you. Dr. Gordon thank you so much for joining me today.

Dr. Gordon:        A pleasure. A pleasure Ben. Yeah. It’s good to be here.

Dr. Weitz:          So how did you get interested in treating-

Dr. Gordon:       A stuck note sounds easier to me.

Dr. Weitz:          You seem to have a musical orientation towards health.

Dr. Gordon:        Well, it’s funny. I’m actually tone deaf but I love the complexity of the orchestra and the possibilities. And it’s always been clear to me once I started treating people that it is an orchestration because it’s not … in health and in disease, you rarely have one player that stands out. It really is an interactive whole, and that’s what makes … it makes medicine hard to understand and is why I think doctors fall back on the single cause for the illness routine because that’s how our minds tend to work. We tend to have engineering minds. That’s just the nature of people. The animal. We see a problem, we want to figure out what caused it and the idea that you can have 10, 20, 50 causes for an outcome is difficult for us to get our heads around.

Dr. Weitz:          Absolutely. I was trained in philosophy and in philosophy there’s something called Occam’s Razor and you always prefer the simplest explanation for any problem that you are trying to solve.

Dr. Gordon:        Absolutely. It’s funny because that’s the title of Dr. Afrin’s book on mast cell disorders.

Dr. Weitz:           Oh really?

Dr. Gordon:        Yes. Never Bet Against Occam. And I’ve had this discussion with him, Dr. Afrin, the whole thing … he’s one of the proponents … proponents? Yeah. He’s one of the people who helped introduced us to the concept of mast cell activation syndrome and he got there, just a little quick aside, by looking at being … he’s a very bright man who is an oncologist but he actually would listen to his patients.  So when other doctors, other oncologists had patients that didn’t fit what they thought they should have, they knew that Dr. Afrin would actually listen and try to keep figuring it out rather than just go, “This isn’t in my box. Go somewhere else.” They did send them somewhere else, but they sent them to Larry to think about. And so he started to see these people who had multiple symptoms. They had irritable bowel syndrome. They had asthma. They had migraines. And they had rashes. And maybe they had interstitial cystitis. And he goes, “Why should somebody have five different diseases?”  And being an oncologist, and being familiar with something called mastocytosis, which is a disease, a cancer of mast cells when you make too many of them. Mast cells make histamine and they cause allergy responses, but they also when they make … Histamine is a big part of each one of those things. Irritable bowel, migraines, asthma, interstitial cystitis, inflammation. He thought, “Huh. These people look like the mast cell people.” And he started treating them with anti-histamine medicines and many of them significantly improved. So his point is Occam’s Razor, look for the single … let’s make it simpler. So that being said, I thought that was a brilliant piece of medical detective work. But, that’s really not how the body works though. The body is a symphony where there are … very simple with genetic diseases. One of the reasons genetics has been kind of a lot of noise but not a lot of … hasn’t been as helpful in chronic diseases is because there are only a few hundred genetic diseases and they are very rare that involve one to five genes. Okay?

Most chronic illnesses, heart disease, Parkinson’s, we don’t even know about Parkinson’s but esp. heart disease, we know. There’s hundreds of genes interacting that you wind up there. So, Occam’s Razor doesn’t work so well there. Looking for the simple answer. It does in the things that kill us quickly. An infection that’s overwhelming. But if your body can deal with the infection and it just hangs around, then you’re no longer dealing with the bug, you’re dealing with your biochemical individuality’s response to the bug. And that’s what chronic illness is, is it’s about the individual. Rather than about the population. And that’s why it’s been so difficult to work with. My favorite subject.

Dr. Weitz:          Yeah. You know what? I would like to-

Dr. Gordon:        Let’s go back to mitochondria a little bit.

Dr. Weitz:          Sure. Yeah. Sure. How did you become interested in treating patients with chronic diseases?

Dr. Gordon:        Well, I had that bad habit of, I believe people. Okay? And when you are a doctor, especially when you are in the hospital, you’re used to people who come in and they have a big … like a pneumonia. A gallbladder attack. A heart attack. But lots of them, even when you take care of that, they still feel terribly, and they felt terribly in ways that didn’t make sense to me. Because they didn’t make sense to medicine. They’re again, they’re the people kind of like Dr. Afrin was seeing. They had so many complaints and they had complaints that moved around. One day they had really bad shoulders. The next day they had bad knees. That doesn’t make sense.

Dr. Weitz:            Right.

Dr. Gordon:        We don’t have a … But I believe them. These were people who I didn’t think we’re coming to lie to me.

Dr. Weitz:            Right. I’d like to clarify for those of us out there listening when they hear the term chronic disease, yes, it’s true that chronic disease is like heart disease and diabetes or the predominant diseases of today. But, what we’re talking about is these complex chronic diseases. What you might call the chronic-chronic diseases. There’s acute diseases, like you get an acute infection and you take an antibiotic, it’s over. And then there’s these chronic diseases like diabetes and you have these blood sugar problems and there are strategies that can fix some of these people by following diet, lifestyle, et cetera. And sometimes these strategies work and they’re totally under control. In other cases, maybe they have to be managed. But we’re talking about a third category of chronic patient who have these unexplained diseases.

Dr. Gordon:        Chronic fatigue. I mean people don’t like … people prefer the term myalgic encephalitis or chronic … And I agree because chronic fatigue is insulting to many people because it sounds, “Oh, you’re just tired.” Which is far from it. It’s much … yeah. Much more life defeating than that and intrusive. But yeah, it’s when people are left with inability to function and we don’t know why. Often it’s precipitated by an infection but it doesn’t have to be. It can be a minor trauma, car accidents. I mean just things happen and the body winds up in a state of chronic inflammation and it doesn’t always have to have pain. Sometimes the inflammation is mostly in the brain and in that case, it just might be difficulty thinking and being able to organize your day. I mean, it’s amazing how debilitating these illnesses are.  Now they are often lumped under this chronic fatigue, immune deficiency syndrome or chronic Lyme disease, or post-Lyme. I mean these are all names depends on which doctor you go to. Or, some people they are called CIRS, chronic inflammatory response syndrome. Dr. Shoemaker has put forward. But basically, these are illnesses that we do not understand. We have lots of theories about and thankfully in the last few years, we’re actually beginning to get research which has been quite amazing. So anyway, so those are the people that I work with-

Dr. Weitz:            Isn’t it interesting how there’s almost this chronic disease de jour diagnosis? So, you get a lot of these patients at one time were all being diagnosed as having hypothyroid. And then they’re all being diagnosed as having adrenal fatigue. And then everybody’s being diagnosed as having Lyme disease. And then everybody’s being-

Dr. Gordon:        Absolutely. When I started, everybody had this in these … like I said, in the 80s, it was everybody had candida. Actually, hypoglycemia was the first thing. But what it is is that this is the blind men and the elephant okay? Each thing, number one, there are some patients who that is their problem but this is what they look like. And otherwise, as doctors learn things, the problem with being a doctor is that it’s a, as you know, it’s a very difficult business because you get good at pieces of it. It gets too broad for most people to be good at everything. I mean nobody’s good at everything in this business. So, the tendency is to get better and better at one aspect of it. I happen to have a little ADD so I kind of go all over the place, but that’s why I have people who work with me who really go deep in certain aspects, because there’s just too much to know.  So the problem is that many people who have “adrenal fatigue”, quote on quote, now some of them do. Some of them really are people who are fairly healthy who just overdid it. Okay?  And those folks do great with rest. Graded exercise, proper nutrition. Fix their guts and kind of maybe address their hormone and support them with herbs or some hormones and they do phenomenally.  But, they’re the kind of like the outskirts or the suburbs if you will of the people that I see.  The people that … I used to see those folks.  But the people that I see have failed that, okay?  They kept staying sicker because their system is more stuck, okay?  When you have adrenal fatigue, usually, if you remove the stressor, the body kind of comes back online. Generally.  And with a little bit of support. Okay?  But with these chronic … what I’m calling the chronic complex illnesses, you are now in a system that’s not allowing you to get better. And this goes back. We’re stuck. I hate to use psychological … actually I love to use psychological terms but I always wary of them because these are not psychological illnesses, you know?

Dr. Weitz:          Right.

Dr. Gordon:        I just find that the story that psychology weaves, it’s a little bit like Chinese medicine in the sense that it’s much more fluid and able to explain things that aren’t linear. I mean, because it’s the idea that the body is stuck in a pattern of response and so a great example of that is like behavior. I mean some people have trouble with time. No matter how often, they are always late. They are not doing it on purpose. It’s just how they’re wired. They don’t quite believe … they really think that they can get something done in a minute or five minutes, that’s going to take half an hour, and they just can’t get through their heads that every day they do the same thing. I’m going to be on time and they forget that they got five things to do. They’re not going to do them in five minutes.  So that’s the kind of same stuckness that we have at the mitochondria level.  At the biochemical level in the body, in these chronic complex illnesses. The body is stuck in a behavior, and even when we remove the inciting event, like the infection or the stressor, the body doesn’t turn back on and go back to the health.  And go back to health. It is stuck in a lower level of functioning. But it’s doing that as a survival mechanism. It’s not doing that … it’s just that it’s a survival mechanism that is no longer probably useful as far as we can tell.

Dr. Weitz:          Right.

Dr. Gordon:        So, and that’s where the mitochondria come in because we’ve always been taught that the mitochondria were the energy producers and they are. But also serve as one of the … well, you never know but we believe main modulators of the immune response which is something people haven’t thought about or hadn’t quite put into the words. Dr. Naviaux, Robert Naviaux from the University of San Diego has been writing about this a lot and he’s well … well, well known or should be better known for … He developed a treatment that may work for autism that involves trying to restore how you say … mitochondrial communication with the rest of the cell, or cell to cell communication. But I don’t want to go too far afield. It’s like the mitochondria, when they sense danger, they are … I mean in single cell organisms, and in your body, as soon as they can tell like a virus is in the cell and the virus is starting to use your raw materials to make more virus, the mitochondria sense that and they begin to turn down energy production, okay?  And when they turn down energy production, they use less oxygen and suddenly there’s more oxygen in the cytoplasm, in the material that’s in the rest of the cell, and that creates an oxidative stress that helps kill the virus. And it also gets the nucleus to make proteins that will help kill the virus and at the same time increase oxidative stress and then after a short period of time, begin to make more things like glutathione, and NfKB, which will begin to reduce the oxidative stress. You see, this cycle, there’s a cycle in health. It’s not linear. It’s a circle. Okay? You get … your body gets stressed and then you respond. Like a lot of the herbs that we use. That most of the herbs that we consider antioxidants are actually pro-oxidants, okay?

Dr. Weitz:          We’re talking about things like vitamin C and vitamin E and folic acid and …

Dr. Gordon:        I’m thinking more like some of the herbal things like-

Dr. Weitz:          Resveratrol or carotenoids.

Dr. Gordon:       Especially resveratrol is a good example and-

Dr. Weitz:          Curcumin.

Dr. Gordon:        Curcumin. These things actually cause stress but the body’s response to the stress is stronger, okay? And you make more of the antioxidants, but you need that little stress. I mean just like exercise. I mean, when you exercise, you actually are tearing down, you are disrupting tissues.

Dr. Weitz:          Absolutely.

Dr. Gordon:        And it’s the healing that makes you stronger. And that’s happening … that’s orchestrated by, or conducted by the mitochondria. And it’s a separate function but it’s a dance. The mitochondria are constantly moving between this stance of producing, of using oxygen up or sometimes just not increasing the oxygen content in the cytoplasm to kind of stress the system.

Dr. Weitz:          Right. By the way, I just wanted to go astray a little bit. I wanted to point out that there’s all this talk these days about fasting creating autophagy. Well, guess what? Exercise creates autophagy. That’s how it works. We’ve known about this for a long time. This idea of that you have to do this special kind of fast to get rid of old, damaged cells to create autophagy, exercise.

Dr. Gordon:        Yeah, no, exercise does it. But the problem we have, if it’s just exercise is that if you, for instance, if you take a lot of antioxidants before you exercise, you don’t get the training effect because you got to stress the system. It’s just nice because when the body is in a fed state, it wants to build tissue, and when it’s in a less fed state like at night, when you are sleeping and with the fast, your body works at breaking down old tissue and using those parts to rebuild things with. Because the problem we have is when you are young, and you’re healthy and you’re rebuilding tissue, it’s really great. Those signals for growth are perfect. But as we get older, if all we keep getting is the signal of fedness and is that we keep old half dead cells alive and we wind up with a whole body burden of half, like people are talking about zombie cells.  Basically, they are cells that are growing and living but they really are not communicating well with each other and they’re not doing the cellular function. Like the liver, they’re in your liver and they’re alive but they are not processing chemicals like they should be. They’re just busy trying to stay alive and so when you exercise, you stress them but if you want to stress your liver cell, you’re better off doing it by not feeding it for awhile.

Dr. Weitz:            Right. Okay. Well let’s get back to mitochondria. So how is mitochondrial issues related to this chronic disease cycle?

Dr. Gordon:        Okay. Well I think the big thing is it was kind of like I was saying in the beginning, if you have somebody with quote on quote, “adrenal fatigue” or hypothyroidism or things of that nature, usually if you support them either with the hormones or even better, with lifestyle changes that will allow these things to happen, maybe getting rid of the gluten so you stop causing the inflammatory response in the thyroid, that’s great. But, if … one second. I’ve lost my train of thought there for a second. But when you are in complex disease, what I call the chronic complex diseases, it doesn’t work anymore because the problem isn’t that the mitochondria are low in let’s say CoQ10. I mean CoQ10 is very important in the electron transport train and if you give lots of people like with sometimes with adrenal fatigue, as they’re getting better, CoQ10, carnitine, which helps get the fatty acids into the mitochondria. Those things really help.  But, that’s because their mitochondria are functioning normally and they just needed a little help. But in things like chronic fatigue, you are actually … your mitochondria have turned themselves down for a reason. So it doesn’t matter. It’s like they have locked the door. So it doesn’t matter how much you are giving them, okay? They’re not going to use it and they’ve turned themselves down because they’re trying to … instead of just working right now as a energy production machine, because when they are working as the energy production machine, you give them more CoQ10. They’re able to move more electrons along that chain more efficiently, okay?  But when they are now working as to modulate your immune defense system, they’re not producing energy. They’ve changed what they’re doing.  So, I guess it’s like if you have a factory that’s making cars and you’re delivering carburetors, that’s great.  But if suddenly the factory decides now to start making artillery, the carburetor isn’t used anymore.

Dr. Weitz:          Right.

Dr. Gordon:        And that’s basically it. So the mitochondria have changed function, partially. Obviously it’s not 100%, but it’s a significant change.  So giving them more raw materials to make energy doesn’t work because they’ve reprogrammed themselves to actually modulate your immune response.

Dr. Weitz:          So how do we fix these people? How do we change their mitochondria? How do we-

Dr. Gordon:        Well, that’s the million dollar question. That is what everybody is working on from different perspectives. Remember, this is one way of looking at the problem. I don’t want to tell you that this is the issue. This is one way of looking at it. But because the body is a system, we keep trying to get at it from a multitude of ways because ultimately, if you are stuck in one way, we start looking at others. So structure is one of the ways that I often begin to work with people who have been chronically ill because the vagus nerve has two components and one of the most basic component, the older component, is about self-defense. The newer component of the vagus nerve is about love and relaxing and feeling good. But the primitive part of the vagus nerve is there for self-defense and it also has a lot to do with controlling the gut.  And if we can begin to get the cranial mechanism and the thoracic spine and all that working better, we take some of the stress off the vagus nerve and we change the information because remember, this is an information system. What we’re talking about, I think, in chronic complex illness, is often the trigger is either gone or not as important anymore. The thing that caused it. And I have spent my life trying to get rid of the triggers. Treating Lyme disease. Treating all the HH6 and the EBV and all the viral infections. The heavy metals and the toxic load. So, these are all triggers and perpetuating factors that we have to address but in many people, that doesn’t work so well because when you try to treat the infection, you make them sicker because they can’t detox. They can’t detox because their whole body is stuck in this self-defense mode and it’s like frozen.

Because it’s very simple. Like when you get scared normally you can jump and then you can run. But when you get really scared, you freeze. You don’t even move. That’s the ultimate defensive mode. Like ontologically, how organisms are wired. It’s not about personality. It’s just about, you scare anybody, anybody deep enough, they will just freeze. And that’s what your cells do. That’s what your whole system does. When it’s significantly stressed, it stops moving. So any way we can return movement to the system might signal the body that it’s safe and the mitochondria are sensing danger signals. And this is what gets confusing. People always, once we start talking about safety and danger, people think we’re talking, oh this is a psychological problem. But safety and danger signals also operate, yes in a psychological space but on the chemical space.  Smells can trigger danger.  Viruses trigger danger signals.  There is no psychological body separation.  Every immune cell has receptors for the neurotransmitters that deal with mood.  Serotonin and dopamine.  There’s no psychological, physical separation. I get so frustrated when people try to make things, oh this is a psychological illness.  One of the things that I’ve been interested in is something called metabolomics, which is looking at a few hundred chemicals in the blood and we can see depressed people by the biochemical signature.  This is a strict … so it doesn’t mean that … so yes, you can be depressed because you’ve been divorced. Your mother died. But ultimately, it’s a biochemical state. And that biochemical state is what controls the organism and because the mitochondria are just sensing those small chemicals that affect mood, that’s the same chemicals that your mitochondria are sensing. So when you get infected by a virus, you get sickness behavior. What happens? You get tired. And you don’t want to be around people.  I mean not many people when they get sick want to go to a party. They want to go quiet … in a quiet room, by themselves. That’s a strictly physiologic response, but it’s driven by the same chemicals. This is driven … this is what we call a sickness behavior and it’s biochemical. It has psychological outcomes. And so I just … I might be killing this but I just always worry that people are going to hear me saying that these are psychological illnesses, when they’re the farthest thing from it. Most of my patients were successful, highly motivated, and not depressed human beings. The problem is is that when they go to the doctor, and the doctor, their blood tests are normal. Their regular blood test, like their blood count, and their kidneys and liver functions look good. And their EKGs normal, and their chest x-ray is normal and whatever else they test-

Dr. Weitz:            But patients think those are very sensitive tests to how their body’s functioning but those are very insensitive tests and your liver enzymes are only going to be positive if there’s significant destruction of liver cells.  It doesn’t tell you whether your liver is really functioning very well.

Dr. Gordon:        At all. Absolutely. So the bottom line is, is that these people who I see are almost always labeled for the first five or 10 doctors that they see as being depressed, and that’s why I am so sensitive to the idea that I’m talking that this is a psychological illness. But it is not. But that is what medicine has always done. And multiple sclerosis. 40 years ago, half the time that people were diagnosed as depressed. Okay? And before we had … well, we had an MRI 50 years, but still, before the diagnosis was made conclusively by physical, by evidence, people were told that they were depressed.

Dr. Weitz:            Right.

Dr. Gordon:        And that’s what we do. So we do not understand these illnesses well. We’re developing more and more treatments, and they work. The problem is, we’re now dealing, like I said in the beginning, the disease of the individual. Because I think Lyme disease is ubiquitous. I think it’s all over. I think millions of people have Lyme disease. But they don’t have any symptoms. Just like how many people have the herpes infection? Everybody’s got herpes.

Dr. Weitz:            Or get exposed to some mold or get exposed to some heavy metals. You start measuring trace amounts of mercury.

Dr. Gordon:        Everybody. It’s just that … but some people because of their biochemical individuality, and the number of environmental stresses they’ve had, they wind up with illness, and that illness is just a reflection of their body and their life exposures. And that is why we don’t do well with them in a medicine that is looking for treatments that are going to work for 80% of the people. So it gets difficult and we start having to look much more at the individuality and we’re getting there, because finally in the last five years and maybe hopefully in the next two or three, we’re going to get enough ability to look at what’s called transcriptomics, what RNA … not just your genes, but what genes are you actually expressing, okay? So what proteins you’re actually making, plus what I call the metabolomics, what small molecules you’re making and maybe when we put these together, we’ll actually be able to see which pathways in you are most stressed and need supporting or addressing.

Because right now, the more information we get, we’re actually getting almost more … I think I’m getting more confused, anyway. I don’t know about the other people out there. It’s because individual chemicals … I mean, you can be very high in succinate, but succinate can be used all over the body for different processes. So we only think of it in terms of the Krebs cycle. But, it’s a building block. You used to make porphyrins, and just make hemoglobin and all these parts of your body. So when it’s high or low, assuming it has something to do with the Krebs cycle, is a huge assumption. And that’s the problem.  We have to look at the body from multiple viewpoints. And we’re almost there. I think we’re almost there but-

Dr. Weitz:            And by the way, for those listening who are not familiar, succinate is something that might show up in an organic acids profile, right?

Dr. Gordon:        Yeah. Exactly. Exactly. Yeah. Because it’s like … and these tests are … I mean, I don’t mean that we shouldn’t be doing them because occasionally, they do give us insight but lots of times, the insight isn’t really useful for that person because it’s not like when we measure your blood count, and you’re anemic, we know that for most … I mean, that’s not always true, but for most people if they are anemic, their blood count is low. We measure their iron is low. We go, oh, give them iron and their blood count goes up and they feel better. That’s wonderful. Right. But if you have chronic disease, many times your iron can look low but giving you iron might even make you worse because your body has turned down production of the red blood cells for a reason and when you give more iron, you’re just increasing oxidative stress because iron really … excess iron might be one of the more toxic things we have.

There are some people in the longevity world that are actually busy donating blood a few times a year because they want to keep their iron stores low. It’s … that’s what I meant about the symphony. All these things play a role but if they don’t play a role at the right time, if they’re making discordant notes, then we get disease. And it’s just a … I guess my plea to patients, I should say actually the point of all this. I don’t want to sound overwhelming. Like oh my god, we know nothing. The beauty of all this mess is that we still know a lot of what to do for the individual but what happens is that people get very frustrated because as you said in the beginning is that when you start off with this complex disease, and if you go to one doctor, you’re going to be told you have hypothyroidism. You try that, it didn’t work. Then adrenal fatigue. And then you’ve got mold illness and then maybe you go to somebody else and you got Lyme.  And it’s frustrating. The point is, there’s a lot of doctors out there right now who are getting the experience and beginning to be able to tell when you just have a positive test, or whether that test is being expressed. Whether the symptoms you have really fit the Lyme or the mold or more importantly, it’s often … many people … what really makes this tough is that in my experience, most people don’t develop significant mold illnesses. Mycotoxin sensitivity … Now I’m talking about allergy, but sensitivity to the toxins that molds can make. Most of us can be exposed to that and we can detox them and deal with them fine. Okay? It’s the people who’ve often had Lyme disease, and Lyme changes how your immune system responds and then they have difficulty with being able to metabolize the mold toxins. So it’s a house, not of cards, but it’s a house being built in your body of reactions to things because it’s a interactive dance between your immune system and these bugs.  Because these are the bugs that want to live with us. They’re not trying to kill us. They want to be part of our community.

Dr. Weitz:            And should we think of it in terms of cumulative overload? Some people refer to the, you have this giant bucket and when it’s close to the top and you get exposed to something that stresses your system, it overflows and you get all these symptoms and if you could empty out several pails of water from the bucket, now you’ve got a reserve so you can deal with things.  

Dr. Gordon:          Well, yes. I think that always has been a good analogy.  

Dr. Weitz:            Right. That’s kind of the model that we look at.  So okay, we take the mold factor out. Maybe we get rid of the heavy metals, and now we’ve removed some of the triggers, so now you … yeah, rebuild some of your cellular reserves. So now if you do get exposed to something, it maybe is not problematic for you. Whereas if you are always close to the top, you’re going to react to everything.

Dr. Gordon:        Well, yeah. I mean, and another lens on that is that when you remove, let’s say the heavy metals, then suddenly your immune system is now working better and then it can keep Lyme or the viruses in check.

Dr. Weitz:          Exactly.

Dr. Gordon:        And so if you remove them slowly, they’re not making you ill. Because you see, or more importantly, sometimes I think you actually can control your own immune response because many times, there are people who’s significant symptoms in Lyme and the tick borne illnesses are not the bugs, but their body’s response to the bugs are overwhelming. They create this … The cellular defense response is so heightened that it makes you sick because remember, most symptoms of inflammation, the swelling, the redness, that’s your own cellular response. That’s not the bug. Your body does that while it’s fighting. And like I said, the sickness behavior. Wanting to go lie down. Fatigued. Not losing your appetite. That’s not the bug. That’s the body’s own self-defense response that’s now stuck on. So when we remove some of the toxic exposure, your immune system can often come back and stop overreacting and stop acting like a three year old. I mean, that’s the problem. The immune system goes into a primitive place where everything is danger. Everything is no, or screaming at …

Dr. Weitz:          And then the immune system starts tweeting in the middle of the night and declaring national disasters and where there aren’t any.

Dr. Gordon:        Exactly. That’s it.  But it goes back to a primitive pattern. Right, a fear. Very similar to yes, our midnight tweets. Yes. Fear. Instead of reacting like an adult which can grade and realize that life … You see, that’s it. It’s very interesting is that life, in the complexity of life in the organism only happens when there can be learned of cooperation and balanced responses because that’s how your body works. In fact, that’s how we interact well with viruses. Viruses will succeed if they learn how to have a balanced response, if they kill us, which is the … like not the win-win, but I win, you lose situation, they don’t do well in the long-run.

Dr. Weitz:          Right. No, they want a host that they can reproduce and go into another host. Right.

Dr. Gordon:        Exactly. That requires cooperation which is another … but that’s really what happens. So getting back to the idea is the toxicity of our world. One of the points that I’d like to make that I think is so important is I been doing this now since 19 … so close to 40 years. And I can tell you that … autoimmune diseases, like Hashimoto’s for instance, thyroiditis, I mean when I started in medicine, we could test for it. It was not that common. Now it’s a dime a dozen. I mean, all the autoimmune … it’s called autoimmune diseases, the kind of Lyme symptoms we see. When I … Joe Verscano, like my partner, like Wayne Anderson, he started treating Lyme in like 1990, ’91. It was still often relatively easy. The people have gotten sicker, and sicker and sicker and sicker. I don’t think the bugs have gotten … maybe the bugs have changed. But I think it’s us. I mean, the toxic load in our environment has gone like not linearly but logarithmically up over the last 40 years.  And I think that is why we’re seeing these illnesses and we’re seeing so much dysfunction at the mitochondrial level because when the mitochondria sense toxins, part of their job … They are smart but they are not that smart. If the toxin ties up the biochemical reaction that is going to produce the raw materials that the mitochondria need, the mitochondria can’t tell the difference between that and a virus using those same raw materials. All I knows is that it’s not getting the raw materials that it should get. The NADH and NADPH. It’s not coming in, into the mitochondria from the cell. And that triggers the, what we call the cell danger response. Where the mitochondria stop producing as much energy. They start using ATP, the energy molecule, as a messenger, okay? The ATP, they start sending ATP outside the cell.  So normally, there’s a very tiny amount of ATP around the cell because actually, it’s a neurotransmitter in a way. There’s actually 17 receptors on the cell membrane and different cell membranes for what they call purinergic ATP, and AMP and all these energy molecules. They actually work to communicate. They’re part of the cell’s cell signaling function and when the mitochondria sense danger, they start sending more ATP outside the cell and this gives the signal that the cell’s in danger and they’re also making less energy so toxic load acts the same as a virus on your body.

Dr. Weitz:          Cool. So I’m going to have to bring this discussion to a close in the next few minutes.

Dr. Gordon:        We were definitely not linear.

Dr. Weitz:          Definitely not. So how do we want to end it?

Dr. Gordon:        Oh.

Dr. Weitz:          What kind of final thoughts you want to have?

Dr. Gordon:        Final thoughts. Is I think the most important thing is to if you’ve been ill for a long time, is to not give up hope. Okay? Is that it’s … the unfortunate part of this illness I think is many more people actually run out of money than of hope. Because, honestly, because we don’t have perfect treatment regiments. We don’t even have … I don’t even think we have decent treatment regiments. So much of the time, I said what that doctor knows how to do, that you wind up spending a lot of money and not getting very far. But the reason I say don’t give up hope is I’ve seen people who have been sick for 20, 30 years, get better. But, to be fair, I’m not going to tell you. I don’t get everybody better. Far from it. I mean, I wish I did. These are difficult illnesses. But so many people do get better because there are so many different reasons that you can wind up with chronic fatigue. And I think that’s the thing. Don’t give up because somebody you know didn’t get better. You are different, and it might turn out that with you, the pick-up sticks model that’s need is maybe just getting out of the moldy environment for you.

Maybe that’s going to be the big deal. Maybe getting the toxins out of your system. Maybe just getting the right structural work done. I mean, there’s so many pieces that can then allow the body to enter the healing cycle and really go back to normal. I mean, that is my message of hope. The frustration is picking the first step, is not always clear. But don’t give up because there is a step that will help you. We just have to find it for you.

Dr. Weitz:          Great. So how can listeners get a hold of you or find out more information about you? Are you accepting new patients?

Dr. Gordon:        Yeah. I started to again. For awhile I wasn’t and it was getting … but now I started seeing new patients because I like to send people on quicker. I find that what I’m really good at is evaluation and giving people pretty good idea of where they need to go. But I like to send people because I do so many things, I prefer to send people on to other doctors who kind of specialize in the area that they need the most support in. And then they can come back to me and we can go to the next level. So with that being said, I am concentrating my practice, as of May, in San Rafael. Our website, or what is it … I think it’s gordonmedical.com, I believe. I don’t know these things. Okay. Yeah, is the website and they can find the information there. But I just … what I’m hoping to do is more research. I’m trying to get, I said some of the right called leaders together because the more brilliant doctors are, often the harder it is to get them to work together.

Dr. Weitz:           Yes. Absolutely.

Dr. Gordon:        And that is my dream, because I don’t know everything. I need a lot of help.

Dr. Weitz:          You sure know a lot and thanks for sharing with us today, Dr. Gordon.

Dr. Gordon:        My pleasure. Really. It was fun, Ben, and next time we get to chat, we’ll talk more about … I would love to talk to you about the body.

Dr. Weitz:          Absolutely. Yeah.

Dr. Gordon:        That to me is what’s missed by so many physicians. The structural…

Dr. Weitz:          The structural component. Yeah.

Dr. Gordon:        How important structural component is.

Dr. Weitz:          Yeah. Great. Excellent. Thank you, Eric.

Dr. Gordon:        Be well.