Sleep with Dr. Felice Gersh: Rational Wellness Podcast 135

Dr. Felice Gersh discusses Sleep with Dr. Ben Weitz.

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Podcast Highlights

3:21  Sleep is so important for our health and for rejuvenating our brains and our bodies. And it’s also important to sleep at the right time. Our bodies are designed for us to go to sleep when the sun is down, so we should ideally go to sleep at around 10 pm and get between 7 and 8 hours of sleep.

5:35  But many of us today, esp. women with PCOS, fail to get enough, deep, quality sleep.  Watching late night television and eating late at night throw off our body’s natural rhythms. And we have all these bright lights that contain a lot of blue light in our homes.  And besides television, we sit in front of computer screens, iPhones, and iPads and all this blue light suppresses our melatonin, which under natural circumstances, would gradually rise with the sunset. And our television and computer screens stimulate our cortisol, which keeps us awake.  Higher cortisol also leads to elevated blood sugar and causes metabolic syndrome, which raises our risk of obesity, diabetes, heart disease, dementia, autoimmune disease, and even cancer. Some folks claim that they are naturally night owls and they stay up until three in the morning, but they are really ignoring their natural circadian rhythm and they are putting their health at risk.

8:48  There is a lot of talk about the dangers of blue light at night, but blue light is not necessarily inherently bad.  In fact, we’re supposed to have blue light and white light in the morning to wake us up. It’s just that it’s supposed to change as nightfall comes.  We have scientific data showing that watching the sunset with all the yellows, oranges, and reds of the sunset will actually trigger the production of melatonin and shut down our cortisol production.  A weekend of camping outside with natural light and being grounded and sleeping on the ground will help to reset our circadian clock.  It makes you want to go to sleep at the right time and wake up at the right time.  Dr. Gersh points out that we need to understand that we are part of the animal kingdom.

13:04  Dr. Gersh said that she likes to think of the human body like a heart, which basically has two phases.  The heart contracts and pumps blood out and it relaxes and refills with blood.  Even a lot of cardiologists today pay little attention to the filling or resting or diastolic phase.  But resting is just as important as running and acting out and doing things. So that’s why we’re like a heart.  Sleeping, just like for the heart when it’s resting and filling is just as important, if you’re going to have healthy longevity.

16:40  When we are born, we each get on our own individual conveyor belt. Some people have a rough ride and bounce off really fast and others have a long ride but it’s rough and goes down and down. We want to have a smooth ride that goes sideways rather than down. We want to avoid that descent into all the chronic diseases that reduces the quality of our lives.  In order to maintain the health of our brains, we need to maintain our circadian rhythm. If we get good, quality sleep, our melatonin will be peaking around 2 AM and that is when the flow of blood to the brain is also peaking.  This is when the lymphatic system of the brain drains garbage from the brain and rejuvenates it. But this requires good, quality sleep and many people aren’t getting it. If the go to sleep with the television on, then they have this blue light coming through their eyelids that lowers their ability to produce melatonin and lower their cortisol. They will stay in an insulin resistant state all night long, creating inflammation.  They won’t be producing enough melatonin in their GI tract and their guts will be messed up and they will develop an unhealthy microbiome in their gut. When we produce melatonin at night in our guts, it causes the microbes to swarm like insects and they produce different metabolites that lower our risk of colon cancer, which is an epidemic today, including in young people.

20:31  Dr. Gersh explained that a lot of older folks are sad and depressed and lonely, so they think of their television as their company.  But this interferes with their sleep.  Or they they have dogs or cats, which can be great pets, but if they sleep in their beds with them, then this can negatively affect their sleep, esp. if their dog has to go out to the bathroom at 3 AM.

23:28  Some patients will turn to alcohol to help them to sleep.  But they don’t get good sleep from alcohol and it’s a brain toxin, a gut toxin, and a liver toxin.  They often get a paradoxical reawakening in the middle of the night. 





Dr. Felice Gersh is a board certified OBGYN and she is also fellowship-trained in Integrative Medicine. Dr. Gersh is the Director of the Integrative Medical Group of Irvine and she specializes in hormonal management. Her website is IntegrativeMGI.com, and she is available to see patients at 949-753-7475, she lectures around the world, and her first book, on Polycystic Ovarian Syndrome is PCOS SOS: A Gynecologist’s Lifeline to Restoring Your Rhythms, Hormones, and Happiness, which includes a wonderful chapter of sleep.  

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


Podcast Transcript

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

Today our topic is sleep with Dr. Felice Gersh. Dr. Gersh, recently authored a wonderful book on how women can overcome PCOS, polycystic ovarian syndrome called, PCOS SOS: A Gynecologist’s Lifeline To Naturally Restore Your Rhythms, Hormones, and Happiness. This is an excellent book for women with PCOS but it’s also a treatise on how to lead a healthy lifestyle. And her chapter in the book on sleep has so many clinical pearls that I thought we would focus on this for our discussion today.  We all know that sleep is important for our health, but that doesn’t mean that most of us pay any attention to it. Many Americans today are not getting enough sleep due to working longer hours around the clock, entertainment and poor diet and lifestyle. Getting good sleep however, is crucial for the rejuvenation of our brains and our bodies. And a chronic lack of quality sleep increases our risk of heart disease, high blood pressure, diabetes, obesity, et cetera. And when we sleep we cycle through different stages. Actually four stages of sleep, multiple times per night, two periods of lighter sleep, one period of deeper sleep and one period of rapid eye movement sleep. Dr. Felice Gersh is a board certified obstetrician and gynecologist and she’s also fellowship trained in integrative medicine. Dr. Gersh is a Director of the Integrative Medical Group of Irvine where she continues to see patients. She also lectures around the world and I just mentioned her bestselling new book, PCOS SOS, that’s available from Barnes & Noble and Amazon. Dr. Gersh, thank you so much for joining me again today.

Dr. Gersh:           Well, it’s my pleasure and I just love just listening to your beautiful summary of sleep. I think we can all take a nap now. That was so good.

Dr. Weitz:            You’re such an amazing doctor that you can talk about so many different topics. I am just amazed. But let’s talk about sleep and what constitutes a good night of sleep?

Dr. Gersh:           Well, like everything we’ve learned about our human bodies, we need to not only sleep, we need to sleep at the right time. So everything is about quantity and quality and timing. So in terms of sleep, we are designed as diurnal human beings, right? We are not nocturnal. So we need to sleep at night. So our bodies are designed for us to go to sleep when the sun is down. And typically we have adapted and this is probably not the same as what ancient people did or prehistoric people did, but we have adapted to a lifestyle that would be very good for us if we went to sleep between 10:00 and 11:00 at night, even closer to 10:00 is better. And then getting somewhere between seven and eight hours of sleep every night. Hopefully it was not too much disturbance in the middle. Now, probably in the ancient times, people went to sleep even earlier, and when the sun went down, because in early times age, they maybe didn’t even have fire. They weren’t going to stay up late at night.

                                So when the sun went down, they went to sleep and they would get up with the sunrise. So that’s probably really how we evolved, but we can do quite well because we have to realize that we invest not like prehistoric people, so we have to make some concessions. I can’t expect everyone, the sun is down, jump in bed. But probably, during the times when it was cold out and the nights were longer, they didn’t necessarily want to sleep longer. They may actually have gotten up in the middle of the night and did a few things, chatted, maybe they had sex or whatever. And then they went back to sleep for another few hours. So we do have some adaptive lifestyle, but I’m perfectly happy with anyone who can get to sleep between 10:00 and 11:00 at night and then have a nice continuous sleep for seven, eight hours. And your body will have a lot of wonderful opportunity to do all that rejuvenation that you mentioned in your little introduction.

Dr. Weitz:            So why do so many of us fail to get enough deep quality sleep and especially women with PCOS?

Dr. Gersh:           Well, if we talk first about the general population, a lot of the things that you mentioned, people are just doing so many things wrong. We are enticed to watch late night television. They say, what’s the late, late show? And people get, they think of these people on TV as their friends. They really want to see their funny monologues and everything and they forget this is all now recorded and you can have it on demand, you can watch it at a different time. But they get used to getting into that pattern. And people often are eating very late at night and they just don’t really feel as tired because their body’s rhythms are so off. And then we have all this ubiquitous lights, they have bright lights.

                                Remember ancient peoples didn’t have all that artificial light maybe in less ancient times. But still long time ago they had candle light, which puts out a whole different hue, the candle light compared to the all blue lights that we have now, the fluorescent light bulbs and so on. And they’re bright light. And then we watch computer screens, iPhones, iPads. And then with television screens, with all that blue light, it’s just totally suppressing our melatonin, which should be gradually rising with the sunset. So our rhythms are so off, then people are often not feeling as tired, they’re often feeling more alert at night because they’re eating, they’re watching television and computer screens. They’re actually being so stimulated to wake up and their cortisol is going up that they don’t feel tired. And so they say, you’ve heard this a million times, I’m a night owl and I don’t feel tired. I’m fine, but they’re not really fine because their bodies are not getting what they need and then not realizing the incredible metabolic risks that they’re putting themselves into.

                                And of course, we now know that metabolic ills are the ills of everything. That’s what leads to cancer, to autoimmune disease, to dementia, to cardiovascular events. Everything is linked to metabolism and your metabolism will be off guaranteed, like you mentioned, you’re going to gain weight. Is that your goal? You don’t even have to eat really unhealthy foods if you eat at the wrong time of day. So we have a society that sort of pushes people to be up and now we know that, close to like one third of people or 3% of people, are working at night because our society demands a 24 hour worker crew.  And so those people have the worst of all worlds because no matter what they do, their circadian rhythm will never really be properly fixed because some days they’re up until three in the morning and then other days they’re working at a different time of day. ER doctors are among the worse off. But I was in that category when I did obstetrics for 25 years.

Dr. Weitz:            Sure late night…

Dr. Gersh:           I was up all night, so many nights. It’s like a wonder, still in recovery mode.

Dr. Weitz:            So you were talking about blue light. So blue light is not necessarily inherently bad. In fact, we’re supposed to have blue light and white light in the morning to wake us up. It’s just that it’s supposed to change as nightfall comes.

Dr. Gersh:           Absolutely. So it’s really wonderful how humans have adapted to live on planet earth. It’s like the … I love science fiction. My favorite show when I was a kid was Star Trek. And I love all these sciences, the science fiction, Star Wars and all of that. But we really are earthlings and we evolved with the beautiful rhythms of earth in our planetary system. It’s so amazing. We have a 24 hour rotation of earth and so we are the day creatures and there are other creatures that are night creatures. And it’s just so amazing how we have evolved. So the light of the morning, like you mentioned is our wake up lights. And it has a different spectrum of light than when you look at the sunset. And now there’s actually data that watching the sunset and the beautiful sort of yellows and oranges and reds of the sunset will actually start triggering the production of melatonin and shutting down our cortisol.

                                So living outside, and so many of us are so, we’re living in constructed man-cave. We’re in buildings where so many people they don’t even have the lighter day, people who work in basements or they work in cubicles that are interior to buildings where there are no windows. They’re just surrounded by these phony walls and things. And they really have very little natural light. They don’t get outside. And if they live in a big city, like New York City or Chicago where you have really tall buildings, it’s like blocks the sun. So they’re always in the shadows, except when the sun is right overhead, which is very brief in the course of the day. So it’s so important for us to be outside. There’s data that when people go camping and they live with the natural light of the sun, the way we evolved, where they actually have the sun, they’re sleeping outside maybe in a little tent where the light comes right in and the sunlight actually really wastes them up because that’s just what happens.

                                And then when the sun goes down, there’s no television, there’s not much to do. Hopefully, they didn’t bring in all their equipment so that they could watch free recorded stuff. Hopefully they didn’t do that with the batteries. So they’re actually camping like people should in the woods without any of that stuff. And then after the sun goes down, they’re tired. And when people are in the sun all day long, it changes how their brain works, how they produce serotonin and melatonin. So they’re really tired. Everyone has spent a day at the beach, right? Something like that where you’re outside in the bright sun and then when the sun goes down, you just can’t even keep your eyes open. It’s like, I just want to go to sleep. And that’s what nature intended. So you’re doing your own thing, you’re grounding, you’re on the ground, you’re getting all that beautiful sunlight and it makes you want to go to sleep at the right time, wake up at the right time.

                                So just a weekend of camping outside with the natural light coming and going from the sun and the moon will actually help reset your circadian clock and you will sleep so much better. And it’s just an amazing thing, how when we’re out in nature, how much better we do. And there’s so many studies about the calming effect of nature, just looking at a tree can lower your cortisol level. And so even looking at a picture of a tree can lower your cortisol level. So we need to understand that we are part of the animal kingdom.

Dr. Weitz:            It’s actually a therapy now, they call it forest bathing.

Dr. Gersh:           Oh, really. I should have discovered that one. Well, maybe we can promote it on our own word, we’ll call it and stuff. We’ll modify it, we’ll call it jungle something.  You should look like, this is so beautiful. So basically we need to rethink so much of what we have done in our lives because we cannot neglect the value of sleep. It’s like the heart. I really think about the human body like a heart. So a heart sounds so simple. It just has two things. It contracts and it relaxes, right? It pushes the blood out and then it refills with blood. And people, in fact, many cardiologists today, pay very little attention to the filling or diastolic, the resting phase. They only look at the contracting phase. And of course, when people have congestive heart failure, the standard, that’s when they don’t contract well, okay? But now we know how the heart rests. The diastolic filling phase is equally important, the diastolic phase. So we can’t think that resting is not as important as running and acting out and doing things. So that’s why we’re like a heart.

                                And during the day we’re busy and we think that that’s all that matters. But sleeping, just like for the heart when it’s resting and filling is just as important, if you’re going to have healthy longevity. What we call health span, right? Because we are very good in conventional medicine and keeping people alive, but with pretty low quality of life, right? If you’ve ever been to a nursing home, it’s pretty darn distressing and depressing. People alive who have no quality of life and that is so not what my, I want my future, my patient’s future to be like … Everyone should have a role model of someone who does things right and has good results. So my personal favorite right now is my aunt, my mother’s sister, and she’s heading into her mid 90s. She lives by herself, she goes out for outdoor walks. Every day, she gets the sun and she gets the exercise the way nature intended and so she can travel, she travels around the world. She does everything just as if you were 40 years old, and she’s in her 90s and she’s amazing.

                                So we should all find a role model because if all we know as role models are the people who are in nursing homes, who are really having poor quality of life, because I have patients and say this to me, “I don’t want to live long.” Because the only role models they have are people who are living long with no quality of life. Then it doesn’t have to be that way. It really doesn’t. But we have to be really actively going against what most in society are doing. We have to live off the beaten path because the beaten path is full of people having poor quality of life. We were talking earlier about statins, and does every person have to understand I would qualify for statins simply based on age. They made it into their protocol. It’s built into their algorithm that it doesn’t matter what the quality of your life is, your health, what your labs show, anything, nothing. All that matters is your age. So if you hit a certain age, you qualify for statins. What is that all about? We can define-

Dr. Weitz:            It’s all about accepting that there’s this inevitable decline in your health. After your 30s or 40s, it’s all downhill after that. And really anti-aging medicine, like both of us practice is not just about lifespan, it’s much more about your health span and yours can you have a long healthy functioning life. And then the decline maybe happens quickly towards the end. It’s-

Dr. Gersh:           That’s right.

Dr. Weitz:            Long, slow, gradual-

Dr. Gersh:           That’s interesting.  When we are born we each get on her own individual conveyor belt, right? And some people have a really rough ride, they bounce off really fast and others have a long ride, but it’s really rough and it goes down, down. So we want a smooth ride on our conveyor belt. It always goes in only one direction, it can never go backwards, it can’t go sideways. And then you get to the highway conveyor belt, about get to get to this and then it goes to happen. But that’s how we’re having a smooth long ride. And what has to happen. I have, in one of my talks, I have a slide, I just love this slide because it shows what happens in the 24 hours. So it has 2:00 PM, 2:00 PM and in the middle it’s 2:00 AM. So it really shows you what happens and it shows you the circadian rhythm of flow of blood to the brain. I love it. You look at that and you see that when melatonin is peaking at 2:00 AM the way it should, the flow of blood to the brain is also peaking.   Oh my gosh. It’s like if you don’t have that amazing flow of blood to the brain, that’s what nature intended so that your brain can rejuvenate. And now we’ve discovered that there’s a whole lymphatic system to drain garbage from the brain. But all of this requires quality sleep, and people aren’t getting it. The other thing is the environment of the bedroom. So I have so many patients. The first thing I ask is, “Do you have a television set in your bedroom?” And the answer is overwhelmingly yes. I have so many patients they go to sleep with the television on and you can’t come up with a worse scenario than that. So they have this blue light blasting at them along with all the noise and the sound, and then they’re so tired that they just fall asleep. But what they don’t know, what they don’t understand is that even a little bit of this light coming through their eyelids is lowering their ability to produce optimal amounts of melatonin and it’s not lowering their cortisol properly.

                                So they’re going to stay in a somewhat insulin resistant state all night long, creating inflammation instead of anti-inflammation, which is what the body designed. They’re not going to get all of that amazing antioxidants and reducing free radicals and everything by the melatonin, their guts are going to be messed up. They’re not going to produce enough melatonin in their GI tract, which is key to having a healthy gut microbiome we now know. They’d sat there are microbes, all the microbes in our gut and all the microbes everywhere, they all have clots too. They have clot genes and they actually are sensitive to the way that we eat, when we eat and so on. And when we produce melatonin at night in our gut and also we make it from our own cells and also the microbes make melatonin as well.  When we have this surge of melatonin in our GI tract at night, the rest of the different microbes actually swarm like insects, they actually swarm and they produce different metabolites that have all these different effects, that help to keep the gut healthy, so we lower our risk of colon cancer, which is a modern disease which is at epidemic levels. Now even in young people, I’m sure you’ve seen that young people having higher and higher rates of colon cancer. It’s shocking because they too are not having proper lifestyle. They’re born with all this light at night, not getting enough melatonin in their GI tract, which is protective as well and it helps to develop the right microbiome. So the implications of having inadequate sleep or whole body white systems, white cell is every single system of the body is going to be harmed.

                                And then, as well, we just have to understand that a lot of people are tired and sad and depressed and they think of the television as their company. And they may have a sound snoring next to them but they’re still feelings lonely. There’s a lot of isolation, we don’t have the family tribes the way we used to and so people watch television for companionship. So we have to have better ways for people to relate to other people. We know, for example, that one of the biggest factors for elderly people dying is loneliness. But we can’t use a television to help put us to sleep because we’re not going to have quality sleep. We have to have other ways to have relationships and meaning in life. And there are ways, some of them, I spend my time with my patients who are elderly, exploring what they can do to have relationships with people, volunteer work, working with, even going to animal shelters, if they love animals.  I mean, there are ways that people can access other people, and if you need to, you get a few pets. But I don’t want them sleeping in bed with you. That’s the other thing I’m finding. They’re lonely, they love their animals and they’re all over them at night. They’re sleeping in the bed, like these big dogs and cats. They talked about the baby family bed, now it’s the pet bed. So you can’t get a really good night sleep when your animals are roaming all over. And then my patients who have elderly animals, like dogs that need to somehow go out at three o’clock at night, so they have poor bladder function. I mean, we have to figure this out.  We can’t destroy our health for the animals.

                                But I had one patient recently who said that her cat is very picky and likes to get wet cat food at two o’clock every morning.  Oh my gosh, your cat needs to be retrained, getting up at two o’clock in the morning to feed the cats.  No, this is not good to happen.  So we need to control cats also children.  Okay, I have young women patients who just don’t understand that kids need to sleep and they don’t know how to control their kids and they don’t help their kids to have good sleep habits.  So this is starting from very young ages and their kids are all on all these other blue light emitting devices and they can’t sleep. So the kids are roaming the house in the middle of the night-

Dr. Weitz:           They’re on their phone or on their iPad and-

Dr. Gersh:           I know.

Dr. Weitz:           Keeping the TV out of the bedroom. They got to keep their phones and their iPad and those devices out of the bedroom.

Dr. Gersh:           All of that out of the bedroom. That’s the phrase that they get all of that stuff out of the bedroom and the kids’ rooms too. So they have the kids playing on these things in bed before they go to sleep. And then the kids-

Dr. Weitz:           Not to mention EMFs that are being emitted from these devices and the blue light. 

Dr. Gersh:           Yes. And then what some of my patients do, they turn to alcohol. Oh my God, they say, well the alcohol puts me to sleep, but they don’t understand that it’s not a good sleep. Alcohol is a brain toxin, it’s a gut toxin, a liver toxin. And then they get this sort of paradoxical reawakening in the middle of the night. So you have children roaming the house, you have animals roaming the house, you have people drinking alcohol to try to sleep, you have the television on all night. We have to stop, stop in its tracks. And then you have women, like all my women with PCOS, and they have also on top of all of that that’s going on like in everybody else’s life, they have inherently a problem with estrogen.  And estrogen is very key to brain health and brain function and mastering the master clock and keeping the clock on beat.  The master clock that sits at top of the optic nerve in the brain.  So their master clock is not set properly do this. So they have often what they call phase disorder. So they wake up too late, they go to bed too late but if they have to wake up early so they can’t. They’re like shifted so that they want to go to bed later and then wake up later. Kind of like, a lot of teenagers are like that. And our society is not tuned to that, so you got to get up and go to work. So they go to bed too late, they get up earlier than their bodies want to. They’re still at that point having more melatonin, although they don’t have proper functions on their melatonin. But they have of course melatonin and so they’re feeling really groggy in the morning. And then because they don’t have the proper circadian rhythm of their cortisol, they’ll have high cortisol at night, low in the morning.

                                They have no appetite. Nature made it so our appetite has a beautiful circadian rhythm. When things are right, you’re not supposed to be healthy at night. If you’re hungry at night, that’s a sure sign you have circadian rhythm dysfunction, and now we know and we can talk about this more another time too. The whole incredible endocannabinoid system, which goes with our hormones and is incredibly circadian. And everyone knows that, whether they do it or not, hopefully not, but if they smoke marijuana, people who smoke marijuana get the munchies, right? People always talked about that. Now why is that? Well, that’s because there’s a component called THC in marijuana that can act on the receptors or one of our endogenous cannabinoids, an endoccanabinoid called enendomide. Now enendomide is part of the appetite regulation system. But if you stimulate it a lot, you will have uncontrolled appetite, you’ll have the munchies.

                                And people who have circadian rhythm dysfunction have what they shouldn’t have. You should have very low production of enendomide at nights, very low. And you should have no appetite at night and then it should rise in the morning. But people with dysregulation of this system, they have high production of enendomide at night, so they are really hungry. Remember our bodies are finely tuned for input of food to match our metabolic needs, but we are so dysregulated now that our appetites are not matching our metabolic needs and or the timing. So people who, the people out there who have this or their patients, if they are really hungry at night, that is a red flag. You have circadian rhythm dysfunction. You’re producing a lot of enendomide at night when you should have none. And people who urinate a lot at night, they’re always getting up to go to bathroom, that is another sure sign that they have circadian rhythm dysfunction. Because at night you should be making a lot of the hormone, antidiuretic hormone.

                                And I have on my beautiful slide that shows what happens during the day. It shows that urine is being produced at very low rates during the night when you’re doing things right. Because nature did not want people to have to get up and go to the bathroom all night long or have to go and poop in the middle of the night. That’s a sure sign. If you’re going to the bathroom for any purpose in the middle of the night, especially multiple times, you have a problem with your circadian rhythm. And now we know this epidemic of sleep apnea, which is hugely exacerbated in women with PCOS, women after menopause have high, high rates of sleep apnea, that’s really a circadian rhythm dysfunction. And people are not putting that together. And of course elderly people who have hormonal deficiencies and so on and they also do things that are not proper for their circadian rhythm, they have a lot of sleep apnea. And obese people have a lot of sleep apnea.

                                It’s not just about their tongue is big and their throat is getting bluff at the top. That’s just part of it. They really are having a brain inflammation problem and their area of the hypothalamus that controls breathing and sleeping and appetite and blood pressure and urine production, all of that. The whole autonomic nervous system is out of whack, it’s off the beat. And so sleep apnea is not just about your tongue, it’s [inaudible 00:28:37], that’s part of it. It’s also a problem in your hypothalamus, in your brain, that your brain is not putting out the right signals for breathing, coordinating with sleeping. So it’s really a significant issue. And then people shouldn’t just do a CPAP machine and call it a day. If you have high cholesterol, even if you go on a [inaudible 00:28:59] that is not the solution to the problem, that may lower your cholesterol, but it’s not getting to why is your cholesterol high in the first place, right? So we need to look at that. So we do in functional medicine, right? We look for root causes.

                                So we don’t want to just say like, Oh, it just breaks my heart, my conventional medicine. Somebody goes into the doctor and they say, I can’t sleep my insomnia. They don’t even do a study of, often if they have sleep apnea, if they do, they never talk about why they have sleep apnea. They don’t ask about their sleep hygiene, they don’t ask about what’s happening in the middle of the night with the pets, the kids, the spouse. The spouse keeps them up because the spouse is snoring all night, all kinds of things are happening. The television light all the time. They don’t take any history and then they just give them a sleeping pill. And sleeping pills do not allow the normalcy phases that you alluded to at the beginning in your wonderful introduction about, we have sleep phases. And we know that for example, women who have sleep apnea, they don’t have long pauses in their breathing. There can be a tiny fraction of a second. They often are not snoring. You can’t witness this kind of cause, it’s only seen if you do a monitor of it, but it disrupts their sleep patterns.

                                So they don’t get the proper phases of sleep, so they don’t get the restorative functions of sleep. So these are huge deals, but we have to start. Sometimes I think I’m into simplistic thinking. It’s like you just have to do certain basic things in life. And I’m not against hyperbaric oxygen and all kinds of electrical magnetic waves to the brain and all these things that people are doing, high tech stuff. I’m so foundational. It’s like major bedroom cool. Because you sleep better and your temperature should dip at night. So try to make your bedroom really dark and really cool and really comfortable. Get all the devices, like you mentioned, all the devices out of the room. Go to bed at the right time. Oh, another great tip. If you take a really hot bath for as much as an hour, I do this myself. This is my part of my routine. It dramatically drops your cortisol.



Dr. Weitz:                            I’ve really been enjoying this discussion, but now, I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic research-based dietary supplements. Pure products are meticulously formulated using pure scientifically-tested and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners and preservatives.

Among other things, one of the great things about Pure Encapsulations is not just the quality products but the fact that they often provide a range of different dosages and sizes, which makes it easy to find the right product for the right patient, especially since we do a lot of testing and we figure out exactly what the patients need. For example, with DHEA, they offer five, 10 and 25-milligram dosages in both 60 and 180 capsules per bottle size, which is extremely convenient.

                                                Now, back to our discussion.



Dr. Weitz:  can we just talk about cortisol, melatonin for a minute, for some those who don’t know. So these are two hormones that are playing an important role in regulating our circadian rhythms and our sleep. And so cortisol is a hormone produced by the adrenal glands, right? And it tends, it’s supposed to spike in the morning and that helps us wake up.

Dr. Gersh:           Yeah. So it’s all beautifully, perfectly aligned for what we need to be healthy. So cortisol starts to gradually rise and then it peaks right about the time that we should be getting up. So what does cortisol do for us? It makes us feel activated, it increases appetite and it makes us a little bit insulin resistant. What does that do? It helps to elevate our blood sugar levels, right? So in the morning when you’re still fasted, you want to have higher blood sugar so that you can get going. Because if you think about ancient times they had to go out and do stuff like get the food and actually make sure that the other wild animals are now up, right? So they need to be on alert to protect themselves and their families. So cortisol makes you more on high alert.  It makes your blood sugar go up, it starts mobilizing fats so that your body really can just get going. But then if you don’t eat, what if you don’t eat? What if you’re into this problem? I call it problem, where people think that they should fast through the morning. They don’t get it. So they think I’m fasting, I’m doing time restricted eating, so I don’t eat until one or two o’clock in the afternoon, and they think they’re doing themselves a favor. They’re really harming themselves because our bodies were designed, just like we’re supposed to sleep at night, we’re supposed to eat in the morning. Now we’re adaptable, resilient creatures. That’s why we can get away with all kinds of stuff and still live, but we’re not going to be living optimally. And that’s really important because if you don’t eat in the morning, your cortisol is not going to start dropping.

                                So you’ll maintain a high cortisol and consistently high cortisol is actually harmful. Then you are going to get leaky gut, you’re going to get more stressed out, you’re going to start getting more hypertension, you’re going to have fluid retention because you’re going to get into a more chronically inflamed safe. So cortisol should not be chronically high. It’s critical. In fact, it’s the only hormone that you cannot live with. In 24 hours, if you don’t have any cortisol, you’ll be dead. You could live without thyroid hormone or estrogen or testosterone for a day, you will not die but cortisol you’ll be dead. That’s how critical cortisol is. So we should, I sometimes have to defend cortisol because people stay down with cortisol, no it’s about having the right amount at the right time. It’s essential but we don’t-

Dr. Weitz:            In fact, patients who have very low cortisol throughout the day, that’s associated with the worst prognosis in cancer and other chronic disease.

Dr. Gersh:           Terrible. That’s right. And then those people always have really high [crosstalk 00:35:32], they always have low T3 because cortisol and thyroid are so intimately related and it turns out that our insulin sensitivity is also on the clock. Just like I said, if you eat at night, you’re going to be insulin resistant, you’re going to be prone to diabetes and weight gain because we are eating on the clock. If you eat in the first half of the day, in the morning time, that is when our insulin is most effective, our insulin receptors are most sensitive and that really matters. So when you eat food in the morning, the glucose that is produced will go readily into our muscles, into all of our tissues, our borne, our brain. Because we want to utilize glucose. Glucose is the preferred energy source for most every organ in the body. We can use ketones fats as a secondary source, that’s because we we’re so resilient and food is not always available. So you have to use your backup source, your own body fat as a source of energy when you can’t eat, right?

                                But the preferred source of energy is glucose. But the problem is people are so insulin resistant, the receptors don’t chase up the glucose. And so they just set higher and higher levels of sugar in their blood, which becomes very inflammatory and damaging. And then you have high levels of insulin but it doesn’t work well. And high levels of insulin is also inflammatory and it increases IGF-1 which you need. But you don’t want it all the time because then it’s called cancer because your pro grows. So insulin promotes fat production, fat storage and IGF-1 promotes growth and proliferation, which you need but not all the time. Because chronic proliferation and when you have chronic inflammation, that’s the perfect team for DNA breakage in cancer. So we don’t want all of that. We want to have the beautiful rhythms. And if you keep fasting through breakfast and you don’t eat until the afternoon-

Dr. Weitz:            But they’ve been told that the way to reduce your IGF-1, to reduce those growth factors is by fasting. And so that’s why a lot of people are doing it.

Dr. Gersh:           That’s why I’m telling you, when you do time restricted eating, so here’s these definitions. So fasting is when you’re not eating, right? So that’s pretty obvious. But we have these words that just sort of tell what you’re doing-

Dr. Weitz:            So the other one is intermittent fasting, that’s-

Dr. Gersh:           So if you don’t eat for certain periods of time in the 24 hour day, that’s time restricted eating. If you don’t eat for a full 24 hours, that’s intermittent fasting. If you don’t eat for a few days, that’s periodic fasting. If you don’t eat for more than a week, that’s prolonged fasting. So these are just definitions so we know what we’re talking about. But so if you want to do time restricted eating, that’s doing periods of fasting during the 24 hour day, it matters which portion of the 24 hour day. Just like it matters when you sleep, it matters when you eat, it matters when you don’t eat. So I’m all for time restricted eating, but the time that you should stop and be fasting is in these later part of the day. So you should get 13 hours.

                                You can have more than 13 hours of fasting in the 24 hours, but the return on investment goes down so you don’t get as much bang for the buck. If you fast for 14 hours versus 15 hours versus 13, but the difference between 13 and 11 or eight is very significant. So you so plateau, that’s what I would say. But if you fast from say five o’clock in the evening or six o’clock and then you don’t eat until nine o’clock then I’d say something like that’s fabulous. But if you don’t eat from like nine o’clock at night until two o’clock in the afternoon that you got it wrong. Because, I am so sorry for those of you who are doing this to tell you this, but you’ve got it wrong. Because you’re eating too late at night, if you’re stopping eating at nine o’clock and then you’re not eating when your body is most prepared and evolutionarily designed to receive food, which is in the first half of the day.

                                They’ve done studies on prisoners because they’re our captive audience. So where they’ve taken the same food and giving it to them either in the morning or the night, the same food. So they give almost all their food in the morning and then they do a watch out for two weeks, and then they do the same thing where they give all the food at night. It would just about, and they found that you can give the exact same food, but when you give it will determine if you gain weight or lose weight. It’s not just about calories in, it’s about your metabolic state. So you’re metabolically prepared and equipped to properly handle food in the first half of the day and not once you get past about seven o’clock at night. And don’t blame the messenger. For those of you who like to eat late at night, it just is what it is. We are who we are. We’re not owls, we’re not bats, we’re humans. That is so so what it is.

                                And I used to wonder, why are all my patients going into labor at night? It’s like, are they doing this to torture me? Why do I have to have all these laboring women in the middle of the night? Because I thought that was like a white sail until now, of course, I understand circadian rhythm. Women are designed to go into labor when it gets dark, to labor through the night and deliver in the early morning hours because that’s the safest time. Because when women are in labor, they are very vulnerable. What are they going to do? Get up and run away when they’re about to have a baby? So that’s nature’s way to protect women. So women are designed to labor during the night, have their babies in the early morning hours and then they can move, they can protect themselves and their baby. So that’s why women labor during the night, that’s actually totally natural.

                                And we even have seasonal rhythms, right? Left to nature. Have you ever seen the movie Bambi? All those babies born in the spring? Because if a baby from an animal is born in the spring, then were likely to survive because there’s so much more food available right in the spring. And the summer they can set a nap so that the mum will have a fat source. So that they can continue to take care of their little offspring through the colder winter time. And so everything is based on our beautiful solar system, all the rhythms. And that’s the part that drives me crazy is that, and now we have evidence that women on birth control pills have altered it’s weak, because you do not have rhythms when you’re on birth control pills. There are no hormonals in birth control pills. They are chemicals, they’re not hormonal, they should be called anti-hormonal contraceptives.

                                And the problem is, and I feel very sorry about this because I know that I don’t have all the most amazing solutions for contraception, but we need to define the problem if we’re ever going to get better solutions. And the problem is that everything in the female body is designed to support successful reproduction. Whether we want to have babies or not. That’s how our bodies are designed. Just like if we want to work at night, I am sorry but we are not designed to work at night, it’s just so we will pay the price. If we really don’t want to conceive, we need to understand that that’s how our bodies were designed. So all the systems in the female body are designed to support the health of the woman for the purpose of successful reproduction. That’s why I talk a lot about estrogen as the hormone, the master hormone of metabolic homeostasis that links reproductive functions and metabolic functions. And birth control pills alter our rhythms.

                                You don’t have normal rhythms, either lunar rhythms or even circadian rhythms when you’re on birth control pills and there’s higher rates of depression. We know people who don’t get adequate sleep have much higher rates of mood disorders. It’s horrible. They’re depressed, anxious. And women on birth control pills have higher rates of depression, anxiety, and we need to recognize this and we need to develop contraceptive methods that don’t poison reproduction because you’re poisoning reproduction, you’re poisoning the whole body. We just need to understand that we need these beautiful rhythms. In fact, part of the aging is loss of these beautiful rhythms, right? And women after menopause, when they no longer have rhythms and they don’t have these hormones being produced by the ovaries, that’s the onset of the whole array of metabolic dysfunctions that are assigned to the aging, but they’re really about estrogen deficiency.

                                And of course, not just that, everything that goes with it. They’re beautiful rhythms. That’s why women in menopause have tremendously high rates of insomnia and gurge, acid reflux, mood disorders, increased in all the pain syndromes. They have a lot more osteoarthritis, osteoporosis, they have a lot, women have almost three times as much dementia as men. They don’t sleep as well. And that’s a big part of it. Remember we need that big blood flow to our brains at night. So it’s all late and we’re giving birth control pills to young women. I see them getting it at age 14 now, 13, 14. So what is happening to their brains and their beautiful rhythms? And what’s happening to their sleep? They’re not having the same sleep. The blood flow to the brain is not there. So nobody links things that happened 40 years later, right?

                                But what happens is it turns out that all the women that send most of their lives on birth control pills, is they have higher rates of dementia and I’m seeing muscle skeletal problems. I’m sure you are too. They’ve been on birth control pills for 20 years and they’re only in their early 30s and they want to have kids now at 36. They delay it because they’re busy going to school and having a career, and they were put on birth control pills when they’re 14 and they’re on a continuously, now they’re 34. They go out Zumba dancing and they just pick up their own videos dancing and they’re doing nothing. They’re just dancing and they rip their shoulders, things like that. And then go to the orthopedist and they say, you need to have shoulder surgery or we’re going to inject you with steroids which great the tissue more, and all these things.

                                And nobody’s saying what on earth is a young woman in her early 30s getting her shoulder ripped, just because she goes dancing and lifts her arm. And because they don’t develop proper musculoskeletal health from being on all those years, not having proper sleep, not having proper hormones, not having proper development of their muscle cell system. And you don’t know, we don’t know how to fix that. We can’t go back and do a redo. And all of this is interlinked with sleep and with nutrition and gut health because everything is one in the body. It’s like, that’s when you said, how do I talk about everything? Because unfortunately for me as a lecturer, if I don’t understand the whole body, how am I going to put it all together? So it’s kind of fun.

                                But once you realize that every system links with every system, like you have lines going everywhere, so you have the access to everything. You kind of have to learn about everything. Not necessarily everything on the cellular level, about every single, I’m trying to, it’s really complex, but at least on a more macro scale to really understand how all these systems interlink. And sort of if we’re going to create a pyramid at the top, if we put sleep at the top, because if you don’t have sleep, everything below is going to kind of crumble. It’s going to just fall apart. So we have to have sleep. It’s just part of being a healthy human. Got to have that sleep.

Dr. Weitz:            I got it. That was awesome. Let’s touch on one more topic in terms of helping us to sleep. In your book, you talk about using melatonin and it was interesting. I’d never seen anybody recommend taking two separate dosages of melatonin. And the dosages you’re recommending are very, very small which is different than what I’ve heard with other practitioners.

Dr. Gersh:           Yeah. Well, sometimes less is more so it turns out, everything I do is I try to be evidence-based physiologic. So when we see the sunset, which is so important for people who have trouble sleeping or have mood disorders, just go outside every day unless it’s pouring or snowing or something like that and see the sunset. It’s a beautiful spectacle and it just helps to do what for so many things. It starts slowing the production of cortisol and starts increasing the production of melatonin. So, but little bits, so it doesn’t make us want to go instantly to sleep. It’s just the process begins, the process of preparing us for sleep by decreasing cortisol. And the melatonin just starts to come up a little bit. And the trigger to that can be to give a half a milligram of melatonin. We don’t have to do it at the time of the sunset but we can do it like a couple of hours before we go to bed. You can even do it earlier. You can do it as early as six hours before you go to sleep.

                                So somewhere in that time frame, depending on what you’re, you can play with it. So you can do a two hours, three hours, up to six hours even before you actually will go to sleep and try that little bit of melatonin. It’s just a half of a milligram. And that can just sort of set the tone for your body transitioning because remember everything is a beautiful curve. The cortisol rhythm, it’s just, it’s not like jaggedy, it’s curves. It’s like beautiful curves. And so this will help start you on the curve to up the melatonin, down the cortisol. And then, specifically in women who are menopausal and women with PCOS because they don’t have the proper amounts of estrogen or estrogen receptor function and so on.

                                And this is all linked, if everything is linked, all these different hormones are interrelated. Giving a little bit at bedtime. So like a half hour or so before bedtime. And not a large amount, because remember melatonin is also on a curve, right? So in peace to 2:00 AM, but if we give a whole gigantic bolus of melatonin early on, right before when you’re starting sleep, you may knock people out. You may sedate them heavily, but you’re going to alter those sleep phases. And remember, so sleep is a dynamic process. Otherwise, we could do things like give everybody Ambien, right? That’s all that matters. Who’s knocking people out. But we don’t want to go from a drug to a supplement or a hormone to effectively do the same thing, knock people out. So we don’t want to knock people, we want to get them into a natural sleep rhythm.

                                So giving a smaller amount of melatonin and you can do other things like ashwagandha. I know you know that. Ashwagandha is wonderful at lowering cortisol. You can’t, I always say things like, you can’t multitask. We keep talking about multitasking, you can’t burn fat and build fat at the same time. You can’t lose weight and gain weight at the same time. It doesn’t work that way. And you just have to look at what you’re doing so you can’t lower cortisol and raise cortisol at the same time and get any of fat. So what we want to do is have our bodies naturally start to lower the cortisol and raise the melatonin but we have to do it in a gradual way so that everything will work out probably for the whole sleep phase. So this is how we’re going to do it.

Dr. Weitz:            So you talked about using a half a milligram a couple of hours before bed and then two or three milligrams 30 minutes before bed. Right?

Dr. Gersh:           Right. So what that will do will be to help start you on your sleep process and then your body will make melatonin in the natural space. So we don’t want to push the melatonin too fast so that you get disrupted, improper sleep phases. Now, there are people that sometimes can benefit from a very, very high dose of melatonin, but we’re not really using it to get a proper sleep phase. They’re using it for its antioxidant value. For like anti-cancer, like people have breast cancer. So we’re using it like a drug.

Dr. Weitz:            I know one prominent functional medicine doctor who takes 50 milligrams.

Dr. Gersh:           Well, if you’re trying to use it as a drug to deal with cancer, then that’s a whole different thing than if you’re trying to-

Dr. Weitz:            [crosstalk 00:52:14] like preventative anti-aging purposes, there’s that-

Dr. Gersh:           I think that is misguided. Okay. I think not just-

Dr. Weitz:            [crosstalk 00:52:23] anybody else who takes that much.

Dr. Gersh:           Okay. Well, I’m also open-minded. If there’s documentation, some kind of study that really proves that if you take 60 milligrams of melatonin at bedtime, you’re going to prevent all kinds of diseases of aging, I’m all for it. But right now, like I said, I’m a little bit simple minded that I just figured nature does, we evolved in such a way that nature does everything best. So I just tried to try to get people back on track with what nature intended. Now that said, I actually go against nature when it comes to menopause. And of course, if you have a medical problem, like PCOS, because nature has not really done anything wrong to you. It’s our society that really has damaged women who have a genetic predisposition to something that happens with a lot of things.

                                The lifestyle, the food, everything else has come to play to alter women so that they don’t function properly. But menopause is universal for women and every woman when she goes through menopause is going to have some disruption of her sleep and her metabolic state. So I don’t care that it’s natural, I don’t like it. So I go against nature. I say, I love you nature, but in this case I am going against you because nature only really supports reproductive creatures. We’re sorry that nature doesn’t like us much after we’re no longer reproductive. Most creatures on this planet are no longer alive when they stop being reproductive. Most animals die at the end of the reproductive function but humans are among the very few that continue to live. The women can still live but they don’t necessarily live long.

                                Women lives longer than men because we do have more robust immune systems and we tend to survive infections better. And that’s built into our X chromosomes and it’s not just hormonal, it’s actually in our X chromosomes. So we tend to live longer, but we actually live with more chronic diseases than the men. And so I go against nature when it comes to menopause and I’m very open to bash. It’s like I love you in nature, but sorry, I’m not accepting menopausal status as what nature dishes out. Now the other thing is that in earlier times people went into menopause with, I called it like, more health in the bank. They had better musculoskeletal systems, they didn’t spend their life on birth control pills, they ate real food and so forth. And because they didn’t have all these electrical devices, they actually went to sleep at the right time.

                                So when women hit menopause, they had more reserved and more resilience to deal with it. So I look at menopause, it’s like you’re in a plane and the engines go out. Now if you have a lot of health to begin with and you have great reserves, then your plane without the engines goes into a glide and it becomes like a glider and it goes down but it’s like a slow decline and maybe a softer landing, but it will land. But if you have no reserves and then you hit menopause and the engines go off on your plane, you go into another a nose size. and that’s what’s happening to women more. Because when they hit menopause, they don’t have reserves because they haven’t had good health their whole lives. They’ve not had proper sleep, they’ve not had proper food, they’ve not had exercise, fitness, and all the things that go into making a person healthy and resilient, they don’t have it.  So they hit menopause and they lost their last support system, which is their estrogen and their progesterone so they do go into a nose size. And we now know, for example, that hot flashes are associated with increased risk. So everything bad you can think of because it’s really a sign of brain inflammation. Neuroinflammation is actually an ominous sign of [inaudible 00:56:10] and we know that. So women who go into menopause and they have no hot flashes, that’s a very good prognostic sign for their future because it shows that they have resilience and they don’t have a lot of neuroinflammation that’s happening in their bodies. That’s it.

Dr. Weitz:            Interesting. Awesome. Okay. So thank you so much Dr. Gersh. You’re still seeing patients at your office in Irvine, right?

Dr. Gersh:           I sure am. I’m a regular brick and mortar doctor. I’m in my office. This is my exam room. So yes, I definitely see patients everyday. I’ll be seeing someone in a few minutes and I would love to see anyone who is interested in integrative women’s health care. And I also, and so I’m in Irvine, California and my group is called the Integrative Medical Group of Irvine. And so I have my support team, I have a naturopath, integrated PA, nurse practitioner, fitness specialists. We have a gym in my office and we do high tech ultrasounds for vascular health and of course abdominal and pelvic ultrasounds. I have a fabulous body worker, massage services. So we try to uncover, and I have a new person who’s going to be starting a holistic naturopathic, not naturopathic, natural chef. So she’s going to help people to not only see, Oh, I do things like I say eat more vegetables.

                                And then I find out that people don’t even like vegetables, they don’t know how to cook them and they don’t know what half of them are. So my saying eat more vegetable is not really resonating too well. So I’m having a chef who will actually teach patients how to shop for vegetables, how to find good ones, how to cook them, find ways to enjoy them. Because just telling people eat more vegetables just doesn’t do it. So obviously I need help and so I’m getting it because it’s like one thing to tell people, but that’s the problem. You tell people do something, but then you don’t give them the real tools and they don’t like it. So we have to take it one step at a time. And we have to recognize that many people have grown up in families where they didn’t eat vegetables and they don’t know what it is, really. So we’re trying to help people to have a love affair with vegetables.

                                And I brought my book so that people can see it. You have it too. All right, we have matching books and I have my new book, which is actually out in Kindle version, but it will be officially debuting in January. And this is the PCOS SOS Fertility Fast Track. So for people who want to have a baby and has a healthy pregnancy and a nice healthy baby. But like everything, it’s all lifestyle medicine. So even if you, remember, I always say fertility and health are one. Fertility is a vital sign of female wellbeing. If you’re not fertile, then you’ve got a metabolic problem. And especially in the reproductive years, if you have a fertility problem, you have a health problem.

                                So even people who don’t want to get pregnant, they just want to be healthy, you can follow this because this is how to get healthy. And then of course for women who want to be pregnant, this is a key. So we call it Trimester Zero, right? Two months before you even try to get pregnant, we have to optimize women and men’s health because just getting a baby is not the answer. We want to have a healthy baby and we want to have a low complication rate during pregnancy. And these things are really astronomically increasing. Pregnancy related complications and children who already at birth are having metabolic issues. So anyway, those are my new missions is to-

Dr. Weitz:            When is your new book available?

Dr. Gersh:           What? I’m sorry.

Dr. Weitz:            When is your new book available, is it out now?

Dr. Gersh:           Kindle version, it’s available on Amazon right now, but then the physical version of it will be available January one.

Dr. Weitz:            Awesome. My pleasure. Thank you Dr. Gersh.

Dr. Gersh:           My pleasure.



Alzheimer’s Disease Prevention with Dr. Aristo Vojdani: Rational Wellness Podcast 134

Dr. Aristo Vojdani discusses Alzheimer’s Disease Prevention with Dr. Ben Weitz.

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


Podcast Highlights

5:16   Dr. Vojdani explained that the pathogenesis of Alzheimer’s Disease is largely environmental with genetics only accounting for 1-5% of cases, depending upon whether the APOE 44 genetic variant gets expressed, which is also dependent upon environment.  There is an early onset form of Alzheimer’s that is largely related to genetics, but this only accounts for 1% of cases.  The key to preventing Alzheimer’s Disease is healthy lifestyle choices.

10:30  One of the potential possible causes of Alzheimer’s disease are pathogens, including oral pathogens, like Porphyromonas gingivalis.  P. gingivalis, which is the cause of gum disease, makes a toxin called gingipain, and this has been found in the amyloid plaque of the brains of patients with Alzheimer’s Disease.  We used to think that the blood brain barrier prevented bacteria and viruses and other pathogens from entering the brain, but now we know that when this barrier is leaky, like leaky gut, such pathogens and even spirochetes like Borrelia Burgdorferi, the causative agent in Lyme Disease, can get into the brain. Other pathogens that may be involved in Alzheimer’s Disease include Herpes Simplex type I, Chlamydia, Epstein-Barr virus, cytomegalovirus, E. coli, salmonella, and lipopolysaccharides produced by such bacteria–E. coli, salmonela, Shigella, and Campylobacter jejuni.  If these pathogens or their toxins get into the brain they cause inflammation and can contribute to a degenerative process in the brain and because of an antigenic similarity between these pathogens and proteins in the brain, this leads to immune attack on brain tissue like beta amyloid and tau proteins and this results in aggregating and clumping of these proteins.  Beta amyloid protein is really being produced as a way for the brain to protect itself against pathogens and it is thought to have an antibiotic effect.  Dr. Vojdani published a paper on this in the Journal of Alzheimer’s Disease:  Reaction of Amyloid-β Peptide Antibody with Different Infectious Agents Involved in Alzheimer’s Disease

17:45  This story of the function of beta amyloid protein is similar to the cholesterol story where we used to think that simply ingesting cholesterol and fat would lead to a build up of cholesterol in the arteries.  But you have to wonder why would the body lay cholesterol down in the arteries when that might kill us?  Well, because there is inflammation and oxidative stress and the body’s coating your artery wall using cholesterol. And so it’s actually beneficial. But once it builds up to a point, then it blocks the blood flow and it becomes pathological. And the same way in the brain, the brain is using the amyloid protein to protect the brain from the pathogens, but when it forms tangles, it becomes pathological and contributes to neurodegeneration.  Dr. Vojdani explained that this process can start with bacteria in the gut releasing a toxin that results in leaky gut. Then the bacterial toxin, LPS, get into the blood stream, resulting in pro-inflammatory cytokines being released which then breaks down the blood-brain barriers, causing brain inflammation. The microglia of the brain then become activated, which results in a lot of beta amyloid protein becoming aggregated, forming a plaque, which contributes to neurodegeneration.

21:38  Toxic chemicals can also be one of the triggers for Alzheimer’s Disease.  Here are a couple of quotes from the Alzheimer’s society website:  “At present, there is no strong evidence to support the fears that coming into contact with metals through using equipment or through food or water increases your risk of developing Alzheimer’s disease…. It is also unclear whether reducing metals, [like aluminum] in the brain via drugs or reducing our exposure would have any beneficial effects. These metals are essential to the healthy function of our brain. So further research into changes before or during disease development is also necessary to understand if reducing the amount in the brain would actually be beneficial.”  Dr. Vojdani does not agree with these statements and believes that exposure to toxic metals like aluminum can be factors in the pathogenesis of Alzheimer’s Disease.  Consider when you cook with your turkey or chicken covered in aluminum foil at a high temperature in the oven, a significant amount of that aluminum will become part of your food and you will ingest it.  Aluminum is positively charged (AL 3+) and proteins are negatively charged, so positively charged particles are quite likely to cross link to the proteins.  And this can make it difficult for you digestive enzymes to break down these proteins, so they may trigger leaky gut and leaky brain, leading to inflammation and autoimmunity.  But aluminum has been found in the epithelial cells and in the brain.  Among the toxic chemicals that have been shown to contribute to Alzheimer’s Disease are heavy metals like lead, mercury, and aluminum, plasticizers like BPA, pthalates, and dinitrobenezenes bind to our serum albumin or to our hemoglobin and change their structure so they look like amyloid beta or tau protein.  Then the immune system will produce a new antigen against this toxic chemical that will then cross react and attack the brain cells, thus contributing to the pathogenesis of Alzheimer’s Disease.

32:40  Food sensitivities (not food allergies) can contribute to the pathogenesis of Alzheimer’s disease.  Dr. Vojdani has found that some of the most common food sensitivities include gluten, dairy, egg yolk, and canned tuna (more so than fresh tuna).  Of course, tuna is known to have mercury in it, but canned tuna, because it is in an aluminum canned that is lined with BPA and the tuna is cooked in the can, will have mercury, aluminum and plasticizer in it.

38:54  Dr. Vojdani developed the Alzheimer’s LINX Panel for Cyrex Labs to screen for the risk of Alzheimer’s Disease.  This is really the first test that can screen for Alzheimer’s Disease risk.  The first part of this panel tests for antibodies to the brain proteins, including amyloid beta, tau protein, and alpha-synuclein.  Having antibodies to these brain proteins may indicate early, pre-clinical indications of future Alzheimer’s Disease. It also measures antibodies to brain growth factors, including Brain Derived Neurotrophic Factor (BDNF) and Beta Nerve Growth Factor.  Alzheimer’s LINX also looks at antibodies to the enteric nerve, which is the nerve in the gut that communicates with the brain. This test also includes antibodies to the most common pathogens (Oral Pathogens, Enterococcus faecalis, E. coli, Salmonella, Campylobacter jejuni, Herpes), toxic chemicals (Aluminum, mercury, Dinitrophenyl, Phthalates) and food sensitivities (Egg Yolk, Lentil, Pea lectin, canned Tuna, Hazelnut, Cashew, Scallops, Squid, Caseins, Alpha-Gliadin, Non-Gluten Wheat Proteins) that cross react with brain tissues. This test also looks at the blood brain barrier, which if it is broken will allow these other antibodies to enter the brain.  To repair the blood brain barrier, we need to repair the gut barrier by taking a Functional Medicine approach by removing the triggers (pathogens, chemicals, food sensitivities), and then use gut healing nutrients like B vitamins, vitamins A, D, and E, cruciferous vegetables, resveratrol, etc. and also exercise. 

This Alzheimer’s LINX panel is also beneficial for Parkinson’s disease risk and other neurodegenerative diseases.  In fact, this test is a great overall health screen, since it really combines 5 or 10 different arrays offered by Cyrex Labs and it looks at the gut, the brain, the blood brain barriers, nerve growth factors and various environmental factors.  Cyrex Labs cannot be ordered directly by patients.  They must be offered by Functional Medicine practitioners like myself by going to CyrexLabs.com.  If you want to test for various pathogens like Lyme Disease, Herpes and other viruses, you can contact Dr. Vojdani’s Immunosciences Lab or call (310) 657-1077.



Dr. Aristo Vojdani is the Father of Functional Immunology, one of the most important doctors in the Functional Medicine world. Dr. Vojdani has a PhD in microbiology and immunology and he is an adjunct professor in the Dept. of Preventative Medicine at Loma Linda University. Dr. Vojdani is the Chief Scientific Advisor to Cyrex Labs and he is the CEO and Technical Director of Immunosciences Lab in Los Angeles. He has authored or co-authored over 160 scientific articles and he is actively involved in research related to autoimmune, neurodegenerative, and autoinflammatory conditions.  Dr. Vojdani has written several books, including his latest, Food Associated Autoimmunities: When Food Breaks Your Immune System.

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


Podcast Transcript

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

                                                Today our topic is the prevention of Alzheimer’s disease with Dr. Ari Vojdani. Alzheimer’s disease is the most common cause of dementia, which is the loss of memory and other cognitive abilities. Seriously enough to interfere with daily life. Approximately 5% of patients have early onset Alzheimer’s disease, which occurs before age 65 and it’s more related to genetic factors, especially mutations in the following genes, APP, PSEN1, and PSEN2. The other 95% of patients with Alzheimer’s disease have late onset disease and this is generally regarded as an autoimmune disease. Alzheimer’s disease is a progressive neurodegenerative disease that is marked by the progressive accumulation of plaques of amyloid beta protein in the brain and of neurofibrillary tangles of tau protein within neurons within the brain.

                                                The most common early symptom of Alzheimer’s disease is difficulty remembering newly learned information because Alzheimer’s changes typically begin in the part of the brain that affects learning as Alzheimer’s advances through the brain, it leads to increasingly severe symptoms including disorientation, mood and behavior changes, deepening confusion about events, time and place, unfounded suspicions about family, friends, and professional caregivers. More serious memory loss and behavior changes. And finally, difficulty speaking, swallowing and walking. Obviously anything we can do to prevent such a horrible disease, we need to do as much as we can. Dr. Aristo Vojdani, is the father of functional immunology. He’s one of the most important doctors in the functional medicine world. He has a PhD in microbiology and immunology and he’s an adjunct professor in the department of preventative medicine at Loma Linda University.

                                                Dr. Vojdani developed all of the testing offered by Cyrex Labs and he is their chief scientific advice and he’s the CEO and technical director of Immunosciences Lab in Los Angeles. Dr. Vojdani has authored or coauthored over 200 scientific articles and he is actively involved in research related to autoimmune, neurodegenerative, and auto inflammatory conditions. He’s written several books, including his latest, which is Food-Associated Autoimmunities: When Food Breaks Your Immune System. By the way, this is a great book. If in case you don’t have time to lift weights, you just lift this book up and you’re going to get very strong. He’s also the recipient of the Herbert Wrinkle award from the American Academy of Environmental Medicine, the Linus Pauling award from the American College for Advancement in Medicine and the Carrick Research Institute’s Lifetime Achievement Award. And I know he also received a Lifetime Award from Jeffrey Bland’s PLMI Institute. Dr. Vojdani, thank you so much for joining me today.

Dr. Vojdani:                        Thank you Dr. Weitz, and I would like to thank you for your contribution in the field of Functional Medicine. I had many time the honor, to be part of your Functional Medicine meeting and in March I’ll be your guest again, and thank you for giving me those opportunities.

Dr. Weitz:                           And thank you and thank you for your friendship. So what do we know about the pathogenesis of Alzheimer’s disease?

Dr. Vojdani:                        Okay, so let’s first of all start with Alzheimer’s disease. In my article I wrote 95% and 5%. In reality right now actually, the Alzheimer is divided to two types, early onset, the late onset. Actually the early onset is only 1%.

Dr. Weitz:                           1%. Okay.

Dr. Vojdani:                        1%. And the late onset right now probably is 99% however, there is also the issue, you talked about those mutation with those genes.

Dr. Weitz:                           Right.

Dr. Vojdani:                        There is nothing you can do about that, your early onset, if you have mutation in those genes, you are going to develop it at age 30, 40, 50, before 60. The late onset of Alzheimer’s, other than APOE involvement, there is no other genes so far, leave alone what will be in the future. That’s why, and I was very careful saying five and 95.   So probably in the future more genes will be discovered. However, right now we are talking about is that 1%, 99%, the late onset. Also APOE is involved. However, APOE is the gene responsible for transport, as you know, of cholesterol into the cells because our cell membrane is made of cholesterol. And so APOE is involved in that job and of course brain, is made up 80% are made of fat.

Dr. Weitz:                           Right.

Dr. Vojdani:                        And so we need APOE also to transfer some fat to the brain cells in order to survive.

Dr. Weitz:                            Right. Which is one reason why patients with statin drugs often have cognitive dysfunction.

Dr. Vojdani:                        Exactly. So APOE is found in about 10%, APOE 44. APOE 34, and APOE 44 traveling about 10 to 15% of the population. However, having APOE or being APOE44 positive, not necessarily you are going to develop Alzheimer’s disease. The probability or the chances of developing Alzheimer’s is much higher. And that’s why the message of prevention you and I that we are giving to the audience.

Dr. Weitz:                           Right. So just to clarify, APOE 44 means you have two copies of the E4 variant of the APOE. If you have one copy, you would be APOE 43 because 33 is the most common.

Dr. Vojdani:                        So having or being positive with two copies, not necessarily so, but the chances of developing Alzheimer is 10 times higher.

Dr. Weitz:                           Right. Now is having two copies of the APOE4 gene, just a death sentence?

Dr. Vojdani:                        Absolutely not. That’s the message.  So that’s why our message is lifestyle modification.

Dr. Weitz:                            Yes.

Dr. Vojdani:                        Lifestyle modification. So please, if you did your test and you are APOE 44 positive, just listen to us and our message is going to be healthy diet, physical activity, and mental activities and that’s a huge umbrella.

Dr. Weitz:                            Absolutely. Yeah. Basically if you happen to have the APOE 44 gene, it’s not a death sentence. What it means is you just need to pay even more attention to doing all these lifestyle preventative factors than somebody who doesn’t have it.

Dr. Vojdani:                        Right. So APOE 44, about 10% of the population and only about maybe 20% of those, of the 10% will develop Alzheimer’s. If they don’t follow good lifestyle. Healthy lifestyle. These numbers, it comes to about really 5% that you were talking about. If you combine the 1% plus another three, 4% becomes like, so Alzheimer’s is 95% environmental, 5% is genetic.   Even if we count APOE 44 as genetics, which is not, but, that’s why 95 and five. So then your question was, what do I know about pathogenesis of Alzheimer’s disease?  I know a lot about pathogenesis of Alzheimer’s disease.  What are the environmental factors contributing to Alzheimer’s disease? So because the word pathogenesis, I will start with pathogens.  So first pathogens, oral pathogens, Porphyromonas gingivalis.

Dr. Weitz:                           Basically you’re talking about gum disease.

Dr. Vojdani:                        Gum disease. Correct. And if you follow and read some articles that Porphyromonas gingivalis makes a toxin, called gingipain. And when they looked at the brain of Alzheimer’s patients, they found when they looked at amyloid plaque or tau protein, They found gingipain of Porphyromonas gingivalis in the plaque. So we’ll talk more about blood-brain barriers, how this toxin, which is such a huge molecule penetrated the blood-brain barriers and now is, probably bound to amyloid beta and causes amyloid beta plaque formation.

Dr. Weitz:                            Right. So what you’re saying is, is that we previously thought up until several years ago, that you couldn’t really have pathogens like bacteria and viruses in the brain because we had this blood-brain barrier that prevented it.  But now Dr. Rudolph Tanzi and others have discovered that there are bacteria and viruses and even fungi that penetrate the brain.

Dr. Vojdani:                        Absolutely. For example, I used to criticize people because I do Lyme disease, test for Lyme disease, you know ImmunoSciences Lab and I have one of the best tests which patented by us and all of that. I used to criticize people saying that Borrelia burgdorferi, this huge spirochete can cross the blood-brain barrier and goes into the brain tissue.  Until I started reading about the Alzheimer’s.  25% are facing with Alzheimer’s disease, the whole spirochete, not the toxin or antigen have spirochete. In this case Borrelia burgdorferi.  25% of them had the whole spirochete in their brain, so therefore the blood-brain barriers, the curtain, which is protecting the brain, very similar to gut barriers is not that perfect.

Dr. Weitz:                            Right. We learned in recent years how there is leaky gut, everybody’s familiar with that concept of leaky gut, meaning that’s permeable and large molecules can get through that aren’t supposed to.  Same thing with the blood-brain barrier.  Just like, you can have leaky gut, you can have leaky brain.

Dr. Vojdani:                        And these two are connected. We’ll get a little bit in few seconds also to that. So oral pathogens, spirochete including the other spirochetes. Treponema.  Then herpes type 1, and herpes the cause of a cold sore.

Dr. Weitz:                            Right. Herpes simplex.

Dr. Vojdani:                        Right. Chlamydia. To some degree, Epstein-Barr virus, cytomegalovirus. But you mentioned Tanzi and other groups from UC Davis found the whole E. coli or salmonella and lipopolysaccharides produced by these bacteria–E. Coli, salmonella, Shigella, Campylobacter jejuni. In the brain of Alzheimer’s patients.

Dr. Weitz:                            Wow. It’s a whole party up there.

Dr. Vojdani:                        Yes. So now, the research that I did, which was published in journal of Alzheimer’s disease, International Journal of Alzheimer’s Disease and then journal of Alzheimer’s and Parkinsonism. We looked at possibility of not only these bacteria can get into the brain, when the immune system attacks these pathogens and we produce antibody against them. Are these antibodies going to protect us against Alzheimer’s or are going to contribute to Alzheimer’s disease? So we took antibodies specifically made against lipopolysacharide or antibodies made against bacteria cytolethal distending toxin of Campylobacter jejuni. Or vice versa antibody made against amyloid beta. And we found these two react to each other. So if the patient is making antibodies against lipopolysaccharides, those antibodies can attack amyloid beta. If those antibodies cross the blood-brain barriers and there will be in the brain tissue.

Dr. Weitz:                           Now why would they attack the brain tissue?

Dr. Vojdani:                        Because of the antigenic similarity between these pathogens with the human brain.

Dr. Weitz:                           That’s cross reactivity.

Dr. Vojdani:                        We call that friendly fire. The immune system is attacking the pathogen to get rid of the pathogens, but the antibody produced against them because the amyloid beta looks like the pathogens. Now the antibodies attacking amyloid beta or tau protein causing aggregation. Therefore this is the mechanism how pathogens can contribute to autoimmune disease and in this case to Alzheimer’s disease.

Dr. Weitz:                            So it’s not so much just the fact that there’s amyloid protein or tau protein, it’s that these proteins become aggregated and form clumps and tangles. That’s when they really become pathological.

Dr. Vojdani:                        Absolutely both. Beta amyloid and tau protein, these are functional proteins. They do their job. In fact, amyloid beta acts like antibiotic. It prevents, it tries to get rid of, prevents some pathogens to infect the brain. Exactly like antibiotics.

Dr. Weitz:                            Yeah. You know what? It’s also very similar to the cholesterol story where we used to think that you ingest fat and because you have a lot of fat, the fat just builds up.  But now we know that cholesterol–why would the body lay cholesterol down in the arteries? Well, because there is inflammation and oxidative stress and the body’s coating your artery wall using cholesterol. And so it’s actually beneficial. But once it builds up to a point, then it blocks the blood flow and it becomes pathological. And the same way in the brain, the brain is using the amyloid protein to protect the brain from the pathogens. But then it becomes pathological.

Dr. Vojdani:                        Yes, absolutely. So here is an example. An individual is having a problem in the gut. One of these bacteria E. coli, salmonella Shigella, Campylobacter jejuni, releasing the toxin. The toxin causes leaky gut. Leaving it open. Now the toxin is going into the blood. Now the toxin because of inflammation in the blood and using immune system reaction against that releasing cytokines, pro-inflammatory cytokines such as TNF alpha, tumor necrosis factor alpha. Now LPS, the bacterial toxin. And TNF alpha and other pro-inflammatory cytokines. They break the blood-brain barriers, so now lipopolysaccharides, TNF alpha, antibodies, even T-cells completely get into the brain area causing inflammation. During inflammation, the microglia become activated. When microglia become activated, then also the body produces a lot of amyloid beta from the gut, goes to the brain to help. More antibiotic in the brain to help. But in the process, those amyloid beta become aggregated and then finally huge size of plaque is formed, which further contributes to neurodegeneration.

Dr. Weitz:                            Right. Or is there even a microbiome of the brain, that we have all these bacteria in there?

Dr. Vojdani:                        That’s a fantastic question. I don’t think so because we cannot teach from one hand saying that, only small molecules such as glucose and other nutrients, which are necessary under normal conditions, can cross the blood-brain barriers and feed the brain cells. If we have microbiome in the brain, like in the gut, do we have really under normal condition, E. coli in the brain, I don’t think so.

Dr. Weitz:                            Right.

Dr. Vojdani:                        But if you call microbiome of the brain under abnormal condition, E. coli salmonella, Shigella, Campylobacter jejuni, H. pylori and others manage to go into the brain and causes inflammation, induce fire in the brain. If we call that the microbiome of the brain, then you may be right, but I don’t think so. No research.

Dr. Weitz:                            Okay. So let’s go on to toxic chemicals and what part they play in Alzheimer’s. And I wanted to read you something, I went to the Alzheimer’s society website and this is a couple of quotes from their website. “At present, there is no strong evidence to support the fears that coming into contact with metals through using equipment or through food or water increases your risk of developing Alzheimer’s disease. It is also unclear whether reducing metals, [like aluminum] in the brain via drugs or reducing our exposure would have any beneficial effects. These metals are essential to the healthy function of our brain. So further research into changes before or during disease development is also necessary to understand if reducing the amount in the brain would actually be beneficial.”

Dr. Vojdani:                        Thank you first of all, for choosing that from Alzheimer’s association. I’m extremely surprised that Alzheimer’s association is putting such a statement, their role is to help people with Alzheimer’s and many people are supporting the cause of Alzheimer’s by donating so much money to the society, to Alzheimer’s Association.  I believe this is, when I was listening to you, sounds to me more like a legal terminology rather than scientific.  Just pay attention to the wordings, to becoming in contact. What does that mean? To become in contact? Of course, if I touch something with aluminum, it’s not going to hurt me, right? I’ll take aluminum pan and cooking that aluminum or I’ll take aluminum foil, put it on top my chicken and put it at 450 degrees.

Dr. Weitz:                            Put it on your Turkey with Thanksgiving coming up.

Dr. Vojdani:                        I assure you a lot of aluminum, from that gets into the meat and aluminum. And aluminum as you know that AL3+. Proteins are negative charge. The positive charge covalently almost cross links to the proteins. And so are you surprised that why we do not digest so many proteins? I gave example in my book, for example, gluten or peanut butter. Why some people don’t digest that because if these molecules such as aluminum bind to the protein of the peanuts or to the chicken or to the gluten, they’re digestive enzyme will not be able to digest them. And therefore immune reaction in the gut, leaky gut, leaky brain, inflammation and autoimmunity. So I cannot believe that they made such a controversial statement. And also I read in many places that aluminum in the food is harmless. Right? But I gave you example right now that aluminum in the food can buy into the food proteins and therefore it is harmless. It is harmful. It’s not harmless. And interestingly that I was reading also saying that, it’s harmless because aluminum bind to the proteins of the food.

Dr. Weitz:                            Yeah, I was listening to, you had a discussion, you and Elroy and Dr. Bredesen and Dr. Bredesen was talking about why the mainstream medicine right now is having a tough time buying into his theory of the complex causes for Alzheimer’s disease. And he was saying how they go through these different stages and initially they just dismiss it as nonsense, then they attack it and then finally they accept it. And I think this is part of, mainstream medicine, coming to accept a functional medicine outlook on understanding how to diagnose and explain and treat these conditions. And so, they’re having a tough time with the idea that all these toxins in our environment are as really significant contributors to chronic disease.

Dr. Vojdani:                        I agree with you. And the statement you just read is against the articles published in their own journals. I can open files behind me and show to audience that in variety of articles, published in Alzheimer’s related journals, including the association journal related to Alzheimer’s, that aluminum is neurotoxic. So make your decision, is it neurotoxic or it’s healthy. I don’t want to be exposed to aluminum. There’re two reasons. One, first of all it is not true that aluminum is in and out. Maybe 60% is in and out, but we know that 40%, this is an article published in Journal of Mucosal Immunology, three or four years ago. 40% of aluminum from food gets into the epithelial cells in the gut. What is going to do to those epithelial cells? Inflammation, leaky gut. Small percentage gets into the muscles. Therefore, in your field, this function of musculoskeletal.

Dr. Weitz:                            Yes.

Dr. Vojdani:                        2% of aluminum goes into the brain. In fact, in one of my lectures I showed those who participate in that, they’re aluminum, they stained or they found aluminum in the brain of Alzheimer’s patients. Now you can argue having aluminum in the brain, is not going to cause Alzheimer’s. You may argue with this until next year or 10 years for a period of 10 years, but I don’t want to have Alzheimer’s in my epithelial cells and in my brain cells. If you guys want to have that, those who wrote that statement by the Alzheimer’s association, that’s up to them.

Dr. Weitz:                            Well, in 10 years they won’t remember that they said it.

Dr. Vojdani:                        So really, you know right now let’s give the right advice to, I don’t want to have Alzheimer’s in my muscles, in my gut and my brain. Aluminum. I don’t want to have aluminum. If you guys want to have that, God bless you.

Dr. Weitz:                            So what are some of the other toxic chemicals that play a role in Alzheimer’s?

Dr. Vojdani:                        So plasticizers, pthalates, mercury, other heavy metals, because here they say heavy metals in general. I don’t know. That statement is so wrong that our brain is heavy metals. The statement that you read.

Dr. Weitz:                           I know, I know.

Dr. Vojdani:                        Based on what?

Dr. Weitz:                           They say metals are essential to the healthy function…

Dr. Vojdani:                        If they mean, maybe they think of a [inaudible 00:29:48].

Dr. Weitz:                            Maybe. I mean there are metals, not aluminum, but maybe, zinc or iron.

Dr. Vojdani:                        Zinc we need. I have no problem with zinc and iron. But that’s again, that’s a legal statement. What they mean. It’s not a scientific statement.  And I’m sorry to say that.


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

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



Dr. Weitz:                             So some of these other chemicals and how do they play a role in Alzheimer’s?

Dr. Vojdani:                        So some of these chemicals just like plasticizers especially-

Dr. Weitz:                            And by the way, that includes BPA as well?

Dr. Vojdani:                        BPA, pthalates and dinitrobenzene or anything with a benzene ring. These kinds of chemicals bind to human serum albumin, to hemoglobin other proteins changing their structure in such a way the treasury structure almost looks like amyloid beta or tau protein.  So when the immune system attacks the neoantigen. Neoantigen, new antigen, which is a combination of pthalates with albumin or aluminum with albumin, that antibody produced against that, if it penetrates the blood-brain barrier is going to attack the brain cells. So I explained that mechanism of action in an article that I published in journal of Alzheimer’s and Parkinsonism. So chemicals, these few definitely contribute to pathogenesis of Alzheimer’s disease.

Dr. Weitz:                            And what role do food sensitivities play in a cause of Alzheimer’s?

Dr. Vojdani:                        So let’s be a little bit careful about food sensitivity.

Dr. Weitz:                           Okay.

Dr. Vojdani:                        If food sensitivity, you mean by having allergy to food? That’s completely different word.

Dr. Weitz:                           Okay.

Dr. Vojdani:                        I eat something, I eat egg or strawberry and immediately I’m going to have anaphylactic basophil release and other mediator release. That has nothing to do with Alzheimer’s.  But if you eat peanut butter, which is loaded with aluminum or gluten, also loaded with some aluminum, this is just example. And you cannot digest it. And particles, parts of that proteins or peptide gets into the blood and the immune system attacks it and makes antibody against that. Then that antibody due to similarity between gluten, especially gluten toxic peptide, or even dairy, alpha beta- casein. There’s similarity, antigenic similarity with the human brain cells. Now antibodies are getting into the brain, attacking neurons causing aggregation of amyloid beta and tau. Therefore, food through these mechanisms can contribute to pathogenesis of Alzheimer’s disease.

                                                And the food that we found, gluten, dairy, because again, remember Dr. Bredesen in his book recommended gluten free and dairy free. Now we are supporting his theory of gluten free and dairy free by showing that cross reactivity between these, with human brain cells. Egg, especially egg yolk, cross reacted with amyloid beta. Some lectins and agglutinins very interesting. Canned tuna but not tuna, fresh tuna.

Dr. Weitz:                            Right.

Dr. Vojdani:                        We found with fresh tuna, 20% cross-reactivity with canned tuna, more than 50%. 60% cross-reactivity and asked why? Can ask why? Because in canned tuna, first of we have raw versus cooked. I published and again in my book there was a chapter about that. [inaudible 00:35:36] says cooked are complete two different worlds.

Dr. Weitz:                            So what you want to know if you have a sensitivity to a food, which a lot of it has to do with whether or not you’re able to break down the proteins, but if you cook a food as opposed to eating it raw, when you cook it, you change the protein confirmation. So somebody who has a sensitivity to a raw food may or may not have a sensitivity to a cooked food or vice versa.

Dr. Vojdani:                        Absolutely. Thank you so much. That’s why I wrote that book because I got tired of throughout the years all these laboratories are doing wrong testing and providing wrong test results. There are certain foods we don’t eat them in a raw [inaudible 00:36:21]. And so you may react to raw food but not to the cooked food. And this example.

Dr. Weitz:                            And by the way, for people don’t know it, tuna fish is cooked in the can. They stick it in the can, seal it and then heat it up.

Dr. Vojdani:                        And it goes into through sterilization, right? So what happened then, the plasticizers, the aluminum-

Dr. Weitz:                            The plasticizers are coating the inside of the can.

Dr. Vojdani:                        All goes into the… I was extremely surprised. How come? We got reaction with canned tuna but less reaction with the raw tuna. So that’s exactly the explanation. All the chemicals get into the, proteins bind to them covalently and make them completely new antigens and therefore react to them. We make antibody against them and those antibodies turning against us, in this case, turning against our brain eventually causing Alzheimer’s in the future.

Dr. Weitz:                            Interesting. Now it depends on a person though, right?

Dr. Vojdani:                        Of course. Many years ago, Ben, I read this fantastic article by one of the famous toxicologist from New York. And the phrase was this, you and I maybe exposed to same levels of chemicals. You may not be harmed, but I’ll be harmed by the same levels. The reason is… And that’s why personalized and lifestyle medicine, right? Personalized medicine.

Dr. Weitz:                            Right.

Dr. Vojdani:                        You have a good enzyme. Metabolizing enzymes can metabolite the chemicals, change them to metabolites and clear them from your system. I may not have that. Some people are slow metabolizer, some are medium metabolizer, and some are fast metabolizer. For each one of these there is advantages and disadvantages. So you and I may be exposed to the same levels of chemicals. One completely will stay healthy, the other one may become sick.

Dr. Weitz:                            Correct.And some people have sensitivities to one food versus the other as well. Right? Like some people-

Dr. Vojdani:                        Of course. Of course, yes.

Dr. Weitz:                            So now let’s get into this, our term is links panel that you developed for Cyrex. Can you explain exactly what does it measure? Who should get this test and you know, how can this test benefit patients and how can clinicians use to assess patients and guide care?

Dr. Vojdani:                        Absolutely. So the Alzheimer links is the results of more than 30 years of work.

Dr. Weitz:                           And by the way, the background is, there’s really no one test that can assess your risk of Alzheimer’s probably this test.

Dr. Vojdani:                        Absolutely. There is no one test and there is no one treatment. So as far as testing is a combination of tests where we look at immune system attacking the brain cells and the brain proteins including amyloid beta, tau protein, alpha-synuclein and other brain proteins.

Dr. Weitz:                            So what does that part of the test tell us?  And what if it’s positive and what if it’s negative?

Dr. Vojdani:                        That part of the test is telling us that whether or not there is amyloid beta plaque in the brain, tau aggregation and the microglia trying to break it down and get released into the spinal fluid as well as in the blood. When they are released and they are in the blood, immune system react against them and make antibody against them.

Dr. Weitz:                            Okay.

Dr. Vojdani:                        So in this particular case, there are two choices, you measure directly amyloid beta, tau protein, alpha-synuclein or neurofilaments. But as an immunologist, I came to the conclusion that the half life of these proteins, is only a few hours as if you measure, for example, tau protein in the blood, in the morning and in the afternoon you are going to get two different results.  You measure antibody against that. Today or tomorrow or next week you are going to get same results plus minus 10% and so because the half life of antibodies about 21 to 30 days.

Dr. Weitz:                            Okay.

Dr. Vojdani:                        More stable. That’s why the choose and I’m doing research comparing also the levels versus antibodies. I’m going to publish it in the future.

Dr. Weitz:                           Okay. Okay. And so are you finding the-

Dr. Vojdani:                        So I decided to do the antibodies.

Dr. Weitz:                           So far are you finding the antibody and the protein level, that they have a correlation?

Dr. Vojdani:                        Yes. Yes. Yes.

Dr. Weitz:                           Okay.

Dr. Vojdani:                        To some degree. And again, because I explained the half life of levels is much shorter than the antibody. So the correlation is okay, but it’s not 100%, probably about 80% or 60%.

Dr. Weitz:                            Okay. So let’s say we find out that you do have antibodies to these brain proteins. What does that tell us?

Dr. Vojdani:                        That tells us that your immune system, there is inflammation in the brain. The brain cells are dying. They’re releasing these antigens and the immune system attacking them, making antibodies. So if we detect antibodies against these brain cells, meaning, possibly you are at preclinical stage of Alzheimer’s disease. In my article I wrote, and this is based on publications, a publication of an article by scientists from different universities who made calculations claiming that 47 million Americans are at preclinical stage of Alzheimer’s disease. And I believe, sincerely believe that these antibodies are going to tell us whether or not you are brewing some kind of reactions. I’m not calling this is reaction. When we find reaction, we can do something about it and reverse the course of the disease.

Dr. Weitz:                            Let’s say those are negative. What does that tell us?

Dr. Vojdani:                        Okay. If the test is completely normal.

Dr. Weitz:                           No, I mean just the antibodies to the proteins in the brain. Just that part.

Dr. Vojdani:                        If there are positive first.

Dr. Weitz:                           No. If they’re negative.

Dr. Vojdani:                        If they’re negative, at least you will believe that there is, you know, there is no pathological reaction right now going in the brain.

Dr. Weitz:                           Okay. Okay.

Dr. Vojdani:                        Okay, so number one was that that group of proteins.

Dr. Weitz:                            Right.

Dr. Vojdani:                        Number two-

Dr. Weitz:                            And then if they’re positive, then we want to see what might be causing it, right?

Dr. Vojdani:                        Right. Yes.

Dr. Weitz:                            Which is where some of the other parts of this test can be helpful right?

Dr. Vojdani:                        Yes. Because, firstly I’m looking at the brain proteins.

Dr. Weitz:                            Right.

Dr. Vojdani:                        Now there are growth factors.

Dr. Weitz:                            Right.

Dr. Vojdani:                        Many people do not pay attention to the nerve growth factors, beta NGF and all of that, and because some people may not have enough nerve growth factors.  As you know, physical exercise, increasing the level of nerve growth factors, helping regrowth of neurons.

Dr. Weitz:                            Right and brain BDNF also.

Dr. Vojdani:                        So if you are lazy, you don’t exercise and now your nerve growth factor is low or for some reason your immune system is attacking the nerve growth factors, your neurons dying and because you don’t have enough nerve growth factor, they’re not going to regenerate and therefore much faster Alzheimer’s is going to be difficult. For that reason, we included also the nerve growth factors in this panel.  So the next, the three environmental factors that we talked about, pathogenesis of Alzheimer’s disease, the pathogens. The pathogens that cross react with amyloid beta and tau proteins such as herpes, oral pathogens, chlamydia spiral kits, and then especially E. coli, salmonella, Shigella and bacteria cyto-lethal distending toxins.

Dr. Weitz:                           Which is part of SIBO and IBS. Right?

Dr. Vojdani:                        Right. By the way, before that, I forgot also to talk about the enteric nerve, the gut.

Dr. Weitz:                           Okay.

Dr. Vojdani:                        That’s the third component. So brain proteins, the growth factors, the enteric nerve and its communication with the brain.

Dr. Weitz:                            So if the part with the growth factors, if those are low, is that what we’re looking for?

Dr. Vojdani:                        Yeah, if there’s antibody against them-

Dr. Weitz:                            Antibodies to growth factors. Okay.

Dr. Vojdani:                        Meaning they’re not going to function.

Dr. Weitz:                            Right.

Dr. Vojdani:                        And therefore they are not going to help. Even if you have them at normal level, they’re not going to help regeneration of [inaudible 00:46:56]. So brain proteins, the growth factors, the enteric nerve and it’s communication with the brain. Now the environmental factors, the pathogens, we measure antibody against those, the toxic chemicals and the foods that I mentioned. All of these are a part of the panel. And finally, let’s say if you make antibodies against brain proteins, the nerve growth factors, the enteric nerve. Then the pathogens, the chemicals, the foods, you can have those antibodies circulating in the blood. As long as the blood-brain barriers are not broken, you may be okay, your patient may be okay, but in the context of broken blood-brain barriers, these antibodies against these six components now also antibodies against blood-brain barriers such as S100, the water channel proteins, claudins.  If also you make antibody against that, they help to open the blood-brain barriers. So in the context of broken blood-brain barriers, the antibodies which are circulating in the blood, we may not call them pathogenic, but when the blood-brain barriers are broken, they could become pathogenic by going after the neurons, attacking the neurons, contributing to neuro-degeneration. That’s the mechanism.

Dr. Weitz:                            Right. So you’re saying to really get an accurate assessment of what might be going on. If they have some positives with this test, we should also run a Cyrex panel that looks at the blood-brain barrier?

Dr. Vojdani:                        That components are part of the Alzheimer links.

Dr. Weitz:                            Oh, okay. So that’s part of it. Okay.

Dr. Vojdani:                        You want a little bit more information, more complete. You could go also to different arrays by Cyrex.

Dr. Weitz:                           Okay.

Dr. Vojdani:                        But here, we picked about 30 different items. Which includes the brain proteins, the growth factors, the enteric nerve and other factors in the gut, the pathogens, the toxic chemicals, the food, and then the blood-brain barriers. If any components of these seven groups are abnormal. Well let’s talk about at least the environmental factors, the food, the toxic chemicals, and the pathogens are elevated. The BBB is broken, and the antibody against growth factors and brain proteins are elevated. The only choice we have in here is to repair the gut barriers, to repair the blood-brain barriers and stop from entering or from those antibodies made against environmental factors plus inflammatory cytokines, and everything to get into the brain and add to the fire in the brain.

Dr. Weitz:                            So how do we repair the blood-brain barrier?

Dr. Vojdani:                        First of all, you remove the triggers you find based on Alzheimer’s links in one person, the trigger could be food, in another person could be toxic chemicals. The third person could be pathogens and the fourth person could be all three of them. together. You have to find those and remove them. If your patient is reacting to canned tuna, I’m sorry, you have to remove that from the diet. This is not food sensitivity, Ben, that wrongly done. Here we are talking about specific cross reactivity between cook tuna or canned tuna with brain cells. When you react against that or you react against egg yolk or lectins, this is the only time I agree with removing the lectins, not like the book that they recommend. The gentleman, the doctor recommends that, everybody should be avoiding lectins.

Dr. Weitz:                           You are talking about Dr. Gundry.

Dr. Vojdani:                        Yes, Dr. Gundry. I disagree with him but in this case I agree. If you react to certain food in the case of Alzheimer’s, you have to remove that food from your diet. Otherwise, for some reason you could be stressed, your blood-brain barrier can get open and those antibodies can get them to the brain and attack the brain cells, and after a few years you may develop Alzheimer’s disease.

Dr. Weitz:                            So if we run this panel, we find out that there is positives on tuna and some of these other foods, we’ve got to remove those foods.

Dr. Vojdani:                        Yes.

Dr. Weitz:                            If there’s positives on some of these toxins, obviously we have to try to reduce our exposure to those toxins. But now a lot of those toxins are stored in our body. So we need to reach into our functional medicine bag of tools and put them on a proper detox and make sure that we bind those toxins and make sure that they leave the body, make sure we have a healthy gastrointestinal tract so we’re pooping them out and peeing them out and that we’re sweating and doing the things that facilitate the removal. If they have positives on the pathogens, then we have to figure out where those pathogens might be.

Dr. Vojdani:                        Exactly the simplest will be in the oral pathogens. Very…

Dr. Weitz:                           Like P. gingivalis. Right? So you have to-

Dr. Vojdani:                        Okay functional medicine tools.

Dr. Weitz:                           Yep.

Dr. Vojdani:                        Functional medicine tools.

Dr. Weitz:                            Right.

Dr. Vojdani:                        And then how to repair the gut and blood-brain barriers.  Almost the same.  Remember that regulatory T cells in the gut need vitamin A, vitamin D, vitamin E, B complex, cruciferous vegetables. There was a chapter, the last chapter in my book is written about this. In addition to that, resveratrol.  Many years ago an article was published in Scientific American that can repair the blood-brain barriers and nothing is cheaper and better and walking and physical activity.

Dr. Weitz:                            Yes.

Dr. Vojdani:                        That can help to repair the blood-brain barriers. And so if your test is abnormal, very, very simple, first detect, remove, and repair. Detect, remove and repair.  And earlier I mentioned that physical activity, mental activity, lots of, whenever comes part of that and then you remove the environmental factors. So healthy diet, healthy diet, healthy lifestyle, organic diet, everything inclusive and then physical activity and mental activity. I think that would be the best way to remember. Healthy lifestyle, physical activity and mental activity.

Dr. Weitz:                           It would be interesting to see if their results in few tasks correlate with neurocognitive assessment.

Dr. Vojdani:                        I think you know that my son is practicing functional medicine.

Dr. Weitz:                           Yes.

Dr. Vojdani:                        And he has done that on at least 20 patients.

Dr. Weitz:                           Right.

Dr. Vojdani:                        Excellent correlation with that and regarding this whole panel and pricing, Ben, originally because the material used in the testing, for example, amyloid beta can go online and you find that one milligram of amyloid beta cost more than few thousand dollars.

Dr. Weitz:                            Wow.

Dr. Vojdani:                        And the same thing tau protein, the same thing nerve growth factor, the same thing alpha-synuclein and very, very expensive, pure raw material. Maybe food is cheap, but the others are extremely expensive.  So we’re thinking even about introducing this panel for a price of about $2000 and honestly, after thinking and thinking that in this particular case we are here to help and I’m assuring you that with the kind of pricing Cyrex is charging, they’re not going to make much money considering the costs of the panel plus the overhead.  The goal here is to help people.

Dr. Weitz:                            Right.

Dr. Vojdani:                        And they are happy to be part of that. That’s why they decided I think close to $600 is really the cost and plus the overhead and therefore our goal is to help people to prevent Alzheimer’s in the future.

Dr. Weitz:                            Great. Is this test beneficial for Parkinson’s and other neurodegenerative diseases?

Dr. Vojdani:                        100%. Why? Because again, don’t forget that alpha-synuclein is synecleinopathy. It’s part of the Parkinson’s and there is a lot of overlap between Alzheimer’s and Parkinson’s. So these tests not only is good for Alzheimer’s and Parkinson’s, I’ll use that even for health screen because, if you look at, actually this panels combination of five or 10 different arrays offered by Cyrex. It looks at the gut, it looks at the brain, the nerve growth factors, and then the environmental factors. The blood-brain barriers. It’s a fantastic screening for assessing overall health of an individual.

Dr. Weitz:                           Awesome. Awesome. Thank you so much Dr. Vojdani.

Dr. Vojdani:                        My pleasure. Thank you. Thank you for your contribution again.

Dr. Weitz:                           Yes, this was a wonderful discussion and can you give the contact information for those who’d like to find out? I guess practitioners are the ones that order the Cyrex and Immunoscience panels.

Dr. Vojdani:                        Yeah. Cyrex, they go online under cyrexlabs.com I believe. Yes. Immunosciences Lab if you are interested in a good and reliable Lyme test, to exclude or include possibility of Lyme disease because there are many, many bad tests out there, unfortunately, or viral panels, EBV, CMV, herpes one, herpes two, type six, all of that at Immunosciences Lab. Also you can go online. Our telephone number is (310) 657-1077. Thank you.

Dr. Weitz:                            Awesome. Thank you.



Longevity with Dr. Steven Gundry: Rational Wellness Podcast 133

Dr. Steven Gundry discusses Longevity with Dr. Ben Weitz.

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


Podcast Highlights

5:05  The subtitle in Dr. Gundry’s new book, The Longevity Paradox, is How do you die young at a ripe old age?  Most of us want to live a long time but we don’t want a future that includes coronary stents or bypass surgery, joint replacements, living in a nursing home, and not remembering your name.  We want to remain healthy and vibrant for as long as possible.  Dr. Gundry said that we need to make sure that our microbiome is healthy, since this has a major effect on our health.  And this approach resonates with the Functional Medicine approach which usually prioritizes the gut as the focus of our health.

8:35  Dr. Gundry recommends taking prebiotic fibers to help the microbiome.  He explained that while probiotics that are sold are generally not native to our gut and many are dead by the time we consume them and they make their way into our guts.  And even if they are alive, they only become temporary visitors to our microbiome.  Prebiotic fibers are actually the fertilizer to help our native bacteria in our microbiota to grow, so this may be more important than taking probiotics. Eating fermented foods is good because these contain probiotics and the fermentation process breaks down the lectins.

13:04  One of Dr. Gundry’s most controversial positions is his recommendation to avoid eating foods that contain lectins.  But there are many foods that are generally considered to be healthy and that are commonly eaten that contain lectins that Dr. Gundry recommends avoiding, like lentils and other legumes, whole grains, potatoes, tomatoes, and cucumbers, among others.  Dr. Gundry advocates that most people should avoid the major sources of lectins, since this will reduce inflammation in their bodies, including in their arteries.  He mentioned a paper that he presented at an American Heart Association Vascular Biology meeting, Remission/Cure of Autoimmune Diseases by a Lectin Limited Diet Supplemented with Probiotics, Prebiotics, and Polyphenols where he demonstrated that removing lectins in 102 patients resulted in vascular inflammation subsiding and 80 out of the 102 were able to be weaned off of immunosuppressive and/or biological medications without rebound.  Dr. Gundry also pointed out that one of the reasons so many of us are sensitive to lectins is that our microbiome, which enjoys eating lectins, has been damaged from broad spectrum antibiotic use in us and in the animals we eat and from pesticides and glycophosate.  Another reason is our lack of stomach acid from the common use of stomach acid reducing medications. Dr. Gundry does think that pressure cooking beans and lentils that inactivates the lectins are ok to eat and he mentioned the Acciarolis in Southern Italy, which are one of the longest lived societies, who have a diet consisting mostly of anchovies, rosemary, olive oil, wine and lentils, though they do not eat bread or pasta. Dr. Gundry mentioned that lentils are good source of polyamines, which are interesting longevity compounds, also found in mushrooms and Parmesan cheese.  Dr. Gundry recommends cooking with a pressure cooker like Instant Pot or a Ninja Foodi.

20:53  The concept is that plants produce lectins to prevent animals from eating them.  But don’t plants want animals to eat them and poop out their seeds in a different location to promote their propagation?  Dr. Gundry pointed out that the plants that produce fruits that they want to be eaten by animals cover their seeds with a hard shell, like an apple seed or a flax seed, neither of which we can break down in our digestive system. These plants do want animals to carry their babies off someplace else and poop them out away from the mother tree. But grasses don’t want their babies carried away. They’ve got an open space and they want their seeds to fall directly to the ground. They use a system, primarily lectins in the hulls, to dissuade predators from eating their babies.

24:05  Dr. Gundry believes that the positive aspects of the Mediterranean diet, (often touted as the healthiest way to eat), which are the emphasis on consuming red wine, olive oil, fish, fruits, and vegetables, are balanced by the negative aspects of this diet, which are the grains and beans.  So Dr. Gundry does not recommend the Mediterranean diet.  He points out that even though the Sardinians are one of the Blue Zones (the areas in the world where people live the longest), they have the highest incidence of autoimmune disease in Europe because they eat large amounts of grains in their diet.  Another Blue Zone region is the Okinawans and it is often said that they eat a lot of rice, but 85% of their diet is actually purple sweet potatoes and only 5% of their diet is white rice. White rice does not contain the lectins that are in brown rice. The other 5% of their diet is fermented soy in the forms of miso and natto.  So only a very small part of the Okinawan diet is grains and beans. And another Blue Zone is the Seventh Day Adventists in Loma Linda, where Dr. Gundry used to teach medical school.  The Adventists’ primary protein source is texturized vegetable protein, which is defatted soy meal that’s extruded under high heat and high pressure, which pressure cooks it, which removes the lectins.  Dr. Gundry points out that the common factor in all these Blue Zones is that they eat very little animal protein.

28:03  Dr. Gundry is a big fan of consuming a lot of olive oil and he also recommends cooking and frying with it as well.  Even though olive oil has a low smoke point, it is the least oxidizable oil of any oil studied and it beats coconut oil and avocado oil in terms of oxidation.  One of the main benefits of olive oil is the polyphenols and everyday olive oil has about 10 times the polyphenols of extra virgin coconut oil.  Unfiltered olive oil has even higher polyphenols.  If you cough a lot when you gargle the olive oil, this indicates a high polyphenol content. Dr. Gundry sells his own olive oil, which has the highest polyphenol content of any olive oil on the market: Gundry MD Olive Oil.  The American taste is for a very bland olive oil, which has a very low polyphenol content.

35:31  Dr. Gundry recommends nuts, but he does not recommend peanuts, cashews, or almonds, the most commonly eaten nuts in the US. As we all probably have heard, peanuts often have aflatoxins from the fungus that often grows on their skin. Dr. Gundry noted that a lot of his patients react to a lectin in the peel of almonds.  Blanching almonds will remove this. Cashews are from the ivy family and there is even a cashew picker’s disease where the hands of the cashew pickers get burned from the toxins and lectins in the peel of the cashews. He has found that he has had a number of patients that when they stopped eating cashews, their GI distress improved.

37:20  Too much animal protein can contribute to reduced longevity.  Dr. Gundry recommends limiting animal protein to 20-30 gms per day, though vegetable protein is unlimited.  Dr. Gundry said that his colleague at Loma Linda, Gary Fraser, has shown that incremental increases in animal protein incrementally decrease our health span and longevity.  Higher animal protein leads to an increase in the IGF-1, which is associated with more disease and lesser longevity. Dr. Gundry said that his older patients who are doing well are typically running lower levels of IGF-1, such as below 100.  Dr. Gundry argues that consuming higher amounts of protein does not improve muscle mass. He says that sarcopenia occurs because our gut wall has been damaged by eating lectins and when we repair our gut wall, albumin and total protein levels, if they were low, dramatically increase.

44:57  Dr. Gundry recommends intermittent fasting by skipping dinner one day per week and eating dinner early on a regular basis so that when you sleep, you activate the glymphatic system in the brain that squeezes toxins out of the brain, such as beta amyloid, and produces a brain wash.  You want to have at least a 3 hour period of time between eating dinner and going to sleep.  In fact, Dr. Gundry says that from January through June every year he fasts for 22 out of 24 hours of the day.  He said that almost all human societies until the present time went through prolonged periods of not much food, which usually correlated to the winter.  Humans are the fat ape and have the ability to go extended periods of time without eating.


Dr. Steven Gundry is a cardiovascular surgeon who has changed his focus to a Functional Medicine/Integrative approach. He is the director of the International Heart and Lung Institute in Palm Springs and the founder and director of the Center for Restorative Medicine in Palm Springs and Santa Barbara.  He is the best selling author of Dr. Gundry’s Diet Evolution, The Plant Paradox, The Plant Paradox Cookbook, The Plant Paradox Quick and Easy, and his latest book, The Longevity Paradox.  Dr. Gundry can be reached through his website, DrGundry.com or by calling his office at (760) 323-5553.

Dr. Ben Weitz is available for Functional 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 Podcast podcasters. Thank you for joining me again today. For those of you who enjoy listening through our Rational Wellness Podcast, please go to Apple Podcasts or wherever you listen to podcasts and give us a ratings and review. Also, you can find a video version on YouTube, and if you go to my website, drweitz.com, you can find complete transcripts and detailed show notes.

                                Our topic for today is longevity with Dr. Steven Gundry. Longevity refers to length of life. There’s a bacteria that’s over 250 million years old. There’s a type of clam that can live up to 500 years. The longest living mammals are whales, which can live for over 200 years. It’s generally thought that the limit to human lifespan is approximately 125 years with only 48 people in recorded history making it to age 115 and one recorded person making it to 122. The average lifespan is the longest in Hong Kong at 84.7 years, though I suspect that may be changing there with all the stress associated with what’s happening. The average lifespan in the US is approximately 78.8 years.

                                What may be more important than the lifespan is the health span, which is the number of years a person is healthy. Others make a distinction between chronological age, which is the number of years you’ve been alive and biological age, which is a measure of your physiological age and of your functional and health status. This may be measured with a test called the telomere length test. Anti-aging medicine can mean different things to different anti-aging clinicians. For some, anti-aging refers to improving the appearance of the skin with special creams and treatments and even surgery, while for other anti-aging specialists, the focus is on restoring the body’s hormones to the level of the 25-year-old by taking bioidentical hormones like estrogen, progesterone, testosterone and even growth hormone. For others, it means research and the reasons why aging occurs and finding interventions, whether they be changes in diet, lifestyle, exercise or the use of medications or nutritional supplements to positively impact these biological pathways and processes.

                                Dr. Steven Gundry does not really need an introduction, but he is a heart surgeon, professor and researcher who has changed his focus in his medical practice to nutritional and preventative medicine. He’s the director of the International Heart and Lung Institute in Palm Springs and the founder and director of the Center for Restorative Medicine in Palm Springs in Santa Barbara. He’s the bestselling author of Dr. Gundry’s Diet Evolution, The Plant Paradox, The Plant Paradox Cookbook, The Plant Paradox Quick and Easy, and his latest book, The Longevity Paradox. Dr. Gundry, thank you so much for joining me today.

Dr. Gundry:        Hey, thanks for having me on. Looking forward to this.

Dr. Weitz:           Absolutely. I just wanted to start by saying I’ve been following your work since listening to an interview that you did with Dr. Bland in 2011 on his Functional Medicine Update. It was before podcasts were popular and I was a subscriber for 25 years. At first, we used to get these little cassette tapes that we would pop in and then we would get these CDs. Anyway, I remember you came on and you talked about this patient, Big Ed, and he had all this coronary plaque and you looked at his scans and another cardiologist said there was no way that they could intervene. He also had this big shopping bag of supplements. You said, well, those are all going to be a big waste.

Dr. Gundry:        Yeah, I did say that.

Dr. Weitz:            You looked at some new scans and it turned out that he had reversed quite a bit of his atherosclerosis, so you started rethinking that they may have some benefit.

Dr. Gundry:        Yeah, that’s exactly right.

Dr. Weitz:           The subtitle of your newest book, The Longevity Paradox, is how do you die young at a ripe old age?  What do you mean by dying young at a ripe old age?

Dr. Gundry:        Well, The Longevity Paradox is that most of us want to live a long time but we just don’t want to get old. When we look at living a long time, it really doesn’t look very good. We’re looking at stents or heart surgery or joint replacement or living in a nursing home and not remembering your name or your family’s name. Just getting old doesn’t look very good. Particularly the last three years, our life expectancy in the United States has actually declined three years in a row, and people thought it was a fluke, but it’s now … We boomers sadly will probably be, unless something dramatically changes, will be the longest living Americans. Our kids and our grand kids, if things don’t change, will have shorter lives and more miserable lives.  The evidence is increasing that we had very little time in our lifespan where basically it was a fairly quick downhill boom. Now the reason longevity looks so bad is we spend a great deal of time in senescence, in getting worse and worse and worse. The whole point of the book is it does not have to be that way. It’s quite possible to die young at a very old age. I think that’s actually what most of us would like to do.

Dr. Weitz:           Absolutely. Essentially what you’re saying is instead of hitting 40 or 50 or 60 and a steady decline with all these chronic diseases, we want to have a high level of function and go screaming right into the end.

Dr. Gundry:        Yeah, that’s exactly right. One of the benefits of having one of my clinics in Palm Springs is that Palm Springs is often called God’s waiting room. I’ve had the pleasure of, for over 20 years, super old people and learning some of their tricks. Plus, for most of my career, I was a professor at Loma Linda University, which is the only blue zone in the United States. A lot of my career has been spent looking at the tricks of good older people. The book is taking what I learned in The Plant Paradox and learning a lot more on the microbiomes’ effect on aging and then giving folks an action plan. It’s actually exciting stuff.

Dr. Weitz:           Absolutely. Your focus on the microbiome is definitely part of the average Functional Medicine approach, which really prioritizes gut health as a major factor in many other chronic diseases. In terms of improving the microbiome, you recommend prebiotic fibers, which feed the gut bacteria. It’s very common to recommend probiotics, which are the gut bacteria themselves, but you don’t seem to recommend those. Why is that?

Dr. Gundry:        Well, I have nothing against probiotics. I make several probiotic formulas for my own company.  What I think most people don’t realize is that most probiotics are not native to our gut.  If they make it into our gut, and that’s a very iffy proposition, they basically stick around on vacation.  You have effects.  Yes, absolutely.  In fact, dead probiotics can have actually dramatic effect on the immune system.  Just to give you an example, there’s a dead yeast, the brand name is called EpiCor, that absolutely modulates the immune system and actually probably makes us make more red blood cells. Dead probiotics, what I tell people, for instance, in Palm Springs, if I sold grass seed to a patient in Palm Springs, which would be probiotics, and say go plant it. They’d come back a month later and said, you sold me bad grass seed because it didn’t grow. I said, well, what did you do? They said, well, I took it out on the desert and sprinkled around it. I said, well, did you water it? No, you didn’t tell me too. Well, did you fertilize it? No, you didn’t tell me to.

                                We have to give the microbiome prebiotics, the fiber that these bugs like to eat.  With the Human Microbiome Project, we’re beginning to realize that there are certain fibers that certain bugs thrive on, and if we give them what they want to eat, they will actually start taking care of us. We’re sadly or fortunately a condominium for bacteria and they outnumber us. There are a hundred of them. If you actually look at the genetic makeup, about 99% of all the genes in us are non-human gene. There are viral and bacterial genes. Most of what’s going to happen to us as I talk about in the book is not our heredity, is not our genes that we inherited, but the effect, particularly on environment and the microbiome, on our epigenome, on turning off and on genes.  That’s actually what’s exciting about this research that our fate is not fixed in our genome, but our fate is actually tied to our bacteria. We can feed them what they want.

Dr. Weitz:            What do you think about fermented foods like kimchi and sauerkraut and things like that?

Dr. Gundry:        I think it definitely has a place, but we have to remember that fermentation was one of the oldest forms of breaking down lectins in food. Fermentation is a really good way of bacteria and yeast eating lectins in plant materials. In fact, the Incas, who did knew how toxic it was, they had three preparations for kimchi. They soaked it for 48 hours and then changed the water. Then they allowed it to ferment and then they cooked it. It’s another package directions. Fermentation was a really good way to break down lectins. It gets back to the same thing. Probably most of the probiotics in fermented foods don’t even survive gastric digestion, but they can have compounds that educate our immune system. Ferment as many things as you can because it’ll break down lectins. How is that?

Dr. Weitz:            Okay, sounds good. Speaking of lectins, that’s one of the more controversial things in your books. One of the issues people have with it is there seem to be all these foods that people have eaten for many years that seem to be healthy like legumes and lentils and hummus and potatoes and tomatoes and cucumbers. A lot of people who seem to be really healthy eating these don’t seem to have any reactions. How can it be that these lectins in these foods are really harmful? The other question is, since we now can test for lectins and we can test for our sensitivities to eating these foods, wouldn’t it make more sense to test for those food sensitivities and lectin sensitivities and then decide whether or not it’s okay for our individual bodies to eat them?

Dr. Gundry:        Yeah, we do that often with patients who really … on why they continue to have an autoimmune disease despite a pretty good elimination diet or eliminating most common lectins, but unfortunately, insurance doesn’t pay for these tests. We found that eliminating most of the major lectins from most people’s diets have a profound effect on the inflammatory markers that we do measure. In fact, I just this year published another paper in the American Heart Association at the Vascular Biology Meeting where we showed that lectins are a major cause of vascular inflammation, and removing lectins from the diet of several hundred people showed that the vascular inflammation subsided, and reintroducing lectins caused the vascular inflammation to reappear.  To get back to your original point, we forget that the reason so many of us are now sensitive to lectins is that our microbiome, which is a major defense system against … plant lectins. The microbiome actually enjoys eating lectins. There is even a bacteria that enjoys eating gluten.  We’ve wiped out much of our microbiome from broad spectrum antibiotic use in us and also in the animals that we eat.

                           I think the other thing that we’ve lost sight of is that so many people take a stomach acid reducer without realizing that acid in our stomach are proteins and lectins are proteins. We’ve had that defense system gone in so many people. Lastly, almost all the foods that we eat have glyphosate, have Roundup, in them, and most people don’t realize that glyphosate was actually patented by Monsanto as an antibiotic.  It was not patented as an herbicide.  Glyphosate is really good at killing the microbiome.  Plus, work from MIT has shown that glyphosate by itself causes leaky gut.  We’ve set up a perfect storm where the vast amount of defense systems that we’ve enjoyed up until 50 years ago are pretty much wiped out. In the football analogy, not only is our defensive line injured, but all the linebackers are out.  A good running back like a lectin has a straight shot to the goal line time after time.  I think that’s what we’re seeing.

Dr. Weitz:           When it comes to legumes, from reading The Longevity Paradox, I came away with the idea that we shouldn’t eat legumes or lentils, but then I watch one of your YouTube videos where you said that properly cooked beans and lentils were okay.

Dr. Gundry:        In The Longevity Paradox, I make a very strong case for people eating pressure cooked lentils.  One of the longest lived societies who are the Acciarolis in Southern Italy, south of Naples, that I visited last year, these people have a fascinating diet.  They eat anchovies, rosemary, olive oil, wine and lentils. They actually, even though they’re Italians, do not eat bread or pasta.  They have absolutely no grains in their diet.  There are some compounds in lentils that are called polyamines, that are some of the most interesting longevity compounds that have been described.  Lentils are a great source of this.  Mushrooms are a great source of this.  Interestingly enough, true Parmesan cheese from Italy is a great source of polyamines.

                                I think everybody should have one of the modern pressure cookers like an Instant Pot or a Ninja Foodi.  They make things so easy.  In fact, I have a new cookbook coming out next month in November called The Plant Paradox Family Cookbook, which is dedicated to raising kids in this way.  Most of the recipes in the book are using it.

Dr. Weitz:            As an alternative to a pressure cooker, what if we soaked the lentils overnight and then cooked them in our rice cooker or however else we’re cooking?

Dr. Gundry:        I spent a lot of time in working with chefs in Italy and France and Spain and Portugal learning what their tricks were. Soaking of beans and lentils was always done. In the soaking, the water was changed every four to six hours and refreshed. Clearly, the evidence is very clear that soaking will remove a large amount of the lectins from the beans. What’s happened though is we’ve lost this connection with our parents and grandparents and great grandparents that these techniques, which were normally handed down from generation to generation, now that we don’t really have nuclear families anymore and great grandma is not helping in the kitchen, we’ve really lost these tricks. In our speed to have everything instantaneously, the idea that we would really bother to soak beans for 24, 48 hours is silly.  These cultures, it’s amazing, when I worked with chefs in Italy, not one of them would ever think of making a pasta sauce, a tomato sauce with tomatoes that aren’t peeled and de-seeded. I’ve been…. We’re missing these honored traditions of how we detoxified these plant compounds that are mischievous.

Dr. Weitz:            One of the concepts that people often talk about is they say this is the way that plants protect themselves against being eaten. Isn’t it the case that in order for plants to reproduce and grow in different places, they actually want animals and humans to eat them, so that we can poop out the seed somewhere else so that they can continue to flourish.  It seems to me that plants really want animals to eat them.  Perhaps the lectins are just there to discourage the bugs from eating them who really are not going to proliferate the seeds.

Dr. Gundry:        As I talk about in The Plant Paradox, there are two plants that make fruits in general want their predators to eat the seeds, but they, for the most part, protect those seeds with a hard shell that’s indigestible. For instance, we can’t digest an apple seed.  We can’t digest a flaxseed.  Just as an aside, I laugh when I see all these flaxseed crackers with whole flaxseeds or flaxseed cereal, and we cannot digest the outside of a flaxseed, which is why we have to grind them. They don’t use, because they can make a hard shell, they don’t use lectins to defend themselves, and they want the animal, their predator, to carry their babies off someplace else and poop them out away from the mother tree.

                                On the other hand, grasses don’t want their babies carried out. They’ve got an open space and they want their seeds to fall directly to the ground. They use a system, primarily lectins in the hulls to dissuade a predator from eating their babies. I think that’s a very important distinction that many people miss. The other distinction that people miss that I learned as a young man growing up in Omaha with the green apple two step, we often like to eat green apples long before there was a Granny Smith. These were immature apples. There was a very high lectin content in mature fruit to dissuade the predator from eating it before the baby seeds could … That system actually caused pretty impressive diarrhea and abdominal cramps. You usually learned your lesson very quickly.

                                One of the problems is so much of our fruit is now picked unripe in Chile or Argentina or Mexico and then flown long distances, and then we ripen that fruit with ethylene oxide and we never get the switch that turned off or decreased the lectin content as the fruit ripened naturally on the vine or the tree. I think there’s actually a big difference in the method of protecting seeds from being eaten.

Dr. Weitz:            Interesting. You state in The Longevity Paradox that it’s a myth that the Mediterranean diet promotes longevity. Haven’t there been a ton of studies showing that the Mediterranean diet is associated with lower rates of heart disease and longevity, etc. and actually the Mediterranean diet tends to emphasize lots of vegetables and olive oil, which I know you’re a big fan of, and even nuts and fish. Is it really the case that the Mediterranean diet does not promote longevity?

Dr. Gundry:        Interestingly enough, the work by Staffan Lindeberg in his book, Food and Western Disease, which I highly recommend to anyone, he shows data that grains and beans are a negative aspect of the Mediterranean diet that are compensated for by the positive aspects of the Mediterranean diet, which are the examples that you mentioned, red wine, olive oil, fish, fruits and vegetables. People, when they hear Mediterranean diet, think, oh, healthy grains and beans. His point and the research on that I think should be noted. For instance, the Sardinians, one of the blue zones, have the highest incidence of autoimmune disease in Europe, and it’s because they eat large amounts of grains in their diet.  Again, each diet is different. The case I make in The Longevity Paradox is that people who applaud blue zone diets as groups that eat large amounts of grains and beans somehow either having visited these places or don’t actually see what people eat. For instance, the Okinawans. The only actual description of the ancient Okinawan diet was made by the US government military occupying forces in 1949. The Okinawan diet was 85% purple sweet potato, blue sweet potato. About 5% of their diet was rice, but it was white rice, not brown rice because they got rid of the lectins in brown rice. Another about 5% of their diet was fermented soy, miso and natto, not tofu. There’s an example of great longevity that doesn’t eat grains and beans for the most part.

                                Even in Loma Linda, where I was a professor, the primary protein source, the Adventist diet was texturized vegetable protein, TVP, which we made into mystery meats of all sorts. This is defatted soy meal that’s extruded under high heat and high pressure. In other words, it’s pressure cooked soy meal. That was the staple, and nuts. It was the staple of the Adventist diet. Three of the blue zones use a liter of olive oil per week, which I highly recommend. Again, the Acciarolis, which is the newest discovery of the blue zones, they don’t eat grains and they eat lentils and they eat olive oil and anchovies.  The one thing that keeps all of these blue zones I think together is that interestingly, they have very little animal protein as a part of their diet. That’s the common factor of all these.

Dr. Weitz:            I want to get to the animal protein in a minute, but let’s hit on the olive oil thing. A lot of people in the health world are always trying to optimize what’s the best fat, what’s the best oil to cook with. You have so many vegans out there saying you shouldn’t cook with any oil. Other people are saying you should cook with only butter. Olive oil was the big oil and then everybody said no, it burns very easily at reasonable temperatures. It doesn’t hold up under high heat so we have to go to coconut oil or we have to go to avocado oil. Everybody is searching around trying to find the perfect oil. I know you feel that olive oil is not as problematic as some people think for cooking, right?

Dr. Gundry:        Correct. Olive oil has a low smoke point, but it actually is the least oxidizable oil of any oil studied. We’ve had actually two olive oil experts on my podcast, both of whom say the same.

Dr. Weitz:           What’s the difference between the smoke point and whether or not it oxidizes? Isn’t the oil getting damaged and…

Dr. Gundry:        No, it actually is the least oxidizable of any of the oils. It actually beats coconut oil and avocado oil in terms of oxidation. Nut oil and coconut oil don’t have a very high smoke point, so that’s for frying. Olive oil has been used for frying for 5,000 years in the Mediterranean, and so far so good. 

Dr. Weitz:           When you say it has a high smoke point-

Dr. Gundry:        Smoke does not mean oxidation. Not at all. It’s like steam coming off of water. There’s no damage to the water as you produce-

Dr. Weitz:           I think that’s where the controversy is.

Dr. Gundry:        Smoke point has nothing to do with oxidation.

Dr. Weitz:           Interesting.

Dr. Gundry:        I learned this from … I knew olive oil … I had no idea it was the best until I was shown the research by two of my guests. Son of a gun, you’re right. Look at that. The benefit of olive oil is that the polyphenol content of olive oil is extremely high, and you’re using oleic acid, which is the monounsaturated fat in olive oil and also in avocado oil. Isn’t that a particularly interesting beneficial oil or bad oil one way or another but it’s a carrier for polyphenol? For instance, plain old everyday olive oil has about 10 times the polyphenols of extra virgin coconut oil. If you agree with me and others that the more polyphenols in your diet, the better you’re going to be long term, then you want a high polyphenol olive oil.  When I do olive oil tastings in Italy, I go and study olive oil producers and learn there is one-cough olive oil, two-cough olive oil, and three-cough olive oil. The coughing that it induces and when we taste, we actually gargle the olive oil.

Dr. Weitz:           Really?

Dr. Gundry:        Really. We gargle olive oil. The more coughing it induces, the higher polyphenol content of the olive oil. You can use that trick to decide the polyphenol content of olive oil.

Dr. Weitz:           Do we want the extra virgin and do we want the unfiltered or which one is best?

Dr. Gundry:        You’ll have more polyphenols in the unfiltered. Extra virgin actually only refers to the acidic level in the olive oil, and it has nothing to do with the olives didn’t have sex or something like that. Sorry. I couldn’t resist. In processing olive oil, there is first press-

Dr. Weitz:           We’ll get censored by YouTube now.

Dr. Gundry:        That’s right. You should, if you can, get the nouveau olive, first batch of olives, which are usually picked green. As many people know, I now have my own olive oil, which is the highest polyphenol content of any olive oil studied, 30 times higher than any previous olive oil that comes from Morocco, of all places, in the desert where a brilliant family, fourth-generation olive oil farmers realized that great wine comes from grapevines that are stressed, that are under watered, that are planted close together and under harsh conditions. The more the plants are stressed, the more polyphenol content in the grapes, better wine.  This family tried this, and lo and behold, they planted their vines close … the trees close together. They under-watered them, desert harsh conditions, planted in rocks and voila, the polyphenol content is massive. They built a bottling plant in the middle of the olive grove so the olives are instantly pressed one time. I’m actually really excited about it.

Dr. Weitz:            Interesting, because there is a big controversy. You read these reports that some of the olive oil on its shelves doesn’t really contain olive oil. It’s olive oil spiked with other oils.

Dr. Gundry:        Yeah, there are actually several good American olive oils. There is a great olive oil at Costco that I recommend to people. It’s Kirkland brand. It’s a square bottle. It’s a plant in Tuscany. It carries a seal, a stamp for authenticity. If it says bottled in Italy, you can bring olive oil in tankers from Greece, Spain, all over the Mediterranean in tankers literally and bring it, un-dock it in Italy and then put it in a bottle and say it’s bottled in Italy. You do have to be careful.  The other thing that people should be aware of, the American taste is for a very, very bland oil. We’ve been raised on corn oil and canola oil. This cough when you have olive oil is not to the American palette.  Olives are blended in grocery stores to an American palette.  Most of the olives that are used have very little polyphenol content. The reason you’re using it, it’s usually not there.

Dr. Weitz:            Since we’re talking about fats, I see that you like nuts from your book, but you don’t like the nuts that are most commonly consumed, which are peanuts, almonds and cashews. I certainly understand some of the issues with peanuts with fungal problems, etc. What’s wrong with almonds?

Dr. Gundry:        Almonds, a lot of my patients with rheumatoid arthritis react to a lectin in the peel of almonds. There’s nothing wrong with peeled almonds. Anyone growing up in Spain knows their mother teaches them how to properly get the peel off of almonds because in Spain, anyone knows that the peel of almond is toxic. Again, you start learning traditions and go, how did that come about? I have about 70% of my practice is people with autoimmune diseases, and we have an interesting handful that clearly react to the peel in almonds. Blanching them is usually pretty safe for anybody.  The other big known … I dearly love cashews, but we have to remember that cashews are of the ivy family, and there’s even cashew pickers disease where the hands of cashew pickers get severely burned from the toxins and lectins in the peel of cashews. I don’t really particularly want to eat poison ivy.  I have a number of patients that cashews was one of their big issues in their GI distress until we got rid of them.

Dr. Weitz:            Now I want to hit on the protein. I’ve heard several discussions on your YouTube page about why we should have very low level of protein and how it’s associated with longevity. You mentioned 30 grams of protein. It hasn’t been the case that my experience shows that. One thing in particular is isn’t there a big difference depending upon who it is, how much protein they’re going to consume? Say, for example, me, somebody who’s worked out my whole life, very active, and my BMR is about 3,000 calories a day. If I’m only going to consume 30 grams of protein, first of all, where do I get the other calories from? Second of all, don’t I need more protein because I’m exercising more, I’m doing heavy resistance training, etc.?

Dr. Gundry:        Well, number one, I recommend that people, if they’re going to have animal sources of protein, they should limit their animal source of protein to 20 to 30 grams. Plant protein on the other hand is pretty unlimited in the amount that you can tolerate. The reason-

Dr. Weitz:            Shouldn’t it matter if you’re a 110-pound woman or you’re a 200-pound guy who’s very active?

Dr. Gundry:        Well, if you are actively building muscle then you can certainly use more protein, but my … is that protein primarily comes from plants. I’m a guy who grew up in Omaha, Nebraska, the beef capital of the world. Believe me, I enjoy a piece of grass-fed grass-finished steak every three months, but that’s it. The evidence certainly from the Loma Linda experience that’s been published by my colleague, Gary Fraser, shows that incremental increases in animal protein incrementally decrease our health span and lifespan. I wish that wasn’t true. I really do, but this is a huge follow up now for over 50 years. Each incremental increase in animal protein in an Adventist diet decreases their lifespan and their health span. Darn it.  Again, I’ve come to this, sadly, I really have, that there are components of animal protein, amino acid profile that increases our insulin-like growth factor. If you look at super old people, particularly in my practice, folks 95 and above, who are thriving, they run very low insulin-like growth factors. Most of them are in the 70s, 80s, some of them are in the fifth work at St. Louis University with the Calorie Restriction Society show those people when they were in physician-restricted vegan diet dramatically dropped their insulin-like growth factors. I see that in my patients as well.

                                I’ll give you an example. I just saw a couple in their late 60s who I’ve been working with for a number of years out of LA, and they used to be disciples, I mean phenomenal. Both he and his wife ran insulin like-growth factors around 80. Both of them ran hemoglobin A1Cs, 4.6, 4.7. She got a 4.4, phenomenal stuff. They went to Europe last summer for an extended period of time and fell off the wagon. It’s interesting. They have been struggling ever since that time. I saw them today for their six-month follow-up visit. We track these so that they can see it. Four years ago, they were both running insulin-like growth factors of around 80. Now she’s up to 160 on her insulin-like growth factor, IGF-1, and he’s up to 180, and their hemoglobin A1Cs have gone from 4.4, 4.6 to 5.4, both of them. 5.4, most people would be thrilled with 5.4. Most 68-year-olds would be thrilled to have an IGF of 160.  When you can look at what they did when they were spot on and they go, holy cow. They are aging right before their eyes and my eyes. Today was a real wake-up call for both of them. They said, okay, that’s it. We’re back. We’re going to hit this hard. That’s just-

Dr. Weitz:            That view, it definitely agrees with Valter Longo and a lot of the other anti-aging specialists these days. The focus all seems to be reduce growth. Anything that promotes growth, we want to reduce. We don’t want to encourage cancer cells. On the other hand, we know as we get older that our muscles tend to break down.  Sarcopenia is a problem.  There are people who can’t get out of nursing homes, and the only thing wrong with them is that their muscles are too weak. One of the problems with our brain health is that the neurons tend not to get replaced.  They tend not to regenerate.  We don’t create new connections between the neurons. A certain level of growth and regeneration is going to be crucial for anti-aging.  Isn’t that the case?

Dr. Gundry:        Yeah, I agree with that. The reason we have sarcopenia is because our gut wall is absolutely destroyed, and when you no longer have … It just pleases me so much that I can take patients and decrease protein consumption and watch their albumin and total protein, which were at dangerously low levels, actually dramatically increase. There are actually other really good studies of super old people that shows that increased protein consumption does not improve muscle mass. The reason for that is that most of us have been so damaged in the wall of our gut by leaky gut, by lectins that when we repair the gut wall, then everything else returns to normal. That is really the whole point of The Longevity Paradox.  Aging at its very core is caused by a breakdown in the wall of the gut. Hippocrates said this 2,500 years ago. All disease begins in the gut, and he was absolutely right. My addition to this is that all disease can end in the gut.

Dr. Weitz:            I totally agree with that. Intermittent fasting is something that’s often recommended for anti-aging purposes. We have complete fasting. We have intermittent fasting. We have the fasting mimicking diet. One of the things I noticed in your book is you recommend skipping dinner, which is interesting because right now, the rage in the Functional Medicine world is everybody skips breakfast, which I think is ironic because when I started counseling people on diet and health 30, 35 years ago, the word was everybody is fat because they skipped breakfast and they eat too much at dinner. The mantra was you have to eat breakfast, you have to eat within a certain period of time of waking up, and you have to have multiple small meals throughout the day. Otherwise, your blood sugar is going to be erratic.  It’s funny how it’s come full circle to now the way to be healthy is to skip breakfast, but you’re talking about skipping dinner. One of the things you talk about is I think you described it as flossing for the brain.

Dr. Gundry:        A brain wash.

Dr. Weitz:           A brain wash.

Dr. Gundry:        It’s interesting. We now in recent years have discovered the glymphatic system of the brain. The brain during particularly deep … about 20%. It literally goes through a wash cycle and squeezes out toxins such as beta amyloid. This needs actually high blood flow to accomplish this. I teach my patients that when I was growing up, we couldn’t go swimming for an hour after we ate lunch because we’d get cramps in our muscles and die. There was actually a bit of wisdom in that old wives’ tale in that when we are digesting, digestion takes a huge amount of energy and blood flow. After we eat, most of our blood flow is diverted to our gut for the purpose of digestion. Good studies show that the closer you finish dinner to the time you go to bed, the less efficient you are at washing out of having this brain wash cycle.

                           What I ask people to do is one day a week, skip dinner or finish four hours, maximum three hours before you go to bed, and allow that brain wash cycle to happen. Dale Bredesen, who is the author of The End of Alzheimer’s, has become a good friend. In fact, I just talked to him yesterday. He thinks, and I certainly agree with him, that we should have a 14 to 16-hour a day window of not eating. The easiest way to accomplish that of course is to skip breakfast and try to eat your dinner at say 6:00 at night. For half of the year, most of the people who follow me know that from January through June, I’m on that window so that 22 out of 24 hours, I’m fasting. This will be my 18th year of doing this, and so far, I’m not dead, so, so far so good.

                           Why do I do that? Because my study at Yale was in human evolution. We know that almost all societies up until the present time went through primarily a prolonged time of not much food, which usually correlated to the winter. As I tell anyone who listen, you really think our ancestors crawled out of our cave every morning and said, what’s for breakfast? There wasn’t any breakfast. We didn’t have a cupboard. We didn’t have a refrigerator. We had to find … If we didn’t find breakfast, break fast until lunch. That was break fast. We didn’t find it until dinner, that was break fast. The reason humans are like locust is that we have the ability to go extended periods of time without eating, unlike really any animal because we are the fat ape.

                           I agree. Joseph Mercola and I have talked about this. In our current environment, we have so many heavy metals and environmental toxins and pollutants and pesticides in our fat cells where we store them and we store them safely. If we undertake a fast, even a three-day fast, we have to realize that these toxins come out of our fat cells, and we have a horrible system of excreting these products and we actually reabsorb the heavy metals from our gut. The idea that in our modern society, a seven-day fast right off the bat is a good idea. I think that’s bad advice. There are ways to do this safely. Many of us make a supplement to help with this process. Mine is called Untox, but you can got it from other …  I think both his and my advice is this should not be undertaken and just, hey, I’m going to do it because it’s amazing how these things accumulate in us. We did it a hundred years ago. You’re right. Remember, all great … have fasting as a part of their process. Looking back, I think it was to give penance. It was actually a health technique. Every religion, regardless of whether there’s guilt involved with the religion, there are religions that don’t have guilt. They all have fasting.

Dr. Weitz:            Excellent, Dr. Gundry. I think we’ll have to wrap there. How can patients and practitioners get a hold of you and find out about your supplements and your books?

Dr. Gundry:        They can go to drgundry.com. My supplement site is gundrymd.com. I have the Dr. Gundry Podcast, wherever you get podcasts. I have two YouTube channels. You can find me on Instagram and Facebook. We do still see patients. I have a phenomenal physician’s assistant that is a blessing. People follow my Instagram account. Her Halloween costume, today is Halloween, she dressed up as Dr. Gundry. It’s hilarious.

Dr. Weitz:            That’s great. I should have dressed up as Dr. Gundry.



Bioidentical Hormones with Dr. Cynthia Watson: Rational Wellness Podcast 132

Dr. Cynthia Watson discusses Bioidentical Hormone use in Menopause with Dr. Ben Weitz.

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


Podcast Highlights

4:02  During the perimenopausal period, which for women is typically in their late 30s and early 40s, their periods become irregular, either shorter or longer, or they may get heavier.  Progesterone and testosterone levels tend to fall and estrogen levels tend to go up.  This is because if women are not producing an egg every month, the FSH goes higher, which results in producing more estrogen.  Women tend to get symptoms of irregular moodiness, irritability, more PMS, depression and their sex drive goes down.

5:55  To support women during perimenopause, we need to support the adrenal glands. The adrenal glands produce hormones. Prior to menopause, 75% of the hormones are produced by the ovaries and 25% by the adrenals, but the adrenals take over after menopause. If women are really busy, working, taking care of kids, etc. this stress weakens the adrenal glands and the hormone production tends to decrease.  The adrenal glands will tend to take the progesterone to make more cortisol, so we may see progesterone levels fall.  Dr. Watson likes to check the luteal phase hormone levels around day 20-24 of the cycle to see how much progesterone, estrogen, and testosterone they are producing.  They may have high estrogen levels, which can cause breast tenderness, bloating, and irritability. Dr. Watson likes to use herbs and supplements to help lower estrogen and support progesterone. It may be helpful to give women some progesterone during that time in the cycle.

8:35  To help lower estrogen levels, Dr. Watson instructs her patients to avoid phytoestrogens in soy and other foods and environmental estrogens, like Bisphenol-A, and phthalates in personal care products. She will often recommend DIM, which is an extract from broccoli, which helps convert some of the estrone to a weaker form of estrone.  She may also recommend calcium d-glucarate and milk thistle to help with glucuronidation and helps to pull those estrogens out.

10:35  Dr. Watson prefers to do serum testing for hormones, though she recognizes the benefits of urine testing (such as DUTCH dried urine testing) for measuring hormone metabolites.  She mentioned that urine testing is not as good for progesterone, since progesterone is not seen in the urine but only it metabolites.

12:50  Dr. Watson likes to recommend Vitex (chasteberry) at a dosage of 200 mg twice per day to help with progesterone levels during perimenopause.

14:35  Some doctors feel that prescribing hormone replacement therapy for women after menopause is unsafe due to the results of the Women’s Health Initiative, published in 2002, (Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women’s Health Initiative Randomized Controlled Trial), which showed that taking estrogen and progesterone increases the risk of heart disease and strokes and blood clots and breast cancer.  Dr. Watson explained some of the problems with this study, including that the form of estrogen used, Premarin, is conjugated estrogen from the urine of pregnant horses, and the form of progesterone used is synthetic progestins and neither of these are comparable to bioidentical estrogen and progesterone.  Another issue was that most of these women did not start taking the hormones till they were 60 years of age, so they likely had already had developed heart disease and clotting from not having estrogen for 10 years.  This study had 10,000 women and in women treated with conjugated equine estrogens and progestins there were 32 cases of breast cancer and in the control group there were 24 cases of breast cancer, so there were only eight more cases in the treated group but it was recorded as a third more cases.  And in the arm of the study with women who had had a hysterectomy and took estrogen alone without progesterone and there was no increased risk of breast cancer.   With respect to the risk of heart disease and stroke, many of the women in the study were obese and smoked, which is what accounted for most of this risk.

20:46  Dr. Watson uses bioidentical estrogen and progesterone, which are much safer than using conjugated equine estrogens and synthetic progestins.  She prefers to use estradiol rather than Biest, which is a combination of estradiol and estriol, a weaker estrogen thought to be safer.  Dr. Watson said that since estradiol is more effective at reversing menopausal symptoms, if you give an estriol/estradiol combination like Biest, you may end up having to give higher dosages, which can have more side effects.  On the other hand, estriol is great to use topically for the vagina.  Dr. Watson emphasized that she individualizes her treatments and recommendations to each patient’s needs and how their body reacts. 

23:41  Dr. Watson usually prefers to use topical forms of estrogen and progesterone.  She tries to avoid using oral estrogen to avoid the first pass effect that can increase clotting factors and stress the liver.  If the patient will not apply the cream or some women do not absorb it very well, so sometimes she will use sublingual forms.  She will more commonly use oral progesterone, since she may have trouble getting good blood levels with topical progesterone. The oral progesterone doesn’t have the same risks as the estrogen and it helps better with sleep, so Dr. Watson will use the oral progesterone frequently.

25:54  Dr. Watson typically administers hormones statically, with the same dosage throughout the month, though some doctors will use a rhythmic pattern of dosage, such as with the Wiley Protocol. And she has recommended this for a few patients.  She does recommend that women with a uterus to take the progesterone regularly because it prevents the estrogen from leading to the uterine lining becoming thick.  Dr. Watson will often measure the uterine lining to make sure it is not becoming thicker.

28:05  Dr. Watson explained that it is an unanswered question at this time whether hormone replacement therapy protects the heart, but she said that it is important for this purpose if women start estrogen within the first year after menopause. 

31:08  If women have had a history of breast cancer but are having vaginal symptoms, Dr. Watson said that as long as she is cancer free and she is being followed by an oncologist, she may recommend the vaginal administration of estriol or DHEA or testosterone cream.  Testosterone can have antidepressant effects and other benefits, but it can also cause hair loss and acne and irritability and anger in some women.

34:10  Dr. Watson will sometimes include pregnenolone in her hormone replacement program if women tests low on it and have symptoms of MS or other neurological problems, since pregnenolone can be important for brain health, but she has not seen it raise estrogen levels.  She will typically prefer to start women on estrogen and progesterone alone before adding other hormones and make sure she can get the levels correct. Dr. Watson likes to use products from a good compounded pharmacy that tests every batch so that she can easily titrate up or down the dosages.  If you use a patch or pellets, you are stuck with whatever dosage is there.  Also, commercial brands of estrogen are often in an alcohol base and Dr. Watson prefers not to use an alcoholic base. And commercial products have various types of binders and fillers that some women can have reactions to.  Commercial progesterone is often in a peanut oil. By using a compounded pharmacy, you can use an olive oil or emu oil or canola oil or even a powdered base.  Dr. Watson usually does not start women on testosterone and DHEA at the same time as estrogen and progesterone till she feels that her patients are balanced.  She will typically have her patients come back in a month and retest their hormone levels and see where they are at and then add in DHEA and/or testosterone if their levels are low at that point. 

40:03  Dr. Watson believes that bioidentical hormones can be really beneficial for the brain.  This is partially through protecting the vascular system, which allows for maximal blood flow to the brain, which is maximized by starting the hormones close to the beginning of menopause.

42:15  Adrenal function is also very important to hormonal balance and Dr. Watson will frequently test serum cortisol and in some patients she will do the 4 part salivary cortisol testing or she will do the dried urine testing for adrenals with DUTCH Labs. To support the decreased adrenal function, Dr. Watson often recommends maca root, which is a great herb that can stimulate the production of both estrogen and testosterone.  She will also use licorice root to support adrenal production.  For women that have a spiking of their cortisol levels, phosphatidylserine, magnolia, and ashwagandha can be beneficial.



Dr. Cynthia Watson is a primary care Medical Doctor, board certified in family medicine, and she embraces a Functional Medicine/Integrative approach to care, incorporating nutritional and herbal medicine and bioidentical hormones into her approach to health and wellness.  She is still accepting patients and she can be reached through her website, WatsonWellness.org.

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz, with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free E-book on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness podcasters, thank you so much for joining me again today. For those of you who enjoying listening to our podcast, I would really appreciate it if you could go to Apple podcasts or your favorite podcast app and give us a review and a rating so more people can find out about it.  Also, if you want to see the video version go to my YouTube page. And if you go to my website, drweitz.com, you can find a complete transcript and detailed show notes.

                                Our topic for today is the use of bioidentical hormones during perimenopause and menopause with Dr. Cynthia Watson. Menopause is when a woman’s body is shutting off its reproductive capabilities. A woman is technically in menopause when she has not had her period for one year. During perimenopause, the period prior to menopause, and menopause, there is a gradual but dramatic decrease in estrogen and progesterone production by the ovaries resulting in a host of symptoms including hot flashes, night sweats, brain fog, mood swings, sleep problems, depression, weight gain, vaginal dryness, hair loss and fatigue among others. Long term effects of menopause include increased risk of osteoporosis and of cardiovascular disease.

                                Dr. Cynthia Watson is board certified in family medicine, and she embraces a functional medicine approach to care, incorporating nutritional and herbal medicine and bioidentical hormones into her approach to health and wellness. After two years at Ohio State University, she lived on a biodynamic farm in Norway, and developed an interest in the naturopathic medicine practiced on the farm. She also worked as a nurse’s aide in a homeopathic hospital in Germany. She got her BS in chemistry from Duquesne University, and she went to the USC School of Medicine. She has had her own private practice since 1991, and she incorporates herbs, nutrition, homeopathy, intravenous vitamins and bioidentical hormones into her integrative medical approach.  She wrote a number of books including Love Potions: A Guide to Aphrodisiacs and Sexual Pleasures, User’s Guide to Easing Menopause Symptoms Naturally, All About Lipoic Acid, and Better Sex in Midlife. Dr. Watson, thank you so much for joining me today.

Dr. Watson:        Thanks for inviting me, Ben.

Dr. Weitz:           What are hormones, and why should we care about them?

Dr. Watson:        What are hormones? Well, hormones, that’s a broad definition because you’re talking about steroids hormones and other hormones. Hormones basically are defined as something that’s secreted from an organ and it has an effect on another organ. But the sex hormones are the ones that we deal with in menopause and menstruation, and also for men too. They have hormones too.

Dr. Weitz:           Absolutely. What happens during the perimenopause, and how can we help women with their symptoms during this period?

Dr. Watson:        In perimenopause, there are a number of changes that can happen, and it varies from woman to woman. And it also varies according to age because some women will go into what we call perimenopause in their late 30s, early 40s, and some women will not even hit that period until the mid 40s. The timing for menopause is generally between 45 and 55. But prior to that, you’ll see a number of changes. The most common changes in terms of visual changes are problems with irregular periods, where the cycles will either get shorter or the cycles will get longer. And sometimes they’ll get heavier depending on what physiologic changes there are.  The most common things are that the progesterone levels fall, and the testosterone levels fall in perimenopause. And often, the estrogen levels go up. Because as women, we’re producing an egg every month, and as that gets weaker, the FSH gets higher, so the body is producing more estrogen. But the progesterone levels, and the testosterone levels tend to fall. And what that translates into is you’ll see women with either the cycles are getting shorter, where they’re having cycles every three weeks, it’s even every two weeks sometimes if they don’t produce an egg, and/or they’ll have 35, 40 day cycles.  And the other thing that goes along with that is a lot of irregular mood symptoms. I’ll see irritability, more PMS, more depression, and also lower sex drive too, because the testosterone levels tend to fall.

Dr. Weitz:            How can we support women during this phase?

Dr. Watson:        One of the most important things that I talk to my patients about is the adrenal gland. And I wanted to really talk a lot about that in this interview because as women, our adrenal glands produce hormones. They produce hormones just like the ovary does.  And as we go into menopause, the hormone production… prior to menopause, the ovary produces about 75% of the hormones. The adrenal gland about 25%, and that shifts as we go into menopause, whereas the ovaries produce less hormone and the adrenal gland takes over.  What I see a lot and women in our society, especially as we’re so busy, we’re working, we’re taking care of kids, we’re doing so many things, that the adrenal glands get weaker. And so we see the hormone production cut down. And especially where that happens is with progesterone, because progesterone is used by the adrenal gland to make cortisone. So what happens is something we call it the progesterone steal phenomenon where the ovary’s making estrogen, it’s making some progesterone, but the adrenal glands want that progesterone too. So as soon as that progesterone gets produced, it gets used up by the adrenal gland to make cortisone.

                                For me, checking a woman’s hormones, most gynecologists, we learn to check the FSH and the estradiol on day two or three to see how … the FSH is follicle-stimulating hormone, and that’s the hormone that is stimulated when we produce an egg. And as that goes higher, then we see less fertility and we see someone moving more into perimenopause.  But the other important thing to check during that time is what we call luteal phase hormones, where you want to check the estrogen and progesterone and the testosterone around day 20 to 24, depending on how long the cycle is, to see how much progesterone they’re making. And then depending on that … because I’ll see women with low progesterone, I’ll see women with super high estrogen levels, like 200, 400. I’ve even seen up to 700 and those women, they’re uncomfortable. They’re miserable. It’s like their breasts are tender, they’re bloated, they’re irritable. All of those symptoms go along with perimenopause.

Dr. Weitz:           What’s … Go ahead.

Dr. Watson:        What you have to do about that is you have to help to lower the estrogen levels with herbs and supplements, which work really well to do that. And then if the woman needs progesterone to give them progesterone during that time in the cycle.

Dr. Weitz:            What herbs and supplements can help lower the estrogen levels?

Dr. Watson:        This is an important thing because I see women in their 40s where the estrogen levels start to climb as a combination of just this hormonal cycle. And also because of the environment, because there’s a lot of the phytoestrogens and a lot of women are eating soy or they were being exposed to some of these chemicals, the xenoestrogens, which then block our ability to clear estrogen.

Dr. Weitz:           Like there’s Bisphenol-A, like pesticides.

Dr. Watson:        Right.

Dr. Weitz:           Like phthalate in personal care products.

Dr. Watson:        Exactly. So just being cautious and being aware. Those things actually clog up those cycles and make it difficult for us to metabolize the estrogens. And then there’s also genetic factors, which I’m looking at a lot of the genetic factors like certain CYP enzymes that they could have a polymorphism on. Or the COMT enzyme, if you have a polymorphism on those, then you also have reduced ability to clear the estrogen.  So what can you do? You can take a supplement called DIM, diindolylmethane, which is the broccoli, the extract from cruciferous vegetables, that actually helps convert some of the estrone into a weaker estrone. You can also take calcium d-glucarate and milk thistle. Calcium d-glucarate helps with the glucuronidation of the cycle and helps pull those estrogen levels out. And it really makes a difference for some women when they’re retaining high levels of estrogen.

Dr. Weitz:           Do you ever use indole-3-carbinol versus DIM?

Dr. Watson:        I tend to use more DIM.

Dr. Weitz:           And why is that?

Dr. Watson:        Well, just from some of the research that I saw that the DIM is the downward metabolite of the indole-3-carbinol, so the DIM is actually a little more effective.

Dr. Weitz:            Okay, great. You were talking about the hormone levels, the estrogen going up and the progesterone going down. What’s the best way to test or measure hormone levels? And we have serum, we have 24 hour urine, we have dried urine, we have saliva.

Dr. Watson:        Yeah, there’s a lot of different testing methods. I think I’m more partial to blood.  That’s what I’ve been doing for all these years, and I think it also depends on the practitioner and where their level of comfort is because I’m used to looking at blood.  I know how to interpret the blood, I’m comfortable with it. If that’s something that you’re comfortable with, I think blood levels are fine.  Your levels are helpful for the urine metabolites of the estrogen, so if you’ve got someone who you think is not metabolizing in the estrogen, you can get a lot of estrone metabolites, you can get the 2/16 hydroxyestrone and the 4-methoxy and 4-hydroxyestrone.  So you can see if someone’s got high estrogen where you need to help them in that cycle to clear the estrogen.  And so that’s really only with urine. So if I have someone where I really need that, I’ll do urine.

                                I think progesterone levels are not very good at urine because you’re not really measuring the actual level, you’re measuring a metabolite. I tend to use blood and I tend to check the blood depending on where the woman’s cycle is, I tend to check the blood between day 20 to 24. But if I have someone with a 21 day cycle, I’m going to do day 18, something like that.

Dr. Weitz:            We’ve started using the dried urine more and one of the things that’s beneficial for that is you were talking about trying to get a woman on day 18 to 21. And a lot of times, oh, shoot, that’s a weekend. I can’t go, I have to wait till next month. So this way they can do it at home and send it in.

Dr. Watson:        I’ll just adjust it based on whatever day they can do it. But yes, I sometimes do the urine as well.

Dr. Weitz:           Right. What else can we do as far as the progesterone? What do you think about using herbs to support progesterone production during the perimenopause?

Dr. Watson:        I love the vitex.

Dr. Weitz:           Right.

Dr. Watson:        Vitex is the best herb for women in perimenopausal symptoms

Dr. Weitz:           A.K.A. chasteberry.

Dr. Watson:        Chasteberry, yeah. Chasteberry is a great herb for that. I found a lot of my patients when you give them progesterone, they get side effects. Sometimes I’ll just go to the chase berry first, see how that works.

Dr. Weitz:           What dosage do you like for the chasteberry?

Dr. Watson:        I usually use about 200 milligrams twice a day.

Dr. Weitz:           Okay, good.

Dr. Watson:        But I don’t cycle it. I usually have them do it continuously.

Dr. Weitz:            Okay, good. What happens during menopause, and why is it that some women sail through menopause with fairly manageable symptoms and other the symptoms are severe and unlivable?

Dr. Watson:        I don’t also really know why some women have different symptoms because I’ve seen some women, you would think that some women who are a little more overweight, that they have more indulgence estrogen, that they wouldn’t have as many symptoms, but sometimes they do. I think some of it is genetic because I think some women if their mother had an easy menopause, that they may have an easy menopause.  And again, I go back to the stress issue. Some patients, if they’ve had a lot of stress and the adrenal glands aren’t able to carry them, they are going to have less estrogen. I’ve seen some women have very low estrogen levels, and then they’re fine, so I don’t know if we know why. But certainly, there are some women that have really disabling symptoms, and those are the women that I think are good candidates for the hormone replacement.

Dr. Weitz:            Now, isn’t it the case that the Women’s Health Initiative, which was published in 2002 showed that taking the estrogen and progesterone increases the risk of heart disease and stroke and blood clots and breast cancer?

Dr. Watson:        That study, as you know and as reported by many doctors and even some of the doctors that even were part of the study, that the results on that study were very confusing. I think, first of all, the product that was used on that study let me start with that, is Premarin and Provera. Provera is the synthetic progesterone. So physiologically, the effects of synthetic progesterone on the body are different. And Premarin, which is the pregnant mares’ urine is mostly estrone. So because of that, it’s a different kind of estrogen and it’s metabolized in the body differently. And to add to that it is also an oral estrogen, so we tend to try to use more topical estrogens in some women when women postmenopausal.

                                The other problem with the study is that most of those women in the study were actually not having menopausal symptoms. And the reason for that is because they were doing placebo controlled, so they were looking for women who didn’t have menopausal symptoms. Because if they did, they would know whether or not they were on a placebo or not, so that’s the first thing.  The other problem with the study was it was a prospective study. And a prospective study means that if there is a complication they need to stop the study. So it wasn’t just an observational study, it was a prospective study. And what happened-

Dr. Weitz:            Aren’t prospective studies the most accurate?

Dr. Watson:        Well, yes, but the way it was interpreted because there was a slightly higher statistical evidence of cancer, they had to stop the study. But the statistical evidence in that study was it was a very small group of women.

                                First of all on the estrogen, there was an arm of the study that was estrogen alone, they were just Premarin alone. These are women that had a hysterectomy. In that study, there was no increased risk of breast cancer. In the part of the study that had the estrogen with progesterone, those patients there were out of 10,000 women, there were 32 cases of breast cancer. In the control group there were 24 cases, so there were only eight cases more in the treated group. But because eight goes into 32 three times, it was recorded as a third more cases even though that was a very small statistical study.

                                Prior to that time many of the studies … First of all, there’s a wonderful book if patients want to read a little bit more about this that, I don’t know if you’re familiar with this book. It’s called Estrogen Matters, and it’s by Avrum Bluming. And he’s a wonderful gynecologist who … I mean oncologist who was in San Fernando Valley. He was one of my referrals. And he was one of the only doctors after breast cancer that would treat women with hormones and it became quite controversial. He was really in the firing line for a long time because of this. And then one day I was referring a patient when one day I found that he retired. And then a few months later, I saw this book saying Estrogen Matters, why we can give women estrogen even after breast cancer.  He’s the one that did a lot of the research and he produced a lot of studies. Up until that time there were very few studies that showed that there was an increased risk of cancer. And then in the studies in Europe, they started to use bioidenticals because they tend to use more bioidenticals. They use more pure estradiol, and they use a lot of natural progesterone. There’s a very large French study that did not show an increase in cancer.

So let me address the heart disease and the stroke.  Part of the problem too with that study is that many of the women in that study were obese, many of them smoked. And what they’re finding now is the risk of cancer and heart disease and stroke really has to do more with obesity, and that’s been one of the main things. There was a very large article that was written by NAMS, the National Menopause Society and the International Menopause Society showing that really, the risk of breast cancer and stroke in these women is that it’s really from the obesity that seems to be the problem.



Dr. Weitz:                            I’ve really been enjoying this discussion, but now, I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic research-based dietary supplements. Pure products are meticulously formulated using pure scientifically-tested and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners and preservatives.

Among other things, one of the great things about Pure Encapsulations is not just the quality products but the fact that they often provide a range of different dosages and sizes, which makes it easy to find the right product for the right patient, especially since we do a lot of testing and we figure out exactly what the patients need. For example, with DHEA, they offer five, 10 and 25-milligram dosages in both 60 and 180 capsules per bottle size, which is extremely convenient.

                                                Now, back to our discussion.


Dr. Watson:        I use all bioidenticals and primarily estradiol.  I know some doctors use the Biest combination and I do use that in some of my patients, but I tend to use more of just pure estradiol.

Dr. Weitz:            And why is that?

Dr. Watson:        I found that some women don’t tolerate the estriol as much. And since the estradiol has the strongest effect on menopausal symptoms, what was happening is you’re giving estriol and estradiol because estriol is a weaker estrogen you were having to give higher doses of it. So there are some women especially some women, they just don’t do as well on it. Some women do, so I think it … Again, when I’m working with a patient, everything’s individualized. What I would give them would be on an individual basis, based on their body weight, their family history, whether or not it looks like they’ve had a problem clearing estrogen in the past.  Because I think that’s one of the other things that I try to really pay attention to. If I have someone who has a history of fibroids, ovarian cysts, PMS symptoms, they’ve had problems, if it looks like they’ve had or they have problems metabolizing the estrogen, I’m going to want to use lower levels.

Dr. Weitz:            I think a lot of the doctors who are using Biest or using estriol are using it to potentially lower the potential risk of breast cancer since estriol is a weaker estrogen.

Dr. Watson:        Right.  And then I have actually a couple of women who have had breast cancer and they’re on estriol.  Estriol is really great for the vagina. For vaginal dryness, estriol is a wonderful product for that, just for topical application.

Dr. Weitz:           Right, I know. I interviewed Dr. Gersh and she’s not really big on estriol because she explains that estriol is a dominant hormone secreted during pregnancy and it basically stimulates the estrogen beta receptors. And so you miss stimulating those estrogen alpha receptors that are so important. And overstimulating the beta receptor actually down regulates the immune system, which is maybe good for pregnancy, but not so good for fighting off infections or a cancer.

Dr. Watson:        Yeah, but when you’re using estriol in hormone replacement, you’re using such small doses compared to what the body is secreting in pregnancy. In pregnancy, you’ve got super physiologic, really super high levels.

Dr. Weitz:           And what form of the estrogen and progesterone? Do you like topical estrogen? Have you used pellets?

Dr. Watson:        I use whatever is going to work on the patient. I have generally tried to start with some of the topical forms because the topical forms, you don’t have to deal with that first pass effect. You’re using oral estrogen long term can increase clotting factors and you can have some concern with the liver…

Dr. Weitz:           By first pass, what you’re saying is when you take an estrogen orally, it goes into the-

Dr. Watson:        Highest levels go into the liver.

Dr. Weitz:           Right, exactly. Thank you.

Dr. Watson:        But I do use sublingual forms as well for some of my patients. Some women just do not absorb the creams or they’re not going to do it. They’re just not going to do it, so if it’s better in terms of using the … if you’re going to get better compliance, and they’re going to be happier using one of the other forms, I’ll use whatever is going to work.

Dr. Weitz:            Now, one of the issues with using the creams is that serum testing may not accurately reflect hormone levels if you’re using the creams. Is that right?

Dr. Watson:        They do sometimes. Well, I see both. I see some women where I’m just not getting good serum levels, that’s true.  And I know that salivary levels can be used for that.  My problem is salivary levels is that I’m just not sure how they know standardization, how they know what is an actual good dosage. But I see women on the creams all the time and on patches all the time. They get great blood levels, so I think that’s not as much of a problem. With the progesterone though, sometimes I have trouble getting good blood levels, and I have a lot of women that sometimes I have to switch them to oral progesterone.  The oral progesterone doesn’t have the same risks as the estrogen. It’s very well absorbed. It actually helps better with sleep, so a lot of my patients will do the oral progesterone instead.

Dr. Weitz:            Now, when a woman’s menstruating, her progesterone levels are much higher a couple of weeks during the period and estrogen levels tend to fluctuate and spike prior to ovulation. Do you use static dosing for hormones, or do you use rhythmic dosing?

Dr. Watson:        I tend to use more static dosing for hormones, although there are certain doctors that will do the rhythmic hormones and I’m learning a little bit more about that. And I have a couple of patients who have been doing that. There’s the Wiley Protocol, which was the first protocol for that. I think it just depends on the patient and what they’re going to be able to do.  If you have someone who’s not going to be able to pay attention to switching off and doing a different dose every single day, then you’re not going to get good compliance. I sometimes have trouble with women even remembering to take the progesterone. I’ll say like, you got to think that progesterone, it’s really important.

Dr. Weitz:            Right.

Dr. Watson:        … if you have a uterus.

Dr. Weitz:            Right.

Dr. Watson:        And there are some women that actually don’t have a uterus that like the progesterone anyway. They actually feel better on it.

Dr. Weitz:            So then the reason why the progesterone is so important for a women who has a uterus is because it stimulates the sloughing off of the increased endometrial tissue that happens from the estrogen, right?

Dr. Watson:        Well, it’s not so much sloughing off. It balances the possibility of the estrogen causing the lining to get thick.

Dr. Weitz:           Right.

Dr. Watson:        Because in women that are doing these static dosing, we don’t usually see them bleed, so it’s not like the lining is getting thick. If they’ve got an adequate amount of estrogen and progesterone, it’s usually … and also these are low levels. We’re not doing high levels like someone does when they’re menstruating. So you won’t necessarily see the lining get thick if you’ve got the dosage, right?

Dr. Weitz:           Right. Do you ever measure the uterine lining level?

Dr. Watson:        All the time. All the time, yeah.

Dr. Weitz:           Does hormone replacement therapy protect the heart?

Dr. Watson:        Well, that’s a controversial question right now. According to the research, if you start estrogen early on, if you start it early on in menopause in the first few years … That’s one of the things that we’re encouraging right now, is that the benefits that women get in menopause starting hormone replacement early. It’s better to start it early in terms of protecting the bones, protecting the heart, protecting the brain. What happened was when they took-

Dr. Weitz:           When you say starting early, you mean during perimenopause or shortly after menopause starts?

Dr. Watson:        Within the first year of menopause really.

Dr. Weitz:           Okay.

Dr. Watson:        I tailor my hormone replacement to women based on what their comfortable with. There are a lot of women that if they’re afraid they’re going to get breast cancer and they’re doing fine, then I’m not going to push hormone replacement on them. Years ago when I first started practicing and then there were a lot of women who were trying to decide whether to do hormone replacement because the research indicated that it had such good protection on the heart, I had patients come to me and say, my gynecologist wants me to take these hormones and I don’t want to do it.  Because the gynecologist were really like, “This is going to protect you and this is really important.” And then the study came out and everyone was like go off the hormones, these are bad, they’re dangerous, stop the hormones. Now we’re in a reset period, I think, where you have to really choose what is going to be best for your patient individually.

Dr. Weitz:           What do you think the consensus is right now in the standard gynecological community?

Dr. Watson:        Unfortunately, I think there are a lot of gynecologists out there that they’re against hormone replacement. Because I’ll have-

Dr. Weitz:           They tell the patients that they’re unsafe, right?

Dr. Watson:        Yeah, exactly, which I don’t believe to be true. Although, again, I think it depends on each individual person and based on their family history.

Dr. Weitz:            Yeah, from what I’ve seen…

Dr. Watson:        And also there are symptoms. If I have someone who comes in and they’re having no symptoms whatsoever, they’re sleeping fine, they’re doing fine, they’re not having any menopausal symptoms, I may just give them a vaginal cream because the vagina usually will need some estrogen support. But I’m not pushing hormones on someone just because.  Right now, the NAMS, the National Menopause Association, they recommend using hormone replacement for menopausal symptoms, for quality of life symptoms. And so if I have someone who’s really having bad symptoms, I will encourage them to use some hormonal placement.

Dr. Weitz:            What about women who have a history of breast cancer, but are having vaginal symptoms? I’ve heard some practitioners using topical testosterone and even topical DHEA for women who are really petrified about taking estrogen.

Dr. Watson:        There’s two classes of things here. There’s the woman who had breast cancer. Now, I actually have some of my patients who’ve had breast cancer on hormone replacement because their cancer was a slow growing cancer. It was easily excised, it was small, it was low risk. And their symptoms are so bad in terms of depression, mood swings, hot flashes, sleep problems, that I will put them on the dose of hormones.  But then if I have a woman who was menopausal, she’s had breast cancer and she’s not having any symptoms, or that she’s being followed by an oncologist who has specific like, don’t give her more most, you can use estrogen, just estradiol cream. You can use estriol cream, you can use DHEA. There’s a commercial grade suppository and then there’s an over the counter grade suppository with DHEA. Testosterone works great in these women and sometimes even helps with some of the menopausal symptoms. So all of those things are viable options for a woman that doesn’t want to do systemic hormones for just the vaginal dryness.

Dr. Weitz:            So, which is your go-to? Is your first thought to use a topical estrogen rather than the testosterone or the DHEA? Or do you think they all work equally effectively?

Dr. Watson:        For a woman that’s had breast cancer?

Dr. Weitz:            For a woman who’s had breast cancer, but who wants help with vaginal dryness and atrophy.

Dr. Watson:        Well, I’ll usually use the estradiol first just to see how they do. I check blood levels, so if someone has a low testosterone, I will. And testosterone is very well measured in the blood. And if someone’s testosterone is low, or the estrogen doesn’t work, or they’re having sexual dysfunction, where they’re having trouble with orgasm, testosterone works really well for that. It also works really well as an antidepressant. I’ve had some women even not with breast cancer, but some women. I had one woman, I gave her testosterone and she went off her antidepressant because she didn’t need it anymore.  So there’s a lot of good benefits to the testosterone, but there are side effects too. You can get hair loss, you can get acne, and you can get irritability, or some women even with the lowest dose of testosterone, they’ll get rage and irritability and sharp with their partner and we don’t need that. So some women just have bad effects with testosterone. But for the woman that testosterone works for, it’s amazing.

Dr. Weitz:            For your typical protocol when you have a woman … Getting away from the breast cancer thing, if you have a woman in the first year of menopause, and you’re going to put her on a program. Besides putting her on estrogen and progesterone, if testosterone levels are low, if DHEA levels are low, do you typically supplement those as well? And what about other hormones like pregnenolone?

Dr. Watson:        My experience with pregnenolone is though I love it and I think it can be important for brain health and function, especially if you have someone who’s got MS or even any neurologic problem, but I’ve never seen … theoretically, it’s supposed to have a cascade effect where you would take the pregnenolone and it goes into different pathways. I’ve not really seen it actually raise estrogen levels. So I will use it if the levels are low and if someone’s having those particular symptoms.   What I like to do is usually start them on estrogen and we discussed which kind to use. Like the patch, there are other issues like the controversy about compounded versus commercial brands because in the conventional medical wisdom like the OB-GYN’s group, ACOG, the American College of OB-GYN, they’re totally against compounding. They talk about compounding as being like it’s not measured, it’s not accurate, you have no way of quality control. And-

Dr. Weitz:            And there’s been a movement to try to shut down the compounding pharmacies, right?

Dr. Watson:        Right. And I try to use compounding pharmacies that I know that have reliability, that I know to do batch testing. They test their products, so I know that I’ve got someone who’s really paying attention. Have I seen some women get a batch and say this is not right or there’s something wrong with it, or some levels are really high? Yes, I have seen that before. Don’t forget, also even in the generic versus brand, there’s a certain percentage, like what, 20%, which doesn’t have … It has either low levels or higher levels.

Dr. Weitz:           Actually, it’s a whole other topic we can get into, but there’s a huge problem with generic drugs right-

Dr. Watson:        Drugs right now. Yeah, I’m seeing a lot of that with a lot of the drugs that I see. So I’ll use the patch. Again, it depends on the woman. It’s like if they don’t want to wear a patch because they’re swimmers or they take baths or exercise a lot, I’m not going to use the patch. But as someone who wants to be able to get the hormones covered by their insurance, the patch works great. And if they’re not going to take it, they’re not going to put a cream on every day. The patch works great, and it is bioidentical estrogen. It’s the pure estradiol. And then there are a couple of other-

Dr. Weitz:           What are the advantages of using compounded hormones?

Dr. Watson:        Well, I like them because you can titrate the dose more easily. And you can also decide, you can start with lower doses and titrate up if you have someone who you’re not sure what their dosage is going to be. It’s a little bit easier to do that.  And also, if you’ve got someone who you think is going to have trouble metabolizing the estrogen, I’ll have someone, I’ll give them estrogen and it’s like, whoa, it’s way too strong.  Even the lowest amount, you can have them stop for a couple of days.  Once you put the patch on, you have a little bit less regularity.  The other thing, some of the other commercial brands of estrogen that are available at the pharmacy, they’re in an alcohol base and I tend not to like those alcohol bases very much, but some women do fine with them.

Dr. Weitz:            And sometimes women can have reactions to the binders and fillers and things like that, that they’re made with. So by going to a compounding pharmacy, you can have some control over how they’re made.

Dr. Watson:        Some of my patients have the estrogen put in olive oil, which is very clean. They can just put it right on their skin. There’s a company that will make it an emu oil, and you can use hypoallergenic bases. So yeah, for especially someone who’s sensitive and going to be sensitive to chemicals, there’s a lot more options with compounded.  And also, I find that the regular progesterone, the commercial grade progesterone, is in peanut oil. And some women can’t do the peanut oil, so you can have the progesterone made in a compounding pharmacy in your olive oil base or canola oil base, or even a powder base.

Dr. Weitz:            And then how often do you add DHEA and testosterone as part of the mix?

Dr. Watson:        Well, I usually start a woman on the hormones and then recheck their … I like to use estrogen and progesterone alone to start because then if they have a side effect or there’s anything that changes in terms of their metabolism, then I know exactly what to do, and I’m not dealing with a lot of other variables. Because with the testosterone and DHEA, those hormones also can go into the metabolic pathways and if a woman has a very strong aromatase level in her body, she will convert that DHEA and the testosterone into estrogen. And I’ve seen that happen before.  I don’t want to add that in until I know what I’m dealing with, with how they’re doing with the estrogen. So I will start on estrogen and progesterone, and after about a month, I will check the levels and see where they are and then add in the DHEA and testosterone if their levels low.

Dr. Weitz:            What about the benefits of bioidentical hormones for the brain?

Dr. Watson:        There’s a lot of research that shows that the hormones really are beneficial for the brain. There’s certainly even in the women’s health study there, well, there’s some confusing things in that study. Because on the one hand, it did show that there’s less Alzheimer’s in women on hormones. But then there was at one point, a study that came out that showed there was increased dementia. And again, I bring up the issue is like in that study, those women were … Here’s the other benefit of starting the hormones a little bit earlier.  If you start a woman on hormones later, you don’t get the benefits to the vascular system and you can get more plaque formation, more atherosclerosis. One of the few things that no one talks very much about is that estrogen and progesterone have a protective effect on lipids. I see this all the time. I have a woman who’s got low … I’m one of them because I always had a cholesterol of 180 something. My cholesterol was a non issue, and as soon as I went into menopause, even on hormone replacement, my cholesterol was a little higher. My LDL tends to be a little bit higher.  So what happens in that study where they took all these women, they started a lot of these women in their 60s who could have had already vascular changes already. And then you add to that, the fact that you’re using an oral preparation, which increases clotting factors, so you’re going to increase the risk of stroke. If you look at all those statistics, you can’t make assumptions that if you start a woman in their early 50s on the bioidentical hormones, that it’s going to increase their risk of stroke because it’s like comparing apples and oranges. But it’s very clear that there’s better cognitive function in women on hormone replacement.

Dr. Weitz:           Oh, I just wanted to cycle back to one thing you talked about before. You were talking about the adrenals.

Dr. Watson:        Right.

Dr. Weitz:           Does the adrenal function, and how do you support adrenals?

Dr. Watson:        Well, first of all, you want to test. I’ll do a test, I’ll do … And part of my hormone panel is to check the cortisol levels. So I’ll look at cortisol levels.

Dr. Weitz:           So you’re are talking about serum cortisol?

Dr. Watson:        Serum cortisol levels, but in some of my patients, I will also do the salivary levels. Well, the spaces are 12 hours salivary test, where you do morning, noon, afternoon, evening.

Dr. Weitz:           Do you include the cortisol awakening response?

Dr. Watson:        Right, yeah. And so you’ll see some women who will still spike in the middle of the night, or you’ll see where they don’t really get a good cortisol … Cortisol should be higher in the morning and then go down as the afternoon goes up, but you’ll see some women that are flatline and then they go up at night. These are the women that are having trouble sleeping.  And then there’s also the dried spot urine. There’s a company that does the dried spot urine, where you’re doing the four samples throughout the day.

Dr. Weitz:           Right. The DUTCH testing?

Dr. Watson:        Yeah, the DUTCH testing.

Dr. Weitz:           Yeah, actually, one of the advantages of that is when you do the cortisol awakening response, and they have to spit into a tube as soon as they wake up, that’s always problematic.

Dr. Watson:        Right, yeah.

Dr. Weitz:            But The DUTCH testing, they just put a little cotton swab in their mouth, get it wet, and that’s all they have to do.

Dr. Watson:        Yeah. No, it’s a good test. It’s a good test. So for adrenals, I tend to use more herbs for the adrenal gland. There’s a lot of great formulas that are out there. One of the other herbs that really is good is maca root for women, for both perimenopause and into early menopause. And even some of my women who have had breast cancer, who don’t want to use hormone replacement, maca is a great herb because it doesn’t actually have plant estrogens in it. It basically helps stimulate the production of estrogen and testosterone. So maca is a great herb. Licorice root, just the ginsengs.

Dr. Weitz:            So now do you have different protocols if they’re seeing a spike in the cortisol in the evening, as opposed to when it’s just flatline the whole time?

Dr. Watson:        Oh, for sure. Because for the women that have the spikes, I’m using the phosphatidylserine products. There’s a couple of products that have phosphatidylserine. Magnolia works great. There are a number of commercial products that just help to lower that cortisol level, and so you give it to them in the evening, and that really helps. So, yes, I’ll use a lot of those.  Ashwagandha is another one. That’s another really good herb for women that are having that or even men, that are having that issue where they’re having trouble sleeping and we think the cortisol or the cortisol is spiking.

Dr. Weitz:            Right. And then the maca and the licorice root and some of those things to help stimulate the adrenals?

Dr. Watson:        Right. But again, it depends on the person. It’s like, if you’ve got someone who’s spiking cortisol you don’t want to do heavy duty adrenal stimulants. You want good adaptogens, and that’s where the ashwagandha and the maca root really help with that.

Dr. Weitz:            Okay, good. I think that those are the questions that I had. Is there anything else that you want to say before we wrap up our discussion here? And then-

Dr. Watson:        I know you asked me about the pellets and I didn’t really address that.

Dr. Weitz:            Yeah, okay.

Dr. Watson:        I know some women really benefit from the pellets and they like it because it gives them like … if they don’t have to really worry about putting something on like a cream or a patch or taking a vaginal-

Dr. Weitz:            Yeah, I know some women are concerned about the cream. It’s a pain, maybe it’s –

Dr. Watson:        Right.

Dr. Weitz:            … they don’t want to get it on their partner. There’s a bunch of different concerns that women have about the creams.

Dr. Watson:        So again, I think it’s a very individual decision. I think the issue that I have with the pellets is that I see really high levels, sometimes in women, and they get side effects from it, where they get breast tenderness because the levels are very high…

Dr. Weitz:            And you can adjust it once you-

Dr. Watson:        You can adjust it, yeah. So I tend to not use the pellets in my practice. But again, I had women who just love them. I had a couple of patients, it was great and they were very happy. So I think it’s again, we’re very fortunate in that we have options. We have a lot of choices for women. We get individualized therapy and I think of above everything, I think that’s the most important thing. There is no cookie cutter approach.  Years ago it was take Premarin and Provera, that was the thing. There was one dose and that was it. It is not a one size-fits-all. You really have to individualize it based on each individual patient, their genetics, where they are in life, how they metabolize the hormones. Everything’s got to be individualized.

Dr. Weitz:            What is the status, by the way, of compounding pharmacies?  I know that there was a movement to pressure the federal government into shutting down compounding pharmacies, and I know there’s a lot of controversy about it. Where are we in terms of that situation, the political situation?

Dr. Watson:        I’m afraid I’m not really up on the latest of that, except the compounding pharmacies they are still providing hormones for my patients, so…

Dr. Weitz:            Right, I know. I remember signing some petitions to try to keep them from closing them down.

Dr. Watson:        I don’t think they’re going to be able to close them down. I think there’s too many patients that are getting benefit out of it.

Dr. Weitz:            By the way, do you have a preferred dietary approach for menopausal women?

Dr. Watson:        Well, as we go into menopause, we definitely have metabolism changes. I see that, so you’re usually more into the paleo diet, into more like making sure you’re getting … It doesn’t have to be high protein, but you need to make sure you get adequate amounts of protein. I love a plant-based diet, and I think it’s really great, but it’s just not for everyone. And so some of my patients they are doing a plant-based diet, but it’s too high in carbohydrate, not enough protein.  And even if they are on a plant-based diet, as long as they’re getting good amounts of protein, they’re fine. But generally, the diet that I’ve been able to maintain my way into menopause, and how I do that is I eat a lot of vegetables and salads and lean protein and just keep the carbs and sugars to a minimum.

Dr. Weitz:            What about the women who are on a plant-based diet? How can they get an adequate amount of protein? How much protein is adequate, and how can they get that without consuming a lot of phytoestrogens?

Dr. Watson:        The recommended dose that I use is about 40 to 60 grams of protein a day depending upon what their needs are, in terms of how much they’re exercising. Especially though-

Dr. Weitz:            Your body weight and how much exercise, yeah.

Dr. Watson:        Yeah, because as you know, if women are exercising a lot, they need more protein. So using the protein supplements with pea protein or rice protein powders, just working with them on trying to avoid too much soy. So use other plant-based proteins.

Dr. Weitz:            What about that whole soy controversy? Because soy contains phytoestrogens and some of the data seems to show that soy is protective against breast cancer because when you…

Dr. Watson:        Right, that’s weaker estrogen.

Dr. Weitz:            You get the weaker estrogen, attach to the estrogen receptor sites and block the stronger estrogens. In a larger study I think, of menopausal women who consume the most amount of soy, these were women in China, who had a history of breast cancer, had the lowest risk of recurrence.

Dr. Watson:        I think there’s a premenopausal issue with soy and a postmenopausal issue with soy. Because certainly, in the premenopausal period when you have women with high hormone levels taking soy, then that’s a problem because it’s too much. And I’ve actually seen some women get breast problems and heavy bleeding and fibroids eating a high soy diet.  The other problem with soy is its effect on the thyroid. Soy has an anti-thyroid effect. So I’ll see some women if they’re drinking a lot of soy milk or eating a lot of soy based products, their thyroid goes off, their TSH will go up. But their thyroid is still functioning, but the TSH is up and then you get them off soy and their thyroid normalizes, so I’m not a big fan of soy because of that. Plus, it’s very difficult to digest and can cause a lot of GI bloating, gas issues.  But again, postmenopausal where you’ve got women who’ve got low estrogen levels, then those women may benefit from soy, as long as it’s in moderation. In places like China and Asia, they’re eating small amounts of soy. They’re not consuming large amounts of tofu and drinking soy milk. It’s a different kind of intake. They’re not taking large amounts of processed soy, though they may be eating tofu or something like that.

Dr. Weitz:            How else can these women get enough protein besides soy? You say plant-based protein powders with pea and rice?

Dr. Watson:        Yeah.

Dr. Weitz:           Those are the kind you like the most?

Dr. Watson:        Mm-hmm (affirmative), yeah.  If I see that they’re not … I have a couple of women that they’re working out quite a lot, and again, what I see in women that are doing a high plant-based diet is you have to watch their iron levels and you’ve got to watch their B12 levels to make sure they’re getting adequate amounts.  And yes, various different protein forms, and there are these different processed protein. So there’s the whole thing, the Impossible Burger and Beyond Meat and all that stuff, which it’s a very-

Dr. Weitz:           What’s your take on that?

Dr. Watson:        Well, it’s a very highly processed product. But again, it depends on if they’re not getting protein any other way then that may be something that they might need to do. But I just try to get them to do combinations of lentils and beans and rice and things, but just keep the portions small enough so they’re not getting a high carb load.  But it’s possible to do. We have people that are working out that are gaining muscle mass, and I’m sure you have them you have them too who are eating a plant-based diet. It’s definitely possible. You just have to be conscious about it. And what I tell people to watch for is watch for their sugar cravings because if you’re craving sugar, you’re not getting enough protein.

Dr. Weitz:           Or you’re taking in too many carbs, yeah.

Dr. Watson:        Right, yeah.

Dr. Weitz:           So your preferred diet is a paleo diet that’s basically lower in carbs, and it basically does not include grains and beans like the paleo diet does.

Dr. Watson:        Again, it depends on the person and how they have metabolize that, but for me, because I’m postmenopausal and I’m on hormone replacement and I’ve been able to maintain my weight all these years, that’s what’s worked for me. And that’s what has worked for me, so I’m still the same weight I was when I was in my 20s.

Dr. Weitz:           Great, awesome now.

Dr. Watson:        And I really don’t eat a lot of sugar. I think that’s the key. I keep that to a minimum in terms of sweets and candies and things. Not part of my diet.

Dr. Weitz:           That’s good. Okay, awesome. So how can listeners and viewers get ahold of you if they want to contact you or find out about your books?

Dr. Watson:        I have a website, but the books actually, unfortunately are out of print, [crosstalk 00:54:31] and I’ve been very busy in my clinic, so I haven’t really-

Dr. Weitz:           When is your next book coming out?

Dr. Watson:        That’s the question. Well, I am a full-time clinical practitioner, so not a lot of time to write books these days. Maybe when or if I slow down a little bit, I’ll have more time to do that. But it’s not part of my schedule right now. I’m pretty busy in the office. I’ve got a big practice, I’ve been practicing for a long time. I have people I’ve taken care of for a long time, so that’s the main focus for me.  My website is watsonwellness.org, so people can check that out. There’s a lot of information on the website about me. And yes, the books definitely are something that I would like to get back out again, but it just doesn’t seem to be part of the schedule.

Dr. Weitz:           Well, you can take one of those books in and just come up with a new version of it.

Dr. Watson:        Right, yes, that’s on my to do list.

Dr. Weitz:           And are you accepting new patients?

Dr. Watson:        Yes, I am. Yes.

Dr. Weitz:           Okay, awesome.

Dr. Watson:        Okay.

Dr. Weitz:           Thank you, Cynthia.

Dr. Watson:        All right. Thanks, Ben. You have a great day.




Dr. Mark Houston on Preventing Heart Disease: Rational Wellness Podcast 131

Dr. Mark Houston discusses Preventing Heart Disease with Dr. Ben Weitz.

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


Podcast Highlights

4:11  There are a limited number of specific vascular responses to the many insults to our blood vessel walls that result in coronary artery disease. Dr. Houston said that there are 400 different risk factors for coronary heart disease and atherosclerosis. Whether it is E. coli or a heavy metal toxin or LDL cholesterol there are only three things the blood vessel can do to respond to these insults. There’s three of them called inflammation, oxidative stress, and vascular immune disfunction. When these responses occur in the artery wall, it creates biomediators that eventually lead to coronary heart disease or congestive heart failure, stroke, or any kind of cardiovascular illness.

5:47  There is much controversy over whether red meat contributes to heart disease, with a recent paper in the Annals of Internal Medicine, in which a group of doctors and researchers who call themselves the Nutritional Recommendations Consortium and who did an analysis of the literature and concluded that red meat and processed meat do not significantly contribute to heart disease and cancer, Unprocessed Red Meat and Processed Meat Consumption: Dietary Guideline Recommendations From the Nutritional Recommendations Consortium.  Dr. Houston said that red meat is not the problem, but what the red meat has in it that causes problems. If the cattle are being fed corn and grains, which contains pesticides and glyphosate, and they are given hormones and antibiotics, then this will not be healthy to eat. On the other hand, if you eat meat from organic, grass fed cattle, that will have a different effect in the body and is healthy to eat.  Numerous studies show that this type of red meat does not increase coronary heart disease of heart attack. 

9:06  Red meat contains saturated fat, which has been shown to be associated with heart disease.  Dr. Houston explained that there are different types of saturated fat based on the carbon length, whether they be 8, 10, 12, up to 20 carbons.  The long chain C-12 and up are the ones that may have an increased risk of coronary heart disease and heart attack. But Dr. Houston did caution that even this link between saturated fat and heart disease depends partially on where the fat is coming from what it’s associated with, what other kinds of fats are in your diet, and the percent in your diet.  The short chain fatty acids C-12 and below are not associated with coronary heart disease. Dr. Houston recommends to keep your saturated fat intake around 10% of your total calories and try to limit it to the short chain fatty acids.

11:41  Dr. Houston is not a big fan of coconut oil, since it is 92% saturated fat and it’s mostly longer chain fatty acids.  He feels that there is not much data that coconut oil has any health benefits.  This is in contrast to many Functional Medicine practitioners who feel that coconut oil is a healthier oil, partially because of the medium chain triglycerides that it contains.

13:10  One reason some people like using coconut oil is for cooking, since it’s high saturated fat content helps it to hold up to heat better than other oils without being oxidized. Dr. Houston is a big fan of olive oil and cooks with it at a lower heat, and he is careful not to bring it to a steaming point.  He cautioned not to overcook at too high a temperature.  He says that monounsaturated fats are healthy and he recommends pouring some olive oil on your food after you have cooked it.  He also recommends cooking with grape seed oil and avocado oil, which both stand up to higher heat. 

15:47  One of the advanced lipid tests on the market lists monounsaturated fats in the less healthy category and some physicians tell their patients not to eat them.  Dr. Houston said that monounsaturated fats, like olive and avocado, are healthy and they help to reduce coronary heart disease. They may not be as healthy as eating omega 3 fats, but much healthier when compared to saturated fats or refined carbohydrates.

17:00  Polyunsaturated fatty acids include both omega 6 fats, like most vegetable oils, which are not quite as healthy, and omega 3 fats, like fish oil, which are very healthy.  Polyunsaturated fats do break up in heat and can become unstable, because they have a lot of double bonds. Dr. Houston recommends that when you buy omega 3 fats, they should have tocopherol in the bottle to stabilize the oil in the bottle. And you should add some extra gamma-delta tocopherols to stabilize the omega 3 fats in your cells. Further, when you take EPA and DHA (omega 3s), you should also take a little GLA to balance out the fatty acid pathways.  Dr. Houston also likes consuming tocotrienols, but these should be taken 12 hours apart from taking tocopherols, and when you take tocopherol, it should be mostly gamma and delta tocopherol and not much alpha tocopherol.

20:32  The average primary care MD will usually order a basic lipid profile that includes total cholesterol, HDL, estimated LDL, and triglycerides, but this is an inadequate way to assess lipids.  Dr. Houston said that “Regular lipid testing is obsolete. Let’s make that very clear. Advanced lipid testing is state of the art.”  The estimated LDL on a standard lipid panel doesn’t tell you exactly how many LDL particles there are, which requires LDL particle number. The standard panel doesn’t tell you about LDL particle size, which is important.  It’s the small, dense LDL particles that are the bigger risk, that can more easily penetrate the endothelium and cause atherosclerosis and foam cells. Also, just getting an HDL is not as important as knowing HDL functionality, whether that HDL performs the reverse cholesterol transport that helps it reduce reduce coronary heart disease risk. So it is important to know HDL particle number and also size.

23:26  We used to think that only larger HDL particles were to be preferred, but the latest research indicates that the real small HDL are called prebeta and they dock to the macrophages and other tissues to literally remove LDL cholesterol and take it to the liver. Dr. Houston explained that all sizes of HDL are important, “You’ve got to have all of them to kind of transport from little to medium sized, to big through all these metabolic pathways, since they all can work through different metabolic pathways.”  There are actually 100 different proteins and lipids in HDL and if you knock most of them out, then it not only becomes dysfunctional, but it can become pro-atherogenic.  Patients who have very high HDL, say above 85, most of it will probably be dysfunctional. There is now a test from Cleveland Heart Lab that Dr. Houston is using in research to measure HDL functionality, Cholesterol Efflux Capacity, called HDL FX.  This test is not yet available for clinical usage.

26:44  When it comes to VLDL, you want smaller particles and larger VLDL, which is what people think of as triglycerides.  If you have a patient with high VLDL/triglycerides and low HDL and their LDL may be normal, but these patients have one of the highest risks for heart attack, because these patients usually have small, dense LDL.  For treating triglycerides, we can use omega-3 fatty acids, niacin, and fibrates (if you choose to use a drug).

28:18   There is a particularly artherogenic particle known as Lp(a) that is included in advanced lipid profiles.  The Biggest Loser trainer, Bob Harper had a massive heart attack, and his only significant risk factor was an elevated Lp(a).  Lp(a) is not modified very much by diet or lifestyle and is generally considered to be genetic.  There are some different techniques for measuring it, but 30 or less is considered normal and as you go over 30, the risk for heart attack goes up incrementally, as does atherosclerosis, coronary heart disease, clotting, retinal artery emboli, and aortic stenosis.  You can reduce it using certain nutraceuticals, including niacin and high doses of N-Acetyl Cysteine.  Dr. Houston said he also usually places patients with elevated Lp(a) on low-dose aspirin. Linus Pauling had a protocol using vitamin C, proline, and lysine in specific proportions, though there does not seem to be any published data on this.  It is designed to stop the attachment of Lp(a) to the artery wall.  In fact, most of the reports of nutrients to lower Lp(a) are anectdotal. Other nutrients that might help are vitamin C, L-carnitine, CoQ10, pantethine, and tocotrienols.   

31:37  Homocysteine is another factor in an advanced lipid profile and it is a bad actor.  It is more commonly elevated with MTHFR SNPs. It causes vascular damage, strokes, heart attacks, vascular dementia, kidney disease, and it’s elevated by a lot of things in your diet plus your genetics. The risk for homocysteine becomes dramatic at 12 and higher. He likes to get homocysteine to below 8 but 5 is optimal. To lower homocysteine we use methylated forms of B-6, B-12, B-9 (folate), and other nutrients like TMG.  We use various nutrients in the methylation pathway.  If needed, it can be helpful to order a methylation profile and see which enzymes can be helpful.

33:43  TMAO is a new marker for heart health that was developed by Dr. Stanley Hazen from the Cleveland Clinic.  TMA (trimethylamine) is a product that is found in  L-carnitine, choline, and phosphatidylcholine, commonly found in fish, red meat, chicken, eggs, and dairy are converted into TMA (trimethylamine) by certain gut bacteria, which is converted into TMAO (trimethylamine oxidase) by the liver.  TMAO has been associated with blocking reverse cholesterol transport along with other atherogenic effects.  Therefore, supplements of L-carnitine, choline, and phosphatidylcholine (lecithin) would theoretically also raise TMAO levels, but these nutrients have often been found to be beneficial and Dr. Houston mentioned that he uses L-carnitine in his protocol for patients with heart failure and choline is also a beneficial nutrient for the liver and for brain health, so it is hard to believe that we should really avoid these things.  Studies have consistently shown that eggs do not increase our risk of heart disease.  Further, fish is one of the healthiest foods that has consistently been associated with improved heart health, so this TMAO hypothesis seems to run contrary to much of the science.  Dr. Houston explained that when he has a patient with high TMAO levels, he will place them on a plant-based diet for a week or so and give them probiotics and prebiotics and this will usually drop the TMAO.  It may be that elevated TMAO levels are really just an indication of gut dysbiosis, since if you change their gut bacteria, the person no longer overproduces TMAO.

38:18   Which diet is best for preventing heart disease? Vegetarian (plant based), Mediterranean, Paleo, Ketogenic, or does it depend upon each person?  Dr. Houston said that if you go by science, the Mediterranean diet is best for heart disease, diabetes, and other health issues. This diet should consist of 10-12 servings per day of fresh, organic vegetables and fruits, cold water fish and high quality organic meat, and lots of monounsaturated fats like olive oil and nuts, and also lots of omega 3 fats both in the diet and as supplements.  You want to avoid refined carbs like bread and cereals and also pasta, white potatoes, and white rice.  Dr. Houston is not a big fan of the ketogenic diet because it raises your lipids and causes inflammation.  Dr. Houston said that for patients who are heterozygous or homozygous for the ApoE4 gene, they should be on a very low saturated fat diet, such as a vegetarian diet, but with lots of omega 3 fats and monounsaturated fats like olive oil.

41:22  Micronutrient deficiencies can play a role in heart disease. Dr. Houston said that he will often do micronutrient testing through SpectraCell, which measures intracellular levels in a functional way. Take magnesium, which is primarily inside the cells, so serum levels are not very accurate to tell if their magnesium level is low. And magnesium is involved in 400 different biochemical pathways.  When he has a patient with high blood pressure and he determines that they have 5 nutrients that they are low in and he repletes these micronutrients and their blood pressure goes to normal.

44:28  The most effective nutraceuticals/nutritional supplements for reducing plaque in the arteries are:  1. Omega 3 fish oil–4-5 gms per day of a high quality, balanced product with DHA, EPA, some GLA, and gamma-delta tocopherol, 2. A compound with nitrate, like beet root extract, that will raise nitric oxide levels, 3. Kaolic garlic, 4. Vitamin K2–MK-7 a minimum of 360 mcg per day, 5. Lactobacillus rhamnosus GG, 6. Luteolin, 7. Lycopene.

46:27  A Coronary Calcium Scan is a CT scan that looks for calcium in the arteries of the heart to screen for blockages.  There is a perception that this is the definitive way to determine if you have any blockages or not.  If you have a high coronary calcium score could mean one of two things: 1. You have calcium in a plaque in an artery, or 2. you have calcium in the arterial wall but not necessarily any blockages.  On the other hand, if you have a low score on your coronary calcium scan, it doesn’t mean that you don’t have heart disease because you could have a soft plaque in the arteries that is not calcified.  Dr. Houston talked about several patients who had 95% blockage in their LAD (the Left Anterior Descending artery, aka, the Widow Maker because a blockage in this artery) but a 0% coronary calcium scan.

48:33  Red yeast rice can be very effective and Dr. Houston often uses it, esp. with patients who are statin intolerant or who refuse to take a statin.   Dr. Houston cautioned that a lot of red yeast rice comes from China, so be careful to use a quality brand.  He usually recommends a relatively high dosage–4800 mg per day and he will often add berberine and other nutrients.  There is scientific data that shows that red yeast rice will prevent a heart attack.  Dr. Houston says that if he can get a patient on 4800 mg red yeast rice, berberine, a phytosterol and some niacin, he can reduce LDL particle number by 50%.  When Merck Pharmaceutical made lovastatin from red yeast rice, they took everything out except that one compound. But when you take red yeast rice, you get a composite of other ingredients that are beneficial for cholesterol and also for heart disease. Red yeast rice also reduce aneurysms and it is anti-inflammatory.  And Dr. Houston has found red yeast rice at even 4800 mg to be very well tolerated by his patients and has almost never seen a liver problem.  However, he will usually use CoQ10 with as he always does with statins to make sure that it doesn’t lower CoQ10 levels. He likes to keep the CoQ10 level over 3 mcg/deciliter. Statins tend to deplete not just CoQ10 but also vitamin E, omega-3 fatty acids, tocotrienols, carnitine, vitamin K2 MK-7 and vitamin K in general, vitamin A, Heme A, and selenium.

52:28  Plant Sterols. One testing company that does advanced lipids measures levels of plant sterols as a way to categorized if you are a hyper-absorber or a hyper-producer of cholesterol. Dr. Houston said that he tried using this type of test and he found that if someone is a hyper-absorber you block the absorption, the liver starts making more cholesterol.  He finds it better to just use a nutritional agent to block cholesterol production, like red yeast rice, and something to block cholesterol absorption, like plant sterols or berberine. Dr. Houston pointed out that berberine is a natural PCSK9 inhibitor, so you can either buy Repatha for $11,000 per year or you can buy some berberine for 30 cents a day.  Also, berberine is a natural form of metformin and it also turns off mTOR and turns on AMPK, so it is a natural anti-aging agent as well.

54:22  Tocotrienols if taken with red yeast rice or statins will enhance their effectiveness.  Tocotrienols block the production of the HMG-CoA enzyme for the messenger RNA.  They also break down the increased catabolism of the enzyme.   So it’s not a competitive inhibitor of HMG-CoA reductase.  It is best to take the red yeast rice or statin at night with the gamma-delta tocotrienols, which will result in a 10% decrease in LDL and LDL particle number.

55:20  Niacin has gotten a bad rap and many primary care doctors will tell you that niacin has no benefit, but that is because of two large clinical trials that had poor design and other methodological flaws. One study was The HPS2-THRIVE Collaborative Group. Effects of extended-release niacin with laropiprant in high-risk patients, which was published in the New England Journal of Medicine in 2014. Here is an article written by Dr. Houston and Dr. Pizzorno on the flaws in this study and why niacin is an effective agent:  “Niacin Doesn’t Work and Is Harmful!” Proclaim the Headlines. Yet Another Highly Publicized Questionable Study to Discredit Integrative Medicine. The other highly publicized negative paper on niacin was the AIM-High Trial, Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy.  This trial actually did show that niacin significantly reduced LDL cholesterol and triglycerides and raised HDL, but they concluded that it had no clinical benefit. 

Dr. Houston emphasized that niacin is extremely effective at improving nearly every risk factor on an advanced lipid profile including the functionality of HDL, and there are many other studies showing niacin’s effectiveness, such as this study, Extended-release niacin or ezetimibe and carotid intima-media thickness, in which they found that “extended-release niacin causes a significant regression of carotid intima-media thickness when combined with a statin and that niacin is superior to ezetimibe.”  Dr. Houston explained that the only downside to niacin is if you get really high doses you might increase your blood sugar, you might increase your homocysteine, and you may flush.  But typically you can give a lower dose of an intermediate acting niacin and you will get really good effects that are beneficial for atherosclerosis. So, everything prior to these two inappropriate reports that had bad methodology, niacin worked great, so keep using it. Just make sure to get a good quality product.

57:46  Several years back, soluble fiber, such as in oatmeal, was touted to lower cholesterol. Dr. Houston recommends eating mixed fiber, both soluble and insoluble, and he said that fiber works through the microbiome.  Gut bacteria use the fiber to make chemicals that reduce diabetes, cholesterol, blood pressure and heart disease.


Dr. Mark Houston is an internal Medical Doctor and a hypertension and cardiovascular specialist. He is the director of the Hypertension Institute in Nashville, Tennessee. Dr. Houston is triple board certified in hypertension as an American Society of Hypertension specialist and Fellow of the American Society of Hypertension, Internal Medicine, and Anti-aging Medicine.  Dr. Houston teaches at the Institute of Functional Medicine and the A4M programs. He is a prolific writer and has written What Your Doctor May Not Tell You About Hypertension, What Your Doctor May Not Tell You About Heart Disease, Nutritional and Integrative Strategies in Cardiovascular Medicine, Nutritional and Integrative Strategies in Cardiovascular Medicine, and his two latest books, Vascular Biology for the Clinician, and Precision and Personalized Integrative Cardiovascular Medicine. You can contact Dr. Houston through The Hypertension Institute web site HypertensionInstitute.com.

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


Podcast Transcript

Dr. Weitz:                          This is Dr. Ben Weitz with The Rational Wellness Podcast, bringing you the cutting-edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to The Rational Wellness Podcast on iTunes and YouTube, and sign up for my free E-book on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to The Rational Wellness Podcast please go to your Apple Podcast app or wherever you listen, whatever podcast app you use, and give us a rating and review. That way more people can find out about the Rational Wellness Podcast. Also, you can find a video version if you go to my YouTube page and if you go to my website, drweitz.com, you can find a full transcript and detailed show notes.

                                          So, our topic for today is how to prevent and reverse cardiovascular disease. In the 1950s and 60s, Ancel Keys and other researchers told us that eating too much fat, especially saturated fat such as found in red meat, butter, and cheese is the cause of heart disease. Saturated fat raises LDL levels which leads to cholesterol buildup in the arteries, end of the story. Thus, the lowfat mantra was born as a way to prevent heart disease, though, as we have learned after 30 or 40 years it didn’t really do all that much to prevent heart disease. We’ve learned that most of the cholesterol in the body is produced by the liver and it’s made from glucose. We have learned that consumption of refined carbohydrates and sugar is a greater contributor to raise our lipids and contribute to heart disease.

                                          But did you know that inflammation in the walls of our arteries increases the likelihood of cholesterol to be found lining our arteries, what we call atherosclerosis? That inflammation can be caused by many things including heavy metal toxicity, pesticides, mold toxins, chronic infections, food allergies, and consuming hydrogenated vegetable oils among other things. As we will learn today, cardiovascular disease is not just a metabolic disease but also an immunologically mediated condition. Dr. Mark Houston is our special guest today. He’s an internal medical doctor and a hypertension and cardiovascular specialist. He’s the director of the Hypertension Institute in Nashville, Tennessee. Dr. Houston is triple board certified in hypertension as a fellow of the American Board of Hypertension. He’s also board certified in internal medicine and anti-aging medicine. He has a masters degree in human nutrition and a Master’s of Science Degree. Dr. Houston teaches doctors around the world about cardiovascular medicine as part of the Institute of Functional Medicine and A4M programs.

                                          Dr. Houston is also a very prolific author, having written What Your Doctor May Not Tell You About Hypertension, What Your Doctor May Not Tell You About Heart Disease, Nutritional and Integrative Strategies in Cardiovascular Medicine, Nutritional and Integrative Strategies in Cardiovascular Medicine, and his two latest books, Vascular Biology for the Clinician, which has just recently come out and Precision and Personalized Integrative Cardiovascular Medicine, which will be out in November.  Thank you so much for joining me, Dr. Houston.

Dr. Houston:                      Thanks Ben, it’s good to be with you.

Dr. Weitz:                          Excellent, excellent. So, can you talk about some of the specific vascular responses that cause coronary heart disease?

Dr. Houston:                      Absolutely. The cardiovascular world’s literally been turned upside down as far as causes, insults, and how the arterial wall responds to all those insults. And as you rightly pointed out we’ve been mislead down the bad food path for 40 years and now we’re having to go back and reorganize our entire thinking process about that piece. But there’s about 400 risk factors for coronary heart disease and atherosclerosis.

Dr. Weitz:                          Wow.

Dr. Houston:                      Obviously we’ll talk about some of the top ones today, but the concept that I like to get across to people is that these insults that are coming in, the blood vessel can’t name them. It just sees what’s coming in and it may say, “Well, it’s an amino acid sequence or a fatty acid sequence.” So, E. coli, as far as the vessel’s concerned can look just like LDL cholesterol.  So the response is limited, it’s very limited. In fact, there’s only three things the blood vessel can do to respond to these insults. There’s three of them called inflammation, oxidative stress, and vascular immune disfunction. When those three go off in the blood vessel it can create all kinds of biomediators that eventually lead to coronary heart disease or congestive heart failure, stroke, or any kind of cardiovascular illness.

Dr. Weitz:                          Recently in the news there’s been quite a bit of back and forth about the role of red meat in heart disease and cancer with a recent paper in The Annals of Internal Medicine, where a bunch of researchers did a reanalysis of the existing research on red and processed meat and concluded that the evidence for harm from red meat was very limited and does not warrant recommending that citizens reduce their red meat and processed meat intake in order to reduce their risk of heart disease. They shot back with a rear affirmation, I think it’s World Cancer Council, that you do want to reduce your intake of red and processed meat  in order to reduce your risk of cancer.  We’ve got this back and forth on whether or not red meat is a factor in heart disease. Where do you come down on this controversy?

Dr. Houston:                      Well, it goes to show you can try whatever you want to in any journal wherever you go to read it. Pardon the noise. Here, let me get this. He’ll be gone in just a second, my apologies. So, let me try to give you the real truth about red meat.  The meat is not the problem. The red meat is not the problem. It’s what the red meat has in it coming from other sources related to the cow, okay?

Dr. Weitz:                          Okay.

Dr. Houston:                      If you have cattle that are eating corn, being fed bad food, given hormones, getting pesticides, and organicides, and gosh knows what else into their body, that’s going to go into the meat. Whereas if you get organic food and you don’t put any hormones or pesticides out in what they eat, the red meat is absolutely benign and doesn’t cause heart disease.  So, as you pointed out earlier, toxins, infections, pesticides, and hormones are probably the issue in all the bad stuff that’s happened with coronary heart disease and red meat. So, in my opinion, based on having looked at this very carefully also in the last two years, organic red meat is fine to eat. You can find numerous studies that say it does not increase coronary heart disease or heart attack.

Dr. Weitz:                          So, essentially what everybody’s forgetting about is the quality of the food when we are just looking at these macronutrient discussions. We’re not looking at the quality of the meat, we’re not looking at the quality of the carbohydrate, or the quality of the fat so what you’re saying is if we’re consuming a high quality red meat that’s organic, from grass fed cattle, that’s going to have a totally different biochemistry and a different effect in our body than eating feedlot cattle that’s shot up with antibiotics and hormones.

Dr. Houston:                      Exactly. In general what we like to do is stick with something that’s fresh and organic whether it’s a vegetable, or fruit, or meat, or some other kind of fat. Exactly.

Dr. Weitz:                          Right. So, since we’re on the topic of red meat part of the conversation about red meat has to do with the role of saturated fat. What’s your opinion about the role of saturated fat? Does saturated fat raise LDL cholesterol and does it play a role in the pathogenesis of atherosclerosis?

Dr. Houston:                      Well, I have written several articles in the period literature as well as in the book, On Integrative Strategies in CVDs, to talk about what is really the truth about saturated fats. So, this is what the literature is clearly showing now. A saturated fat is not just a saturated fats, there are different varieties within that. What determines what type of saturated fat is going to cause heart disease or not cause heart disease? And the primary issue relates what’s called carbon length. Carbon length 8, 10, 12, and on up to whatever, 20-something.  The long chain fatty acids, that is probably C-12 and up, are considered long chain. Those are the ones that may have an increased risk of coronary heart disease and heart attack, but even that’s somewhat questionable depending on where the fat’s coming from, what it’s associated with, what other kinds of fats are in your diet, and the percent in your diet.  But if you eat C-12 and below, the short chain fatty acids, there’s no evidence that any of those cause coronary heart disease or heart attack. So what I typically tell people to do is keep your total saturated fat intake around 10% or so of your total calories and try to limit it to the short chain fatty acids. It doesn’t mean you can’t have some long chain, it’s just don’t make those an abundant piece of your diet.

Dr. Weitz:                          So, which sources of saturated fat have the shorter chain?

Dr. Houston:                      What you want to do is you’ve got to read labels, that’s the problem. And labels, as you know, can be very, very deceiving. I think if you look at high quality meats of any sort, particularly if you’re talking about organic red meat or organic veal, organic chicken, organic turkey. Fish, obviously, don’t have hardly any saturated fats. They’re mostly monounsaturated and omega-3. Mostly omega-3s. Then you’ve got the end up just getting the good fats, doing that alone.

Dr. Weitz:                          So where does coconut oil fit into this? Because we know that coconut oil is a vegetable source of saturated fat and the arguments have been going back and forth on coconut oil. It’s been lauded by many in the functional medicine community as a wonder fat, and then we’ve got The American Heart Association still telling people not to consume coconut oil.

Dr. Houston:                      Yeah, that’s a loaded question. The coconut oil story is also very controversial. Coconut oil is 92% saturated fat, it doesn’t really have any other kind of good fats in it.

Dr. Weitz:                          Is it the shorter chain or the longer chain?

Dr. Houston:                      No, it’s the long chain. That’s the problem. It’s 92% long chain fatty acids. So, I wouldn’t recommend you consume a lot of coconut oil for that reason. A little bit just like what’s mentioned earlier is fine, but don’t get hung up on drinking a lot of coconut oil or consuming coconuts because they probably may not be healthy. There’s really not much data, honestly, that coconut oil has any really good health benefits. But on the other hand, a lot of it could be detrimental.

Dr. Weitz:                          Interesting, interesting, because I think a lot of people in the functional medicine world have put coconut oil in the healthy oil category.

Dr. Houston:                      I’d much rather you consume omega-3 fatty acids and olive oil, monounsaturated fats. They’re much healthier, with better data. When you get the coconut oil, you kind of don’t find much out there that’s going to help you for heart disease.

Dr. Weitz:                            Now, one of the reasons why people say they like coconut oil is because the saturated fat, because it’s saturated, it’s not going to react to oxygen or other things. Therefore, if you try to cook with a polyunsaturated oil, or you try to cook with an olive oil it goes rancid and gets damaged. Whereas, a coconut oil, because it’s a saturated fat, is not going to have that happen.

Dr. Houston:                      Another great question, what kind of oil should you cook with, and why or why not? The Europeans really laugh at us when we say we don’t cook with olive oil. They said, “No, no, no. We cook with olive oil all the time, just don’t boil it.” Because you will destroy it. We overcook everything. I cook with olive oil, but I don’t bring it to a steaming point.

Dr. Weitz:                          So, what is the temperature cutoff?

Dr. Houston:                      You get it warm, but if it starts…

Dr. Weitz:                          What is warm? Are we talking about 350?

Dr. Houston:                      I don’t know what the boiling point of olive oil is. The point is, you keep it on low simmer and when you see the olive oil starting to steam, you’ve gone too far. Now, you can cook with other oils obviously. Grape seed oil is good, you could cook with olive oil, and you can cook with coconut, or you can cook all these things; point is, just don’t overcook things. The other point is, if you want to cook with olive oil, go ahead and cook with it, pour off the olive oil if you think it’s bad, and then put some olive oil on your food when you put it on your plate. That’s fine.

Dr. Weitz:                            But you look at some of these charts and they’re very confusing. Extra-virgin olive oil has this temperature, another chart has the boiling point at a different temperature. Is it 325, is it 375? If you’re going to say baked vegetables, do we know what a safe temperature is if you’re going to use olive oil?

Dr. Houston:                      I don’t know that I have the temperature because you’d have to put a thermometer in your pan, and even then you’re not sure with all the other stuff in the pan whether it’s going to steam or not. Just don’t let it start steaming and you’re okay. Low temperature, sauteed.

Dr. Weitz:                          What about avocado oil for high heat cooking?

Dr. Houston:                      Avocado oil is fine, it’s a monounsaturated fat and it’ll tolerate the heat a lot better. It’s a good oil to use.

Dr. Weitz:                          By the way, since we’re on monounsaturated oils, we’re going to get to advanced lipid testing, but one of the companies that does advanced lipid testing now puts monounsaturated oils as less healthy. Do you know about this controversy?

Dr. Houston:                      Yeah, I do. I hear it all the time. And I hear a lot of physicians telling people not to use a lot of monounsaturated fats. That’s also not true. Monounsaturated fats, olive oil, nuts, olives are all healthy. There’s plenty of data to support the use for them in reducing coronary heart disease. Here’s the trick though, what’s your comparator?  So, if I want to compare monounsaturated fats to omega-3 fatty acids, they don’t look as good. But if I want to compare them to saturated fats, they look really good. If I want to compare them to refined carbohydrates, they really look good. So, it’s just your comparator. But, overall, monounsaturated fats are very healthy.

Dr. Weitz:                          Okay, since we’re on this topic what about since we just talked about MUFAs, what about PUFAs?

Dr. Houston:                      Okay, so, polyunsaturated fatty acids, those do break up in heat because they’re a lot of double bonds, and they can be more unstable. So how do you get around that problem?  Well, two things.  One, when you buy omega-3 fatty acids you want to be sure it has a tocopherol in with it.  Because, see, vitamin E, tocopherol, particularly gamma-delta tocopherol stabilizes the PUFAs, or the omega-3s in the bottle.  But you also need it to stabilize it in your cell membranes.  Whatever you consume when you’re using omega-3s, be sure that your product contains tocopherols, omega-3 DHA, EPA, but also another one, GLA. Because you’ve got to have those pathways lined up so you don’t distribute them inappropriately.

Dr. Weitz:                          Interesting. You know, I was using the gamma-tocopherol every time I took my omega-3s and was recommending it.  I recently switched over to tocotrienols after talking to Dr. Barry Tan and seeing the amazing research on tocotrienols.

Dr. Houston:                      Yeah, I know Barry very well and his data is incredible with all the forms of vitamin E. The tocotrienols don’t necessarily stabilize polyunsaturated fats, though. They have other tremendous health benefits. I take his gamma-delta tocotrienols, but also I take the gamma-delta tocopherols.

Dr. Weitz:                          Okay, so you take them both, but just not at the same time?

Dr. Houston:                      This is really important for your audience. If you take your tocotrienols and your tocopherols at the same time, and it’s more than 20% alpha-tocopherol, it’ll block the absorption of the tocotrienols. So, you’ve got to take them about 12 hours apart.

Dr. Weitz:                          Right, and when you take the tocopherols you want a higher gamma, right? You don’t want to take the alpha-tocopherol.

Dr. Houston:                      Yeah, you don’t want a lot of alpha. You want mostly gamma and, or, delta.


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

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



Dr. Weitz:                          Okay, so it’s common for primary care doctors to order a basic lipid panel, which is total cholesterol, estimated LDL, HDL, and triglycerides. Sometimes in conversations with patients they’ll say, “Oh, yeah, yeah. I looked and all my lipids were fine.” Can you explain why this lipid profile is not an adequate way to assess for heart disease risk?

Dr. Houston:                      Absolutely. Regular lipid testing is obsolete. Let’s make that very clear. Advanced lipid testing is state of the art.

Dr. Weitz:                          That message has not… It either hasn’t gotten out, or the fact that the insurance doesn’t want to cover it…

Dr. Houston:                      Well, that’s even not an issue anymore. All the advanced lipid testing companies that we use, they’re covered by insurance and if they’re not they’re only like $60. So, it’s not that you can’t afford them. But here’s the really important part about advanced lipid testing.  Let’s take each lipid just individually because you have to do that. LDL cholesterol, different sizes, different atherogenesis, some are modified. So, let’s say you have a big, fat LDL and a real tiny LDL. Let’s use the garbage can analogy because people get this. Two garbage cans sitting in your back yard, if you look at them and say, “That’s my LDL.” And I say, “Well, which one’s bad?” And they go, “Well, I don’t know. They’re both bad, aren’t they?”  I say, “No, no. Take the lid off the garbage can. One side’s got tennis balls in it and the other side’s got golf balls.” And I say, “Well, which of those would you like to have.” And they go, “I don’t know.” I said, “You don’t want the golf balls because that’s the small, dense LDL. That’s when it penetrates the endothelium, goes into the sub endothelial layer and wreaks havoc, causing atherosclerosis and foam cells. The big ones on the other hand don’t necessarily get through as easily.”  So, if you have a lot of little ones the second issue is LDL particle number. The driving risk for coronary heart disease and heart attack is LDL particle number, number 1, and LDL size, number 2. That’s the LDL sort. You can’t get that on a regular profile. Second one is HDL. Well, HDL on a regular lipid profile is a static number. It tells you absolutely nothing. It doesn’t tell you about the size, it doesn’t tell you about how many particles there are, and it doesn’t tell you about its functionality.  So, the latest discovery in HDL cholesterol is the functionality is what determines whether or not it’s atherogenic or not. Second is HDL particle number, which is very important. But you don’t get either one of those on a regular lipid profile. You get a static HDL, which means nothing. It can be low, it can be high, and you see that number you can make no predictions whatsoever whether that HDL is good, bad, or ugly and what’s going to be protective to the patient.

Dr. Weitz:                          So you want larger HDL, right? That’s more protective?

Dr. Houston:                      Well, generally, that’s what we thought. We thought that larger was better than smaller. But it turns out that all of them are important because they all have a different process. The real small HDL they call prebeta, that’s the one that docks to the macrophages and other tissues to literally remove cholesterol, LDL cholesterol, from the tissue and then take it to the liver and dump it. You’ve got to have all of them to kind of transport from little to medium sized, to big through all these metabolic pathways.  So, actually, all the HDL’s are important, and it’s hard now based on data, because it’s getting complicated again, which size is better than the other.

Dr. Weitz:                          Oh, that’s really interesting. That’s kind of new news.

Dr. Houston:                      It is new, it’s the functionality.

Dr. Weitz:                          And by functionality, it’s producing reverse cholesterol transport?

Dr. Houston:                      Exactly right. RCT, reverse cholesterol transport, also called CEC, cholesterol efflux capacity, determines functionality. But the functionality of HDL is probably a hundred different things, so there’s like a hundred proteins and lipids in HDL. So, if all of them are working good it’s totally functional, but if you knock half of them out it’s kind of limping along. If you knock all of them out it’s not doing anything. In fact, HDL, look at this, if you knock everything out becomes not only dysfunctional, it becomes pro-atherogenic.

Dr. Weitz:                          Wow.

Dr. Houston:                      So now you can have an HDL that’s actually inflammatory or causing heart disease. That’s really bad. Now you’ve got nothing protecting you.

Dr. Weitz:                          And I think I’ve heard you say that if you have somebody that has a super high HDL, there’s an increased risk of that, right?

Dr. Houston:                      Yeah. If your HDL is over 85, most of it’s probably dysfunctional HDL; in a male, probably if it’s over 60. But this is another new, kind of, just came out like two months ago. There’s a U-shaped curve with HDL. People who have low HDL may be okay, people that are right in the middle, and then it goes up again it gets worse. So at either end you’re probably looking at an HDL that may not be working. So, it’s kind of got to be at a certain number. I think in the study it was like 32 to 35 was kind of the number that was at the bottom of the curve.

Dr. Weitz:                          Do you measure HDL efflux, cholesterol efflux capacity?

Dr. Houston:                      There’s a new test from Cleveland Heart Lab that does that. It’s not available clinically yet, but we’ve been using it now for about six months in a couple of research trials. The name of it is HDL FX, which stands for functionality. Cleveland Heart Lab has it, they’re in phase B trials right now. It probably will be out sometime in 2020 for the commercial use. That’s all we’ve got for RCT right now.

Dr. Weitz:                          You know, I’ve talked to a Dr. Sri Ganeshan, who has the MitoSwab test and I think that he’s just come out with a cholesterol efflux test.

Dr. Houston:                      I hadn’t heard of that one. I know the one with Cleveland is validated with clinical trials, and so as far as I know that’s the best one on the market right now.

Dr. Weitz:                          Okay. So you mentioned LDL and HDL particles. Normally we think larger is better, now we find out with HDL that’s not necessarily the case. But with VLDL, which most people don’t talk about, actually, larger is worse. Right?

Dr. Houston:                      That’s right. VLDL is basically what people think of as triglycerides, but VLDL comes in all sizes, too. And the big, fat VLDL’s are very atherogenic but also they cause thrombosis.

Dr. Weitz:                          Wow. So, I’m not sure everybody puts a lot of importance on VLDL, but you’re saying that we should?

Dr. Houston:                      Yeah. When you see somebody that has high triglycerides or high VLDL, and it’s the big fat one, can accommodate with usually a low HDL. That group of people are usually metabolic syndrome, diabetes, obesity. Those people are the ones that had the discordance between LDL and the LDL particle number.  So, here’s what happens. You go to the doctor’s office, he orders a routine lipid profile. All your triglycerides are high, your HDL is low, but your LDL’s okay. Well, it’s not okay because the LDL that that patient has is the small and dense, but increase LDL particle patient, that patient has one of the highest risks for heart attack of anything. And they’re ignoring that.   But, yeah, all of these need to be treated.  All the triglycerides. We use all kinds of things for that, omega-3 fatty acids, niacin, if you’re going to go to a drug–fibrates.

Dr. Weitz:                          Can you talk about the importance of Lp(a) for heart attack risk? There was a recent information about The Biggest Loser Trainer, Bob Harper, who had a massive heart attack and apparently elevated Lp(a) was his only significant risk factor.

Dr. Houston:                      Yeah, Lp(a) is genetic. There’s very little you can do to change it. Exercise, weight reduction, eating better doesn’t usually modify LDL… Excuse me, Lp(a) very much. So, when you’ve got this genetic type you have to get a lab that knows how to measure it, number one, because many a labs don’t give a good quality measurement of Lp(a) so you get deceived into whether you’ve got a problem or not.

Dr. Weitz:                          Really? So there’s different ways to measure it?

Dr. Houston:                      Yeah. Some measure mass, some measure different technology. So, you’ve got to find out whether your lab is consistent and has the best technique. That’s number one. Now, assuming it’s elevated, it’s a matter of degree. 30 or less is normal. Incrementally over 30 the risk for heart attack goes up. If you’re like 40, not too bad. But if it’s 150, yeah, you’re in trouble. And what Lp(a) does is it causes atherosclerosis, coronary heart disease, MI, clotting, retinal artery emboli, and aortic stenosis. So, it’s a bad actor. And there’s not many things we have to lower it. Niacin and NAC are the two that seem to be the best

Dr. Weitz:                          And how much do you think it’s reasonable to lower it?

Dr. Houston:                      Well, you try to get it down as close to 30 as possible. It’s hard to do that, but you’re going to have to use high doses of niacin, high doses of NAC, usually put them on low-dose asprin to kind of help block some of the clotting effects. There’s a whole list of stuff, Ben, that has been reported to lower Lp(a). Most of it’s anecdotal. I mean, we’ve got vitamin C, carnitine, CoQ10.

Dr. Weitz:                          Yeah, a lot of people talk about this vitamin C thing. I guess there was one study on that.

Dr. Houston:                      A lot is Pauling’s Protocol.

Dr. Weitz:                          Right.

Dr. Houston:                      It makes sense, the protocol basically stops the attachment, we think. Lp(a) to the vessel wall. But I can’t find any data that Linus Pauling ever published that documents that in humans. They probably got some rat studies, whatever. I’ve used it on people just because sometimes you don’t have anything else you can do and it’s pretty benign. Vitamin C, proline, and lysine in the right proportions.

Dr. Weitz:                          Right. I had a patient who came in today and in about a year we got it down from about 96 to 60 with niacin, a fairly modest dosage. One time I had a patient, couldn’t get her Lp(a) to budge and I sent you an email, this is several years ago, and you said, “Pantethine and tocotrienols.” And, bam, perfect. It was unbelievable.

Dr. Houston:                      Yeah, well, like I said there’s about 15 things on my list for Lp(a). When I get backed into the wall I start whatever I can and see if it works.

Dr. Weitz:                          Well, that worked unbelievable.

Dr. Houston:                      That’s great, good news.

Dr. Weitz:                          How important is homocysteine? That’s often part of an advanced lipid profile.

Dr. Houston:                      Yeah, the protocol that we use has homocysteine on the advanced lipid tests along with C-reactive protein. But homocysteine is a bad actor, too. Most of the studies you read, it’s kind of poo-poo homocysteine. It’s obviously not a big problem, don’t worry about it.

Dr. Weitz:                          Homocysteine is a protein found in the blood that’s independent of cholesterol as a cardiovascular risk factor.

Dr. Houston:                      Yes, and this is very common with MTHFR, heterozygote, homozygote, causes vascular damage, strokes, heart attacks, vascular dementia, kidney disease, and it’s elevated by a lot of things in your diet plus your genetics. But the risk for homocysteine becomes dramatic at 12 and higher. That’s when the curve shoots straight up. I like to get it below 8 in everybody I can, but if I can get it to 5 that’s where the curve becomes fairly flat.

Dr. Weitz:                          5? Wow.

Dr. Houston:                      If you can get there. The risk at 8 is pretty low, but it’s starting to go up. 12, through the roof. So, if you see it up over 12 you’ve got to work hard to get it down.

Dr. Weitz:                          So to lower homocysteine we’re using methylated forms of B-6, B-12, B-9. Are there any other nutrients that can be beneficial if that sort of B vitamin strategy doesn’t get you where you want to go?

Dr. Houston:                      The cocktail, as you know, is methylated folate, B-6, and all the others. There’s about 10 things in that methylation pathway and there’s, as you know, there’s all kinds of snips you have to measure. Not just MTHFR that can be the problem, and if you find out which snip’s missing you kind of know which one to give the most of. What I typically do, I start with a balanced methylator and I see what their homocysteine does. If I’m not getting there then I’ll order a methylation profile and start looking at all the enzymes and then you can attack it directly.

Dr. Weitz:                          Okay. Good, good, good. So, I’d like to bring up TMAO. This is a marker for heart health that was developed by Dr. Stanley Hazen from the Cleveland Clinic.

Dr. Houston:                      Yeah, so TMA and TMAO, we’ll distinguish what those are, trimethylamine is a product that you get primarily in carnitine, maybe phosphatidylcholine, and then the bacteria feed on that stuff and they convert it to TMAO which is trimethylamine oxidase. That’s a conversion in the liver. So, the TMAO has been associated with blocking reverse cholesterol transport along with other atherogenic effects. As Dr. Hazen felt that it was a risk factor for atherosclerosis and therefore you should limit the consumption of things that cause TMA to go up.  Well, there’s a lot of controversy about that issue as well, whether it’s cause and effect or whether it’s just an association. But if you do consume a lot of carnitine and a lot a PC in your diet, you can raise TMAO. It’s no question about it. But then there was a study for Mayo Clinic, because you know they’re always butting heads with Cleveland Clinic, and they found that if you took carnitine you reduce your risk of heart attack even though your TMAO may have gone up.  So you’ve got to balance all this stuff out. What I typically do, I measure…

Dr. Weitz:                          And we know that L-carnitine is super beneficial for the heart, right?

Dr. Houston:                      Absolutely. Yeah, particularly in heart failure. So, it’s not that you don’t want to use it and then you’ve got a balanced TMAO, but what I typically do if the TMA goes up, I’ll put them on a primarily plant-based diet for about a week or so. Kind of get them cleaned up, give them some probiotics, some prebiotics, and then try to get everything back to what I want to. Because I use a lot of carnitine, taurine, and D-ribose in my heart failure patients. And if you stop the carnitine, for example, because that’s transporting the long chain fatty acids into the mitochondria for beta oxidation you could end up causing them to do not so well.

Dr. Weitz:                          And cold water fish contains high levels of TMAO.

Dr. Houston:                      It does.

Dr. Weitz:                          And we know how beneficial fish is and how it lowers your risk for heart disease. So, this whole TMAO thing really doesn’t seem to accord with all the other things we know. Also, you’re talking about choline. And we know how beneficial choline is for liver health, brain health.

Dr. Houston:                      Yeah. I’m not sure I buy totally into the TMAO issue yet, because there’s too many benefits of the things you just mentioned, balanced with the studies of fish. You know that doesn’t pan out. So I don’t know really what the story is. [inaudible 00:36:38] find out about.

Dr. Weitz:                          Well one way that some people have analyzed it is the TMAO is produced by the gut bacteria.

Dr. Houston:                      Right.

Dr. Weitz:                          It may just be a marker for having an unhealthy, dysbiotic gut.

Dr. Houston:                      Exactly. If you’ve got dysbiosis and the wrong bacteria in there, if you clean up the gut, and that’s generally what a plant-based diet will do. It’ll convert very quickly, usually a couple of days. Get your microbiome cleaned up. The next time you challenge them with PC or carnitine their TMO won’t go up. So, I think the dysbiosis is a good explanation for it.

Dr. Weitz:                          Okay, so now you’ve just mentioned the vegetarian diet. Now the question is, what is the best diet to lower your risk for heart disease? Is vegetarian diet better, Mediterranean diet, ketogenic diet, or does it depend on each person?

Dr. Houston:                      If you go by science of published data there’s no question a Mediterranean diet is the best for heart disease, and diabetes, and other issues. And it’s not a vegetarian diet, it’s a plant-based diet meaning you eat a lot of vegetables and fruit. That’s at your base of your so called pyramid. But you also eat meat, particularly fish. You just cut out all the refined carbs. A lot of omega-3s, and MoFAs, and olive oil, and nuts in the Mediterranean diet. So that’s what I tell people to do most of the time. Then we’ll throw in some fasting mimicking diets, some fasting stuff, and we get great results with everything doing that.

Dr. Weitz:                            Okay. So when I’ve looked at some of the studies on the Mediterranean diet one of the confusing things is it’s a little fuzzy exactly what it includes. I mean, we all know about olive oil, and fish, and fruits, and vegetables. But other than that, is bread included? Is pasta included? Is there a lot of legumes? What about cheese and dairy products? And if you look at the different studies they all have different criteria and this may partially be because it depends on which part of the Mediterranean, is there really a Mediterranean diet?

Dr. Houston:                      Yeah, you’re exactly right. When you say Mediterranean you have to define what Mediterranean diet. Is it the one they use in Spain, or Italy, or somewhere else? Greek?

Dr. Weitz:                            Right.

Dr. Houston:                      Sometimes it’s better not to name our diets, it’s better just to say, “Here’s what I want you to eat.” So, let’s just do that. 10 to 12 servings of organic fresh fruits and vegetables a day. Mostly vegetables, 8 to 4. That’s the ratio, okay? High quality organic meat, cold water fish, salmon, mackerel, cod. Complex carbohydrates, get away from refined carbs. That’s usually anything white like bread, pasta, white potatoes, and white rice. And just make sure that your percentages of those things, a lot of monounsaturated fats, olive oil, and nuts, and a lot of omega-3s both in your diet but also as a supplement. Because you just don’t get enough just taking the food probably.

                                                So if you do that you don’t really do a ketogenic diet, which is another thing I don’t recommend because it raises your lipids, and causes inflammation, and it’s just not a healthy diet for heart disease. If you’ve got a brain problem, yeah, maybe different. The problem is when you do the ketogenic diet a lot of people get their saturated fats and other fats up really high and then they don’t get everything else balanced.

Dr. Weitz:                            Interesting. So, patients who are heterozygous or homozygous for ApoE4, I often hear people talk about they need a special kind of diet from everybody else. What’s your opinion about that?

Dr. Houston:                      Yeah, the ApoE4 or E4 are the ones that have a high risk for coronary heart disease and Alzheimer. The do have a differential response to what they eat, particularly different types of fats. And those are the ones who can really have a dramatic effect, particularly with saturated fats. So in that case I would really augment them with omega-3s and monounsaturated, maybe reduce their saturated fats a little more. Definitely keep them off long chain fats and no trans-fats at all, zero.

Dr. Weitz:                          Now, is that a group that you might put on a vegetarian diet?

Dr. Houston:                      Yeah. Yeah, you could do that.

Dr. Weitz:                          Okay. So you’ve also written about micronutrient deficiencies that can play a role in heart disease and for those not in the functional medicine world that seems a really strange idea.

Dr. Houston:                      Yeah, right. So, most people are micronutrient deficient in something if you check it. Let’s just pick one of the micronutrients that’s really common, magnesium. Magnesium’s like 400 biochemical pathways. You say, “Well, would you rather treat every 400th pathway with something or just give them some magnesium and be done with it?” Well, how do you know if their magnesium’s low? Well, you’ve got to measure it. And as you know, magnesium is primarily inside the cells so if you measure just regular blood magnesium you don’t know what their magnesium content is.  So, we measure intracellular magnesium. And we use a company, called SpectraCell which has the micronutrient testing. It measures your intracellular levels in a functional way, which is much better than the so-called bell shaped curve, because how do you compare to somebody else? If you measure your own lymphocytes and what they need to be adequately functioning based on repleting micronutrients that’s missing.  About 30 things they measure. We do this in everybody because it really fits right in with the disease. I’ve seen this happen over and over again. They come in and they’ve got high blood pressure and they’ve got like five deficiencies missing, and we just replete their micronutrients and they’re blood pressure goes to normal. I mean, it’s pretty simple.

Dr. Weitz:                          Amazing.

Dr. Houston:                      Yeah.

Dr. Weitz:                          Yeah, so with this understanding of heart disease you mentioned immunological reactions, and inflammation, which is an immunological factor. Essentially, part of heart disease is really an immunological mediated, really an autoimmune disease. And then when we start thinking about the other diseases, you know, the major diseases, the chronic diseases, we know that cancer is immunologically mediated. We’ve got all these autoimmune diseases that are on the rise and even when you look at gastrointestinal conditions Dr. Pimentel has recently shown that IBS, which is one of the most common conditions has an autoimmune component. It’s apparent that you really need to take a broader approach, to use a Functional Medicine approach if you really want to address heart disease.

Dr. Houston:                      Exactly. I tell everybody if you understand cardiovascular medicine and vascular biology, it crosses all the boundaries. Because those three finite responses, inflammation, oxidative stress, and immune dysfunction, as you mention every organ has those finite responses. So, in essence inflammation in the brain, inflammation in the heart, those two circuits connect very quickly. And then the gut connects to the cardiovascular system. If you don’t get everything kind of lined up and get all those three finite responses in control, you’re not going to do well.

Dr. Weitz:                          Okay. So we’ve talked about diet, we’ve talked about advanced lipid profiles, I’d like to use some of our time to talk about nutraceuticals. The use of targeted nutritional supplements. What are the best supplements to use to reverse plaque in the arteries?

Dr. Houston:                      We’ve done now for the last 10 years a protocol for plaque reversal and plaque prevention, but also we can now reduce coronary calcium score, which people used to think you couldn’t do. But we’ve documented you can.

Dr. Weitz:                          Really?

Dr. Houston:                      Here’s what we do, omega-3 fatty acids, and you’ve got to get high doses. Four grams, five grams a day and it’s got to be a high quality that’s balanced. DEHA, EPA, GLA, and gamma-delta tocopherol. Second is a compound that’s got nitrates in it. You can get a nitrate compound like Neo40, beetroot extract, whatever, but it’s a beet compound. And that supplies nitric oxide through a different pathway, very different from arginine.

Dr. Weitz:                          Okay.

Dr. Houston:                      Kaolic garlic has been studied at UCLA and vitamin K2 MK-7.

Dr. Weitz:                          Okay.

Dr. Houston:                      Now, the recent study has shown that you need a minimum of 360 micrograms a day.

Dr. Weitz:                          360?

Dr. Houston:                      360, that’s the new number.

Dr. Weitz:                          So, we’ve been underdosing.

Dr. Houston:                      Yeah. Get a good quality, get it to that dose. There’s a couple of other things we use. There’s some very specific probiotics, Lactobacillus rhanmosus is good. And then luteolin, lycopene. There’s about six things that clearly reverse plaque. There’s a few things we’ll throw in for other people that have soft plaque versus hard plaque. But if you do that basic program you’re going to see some reversal.

Dr. Weitz:                          And so you mentioned coronary artery calcification scan. What percentage of patients… So, if you have a high score on that, for sure that indicates you have plaque. But let’s say you have a low score. You could still have plaque that’s just not calcified, right?

Dr. Houston:                      Yeah, so let’s talk about that because it is very confusing. A high coronary calcium score, CAC, means two things. One, you’ve got calcium in the arterial wall, or you’ve got calcium in a plaque that’s obstructing. You can’t tell which of those two it is based on the score.

Dr. Weitz:                          So you can have calcium in an artery wall that’s not part of a plaque?

Dr. Houston:                      That’s right. And that’s where you don’t know how to predict whether they’re high risk for obstructive coronary heart disease and you have to do additional tests to find out.

Dr. Weitz:                          So why would a coronary artery have calcium in it if it’s not…

Dr. Houston:                      Well, it’s aging of the artery number one. It’s got micronutrient deficiencies like the ones we mentioned, K2 MK-7, D, and A. That’s calcifying arteries but your bone’s not calcified, so those two are at the opposite extremes.  So when you see a calcium score that’s high you’ve got to to the next value and say, “Okay, is it in the artery or is it just in the wall?” And you do echo, exercise EKG, nuclear scans, or you can do an arteriogram to find out.  Now, you’re right on the other one too, which is if your calcium score is zero or low, it doesn’t mean you don’t have heart disease because it may not be calcified in the artery… I mean, in the plaque. So, I’ve had a couple people who’ve had like 95 block in their LAD and they had a 0 calcium score. But it was soft plaque, it hadn’t calcified yet.

Dr. Weitz:                          Can you explain what the LAD is?

Dr. Houston:                      It’s the left anterior descending artery, it’s the widow maker. That’s the one that supplies the inferior lateral part of the heart. If it goes out, you’re gone.

Dr. Weitz:                          Okay. So, how effective is red yeast rice for improving our cardiovascular risk?

Dr. Houston:                      Red yeast rice is a great product and we use a lot of red yeast rice. Again, you’ve got to have a high quality because a lot of its come in from China and it’s spiked with something. A lot of companies don’t make the high quality.  If you get a good quality, though, it works like a charm. We use really high doses in people that are like statin intolerant or just refuse to take a statin. 

Dr. Weitz:                          What do you consider high dosages?  

Dr. Houston:                      High dosages is 4800 mg per day. And we use it with berberine and some other things to enhance the effect.

Dr. Weitz:                           Tocotrienols?

Dr. Houston:                      … LDL particle number and they say, “Hey, look, I can’t take a statin because my muscles ache.” If I get them on high dose red yeast rice, berberine, a phytosterol, and some niacin I can get their LDL particle number down 50%, which is what most of the drugs will do.

Dr. Weitz:                            Wow.

Dr. Houston:                      And there’s actually data that red yeast rice will primarily prevent a heart attack and also secondarily prevent another heart attack if you’ve already had one. So the data’s there. And actually The Annals of Internal Medicine has written a couple articles that it’s a good alternative to statin if they can’t take it.

Dr. Weitz:                            Now, some people say that red yeast rice is really just a natural version of a statin, and if you’re going to be intolerant to a statin you’re going to be intolerant to red yeast rice. If you don’t want to take a statin, why should you take a red yeast rice? Can you answer that question?

Dr. Houston:                      Yeah, and none of those are actually true statements. Red yeast rice was the compound that Merck Pharmaceutical used to make lovastatin. But what they did, they took everything out except one thing. So, red yeast rice is a lot more than just a statin. Statin is in red yeast rice but it’s not the whole answer. So, when you give a statin, you’re giving just that piece. If you get red yeast rice, you’re giving a whole composite of things that are going to help cholesterol, but also heart disease. Red yeast rice actually reduces aneurysms. It’s anti-inflammatory. I mean, it does a huge number of things.  So, red yeast rice is not a statin, perse. When you give high doses, because it’s not just a statin you don’t get the same side effects you get with a statin. Rarely, even at that 480 milligram dose do I get any muscle problems. I almost never get a liver problem. It’s very well tolerated.

Dr. Weitz:                          So, do you always use CoQ10 with red yeast rice?

Dr. Houston:                      I use CoQ10 because anything that remotely smells, looks, or tastes like a statin, it’s going to lower your CoQ10 through that pathway. Particularly when you get to high doses of anything. So you give a CoQ10 with it. What you do is you measure their CoQ10 level before treatment, and you start measuring it. I like to keep the CoQ10 over 3 micrograms per deciliter. That’s what’s really normal, lab’s it’s all over the place. But, obviously, if it’s not above that level, or it starts to drop, you need to give them CoQ10. And it’s not just CoQ10 that gets depleted by statin, there’s 10 things that statins deplete. So you’ve got to measure all this stuff and then treat it. That’s why in traditional medicine, most cardiologists, lipidologists, they give statins and they don’t even know if they deplete 10 nutrients.

Dr. Weitz:                          What are the 10 nutrients that get depleted?

Dr. Houston:                      You’ve got CoQ10, vitamin E, omega-3 fatty acids, tocotrienols, carnitine, vitamin K2 MK-7 and vitamin K in general, vitamin A, Heme A, selenium. I think that’s 10.

Dr. Weitz:                            Wow.

Dr. Houston:                      Yeah, and they all go down depending on the dose.

Dr. Weitz:                          Amazing. You mentioned plant sterols. Now, one of the companies that’s doing advanced lipid testing is measuring whether you’re a cholesterol absorber or a producer.

Dr. Houston:                      Yeah.

Dr. Weitz:                          And they’re doing this by measuring levels of plant sterols. I’m a little confused if plant sterols are still a good idea as a result of looking at some of that data.

Dr. Houston:                      Yeah, we used to do that and try to base our treatment on that. It never did really work very well.

Dr. Weitz:                          Okay.

Dr. Houston:                      Let me tell you why. If you’re a hyper-absorber and I block the absorption, guess what? The liver starts making more cholesterol. Now you’re a hyper-producer. If you’re a hyper-producer and I block that, guess what? You start reabsorbing more. So, you’re chronically chasing your tail. Best way to treat those people is to just go ahead and block both pathways.

Dr. Weitz:                          Interesting.

Dr. Houston:                      Yeah.

Dr. Weitz:                          Meaning it would be helpful to use something that reduces the production of cholesterol by the liver, like red yeast rice, and then also use something like a plant sterol that helps block the absorption of cholesterol.

Dr. Houston:                      Or berberine. Because you know berberine is great to block cholesterol, plus you get a lot of other great benefits. Did you know that berberine is an actual natural PCSK9 inhibitor? You can go out and buy Repatha for $11,000 a year or you can buy some berberine for 30 cents a day.

Dr. Weitz:                          Yeah, berberine is amazing.

Dr. Houston:                      It’s amazing.

Dr. Weitz:                          It also goes head-to-head with metformin. I use it as an anti-aging agent.

Dr. Houston:                      Yeah. Well, it does. It actually turns off TOR. So, it does everything that you just said plus a lot more. It turns on AMPK as well, which is good for the metabolic pathway and aging.

Dr. Weitz:                          Interesting. So we talked about tocotrienols a little bit, but I also use them with the red yeast rice or if the patient’s taking a statin, tocotrienols will enhance the effectiveness of that, right?

Dr. Houston:                      They do. The tocotrienols are phenomenal agents and I think probably everybody ought to be taking those. But here’s how they work for cholesterol, they block production of the HMG-CoA enzyme for the messenger RNA. And then the other side they break down the increased catabolism of the enzyme.   So it’s not a competitive inhibitor of HMG-CoA reductase. It actually reduces the increase that you get when you get red yeast rice or statin. So, you get about another 10% decrease in LDL, LDL-P, they’re given a gamma-delta tocotrienol at night with whatever you want to because production tends to be higher at night.

Dr. Weitz:                          Interesting. So you’ve mentioned niacin as a beneficial agent. I’ve had a number of discussions with primary care doctors and they all tell me, “Oh, no. Niacin doesn’t do anything. There’s no benefit.” Why is there so much controversy about niacin?

Dr. Houston:                      Well, niacin got a very bad rap when two large clinical trials came out a few years ago. Joe Pizzorno and I, and several others, Mimi Guarneri, wrote scathing articles back to the journal saying, “Your studies were terrible. You’re misleading people. You have not put the nail in the coffin of niacin by any means. Here’s the reason and you should still be using it.”  So let me tell you first of all, continue to use niacin. It works. And the reason it works is multifactorial. It not only makes every lipid parameter better, I mean, if I do an advanced lipid profile on you everything I measure, niacin improves it. Everything. There’s not one thing that goes wrong including functionality of HDL.  And then the only downside to niacin is if you get really high doses you might increase your blood sugar, you might increase your homocysteine, you may flush, get a little rash, whatever. But typically you can give a lower dose of an intermediate acting niacin and get really good effects that are beneficial for atherosclerosis. So, everything prior to these two inappropriate reports that had bad methodology, niacin worked great, so keep using it. Just be good to get a good quality.

Dr. Weitz:                            Yeah, I think one of the reports, one of the studies used niacin along with a drug that blocked the flushing effect.

Dr. Houston:                      Exactly. That was Merck’s multi-billion dollar drug, and the drug didn’t work. It was supposed to stop the flushing. I’ll say this now because I can get away with it because the published study’s out there. The drug that they had used, they had done studies in experimental animals that suggested that it increased atherosclerosis.

Dr. Weitz:                          Wow.

Dr. Houston:                      Now, they never said that and they weren’t about to say that it does in humans because it was an animal study. But it was a little bit, dare we say, deceiving.

Dr. Weitz:                          Yeah. So soluble fiber, there was a lot of talk about soluble fiber, and I should eat oatmeal. What’s the word on soluble fiber?

Dr. Houston:                      You should eat a mixed fiber. Soluble and insoluble. We never really understood why fiber works so great for everything, but as you notice it works through the microbiome. Fiber literally gets rid of a lot of the dysbiosis, bacteria use it to make great chemicals to reduce diabetes, and heart disease, and blood pressure, and cholesterol. Those little rascals do a lot of good job for us if we keep them healthy.

Dr. Weitz:                          I guess the thought was that the soluble fiber would glom on to the cholesterol and take it out of your system.

Dr. Houston:                      Well, it might do a little bit of that but it turns out that it’s probably most if through the microbiome.

Dr. Weitz:                          Right, okay. Great. Awesome. So, I think that’s the questions I had on my mind. What would you like to tell our audience in terms of closing thoughts, and then in terms of getting a hold of your books and or signing up for some of your programs?

Dr. Houston:                      Excellent, thank you for asking. All of the books that I’ve written are on Amazon so they’re easy to find.

Dr. Weitz:                          And Barnes and Noble I’m assuming, as well?

Dr. Houston:                      Yeah. They’re at bookstores, Amazon. The newest one that’s coming out is really incredible, up to date text book of cardiovascular integrated medicine. As you know precision and personalized medicine is the keyword now for everything. But we’ve got like 35 authors, I did the editing on the book. And it’s the who’s-who of their specialty.  If you’re a healthcare provider, this is the book for you. Watch it coming out, it’s Wolters Kluwer, probably December. Educate yourself. Get the books and read them. But the second thing I would say to you today is come to some of the conferences that we do. A4M, American Academy of Anti-Aging Medicine. We teach an advanced cardiovascular course. We also teach sort of an entry intermediate course as well. But Module 16 is the advanced course, and it’s basically like a masters degree. We’re giving dual certification now for people that complete all four modules. It’s like getting a masters from a university.

Dr. Weitz:                          Okay.

Dr. Houston:                      That one’s good. The other one we do at A4M is Module 2, which is kind of the intermediate cardiovascular course. The advanced course is four 24-hour courses.

Dr. Weitz:                          Wow.

Dr. Houston:                      So it’s four weekends at 8 hours a day for three days. That’s 96 hours.

Dr. Weitz:                          Wow.

Dr. Houston:                      The other module, which is sort of an intermediate course is one three day module that’s 24 hours. You could come in depending on your level of expertise to either one of those. We’d love to have you at A4M for those.

Dr. Weitz:                          That’s great. Are you still teaching for IFM, as well?

Dr. Houston:                      Not so much with IFM as I was 15, 20 years go. Still do a lot with AIHM, Mimi Guarneri’s group out in San Diego, which I’m sure you know about. And also with The Natural Medicine Conference that they do also in San Diego.

Dr. Weitz:                          Great, awesome. Thank you Dr. Houston.

Dr. Houston:                      My pleasure. Thank you, Ben.



Peptides with Dr. Kathleen O’Neil-Smith: Rational Wellness Podcast 130

Dr. Kathleen O’Neil-Smith discusses Peptides with Dr. Ben Weitz.

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


Podcast Highlights

3:35  Peptides are signaling molecules. They are bio natural and are not pharmaceutical agents.  If you have a patient in pain, you don’t want to treat the pain, you want to treat the cause, which is what peptides help you to do.  Peptides communicate with our cells and sometimes they enter the cells through pinocytosis and they signal the cell to function better along with the other cells around it to function as a team.

8:07  Most peptides are prescription medications and taken through injection, except for BPC 157 (Body Protective Compound 157) and AOD (Anti-Obesity Drug), which we are focusing on today.  Dr. O’Neil-Smith emphasized the importance of purchasing peptides from a reputable source like from a doctor or chiropractor instead of from China through the internet.  She explained that AOD is a fragment of growth hormone and its action is lipolysis. If you take growth hormone, this can increase glucose and cause insulin resistance, which is not desireable. But when you use AOD, you don’t get these effects. Dr. O’Neil-Smith explained that AOD is effective in conjunction with hyaluronic acid and can be injected into joints to make those joints function more smoothly and to be more elastic. 

11:21  BPC 157 is available in an oral, over the counter form, and also as an injectible and the benefits are potentially amazing and protects the body from many things.  It was first discovered in the gastric juices and it has great utility in the gut.  Dr. O’Neil-Smith explained that if you were to sever the gut or if you were to take a gut and tie a rope around it, you would get a necrotic gut.  If you then take that rope off after three days and you let that necrotic gut sit there and you bathe one half of the necrotic part in BPC and you bathe the other half in saline, 10 days later the gut bathed in BPC grows back.  BPC can be very beneficial for inflammatory bowel disorder, such as in Crohn’s and ulcerative colitis, where it can heal a fragile, bleeding gut and bring it back to health.  If the patient is having an acute flare, it is best to both use oral and subcutaneous injection of BPC.  An oral dosage of 500 mg three times per day would be a good dosage at first to load up, but she noted that there is no reason why you could not take a higher dosage. She also uses it a lot in brain injuries, such as concussions or CTE. 

18:00  Dr. O’Neil-Smith often uses BPC for injuries in athletes, including professional and Olympic athletes.  She notes that BPC is not on the WADA list of banned substances.  While peptides can help heal injuries, they do not provide a boost the way that supratherapeutic levels of testosterone or other anabolic hormones do.  Peptides are bio natural regulatory signaling cells allowing the body to use the body’s own healing properties instead of medicines or drugs. 

22:56  BPC-157 works on multiple pathways in the nucleus of the cell directing the silencing of genes that continue inflammation and promoting the genes that direct blood vessel, connective tissue, fascia, and nerve repair.  BPC is very restorative and regenerative and even stimulates autophagy.  Dr. O’Neil-Smith said that with her patients they need to be taking in the essential nutrients, either orally or through IV.  They need to do either intermittent fasting, time-restricted eating, or the fasting mimicking diet.  They need to have the proper balance of hormones. And then to give peptides makes the most sense.  She also likes to use therapies like sound wave or shock wave therapy to break up the granules and scar tissue to stimulate healing in her office.

31:46  Some of the research indicates that BPC-157 facilitates growth hormone being able to help tendons to heal. (Pentadecapeptide BPC 157 enhances the growth hormone receptor expression in tendon fibroblasts.) Dr. O’Neil-Smith said that for growth hormone facilitation she tends to use CJC 1295 (a synthetic analogue of growth hormone-releasing hormone (GHRH)) and IPA (Ipamorelin) peptides. Dr. O’Neil-Smith explained that using growth hormone is expensive, it requires carefully monitoring insulin levels and using insulin injections, and it will shut down your brain’s production of growth hormone.  There is also a high potential to abuse growth hormone.  CJC and IPA can be used for patients recovering from surgery such as an achilles tendon or an ACL repair.  They can also help with the healing of plantar fascitis and similar conditions.  Dr. O’Neil-Smith uses peptides for recovery from surgery and also for re-regulating insulin signaling, which can be helpful for diabetes and also for weight gain. For an injured achilles tendon she will inject BPC around the tendon and this has been shown in studies. 

39:19  Dr. O’Neil-Smith’s stack for post-surgical recovery in some patients would be BPC, CJC, and HCG, (human chorionic gonadotropin), though she points out that she practices individualized medicine and her recommendations for each patient will be different.  She explained that HCG has a number of benefits, including stimulating testosterone utilization receptor uptake, as well as for repair and regeneration in other ways. 

44:10  BPC can be used to heal the gut, for wound healing, for regeneration of nerves, and for concussion recovery.  It is being researched for its benefits for Multiple Sclerosis. 

46:22  For anti-aging benefits, Dr. O’Neil-Smith recommends the following:  1. BPC-157,  2. Omega 3 fish oil,  3. vitamin D,  4. vitamin K2,  5. NAD  (such as nicotinamide riboside),  6. Resveratrol,  7. Curcumin,  8. NAC,  9. Probiotics.



Dr. Kathleen O’Neil-Smith is an MD with her practice focus on Functional and Regenerative Medicine. She completed a stem cell certification through the A4M.  She is an international thought leader in the clinical use of peptide therapy and she healed her son from a severe TBI with peptides.  She can be contacted through her website Treat Wellness, LLC.  She is now training other doctors through her Peptide Master Class that you can find on her website. 

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 Apple Podcast and give us a glowing review and ratings. That way more people find out about the Rational Wellness Podcast. For those of you who’d like to view this podcast, go to YouTube and you can see a video version.  If you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Today our topic is peptides with Dr. Kathleen O’Neil-Smith. Peptides are short chains of amino acids that are connected by peptide bonds, but they are shorter than proteins. The general rule is that a protein contains more than 50 amino acids. Insulin is generally considered to be the first peptide discovered, but it actually has 51 amino acids, so apparently that’s not a hard and fast rule.  Peptides are just generally shorter and proteins are bigger. Peptides have many functions in the body but some function is hormones and signaling molecules and regulators of various metabolic processes in the body. There are peptides that can have a significant effect on memory and cognitive function, weight loss, muscle growth, immune modulation, gut health, sleep, and anti-cancer, among other effects.

Today we’re going to focus most of our discussion on BPC, body protective compound 157, and it has benefits for healing of soft tissues like tendons, nerves, as well as the lining of gut, and many other tissues in the body. Dr. Kathleen O’Neil-Smith is a magna cum laude graduate of the Boston University School of Medicine. She also has a degree in exercise physiology and she was an athlete on the national rowing team for 39 years and then was a coach for six years. Her current practice is focused on functional and regenerative medicine, and she completed a two year fellowship on this.  She also recently completed a stem cell certification through the A4M American Association of Anti-Aging Medicine. She’s also an international thought leader in the clinical use of peptide therapy, and she healed her son from a severe brain injury with peptides. Thank you for joining us today, Dr. O’Neil-Smith.

Dr O’Neil-Smith:               It’s good to be here. It was nice to see you at the conference in Seattle six weeks ago and to keep in touch, and to know that I’ll be seeing you again at your place in Santa Monica.

Dr. Weitz:                         Cool. So what are peptides?

Dr O’Neil-Smith:               Well peptides are signaling molecules. They’re a means of treatment. They’re bio natural. So when I think of the body, I think that there are many ways to heal it. Conventionally, as an internal medicine doctor, I used to think about pharmaceutical agents, but pharmaceutical agents are generally not helping the body to rebuild. They’re basically treating a symptom. So you can take a blood pressure med and you can reduce blood pressure but that doesn’t treat the root cause.  The medicine that we use is not something that was bio natural to the body. When we think of peptides … when I think of the way I want to treat the body, I want to treat the root cause. I don’t treat pain. You’re a chiropractor. You may see some pain. You may see some brain … some brain injury. You may see some concussion. You may see some joint injury. You never treat pain. You treat the cause of the pain.

                                         If you just treated pain, you’d give them Oxycontin, right, and we have an opioid crisis. If you want to treat the cause of the problem, you have to understand whether it’s structural, mechanical, or functional, or both. Generally it’s both because even if you got an injury that’s structural, right? Even if you got a torn labrum in the hip or in the shoulder, you’ve got a structural problem, but you also have a functional problem.   The functional problem is all the fire alarms and the molecules that are released from that joint problem. When they’re released from the joint problem, the cells start to have crosstalk between them and they signal each other, inflammation, fire, and it’s like fire alarms going off, like in a fire in California, in many different counties.

                                         When we use a peptide as opposed to a medicine, a peptide works as a fire alarm, but to put out the fire it’s natural, as I said, generally speaking. They occur in the body naturally and they occasionally in varying amounts at varying times. As a fire alarm, it goes cell to cell to cell saying, “Hey, this inflammation in here,” in the joint pain for example, the labrum injury. “We’re going to come together. I’m going to do my job as one cell to resolve this inflammation and repair without scar, without fibrosis, without making the tissue more dense, the fascia tissue more dense. I’m going to heal this appropriately. I’m going to regenerate this tissue appropriately, and I need all you other cells around me, the fire departments, to get on board and to do your job.”  That’s called autocrine signaling where one cell tells itself how to do the right thing and not just be a runaway inflammatory cell that becomes scarred, and paracrine signaling that tells the cells around it, or the departments around it, “We’re going to work together to pull this in and not get scarring, but to get healing, as full function back as we can of that particular injury.”

Dr. Weitz:                         And paracrine is essentially another word for hormones, right?

Dr O’Neil-Smith:               No, I mean paracrine … hormones are very kind of more direct. If you use a hormone like an estrogen and progesterone, testosterone, male or female, whatever, and you give someone a hormone, which I’m all in favor of if they’re bio natural, and we need to restore balance, and that’s a whole other topic on fascia that’s fascinating, and the receptors in fascia, the hormone receptors in fascia. But at any rate, the hormone will attach to that cell on a membrane in a receptor and it will go create this whole internal effect within the cell and go to the nucleus and the gene and get inaction.  So if you use testosterone, an action is to increase libido or to increase muscle mass, a muscle, to grow back a muscle. If you use a peptide, peptides actually enter the cells in different ways. They don’t always attach to a receptor on the cell’s surface. They pop into the cell like a dart. They get into the cell with something called pinocytosis, and then they will cause this whole signaling effect, and it’s really cool. It’s a little bit different. So we call them signals, cell signaling molecules, molecules that signal the cell that they’re near and all the cells around it within that tissue, within that organ, to function as a team.

Dr. Weitz:                         Cool. So are peptides prescription medications or are they over-the-counter like nutritional supplements?

Dr O’Neil-Smith:               Both, both. Many of them … most of them are prescription medications, but the ones that we were thinking to focus on today are over-the-counter and there are supplements that you can get … I certainly wouldn’t buy them from China because you don’t what you’re getting. I would buy from a reputable source like a doctor, a chiropractor, an acupuncturist, whatever, who knows that they’ve gotten them from a reputable source.  BPC and AOD are the two peptides that are available pretty readily, and those are all over social media right now because they’re very, very effective.

Dr. Weitz:                         What is AOD?

Dr O’Neil-Smith:               AOD is anti-obesity drug. That’s really not a great name for it. It’s a peptide. It’s a little fragment, a small fragment, of growth hormone. Growth hormone … I used some slides. I’m not sure if you have them, but growth hormone … and AOD was on that. Growth hormone is about 200 amino acids which contains the peptide. AOD is a fragment of growth hormone, so it would be under 50 amino acids, so it’s 15 or whatever it is amino acids.  So that particular fragment of growth hormones has particular actions, and the action of AOD is lipolysis. So breaking down fat, which is really desirable. Growth hormone as its whole can increase glucose and can cause some insulin resistance and that’s not desirable. When you use just the AOD fragment, you don’t get the insulin resistance. You don’t get the elevated glucose and you don’t get fat deposition.  When you use AOD you get breakdown of fat, metabolism of fat, so fat loss. The other really … I don’t use a lot of AOD for that particular purpose, but you can. I do have some patients that do well with that. The other way that you can use AOD is in joints because it also heals soft tissue and cartilage. So it can come as creams. It comes in many ways but it also comes as an injectable that you can do sub-q or that you can put into joints. You can put with hyaluronic acid, which is very soothing and lubricating for joints, so you get good movement in every direction, up/down, all around, diagonally, you name it. You get the gliding and sliding and elasticity of that joint.  So you can combine AOD and HA, and you can use them together within a joint, and I do that often, often, a lot.

Dr. Weitz:                         Yeah some of the collagen supplements contain HA.

Dr O’Neil-Smith:               Exactly, exactly. But when you put AOD with HA, it’s very beneficial. I love AOD/HA. It has many of the benefits of growth hormone, because it’s a small fragment and not a lot of the downsides of growth hormone. So it’s very, very good.

Dr. Weitz:                         So now BPC-157 is both oral and injectable. Is there an advantage to one over the other in certain situations?

Dr O’Neil-Smith:               BPC is a miracle. I work with-

Dr. Weitz:                         I mean when I got that booklet from Dr. Holtorf and started going through these studies, it was … I mean this is ridiculous. The benefits are so amazing, either this is the new wonder drug or it’s snake oil.

Dr O’Neil-Smith:               No. It’s really not. I can tell you a couple of stories about it.  So I work with another doctor in Florida, Dr. Akey. She’s visited and spent time with the doctor who discovered BPC.  He discovered it in the 1990s and since then he teaches at the Zagreb Medical School, so he has been studying this extensively.  When you visit his lab and you meet him personally, you know he’s the real deal.  When you see the work he does and he shows you within his lab the benefits of it, it literally is miraculous and mind boggling.  It’s funny because in the states BPC is … everybody loves BPC.  It’s called Body Protection Compound 157, thus it protects the body from many things.  It was originally by Dr. Sizgorich in Croatia founded to be in the gastric juices. So where we first understood its utility was in the gut and obviously we found it in the gastric juices. What can it do for the gut? We know that it can heal the gut. I teach a lot on BPC to the stem cell group, to the anti-aging group, to everybody, to a lot of doctors and patients, clients, and the public.  BPC for the gut, if you were to sever the gut … if you were to take a gut and you were to tie a rope around it and cut it off, you get what? Necrotic gut. If you then take that rope off after three days and you let that necrotic gut sit there and you bathe one half of the necrotic part in BPC and you bathe the other half in saline, 10 days later the BPC grows back.

Dr. Weitz:                         Wow. That’s pretty amazing.

Dr O’Neil-Smith:               You can see it grossly looking at it. You can see it under the microscope, and it’s the most remarkable thing ever. So it works in the gut. We use it a lot. I use it a lot in any gut dysfunction. I use it a lot when there’s a brain injury because you’ve heard me talk about the gut. The gut and the brain you heard during that whole series of lectures are directly connected.  So whenever there is an injury in the brain, a concussion, an athletic injury, CTE if you think that you’ve got an ex-athlete who’s really had a lot of concussions. They don’t really complain of a concussion but things are disrupted, I always use BPC in an injury that’s in the brain or in the gut.  If someone has inflammatory bowel disorder, I’ve used it a lot in Crohn’s colitis, in ulcerative colitis, to heal that fragile friable bleeding gut and to bring it back to health.

Dr. Weitz:                         So let’s say you have a patient with Crohn’s or ulcerative colitis and let’s say they see you and they’re having an acute flare. Will you use the BPC right away and if so how much and how long will you use it for?

Dr O’Neil-Smith:               So back to your original question about whether I use it sub-q or oral, in an active flare, in an acute flare, I always do sub-q, particularly … you know we don’t know how well the gut’s going to work if we give it orally. So in a sub-q flare and in an acute flare, you’re going to want-

Dr. Weitz:                         But you want it to go in the gut right? Because the gut’s what’s injured.

Dr O’Neil-Smith:               The gut is what’s injured but the gut is usually injured from the inside out as opposed to the outside in. You quiet down what you deliver to the gut. You quiet down food. You quiet down all of those different things. You might give some nutrients in other ways. Definitely if you’re going to use the gut, use it in a liquid way. Use elemental diet, which is broken down food to keep the calories in, to keep the weight on, but you’re not going to want the gut to have to do a lot of work, so you’re going to want to really quiet the gut.  If you quiet the gut and you give a little BPC, most people tolerate it orally but sub-q … I would attack anything acute from the inside and the outside. I’m coming from all angles. If I’m in a war zone, I’m coming from every angle. If there’s something acute going on, I’m coming from every angle. So I’m always going to, in an acute situation, use a sub-q and an oral. If all you have available to you is an oral, load up. Load up.

Dr. Weitz:                         So how much is loading up?

Dr O’Neil-Smith:               Load up would be certainly multiple times a day. You can’t take too much.

Dr. Weitz:                         For what dosage?

Dr O’Neil-Smith:               Well the dosage I think on an oral, like Dr. Holtorf’s product is about 500. So when you take that 500, you can take that twice a day or three times a day, and you can do that until you feel things quiet down. Then you can begin to reduce and go down to once per day.

Dr. Weitz:                         So 500 is in one capsule. Could you take 1000 three times a day?

Dr O’Neil-Smith:               Why not? Won’t hurt you.

Dr. Weitz:                         I don’t know.

Dr O’Neil-Smith:               Yes, you can.

Dr. Weitz:                         Okay.

Dr O’Neil-Smith:               There’s never been found, in the 30 years that it’s been studied, a lethal dose, or a dose that’s harmful. There’s no lethal dose.

Dr. Weitz:                         And do you get better benefit? What level do you think … Do you think 500 is where you get the maximum benefit or what do you think?

Dr O’Neil-Smith:               No I think it really depends on the person. I think that’s why it’s important to work with someone like you or with a doctor who understands this stuff because they’re going to help you figure that out. I would say that mostly in my practice I have used the sub-q and the oral. If I’m using the sub-q, an injection in the belly, small little insulin needle, a little bit of BPC, I will only do the oral once a day.  If I don’t have any sub-q … if they don’t have it for some reason, they’re somewhere in another country. They call me or talk to me about an injury or something acute, I’ll say take oral one, three times a day. That’s the most I’ve ever had to do. So I really have never had to do that. I might do IV. I mean I’ll do it every which way I can depending upon how significant. If it’s a chronic injury … even with athletes. So I’ve used BPC in a lot of elite-level athletes, NHL, NFL, active athletes.  If you’re going to use BPC and it’s not on the WADA list. I hope it never it is. It shouldn’t be on the WADA list. If you’re going to use BPC-

Dr. Weitz:                         A WADA list is the list of banned substances, right?

Dr O’Neil-Smith:               Correct. If you’re going to use BPC in an athlete, I basically tell them they’re going to need … Well one it’s good in the setting of inflammation. So it’s not like they have to stop playing. They can get the benefit of this and some healing from this even in the setting of inflammation, which is contrary to what most people think. People think that you have to stop … that steroids have to be done and then you use a peptide. No, never use a steroid if you can avoid it, ever, ever, ever. Steroids are like Oxycontin. They put out the signal, which is what pain is. They put out the signal, which is what inflammation is, and they don’t allow for healing. They’re wrong. So what we want to do is use something that will redirect the signal to heal.

Dr. Weitz:                         You say that professional athletes can use them. What about Olympic athletes?

Dr O’Neil-Smith:               Yes, yes.

Dr. Weitz:                         But I don’t think they’re allowed to use any injectable substances.

Dr O’Neil-Smith:               Yeah, no well that’s different. I mean the problem with having been on the Olympic team and coached the Olympic team and all that kind of stuff, I mean I remember, Ben, when I was in the 80s racing the Russians before 1984 when they didn’t show up in Europe. When they showed up and we all went into the bathroom and we had to collect our urine to see if we were on anything, and they passed and got to keep their medals, we were all dumbfounded. I was young then. I was still in college and I thought they’re doing hormones. Why aren’t they being found?

                                          When I learned about peptides six years ago, seven years ago, maybe a little longer … the ones that we’re talking about … I realized they weren’t using hormones. They were using peptides. So peptides … they’re not like hormones. They’re not something you can get supratherapeutic on. Testosterone, if a normal range, let’s pick a number 800. If I give Manny Ramirez testosterone, he can go from 700 to 2500 and be aggressive and whack that ball or whatever right? But that is supratherapeutic levels. You can do that with hormones. You can detect that. you don’t get supratherapeutic levels with peptides. So it’s a whole different ballgame.  These, remember, are more bio natural and they just go in and they do their job silently, quietly. They don’t make you a super human. They just make you able to heal more easily.

Dr. Weitz:                         So but are Olympic athletes allowed to use these injectable peptides?

Dr O’Neil-Smith:               They’re not on the list.

Dr. Weitz:                         They’re not on the list. They’re not even supposed to use injectable vitamins.

Dr O’Neil-Smith:               I know.

Dr. Weitz:                         So I would think the injectable ones would potentially be a problem, right?

Dr O’Neil-Smith:               It depends. It depends on … I have athletes that try for the Olympic team. I would have them go to their staff in NHL and NFL and everything else. They go direct to their person and what their person there will do, and it’s not always the same person. It’s not like the doctor, the athletic trainer, or the nutritionist. It’s whoever it is … whoever their relationship is with. What they’ll typically do is send a sample to their lab and say is this okay?  I would say that 100% of the time it comes back okay.  So I have it tested because I care enough that they are well.  So if I have in the NHL a Boston Bruin who’s had a brain injury or a massive concussion, why would they not be allowed to be treated appropriately?  So we have to begin to bridge the gap with the things that are dangerous, the testosterones that are overly used, the anabolic steroids that are overly used.  These are not anabolic steroids.  These are bio natural regulatory signaling cells allowing the body to use the body’s own healing properties instead of medicines or drugs.

Dr. Weitz:                         How does BPC-157 help with the healing of tendons?

Dr O’Neil-Smith:               BPC-157 works on multiple pathways in the nucleus of the cell directing gene silencing and gene promotion. So they silence the genes that continue runaway inflammation and promote the genes that basically … a lot of nitric oxide enhancements. They don’t just do blood vessel repair.  BPC also does nervous system repair.  When I think of an injury, we all talk about blood vessels.  Well the knee doesn’t have a lot of blood vessels. Joints don’t have a lot of blood vessels.  So it’s not really that we want mostly blood flow there because that’s not a natural state for a joint like the knee.  What we want is the nerve endings to not be inflamed.  For the milieu or the bath or the soup that the nerve endings are bathing in to be appropriate. So BPC is very good at allowing for cleanup and that’s called autophagy. You’ve probably heard a little bit about autophagy. Autophagy is-

Dr. Weitz:                         Related to fasting especially or ketogenic diet.

Dr O’Neil-Smith:               Okay so it relates to everything in the cell because autophagy is auto, self, auto means self. Phagy … phagy is clean up. Clean up yourself. You make a mess in your room, clean it up. You make a mess in your cells, clean it up. It’s naturally occurring housekeeping of a cell. So fasting allows for autophagy or housekeeping because you don’t keep sending in food that needs to be metabolized and creates waste.  Food always creates waste. That’s why we stool. Food in the body, not just in the gut, creates waste. In the cell it creates waste. When we fast we allow for better housekeeping, better cleanup of the gut and of the body. That’s ketogenic, that’s fasting mimicking diet with Valter Longo’s protocol at USC. That’s other protocols for dieting. But with peptides we allow for autophagy as well and we clean up-

Dr. Weitz:                         It’s interesting because my general sense of peptides, and especially since I had found out that bodybuilders are using it and athletes. It seems like when we look at the whole anti-aging continuum, it seems to me anyway … maybe I’m oversimplifying things, that we have this … we have the growth signals and then autophagy is part of the … We’re in starvation mode. The body can’t grow because it doesn’t have the necessary ingredients. So that’s when it starts breaking down its own cells to scavenge the amino acids for protein.  Peptides seem to be as part of the growth stimulation factor is not the starvation factor. So I’m surprised to hear that.

Dr O’Neil-Smith:               Woops oh hang on. Sorry the meeting has been upgraded. Okay. Yeah go ahead.

Dr. Weitz:                         Yeah, am I confusing things?

Dr O’Neil-Smith:               No. When I think about the body I think about catabolism/anabolism. You’re breaking it down. You’re building it up. Most of the things in medicine that we do and that happen every day from the time you wake up to the time you go back to bed … go to bed, is catabolic. It’s breaking you down. Same thing when you go to the gym. You’re breaking down. The goal is to break down and build appropriately back. The goal is to get through the stress … good stress, bad stress, whatever of the day and then restore at night.  We are in a fast paced society. The amount of housekeeping that needs to be done is enormous, completely different … every six months it’s bigger. It’s like the clean up of the environment. It’s big. So the reality is, is that mostly what we do in medicine is we just stop the signaling. We never really give the regenerative potential. We just put out the fire but we never rebuild back. So you’re sitting there with a burned building and you never rebuild it back. You’ve got to restore that.  What peptides do as the … So food and fasting mimicking diets or fasting will just stop the fire. Using peptides, they are regenerative. They’re going to build back with the fire burned. It’s a really important way and I think that the primary thing … You know one of the things that … There’s a lot of systems and there’s a lot we don’t know and a lot of doctors like to keep it very simple and work with what they know. That’s great. Work with what you know and then build on what you know.

                                         So when you think … right now the thing I’m thinking about the most in terms of pain and in terms of joints and in terms of injury, and in terms of a gut injury, a brain injury, whatever it is, my passion is brain and soft tissue injury. Kind of everything. But when you understand fascia, fascia is probably the largest organ in the body. Think about that white bright glistening component on meat and you cut through the layer and you’ve got more and more fascia. You understand this. Fascia is so contiguous and so abundant in the body.  Fascia happens in layers. Between those layers of fascia with the collagen, the different types of collagen, one, two, three, four, you name it. All of the different nutrients that collagen needs, they’re also many. Fascia has hormone receptors. It has receptors for estrogen, for progesterone, for testosterone. Who talks about that? Who thinks about that? We get afraid of giving too much of something but we need the right amount of testosterone, of estrogen and progesterone in men and women in order for that fascia to glide and move in all directions, and to be elastic and to be able to withstand the wear and tear of everyday.

                                                To rebuild that, we also need those signaling molecules because they help to keep the nerves, the free nerve endings in that fascia healthy. So the peptides are one component of many things. I make a pyramid when I treat my patients and I think of a house in the middle of an ocean being battered by a hurricane, then a tornado and whatever. That house is sitting on a rock and that rock has to be solid. That foundation has to be solid. So you have to start with having adequate ingredients available to build the body back, which are nutrients.  Whether you give them IV, whether you give them orally, make sure they’re getting in and make sure that the body is receiving them. To do anything else, peptides and other things, if you don’t have nutrients, it doesn’t make sense. If you haven’t cleaned up with a little fast here and there, it doesn’t make sense. Intermittent fasting, time-restricted eating, a little ketogenic, a little fasting mimicking diet prolong, whatever it is you do, you’ve got to be doing some of that. You’ve got to know you’re getting nutrients in.

                                         The second thing in my pyramid going from top to bottom, foundation is bottom. Foundation here … is how do we use hormones? What is the balance of hormones that we need? You really restore some hormones. It might even be progesterone in a man, a little bit, because that’s going to help that fascia move. They have to have an adequate level of estrogen 20 to 30, whatever it is. It can’t be zero with Arimidex. That doesn’t make sense. Arimidex is going to destroy joints.

                                         After hormones the next thing I would think of is if we have a sound wave therapy machine or something like that to break up the granules that are floating around and wanting to heal you. Those contain some peptide-like molecules. Those granules want to be popped to give you the healing ingredients that you need. So some sound wave therapy if you have that. And if you have access to peptides, oral, over-the-counter, or sub-q, I think those are next. But you don’t want to give peptides like a BPC if someone doesn’t have B12, if someone doesn’t have B1, if someone doesn’t have an antioxidant, if someone doesn’t have a magnesium. Why are you going to give a peptide? You’ve got to know that they’ve got the ingredients for that peptide to work.

Dr. Weitz:                         Yeah and you’ve always got to start with the basics, diet and lifestyle. One of your articles I was reading about BPC-157 and tendon injuries seem to be that it had this positive interaction with growth hormone and it seemed to facilitate the growth hormone being able to help the healing of tendons.

Dr O’Neil-Smith:               Absolutely. It will never be one thing alone. For a growth hormone, I like to use another peptide. I don’t use growth hormone in my practice because of the downsides of growth hormone and because of the abuse around it. You can’t-

Dr. Weitz:                         At one time it was getting to be kind of popular in anti-aging circles but it’s sort of fallen out of favor I’ve noticed.

Dr O’Neil-Smith:               Yeah, yeah, it’s totally out of favor because it can be abused. It’s also very expensive so it’s really hard to maintain. If you’re going to do growth hormone regularly, once you shut down your brain’s production of it, you need to use this. If you’re going to do growth hormone regularly, it’s going to cost you $15,000 a year. You’re going to have a difficult time getting it. It’s going to be very difficult because in order for a doctor to prescribe it in a safe way and in a way that the board regulates, you have to have insulin. You have to have specific testing with insulin, etc. That’s just not something I get into.

                                         But CJC and IPA, another peptide, are peptides that I would consider using. Those are peptides that are growth hormone releasing hormones and growth hormone releasing peptides. They’re a little bit different. GHRH, GHRP, different. So GHRH basically will have some effects of growth hormone and it will regulate that, and GHRP will be more like a ghrelin effect. Similar to BPC because the ghrelin and the ghrelin receptors are throughout the GI tract, because the GI regulates so much of the healing that goes on in our body from the mouth all the way through to the anus.   At each phase of the way, there’s different pH’s. There’s different microbiota or bugs. There’s different utilization of food. Water absorption, etc. So the entire GI tract, not surprising, is releasing many of these peptides as signalers to the rest of the cells around the GI tract. Are we in danger? Are we safe? Do we let this in? Do we keep this out? Is there a bug here? Is there a parasite here? What’s going on and how do I keep the body safe? So GHR-

Dr. Weitz:                         Those are injectables, peptides?

Dr O’Neil-Smith:               Those are injectables. CJC and IPA or GHRH and GHRP are injectable.

Dr. Weitz:                         And you need a prescription for those?

Dr O’Neil-Smith:               You need a prescription and you need to regulate them because there are many ways that you could use them. You could use them for healing a joint if necessary. You can use them for someone who has growth hormone deficiency. You can use them for-

Dr. Weitz:                         For recovery from surgery, say?

Dr O’Neil-Smith:               Absolutely. I always use them in my patients for recovery from surgery. You can also use some of these peptides for insulin signaling to re-regulate insulin signaling because diabetes type 2 and weight gain and adiposity, being overweight, is really a big issue. So we can use these to regulate how the body uses fat for energy, sugar for energy, and make it more efficient.

Dr. Weitz:                         Do you have a combination or they used the word stack in some bodybuilding circles. I’m sure other circles that you would use for say an athlete recovering from Achilles tendon repair or an ACL.

Dr O’Neil-Smith:               Okay let’s take an Achilles. Achilles is amazing. Plantar fasciitis a massive problem. I will absolutely use BPC. I will-

Dr. Weitz:                         And this is post-surgery or even just recovery from an injury without surgery?

Dr O’Neil-Smith:               I’m a big prehab girl. You may pregame in California for your sports games, but I prehab before surgery. That’s kind of a principal that we use anyway. So prehabbing means prepare for surgery. Why would you go into surgery? You wouldn’t go into a game that you wanted to win without preparing for it. Don’t go into a surgery that you want to have a good effect from before doing that. I know for you, your motto is, “For those of you who have no time for healthy eating, you’re going to pay the price later,” right?

Dr. Weitz:                         Right.

Dr O’Neil-Smith:               Find the time now because you’re paying the price later. It’s the same thing for surgery. It makes zero sense to me that you would ever consider a surgery without prehab. So prehab would involve peptides. Now I know the surgeon is going to tell you stop everything before you go in for a surgery. BPC oral is never going to change your bleeding time. BPC oral is going to help it. Stop it for 48 or 72 hours. I have no problem with that. But if someone were going to have an Achilles tendon, BPC alone injected can heal an Achilles tendon. That has been shown in studies.

Dr. Weitz:                         And is it injected around the tendon?

Dr O’Neil-Smith:               Mm-hmm (affirmative). Injected in the tendon. So you can inject it in the tendon. You can inject it …

Dr. Weitz:                         In the tendon or near the tendon?

Dr O’Neil-Smith:               All around. It doesn’t have to go directly in the tendon.

Dr. Weitz:                         Right all around it.

Dr O’Neil-Smith:               Right there. Because remember it’s like the fire department. It’s cell signaling. It’s going to recruit to bring in other cells to do healing. Typically when there’s an injury, and I’ve done this with very well-known athletes, I make a triangle around the injury and I inject around that injury with BPC. You get healing. Even people who are suspicious or suspect realize that they get amazing healing with that. You can also use it at the same time as you do that … I’ve sent people home in the last two days to do the triangulated injection, a little tiny, little bit, just like somebody might do a Botox. That’s a toxin. We’re injecting something that’s healing. It’s a tiny little, just like a Botox needle. Little bit around that, just like they do … I don’t know how they do … I don’t do Botox, but if they did Botox here they’d do … all over. You do that with the BPC and then you put some BPC sub-q, intra-abdominally, no problem. It works together.

                                                It gets the signaling from a distance. It gets a signaling locally. You could do that with insulin. For someone who needs insulin for sugar and they need it to live, when you give insulin in the abdomen, even though the brain cells need it, it gets there. There’s signaling pretty quickly. So you don’t have to put it in the head. You can put it in the belly and it will get where it needs to go. We do that all the time for insulin. Type 1 diabetics who wear pumps, they stick the pump in their tush. They stick the pump in their lower abdomen. They stick the pump in their arm.  No matter where you stick this, it’s going to get to the site it needs, just like BPC.

Dr. Weitz:                            So what would be the stack? You’re going to use BPC-157. What else would you use for somebody who needs recovery from surgery quicker or better?

Dr O’Neil-Smith:               If they’re all in, if they’re all game, I’m probably going to do BPC, CJCE with a growth hormone derivatives, and I might even do HCG, human chorionic gonadotropin, HCG, LH, luteinizing hormone. I would probably do those three. I’ve used that many many times.

Dr. Weitz:                         Do you use HCG even if they have healthy testosterone levels, because HCG is a precursor for … it stimulates your gonads to produce more testosterone, right?

Dr O’Neil-Smith:               Mm-hmm (affirmative) it can increase free testosterone, and the testosterone’s action in the body. I probably would use a little bit, yeah, because HCG … This is where we get trumped up. When you understand that HCG, as you just said-

Dr. Weitz:                         You mean we’re all going to turn orange? I’m just kidding.

Dr O’Neil-Smith:               We’re going to get orangutan hair. We’re going to be the products of orangutan. That’s a joke from I don’t know Saturday Night Live or Larry King Live, somebody. At any rate, Bill Maher. HCG, when we think of it, we think of it as predominantly increasing testosterone. That’s not how I think of the peptide HCG. It does that. It’s one of its actions. I think of HCG as a luteinizing hormone and I think of that as having other benefits in the body that repair and regeneration and growth.

Dr. Weitz:                         Oh really? Oh I never thought of it like that.

Dr O’Neil-Smith:               100%. That’s not what anybody talks about. It’s like if we make … There’s a medical food called DEPLIN. It’s a folate. DEPLIN, methyl folate, has been approved to come on the market for depression. I use methyl folate a lot. My people see that it’s on the market for depression and they don’t want to take it. I’m like no, no, no, no. That’s just what it’s approved for. This has many benefits, and you’ve already felt them. You took it before you knew it was for that, and now you don’t want to take it. This has many benefits. It’s the same with peptides because peptides are what we call pleiotropic. Pleiotropic is if you put the peptide in the middle and you create all of the spokes coming off, it has many spokes, so testosterone utilization receptor uptake would be one spoke for HCG, so I would use HCG as well.

                                                So I would definitely use BPC. I would definitely use a growth hormone derivative, not growth hormone, and I would probably use a little bit of HCG.  I mean there are other things I could use. When I treat a patient, I don’t treat just the condition.  It’s not like you come in and my brain goes, “Achilles injury, boom you get this.” I say, “Achilles injury. How’d it happen? What was the milieu when it happened? Let me get some measurements, prehab, preop. Let me figure out the other things you’re going to use, and that’s going to determine my stack.” I don’t have a one stack. You can’t come in and get a number one in my practice because I treat the patient, not the injury and not the disease.

                                                The injury is a component of the patient, but the injury happened in that patient, so I do personalized medicine where I treat the patient, not the disease with the number one through 10. You don’t get number seven because you have a shoulder injury or a number four because it’s a hip injury. I have to understand why did that injury happen in this patient and those are the things that will help me determine what the stack is going to look like. But within my stack I have nutrients. I have hormones. I have 20 to 25 peptides. I have sound wave therapy. I have exosomes. I have all kinds of different tools and I have to look at the labs for that patient, the biomarkers, to see why did this happen in that patient.  Did they have Marfan syndrome? Were they just on an antibiotic and tore their Achilles? Because levofloxacin, which people will use for a UTI. It’s a bad choice of an antibiotic-

Dr. Weitz:                         For tendons…

Dr O’Neil-Smith:               You’re going to rip your Achilles. I have three patients that that happened to. You’ve got to be careful and you’ve got to think before you use.

Dr. Weitz:                        Yeah all the fluoroquinolones.

Dr O’Neil-Smith:               Right.

Dr. Weitz:                        So BPC can be used to heal the gut. Do you use that as part of your gut protocols?

Dr O’Neil-Smith:               I would say because BPC is so pleiotropic with all those spokes at the wheel and so easy to take and affordable. It’s my number one. It’s my number one. I would say everybody. You can use BPC for a wound. I have a patient, 92-years-old, that had a wound. I had her daughter put the capsule and make a paste and put it on the wound. You can use BPC for a wound. You can use BPC for the gut. You can use BPC for a concussion. It helps to regenerate nerves. It’s being studied presently in MS.

Dr. Weitz:                         Cool.

Dr O’Neil-Smith:               Multiple sclerosis. The initial is that it’s beneficial. So if BPC can heal the brain, why not use it? If BPC is … Ben, three principles whenever you treat somebody, is it safe? Is there a possibility that there’s toxicity? With growth hormone there is. With testosterone there is. There is not with BPC. So is it safe? There’s no toxicity.

Dr. Weitz:                         Are there any downsides?

Dr O’Neil-Smith:               Not that I know of.

Dr. Weitz:                         What about downgrading receptor sensitivity?

Dr O’Neil-Smith:               No indication. So BPC safe. Second principle. Three principles. Effective. Effective therapeutically?  Is it going to help heal?  Is it cost-effective?  I think it fits both, safe and effective, therapeutically and cost-effective.  Then the third question is, is it sustainable?  Will it help to sustainably heal something?  Yes.  So BPC is a no brainer.  No pun intended.  It’s good for the brain. It’s good for the joints. It’s good for a wound.

Dr. Weitz:                         So some people would say hey if I take it all the time and then I have an injury, I might not get a beneficial effect.

Dr O’Neil-Smith:               Well it’s not like BPC is the only thing that’s going to heal an injury. You can change the dosing. If you take it all the time, you might not get the injury.

Dr. Weitz:                         Right so it sounds like this could be part of an effective anti-aging program just to take on an ongoing basis.

Dr O’Neil-Smith:               Yeah so if you were going to think about what are the best anti-aging … or rather than that, the best products that you would use for a health span as opposed to a life span.

Dr. Weitz:                            Yeah I just did a podcast very recently and we talked about that with Dr. Kaufmann. She’s got a whole book on anti-aging. She has really some great protocols there.

Dr O’Neil-Smith:               It’d be interesting to know, but everybody has their favorites and it’s probably based on their experience with what they see. Omega 3, hands down. You need omega 3. It makes no sense not to have it. I measure those levels. Everybody is ridiculously deficient. I think the dosage would be between five and 10,000. If somebody has a bleeding diathesis and they could bleed a lower amount, there is no reason to not take this on coumadin because that’s crazy. So I think omega 3.

                                         I think vitamin D, which is not a vitamin, it’s a hormone. It got promoted when Pluto got demoted from a planet. Vitamin D got promoted to a hormone. Vitamin D is really essential for the immune system. It’s really essential for the soft tissue and generally it’s going to be between two and 10,000, depending upon what you’re treating, International Units per day.

Dr. Weitz:                         Vitamin K2?

Dr O’Neil-Smith:               Vitamin K2. You can take that with it. It makes it easy. Now you just have two supplements. You’ve got omega. You’ve got D with K2. The third I would probably do is BPC because it’s easy, it’s affordable, it’s effective. Take a low dose. It’s going to keep you well. The fourth I might consider would be probably an NAD plus. That’s to keep-

Dr. Weitz:                         I’ve been using the NR, nicotinamide riboside.

Dr O’Neil-Smith:               It comes in many forms, but one way or another, get some NAD. It could be as an ATP fuel. It could be as NAD plus. There’s many different ways of getting it, and you’re familiar with that. The next product that I might use is probably a match with resveratrol versus curcumin/turmeric. So I think those are really, really beneficial. Curcumin and turmeric are similar. There are really good forms of curcumin.  Find a good form. Stick with that form. Go with that.  The next product, again resveratrol, you maybe can get that by I don’t know start with drinking two ounces of dark tart cherry juice a day a day instead of buying a supplement.

Dr. Weitz:                         Therapeutic dosage requires 26 bottles of red wine a day.

Dr O’Neil-Smith:               There are some good supplements out there for resveratrol as well.

Dr. Weitz:                         I definitely take every one of those. I’m on the same page with you. Plus tocotrienols, astaxanthin.

Dr O’Neil-Smith:               NAC.

Dr. Weitz:                         NAC. Acetyl-L-carnitine.

Dr O’Neil-Smith:               And then probiotics. I mean probiotics are a little tricky. I would say that everybody probably needs a probiotic with I don’t know 25 billion whatever it is. If they can find a probiotic with resistant starches, fantastic. Those are the prebiotic. The resistant starches are key. Those are more fibrous. They’re very good. You could take resistant starches alone. Phenomenal. So that’s really…

Dr. Weitz:                         As long as you don’t have SIBO.

Dr O’Neil-Smith:               Yeah you want to get your bowel moving before you do that for sure. You want to not be constipated when you do that. And then the things not to do, right, if you didn’t grow it, can’t pick it, don’t eat it. Really important. The longer the shelf life of the food, the shorter your shelf life. Really basic stuff.  Salt.  Get rid of sodium chloride.  We don’t have a sodium deficiency in our body but because the sodium is so high it makes our magnesium low relatively.  It makes our potassium low.  It makes our zinc low.  It makes many minerals low.  So absolutely really be cognizant of those processed foods. They’re full of salt.

                                                If you can figure out the foods that glutamate is in, or monosodium glutamate and where it’s hidden in foods, that’s really important. So if you look up MSG hidden sources or you look up Russell Blaylock, who is an MD, whose really just written some phenomenal books on that, on excitotoxins and how they kill your nervous systems. MSG being one of the major ones, glutamate … I think it’s really important to understand that.

                                                Those are some things to get rid of. Those are some things to add. I think that those are kind of universal. Those are if you come in and you want the number one in my practice, you just got it.

Dr. Weitz:                            That’s great. Awesome. Thank you, Dr. O’Neil-Smith. So how can patients and/or practitioners get a hold of you to find out about your programs and seeing you as a patient, etc?

Dr O’Neil-Smith:               So you know it’s really funny but in the last year, year-and-a-half, I decided to lead. Not to create followers, but to create leaders. I have developed a couple of things with another doc who we work quite closely together with because we have the same why. Simon Sinek says why are you doing this? Our why is to really leave a legacy of making a difference in medicine in a new way and being thought leaders.

                                                I have a program where I teach doctors and that program is a master class. We do that through Zoom. We finished our first master class, which was nine months. We’re going to shorten it to a six-month window. We basically meet on Zoom with a number of clinicians. You can look at treatwellness.com and see information for that. It’s called the Treat Wellness Peptide Master Class, but it’s principles about that. So that was amazing. The doctors … we just got their survey. It’s been amazing. The goal is to lead and create more leaders.  I want colleagues. I want a doctor like me in every state that you can send somebody to if you need help. I also know that in the trenches are the people that I work with, whether they’re the health coaches in my office, the PA in my office, whatever they do, psychologist in my office. Those people are probably more important for me. We teach those. We have a program that we’re developing through full scripts where we teach other than MD/DO, all about these things and how they can use them in their practice and how they can know when to refer and be on a team, and be leaders in their industry.

                                                Because we want to change brain health and we want to change gut health, and we want to avoid continuous injury. The other thing that I have is a website that’ll be published this week called Fire Em Up … Firrimupdoctors.com, and on that website we’ll have podcasts like you have that are designed to just be educational and direct to people like you, people like health coaches, people like really good body workers, athletic trainers, nutritionists, etc., who can be working with patients. It takes a village.  On there we have docuseries with experts, podcasts with experts, teaching on principles on medicine to try to avoid people from having a life span and not a health span. So firrimupdoctors.com. That’ll be out this week. You’ll see us doctors with their patients in the clinic giving an example of specific cases. You’ll hear experts like Dr. Fasano, Alessio Fasano from the Mass General who is a gut health expert and mucosal immunity. You’ll hear hormone experts. You’ll hear brain experts like Dr. Perlmutter. We’ll have all of these doctors on there.  Then we’ll also have … whenever we’re at a conference we’ll do a Facebook live. We’ve got Facebook live conferences in the past. We’re going to promote those as well just to educate. It’s free education. Come on. Learn about who you should go see and for what particular thing that is ailing you. So you don’t only treat the symptom of bloating or pain or headache. You treat the root cause. You get to the cause of that symptom and you make it go away more predictably. Maybe not for good because we can’t predict that, but maybe more predictably.

Dr. Weitz:                         That would be great. If you could email me those links, I’ll make sure to put them in the show notes.

Dr O’Neil-Smith:               That’d be good. Great. I will do that.

Dr. Weitz:                         Thank you, Doc.

Dr O’Neil-Smith:               You’re so welcome. Thank you, and thank you for the work that you do.




Methylation with Dr. Jess Armine: Rational Wellness Podcast 129

Dr. Jess Armine discusses The Truth About Methylation with Dr. Ben Weitz.

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


Podcast Highlights

4:31  What the hell is methylation and why should we care about it?  Methylation, which refers to placing a methyl group on a protein, is an important process in all points of DNA replication and in the actual turning on and turning off different genetic pathways.  Methylation affects whether certain genes get expressed or not. This is the way our physiology gets regulated.

7:00  Dr. Armine says that sometimes he will get a call from a patient who is fearful because they found out that they have MTHFR, which is one of the genes that regulates the methylation pathway. The first two variants that were studied were the C677T and the 1298C, but there are actually 50 different variants.  If you have one copy of one of these variants, you are said to be heterozygous and if you have two copies of one of these variants, you are said to be homozygous.  If you are heterozygous for one of these variants–if the genetic report shows yellow–it means that the enzyme that that gene creates is working at about 60% of the way that it should. If you are homozygous for one of these variants–if the genetic report shows red–it is working at about 20% of the way it should be doing.


10:59  When you look at the folate pathway, which starts with FOLR1 and FOLR2 and then goes to DHFR, which goes to MTHFD1, until you get MTHFS, until you get to MTHFR.  That pathway requires those genes and their enzymes to function, which requires NAD, vitamin B3. For MTHFR to work it needs at least B2 and B3 and if you don’t have enough B2 and B3 and you already have a 40% reduction due to a heterozygous SNP, then that is really significant. Other factors that can slow down the folate pathway are dairy antibodies, methotrexate, synthetic folic acid, large amounts of green tea, and grapefruit seed extract, among others. Synthetic folic acid is a problem because if there is a SNP, then it may not get conjugated and create the end product, 5,10-Methylenetetrahydrofolate. Therefore, synthetic folic acid if it is not properly metabolized can lead to an increase in homocysteine and a hypercoagulable state that increases the risk of blood clots, accelerated atherosclerosis, and miscarriage.  Also consider that in contrast to the natural folate found in green, leafy vegetables like kale, spinach, arugula, and swiss chard, synthetic folic acid is added to many flours, breads, and to other processed foods, as well as in many multivitamins, including prenatals.  Unmetabolized synthetic folic acid can also lead to an immune dysfunction through the dysregulation of natural killer cells, and potentially increasing the risk colorectal and other forms of cancer. [Here is one article on this topic: The hazards of excessive folic acid intake in MTHFR gene mutation carriers: An obstetric and gynecological perspective.]  Dr. Armine explained that when managing a patient who may have genetic variants of the MTHFR gene, it is important to start with foundational lifestyle factors like drinking better water, breathing better air, managing stress, earthing, etc.

20:52  Dr. Armine may run a methylation panel, such as the panels from Doctor’s Data (Methylation Profile) and Genova (Methylation Panel), that measures some of the methyl donors like methionine, S-adnosylmethionine, and choline and plasma metabolites like homocysteine.  He mentioned that it is now preferable to get the raw genetic data from Ancestry.com, since the 23 and Me panel now measures far fewer genes than they used to. 

24:05  When you see Dr. Armine, he will take your raw genetic data and put it through a software analysis, such as Dr. Ben Lynch’s StrateGene and MTHFRsupport.com to be able to pull out the data that allows him to make specific recommendations for diet and supplements to improve your health.  Dr. Armine also said that he likes to run an organic acids profile, which shows the results of the pathways.  You can see indicators of mold, of candida, of SIBO, of clostridia.  You can see the oxylate status, since high oxylates is a major reason for illness. High oxylates is secondary to candida.  In the organic acids profile you can see the function of the Kreb’s cycle and you can see the neurotransmitter metabolites.

29:42  Dr. Armine talked about the importance of cell wall integrity and if you have inflammation, you have leaky cells, which is a lack of cell wall integrity or function. Dr. Armine wrote a book with Elizma Lambert, an Australian Naturopath, called Leaky Gut, Leaky Cells, Leaky Brain. Often we don’t look at the function of the cell wall and one way to assess that is with the Omega Quant test for omega 3 status.

31:32  The idea of methylation essentially is to create SAM-e. Some practitioners concentrate solely on giving methylated vitamins: methylfolate, methyl B12, dimethylglycine, trimethylglycine, or SAM-e.  But there are some patients that respond negatively with methylated B vitamins, esp. those with anxiety.  If patients do react poorly to methylated B vitamins, there are now multivitamins and B-complex products that use folinic acid or natural folate instead of 5-methylfolate and they have hydroxocobalamin and/or adenosylcobalamin, instead of methylcobalamin or the synthetic cyanocobalamin, which is very poorly absorbed, and patients usually don’t have a negative reaction to these.

39:35  If you have a patient with elevated homocysteine and you place them on a formula of methyl B vitamins to reduce their risk of heart disease and if they don’t feel well, then you have to look at the methylation pathways and see where the blockage is.  This is when running a methylation panel and doing organic acids testing can be especially helpful.  The transsulfuration pathway could be blocked up by CBS going backwards.  Homocysteine goes down the transsulfuration pathway past something called cystathione B synthase to become cystathione, and then cysteine to eventually become glutathione, and then glutathione, when it gets used up and gets oxidized, gets recycled. So that whole big, long pathway can get blocked up, if you will, and if you think about it like a highway, it’s going to block up, and where it’s going to block may be one of the reasons for higher homocysteine.  We have to look for reasons why you have inflammation in your body, which from a Functional Medicine perspective could be mold, heavy metals, other toxins, food sensitivities, nutritional deficiencies, leaky gut and other gut problems.

43:31  Overmethylation is not a good thing and could even increase risk of breast cancer.  If you are taking methylated B vitamins or a multi with methyl B vitamins and you feel anxious or other symptoms of being overmethylated, the first thing you should do is stop taking the supplement and switch to a multi with hydroxycobalmin and Naturefolate.  A first aid solution is to take plain niacin, the flushing kind, about 25 mg per hour and it will chew up the methyl groups.  Keep in mind that if you are taking a large dosage of niacin, it can result in undermethylation and elevated homocysteine.  But ultimately you need to discover and treat the underlying causes of inflammation using the Functional Medicine model.



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

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz with The Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field.  Please subscribe to The Rational Wellness Podcast on iTunes and YouTube, and sign up for my free e-book on my website by going to DrWeitz.com. Let’s get started on your road to better health.  Hello, Ration Wellness Podcasters. Thank you so much for joining me again, today. Please go to Apple Podcasts and give us a ratings and write a review. That would really help us. More people will find us when they do a search for alternative health podcasts. Also, if you’d like to see the video version, go to my YouTube page. If you go to my DrWeitz.com website, you can find detailed shownotes and a complete transcript.

                                Our topic for today is the truth about methylation with Dr. Jess Armine. Methylation refers to a chemical process involving the attachment of a methyl group, I know that sounds very scientific, which is a carbon and three hydrogen atoms joined together to our DNA, and this has received quite a lot of attention over the past several years, especially in the functional medicine world.  DNA methylation is essential for normal development and for many functions in the body including DNA production, liver detoxification, controlling inflammation, hystamine metabolism, estrogen metabolism, immune function, energy production, mood balancing, among others. Methylation deficits have been associated with many disease states including various autoimmune diseases, autism, cardiovascular disease, depression, inflammatory bowel disorder, insomnia, fertility problems, among others.

                                On the other hand, over-methylation can also cause a number of health problems including increased risk of breast cancer, etc. It has now become common practice in the functional medicine community to … That’s Dr. Armine. He’s flying in from the East Coast. It’s now become common practice in the functional medicine community to assess methylation status by measuring a few genetic polymorphisms including the SNPs for MTHFR and COMT, and some practitioners will also measure homocysteine levels.  There’s a tendency for those of us who think about methylation to concentrate solely on the gene aspect, but today we’ll discuss the significance of methylation, what it is, what it isn’t, how you can help the methylation process, and what pitfalls to be aware of.

Our interview today with Dr. Jess Armine, he is a doctor of chiropractic, a registered nurse, and he’s been a healthcare professional for over 37 years. He’s trained in chiropractic, methylation, genetic research, neuroendoimmunology, say that three times fast, functional medicine, applied kinesiology, and cranial manipulation.  He’s one of the few specialists in the United States who’s an expert at correlating the genetic SNPs with the neuroendoimmunology. He also correlates this with acquired mitochondrial dysfunction and cell wall integrity, if you have any idea what that means, to identify hidden imbalances and hidden stressors in the body. Then he develops individualized treatment plans for patients. Dr. Armine, thank you so much for joining me today.

Dr. Armine:         Thanks so much, Ben. I appreciate it. It’s a very good introduction.

Dr. Weitz:            So I tell you what-

Dr. Armine:         Whatever this is.

Dr. Weitz:            What the hell is methylation, and why should we care about it?

Dr. Armine:         Well I’ll tell you, methylation is a term that’s been bandied about very, very significantly for the past couple of decades now. Methylation is an important process in all points of DNA replication and in the actual turning on and turning off different genetic pathways.

Dr. Weitz:            Okay, so let me just stop you real quick there. So what you’re saying is we all have these genes, we’re born with the genes. Essentially, they don’t change.  However, some genes get expressed and some genes don’t get expressed.  You could also refer to this as the gene is turned on or the gene is turned off.

Dr. Armine:         That is correct.

Dr. Weitz:            And what you’re saying is that when genes get methylated, they either get turned off or turned on. Is that correct?

Dr. Armine:         Essentially, that’s correct because … If you really want to learn about methylation, honestly, you can go to YouTube and look for the simple … there’s a couple methylation raps, and some people do about a two or three minute video, and it gives you a general idea of what’s happening. One of my favorite sayings lately is that we can understand the body right down to the quantum level, but we can only intervene globally.  The understanding of methylation should be as follows: number one, we’re not talking about the genome, we’re talking about the epigenome. You’ll hear the word epigenetics, and that means that set of genes that creates or encodes the enzymes that run our bodily processes. They are static as is our genome, but the environment and other factors can interfere, can alter, those enzymatic pathways.  Without getting super, super technical, because super technical doesn’t help us.  What helps us is understanding that methylating proteins, putting a methyl group on different proteins, in certain areas will turn things off, in certain areas will turn things on. Let’s think of it as balancing and regulating physiology because that’s what it does. The reason that we should look at it like that is to decrease the amount of angst and fear that I constantly hear from people.  As you said, I’m an epigenetic expert.  I’m one of the recognized in the world.  I take that as a sacred trust.  So when I get a call from somebody who says, “I just found out.  I have MTHFR, compound heterozygous.”  You can hear them sweating over the phone.  My first question is-

Dr. Weitz:            By the way, compound heterozygous?

Dr. Armine:         I’ll explain it in a second.

Dr. Weitz:            Okay.

Dr. Armine:         I’ll simply say to them, “Look, were you sick yesterday?”  “No, I feel fine.”   “Then you’re not sick today.” MTHFR, that was my segue into MTHFR, okay?  MTHFR is one of the quintessential genes that represents the methylation pathway.  MTHFR, the big word is methylene tetrahydrofolate reductase. I always tell my patients, “When I say something fast, ignore it.  Because I’m going to explain it.”   What MTHFR does, really, is take the result of what we do with folates and turn it into the active five level folate.  Which contributes to the creation of SAM-e, and SAM-e is what takes your methyl donors and puts them all around to different places. So the creation of SAM-e becomes a primary thing to do. But we think of the active methylfolate as being the thing that helps DNA repair, and it would be correct.  Does the mechanism really make a difference?  Not unless you’re a practitioner and you have to intervene, in which case then you should know the basics because you want to know how to intervene to the patient’s best benefit.  

                                MTHFR, when they first studied it, they studied two variants. You have to understand something about genes. It’s not just a gene. You have a gene with a whole ton of variance. For instance, MTHFR has got 50, count them five zero, variants. Generally speaking, the C677T and the 1298C are the ones that were studied at first. When they talk about heterozygous and homozygous in a gene, we’re talking about the estimate of its innate ability to function.  You look at a genetic report, you see green next to something which is usually -/-. It means that the enzyme that that gene creates is going to work the way it’s supposed to, given nothing else going on. If it’s yellow, or heterozygous which is a +/- means that it’s working at about 60% of the way it should given nothing else. If it’s red, or homozygous, working about 20% of the way it should be doing, given nothing else going on.  So when somebody has compound heterozygous, they are +/- or heterozygous for the 1298C and the C677T.

Dr. Weitz:            So let me just stop you real quick. I often hear practitioners say, “Well, you’re heterozygous for that so it’s really no significance.”

Dr. Armine:         That’s true. Here’s the-

Dr. Weitz:            And the reports usually say that, too.

Dr. Armine:         True.

Dr. Weitz:            You only have one copy so it doesn’t mean anything, but you’re saying you can still have a 40% reduction of your ability to create that enzyme or for that process in the body to happen. So that could still be significant.

Dr. Armine:         It can be. Let me ask you a question.

Dr. Weitz:            I mean, if I told you you had a 40% reduced heart function, you’d want to know about that.

Dr. Armine:         Well yes you would, but let me frame it in the way that it’s working. First of all, remember that you’re born like this.  If you’re as a baby functioning well means that it doesn’t matter where the polymorphisms are. Now remember… 

Dr. Weitz:            There’s probably different genes that-

Dr. Armine:         There are, but here’s the reality of the situation. Let’s take the folate pathway which starts from FOLR1, don’t worry about these letters, FOLR1 and FOLR 2, DHFR, and DHFD1, until you get MTHFS until you get to MTHFR.  Don’t worry about all of that big stuff.  That pathway requires those genes, those enzymes, most of them require NAD to work, B3.  For MTHFR to work, it needs at least B2 and B3 to work.  So for instance, if you don’t have enough B3 in your cells and B2, those enzymes are going to slow down significantly, and if there’s already a 40% reduction, wow.  Now, there are factors that will slow down the enzymatic reactions. For instance, in the folate pathway, dairy antibodies, methotrexate, folic acid, large amounts of green tea, grapefruit seed extract, are some of the things that will slow those enzymatic reactions down.  Now, I want you to think of the yellow or heterozygous variants…

Dr. Weitz:            Now, you said folic acid. So you’re talking about something different than what is often recommended by a doctor like you-

Dr. Armine:         Right.

Dr. Weitz:            … which would be a form of folate versus folic acid-

Dr. Armine:         Exactly.

Dr. Weitz:            … which is the synthetic form, which is-

Dr. Armine:         There’s significant problems with the synthetic form, and thanks for bringing it up because it’s true. It’s been used many, many years, but there are problems with the way that it’s conjugated. It doesn’t create the end product, which is 5,10-Methylenetetrahydrofolate that MTHFR, methylene tetrahydrofolate reductase turns into 5,10-methylenetetrahydrofolate or 5-methylfolate.  Here’s the thing that I want people to understand, that let’s say that yellow is a four lane highway, red’s a two lane highway, and green’s an eight lane highway. If I had a bunch of yellows and everything’s running the way it should be because nothing wrong with me, but then I start blocking those areas by putting all of those factors in that slow it down, like the dairy antibodies and so forth, and then I don’t give my body enough B2 and B3, that’s like taking a four lane highway and putting a construction crew in there so that maybe one or two lanes are going by. That’s when you start getting symptoms.  It’s the polymorphisms or the SNPs will give you an indicator of what a pathway may not work so well under an oxidated stress load or when other things are going on that would slow it down innately. By itself, it means nothing. Rather it gives you a heads up.  Now if you’ve got a compound heterozygous, you start looking around on the internet, this is where I get the panicked calls. You have to realize-

Dr. Weitz:            This is where you have … When you have a genetic variant, you can have one copy which is a heterozygous.  So let’s say the normal is AA, and then you have an AG, which is one copy of a variant gene, or a homozygous whereas you have a GG instead of an AA, so you have two copies. So you’re saying if you have one copy of one gene, and then you have one copy of another gene involved in the same process that that’s what you’re calling a compound heterozygous.

Dr. Armine:         Yeah, that’s a fairly commonly used term for heterozygous of the gene variants that are usually studied, the 1298C and the C677T. So you go to a LabCorp or you go to Quest, and they test MTHFR. Those are the two variants they’re testing, okay? They’re not testing the other 48 variants, and it’s hard to get a study where you can see a lot of those variants.  Nevertheless, the thing that everybody needs to know, practitioner and lay person, is that when you go to those websites that say, “MTHFR, or SNPs of MTHFR, cause this,” and they’ll say, “cause blood clots, cause infertility, cause stillbirths,” and then if you’ve got compound heterozygous, oh my god you should jump off a bridge because this is a list of symptoms, list of things, you’re going to get it. Those are incorrect, and I’m going to tell you why.

                            When MTHFR was first studied, it was studied in relation to homocysteine.  So they thought that if they looked at the SNPs of MTHFR, we could predict high homocysteine or homocysteinemia and that would be a predictor of cardiac disease.  That didn’t work out so well.  So anybody who had anything wrong with them started testing for these genes, and the erroneous conclusion, because a lot of people have polymorphisms, a lot of people have SNPs. They just do. It’s just the way our genome is, epigenome.

Dr. Weitz:            It’s like 60% of the population has at least a heterozygous SNP for MTHFR.

Dr. Armine:         Right.

Dr. Weitz:            But homocysteine is still a recognized risk factor for heart disease.

Dr. Armine:         Oh it is, absolutely.  Absolutely, it was the relationship between MTHFR and homocysteine.  So everybody started testing for it, and anybody who had anything wrong with them … So the erroneous conclusion was that they came up with these lists of things that MTHFR would cause.  A gene doesn’t cause anything.  So everybody got scared and said, “Look, if I have this problem, I’m going to concentrate on this.”  Well, that’s wrong.  You have to concentrate on the bigger picture.  So yeah, it does have a relationship to homocysteine.  High homocysteine is one of the ways you can test if you have problems with MTHFR and high homocysteine, now you know it’s expressing.  Now you know what to do, okay?

Dr. Weitz:            So any gene is just going to increase or decrease your tendency for something to possibly happen?

Dr. Armine:         Exactly. Okay, and that is more basic … This is where we came up with foundational treatment, otherwise known as the framework…

Dr. Weitz:            Right, it’s your environment, your lifestyle, your diet, your exercise, all of those things that will determine whether or not that genetic tendency get expressed and you actually have some issue in your body.

Dr. Armine:         Hence, hence when you go to look at your MTHFR status and your practitioner does some testing to make sure that you’re not in any kind of danger, the beginning fix is to do exactly that, changing your lifestyle, drinking better water, breathing better air, managing stress.  There’s a lot of talking about earthing these days, grounding, and so forth.  I love on beautiful Cape Cod, except for the sharks. So I do a lot of walking on the beach. I don’t do a lot of swimming. They’re passing by. I know they’re only waving at me, but in the water let’s face it, I look like a seal. I don’t want to look like a seal in front of those guys.

Dr. Weitz:            “Dr. Armine, come in the water.”

Dr. Armine:         No. I’m like this, “Unless you’re a land shark, I’m staying here.”

Dr. Weitz:            A little nibble won’t hurt you.

Dr. Armine:         Yeah. On my phone, we have this thing called Sharktivity, so every time they see a shark, I kid you not, it goes off, and you see it’s plotted where all the sharks are. They close the beaches. Well, now it’s September. The sharks are still around, and there’s a lot of them around. I’m not going in the water, and they’re everywhere. I see some of them, they’re getting a little tired so they’re like on the highways going like this with their thumbs out, if they had thumbs, they’re like,… You know? Get back in the water. No, no, no, no, no. 

Dr. Weitz:            We need some better food. These fish are all loaded with plastic. We can’t eat them anymore.

Dr. Armine:         The reason they’re here is because we have the national seashore, and it’s got thousands of seals. Thousands.  And the seals protect themselves by swimming close to shore. So you see the great whites, we have videos of them, 10 feet off the shore, 15 feet off the shore. That’s not even waist deep, guys. You know? I’m not arguing with a great white shark. I went whale watching. There were whales all over the place. We saw dolphins, and then a great white came by saying, “How are you doing?”  Okay. You know? We’re just waiting for one of those whales to bite.  There was this big whale that was dead, and they were just all feeding off, they were having a good time.  They’re not really aggressive. It’s just you don’t want to look like a seal.

Dr. Weitz:            Right.

Dr. Armine:         You know, like he looks like a seal.

Dr. Weitz:            So let’s get back to methylation.

Dr. Armine:         Well the sharks methylate too, I mean really.

Dr. Weitz:            Of course.

Dr. Armine:         Hey, we all need to methylate. You know, they’re like, “You know about methylation?” You know, like whoa. Okay, guys, just you know.

Dr. Weitz:            That’s how you get over-methylated.

Dr. Armine:         That’s right. You want to know about …, my other background it says the new thing you know, “Keep calm and swim fast.” You know? I’m sorry, I’m in trouble. Go ahead.

Dr. Weitz:            Or use the buddy system. If you see a shark, give them your buddy.

Dr. Armine:         Just remember, it’s like seeing a bear. I don’t have to outrun the bear, I have to outrun you. That’s true, you know. The same thing with the shark. I’m just going to lay there. You’re going to be flapping around. It’s going to go after you, not me. 

Dr. Weitz:            Okay, so if these genes that code for methylation tendencies …

Dr. Armine:         Yes.

Dr. Weitz:            So if we measure some of these genes, do we also want to measure serum levels of the substances that result from the expression of methylation?  Like you mentioned, homocysteine.  There’s some labs like Doctor’s Data that have-

Dr. Armine:         A methylation panel.

Dr. Weitz:            … a methylation panel and measure methionine and SAM-e, and some of these others.

Dr. Armine:         Exactly.

Dr. Weitz:            Is that what you want to do because that tells us whether the genes are getting expressed?

Dr. Armine:         Exactly, and I’ll tell you why.  First of all, if you have a genetic test, whether you get your data from 23andMe or from Ancestry.com.  By the way, I wouldn’t suggest 23andMe anymore.  Okay, Ancestry.com 

Dr. Weitz:            You don’t?  How come?  What’s wrong with 23andMe?

Dr. Armine:         23andMe has changed their … when you do a test, it’s run through a computer, and there’s a chip that reads the genes. It used to be the V2 chip, and it read 500,000 genes.

Dr. Weitz:            Right.

Dr. Armine:         And then they came out with the V4 which is 250,000. Now, they changed their chip, 23andMe, to read only the genes that they were utilizing for their purposes only. The reason 23andMe got so big was because people like myself were able to take the raw data and put it into different programs so that we could pull out what we wanted. Okay, for what we needed to see.

Dr. Weitz:            That’s what we do in the office as well.

Dr. Armine:         Yeah, but they’ve changed it. So what I’ve recommended to my patients, for whatever it’s worth, is to use Ancestry.com’s, their cheapest offering, and they still use a V4 chip.  So wherever I put that data, I’m getting more data, and-

Dr. Weitz:            What about the outside labs that do genetic testing? I know Diagnostic Solutions has … I think they just recently released a new genetic panel.

Dr. Armine:         They have. I haven’t had the chance. I read what everybody sends me, but I have a … You and I have been in practice a long time. I’ve been in practice actually more than 43 years now. Okay, so we’ve seen a few things come down the pike, haven’t we?

Dr. Weitz:            Yes, we have.

Dr. Armine:         Chromium picolinate, ahh. Then all of a sudden, “It’s just chromium,” you know? I remember when GHB was a weightlifting drug, and now it’s a date rape drug. I wait, okay. So when I see … No, seriously. Come on, how many things have you seen come down the pike? CoQ10, the greatest thing since sliced bread, right? No, it only helped a few people here, but in Japan it was helping a lot of people because their diet was deficient in it.

Dr. Weitz:            Right, well DHEA was going to be the almighty …

Dr. Armine:         Right, exactly.

Dr. Weitz:            DHEA was going to reverse everything.

Dr. Armine:         Right, and that’s the way it always comes down. So when something new comes out, I read it, I wait, and usually some patients will bring the test to me, I’ll read it, and after I read several of them, if I see that what I’m looking at correlates with their symptoms then I’m going to start believing the validity of the test. It’s just too early with that one.

Dr. Weitz:            Okay, so you don’t have a favorite panel right now.

Dr. Armine:         The two panels I tend to use are StrateGene, which a new version is supposed to be coming out this month, which is going to be more robust, and I use MTHFRsupport.com, although that’s gotten top heavy lately because there’s too much information in there, and unless you’re a practitioner it’s hard to pull out what’s important. Although, if you wanted to see every pathway like nobody’s business, it’s all going to be there.

Dr. Weitz:            Is that analysis software, or that’s testing?

Dr. Armine:         That’s analysis software. The testing, you would use either the Ancestry or the 23andMe 

Dr. Weitz:            Oh, those are the only two panels you use? You haven’t used any of the other panels?

Dr. Armine:         I haven’t used any of the other panels. I’ve read them. I haven’t recommended them, but people come to me with all different panels from all different places, and I can read them. That’s not a problem, but when I’m looking at … Somebody says, “What do I do with this data?” I give them the options of one of the two, and it works because what you have to do is correlate what you’re reading with their particular symptom complex, and with a good history you’re going to figure out what.  You have your genetic tests in front of you, and then you have a suspicion based on their symptom complex of what might not be working, and if you want to confirm that, things like the methylation panel. They are really strong on the methylation issue. The methylation panel is great. Things like the organic acid tests are great. There’s another test-

Dr. Weitz:            So what can you get out of an organic acids panel?  What will that confirm for you?

Dr. Armine:         The organic acid panel is measuring organic acids, which are the result of the pathways.  So in the typical organic acid test from let’s say Great Plains, you’re going to see indicators of mold, of candida, of SIBO, of clostridia. You’re going to see the oxalate status which is really important because high oxylates is one of the major reasons for illness. It’s secondary to candida, but you’ll see it there.  You’ll see the function of the entire Kreb cycle, how you create your energy. You’ll see the neurotransmitter metabolites. You’ll see the functioning of glutathione and many other things, and you’ll see the levels of the various B vitamins and some minerals. So you can have a really good idea of what’s going on physiologically because you’re not measuring serum levels, you’re measuring the organic acid that is a result of the intracellular functions. So what they’re dumping out of the cell is what you’re measuring. So you can extrapolate the cellular function.

Dr. Weitz:            It’s gone through metabolism, it’s being processed, and that’s what the body’s getting rid of.

Dr. Armine:         Right. So you can really extrapolate easily if you just think of it like that.

Dr. Weitz:            Okay.

Dr. Armine:         Everything’s got a couple of glitches, but once you know how to read it, it’s not a big deal.

Dr. Weitz:            So organic acids panel. Any other tests you like to use?

Dr. Armine:         I don’t use the methylation panel too often because I treat methylation on a more basic level.

Dr. Weitz:            Do you measure homocysteine levels?

Dr. Armine:         I do. It depends on the individual. If they’re in the States, they usually have insurance that will cover LabCorp requests, and I can write them a script for that, and then I can get those, like vitamin D 25, 125, yadda, yadda, yadda. I can get those tests that way. There’s another-

Dr. Weitz:            You ever do a full nutritional status panel like the SpectraCell Micronutrient Test or the Genova NutrEval test?

Dr. Armine:         Concerning NutrEval, NutrEval and the GPL OAT, when I weigh the both of them I lean towards the GPL OAT. The SpectraCell Micronutrient analysis is really wonderful because you can see the status of what’s going on inside the cell, and you’re looking at a six month status. You know how a hemoglobin A1c measures your sugar for the past three months? 

Dr. Weitz:            Supposedly, yeah.

Dr. Armine:         Well, roughly. It’s never an exactitude, but you can see generally speaking what’s been going on.

Dr. Weitz:            Right.

Dr. Armine:         Okay, because of the glycosylation of the proteins, but since the SpectraCell test measures what’s going on inside the white blood cells and they generally last around six month, you can get a bigger view. So instead of seeing what happened over the past couple of days, you’re seeing what’s happening over the past couple of months. Plus, they measure and they test the function of the immune system and the function of the antioxidants, okay? So that’s really valuable.  There’s another type of testing, functional diagnostic testing, and on the status quo, the ODX which is a massive panel that you can do that covers … it’s a blood test, and it covers, oh my god, so many different areas.

Dr. Weitz:            If you do the SpectraCell micronutrient test, if you throw in the cardiometabolic panel, you’ll get blood sugar, lipids, hemoglobin A1c, it’ll include homocysteine as well.

Dr. Armine:         Oh, cool.

Dr. Weitz:            It’s pretty reasonably priced.

Dr. Armine:         That’s good.

Dr. Weitz:            When you order the micronutrient test, you can throw that one in.

Dr. Armine:         Okay, thank you. I didn’t know 

Dr. Weitz:            And oh, it also includes omega-3s.

Dr. Armine:         Wonderful.

Dr. Weitz:            Yeah.

Dr. Armine:         Yeah, I measure omega-3s through something called OmegaQuant, but if there’s a single test. I like 

Dr. Weitz:            Yeah, they include it in their cardiometabolic panel, the 6:3 ratio and all of that.

Dr. Armine:         Yeah, because that’s how you tell what’s going on. You also need the AA:EPA ratio.

Dr. Weitz:            Yeah.

Dr. Armine:         You talked a little bit about cell wall integrity, what does that mean? You have to remember that the cell wall is not just a wall. The cell membrane is what determines what goes out of the cell, what’s being allowed into the cell, and it’s being called, recently but it’s gaining speed, it’s being called the master of the cell more than the nucleus.  When you have chronic inflammation, you have a lot of problems, people talk about leaky cells. What that means is a lack of cell wall integrity or cell wall function, which can come from a lack of phospholipids or a whole lot of other things, and when that happens your cells aren’t going to work.  And if your cells don’t work, nothing-

Dr. Weitz:            Because the cell wall essentially is a phospholipid membrane.

Dr. Armine:         It is a phospholipid bilayer, exactly.

Dr. Weitz:            Right.

Dr. Armine:         Okay. I wrote a book with Elizma Lambert called Leaky Gut, Leaky Cells, Leaky Brain which went through it really, really well. It’s a simple book, it’s an e-book, and I made a very, very large point very easily … because when I write…

Dr. Weitz:            Send me an email with a link so I can put it in the show notes, please.

Dr. Armine:         Oh, absolutely I will. Absolutely. We spent two years on it, and I think it’s kind of a masterpiece because it’s so easy to understand.

Dr. Weitz:            Great.

Dr. Armine:         Nevertheless, when we talk about cell wall integrity as being part of considering how to look at somebody’s condition, you consider the epigenetics, you consider the relationship between neurology, endocrinology, and immunology which is known as the NEI supersystem, you consider the function of the mitochondria, and what many people don’t do is look at the function of the cell wall, and that particular omega test is one of the ways you look at it.

Dr. Weitz:            Okay, cool.

Dr. Armine:         So when you’re talking about methylation, what the idea of methylation is is to create SAM-e, which goes around putting the methyl groups where it belongs. When everything is properly methylated, physiology works the way it was intended.  It gets a little crazy about how the DNA wrapped around histones and it gets a little nuts.  And it’s true, it gets nuts, but the reality is if you get methylation to work correctly, it’s going to be a big contributor to you recreating and maintaining your homeostasis.  Now, how hell the do you do that?  How the heck do you do that?  A lot of people concentrate solely on giving methylated vitamins: methylfolate, methyl B12, dimethylglycine, trimethylglycine, or SAM-e itself. That’s okay. There are plenty of products out there.

Dr. Weitz:            Yeah, for example what if somebody was out there either a patient or a practitioner who was thinking, “You know what? Instead of doing all of this testing, why don’t I do the following?  I’ll avoid any foods or supplements with folic acid, and I’ll just take methyl B vitamins, and aren’t I covered?

Dr. Armine:         Usually, yes.  Here’s the thing that people should know.  First of all, my particular practice is made up of people who have been here, there, and everywhere that aren’t getting success out of their treatments. So obviously I have a very focused population. There are a certain percentage of people that respond very negatively to the methyl vitamins. So, well let’s just talk methylfolate for a second.

Dr. Weitz:            Okay.

Dr. Armine:         There’s loads of reasons for this

Dr. Weitz:            So we have methylfolate which is B9, we have methyl B12 which is methylcobalamin, and then we also have the … I don’t think they’re methyl forms, right? Of B2 and B6, they’re activated forms, right?

Dr. Armine:         No, they’re activated. They’re B2 and B6 would be P5P, B2 would be Riboflavin 5′-Phosphate. Like you said, there are loads of products out there that will put together, and they usually will make a big advertising point about it, and they usually put all the active/methylated vitamins together. This is my advice to everyone who takes this kind of stuff.  Do an experiment with yourself.  Do yourself a favor, especially if you’ve had some really nasty chronic illness for a long time, especially if it’s associated with any kind of anxiety or what I liked to call neuroexcitation.  Only because the reaction to the methyls, they’re going to up-regulate that which is very uncomfortable.  Either take the product you’re going to use or use one methylated product like methylfolate which you can like anywhere, start with a quarter of a dose or a half dose, and over a period of two weeks work your way up to a full dose.

                            Here are the four reactions you’re going to see:   One, if you start taking it and you feel bad, do me a favor: stop. I can’t tell you the people who will say, “I can only take a little crumb of methyl B12.” 

                            I said, “Why are you taking it?”

                            “I need the methyl group.”

                            “No, you don’t. If you’re not taking a therapeutic dose, what’s the sense?” 

Dr. Weitz:            I would like to give a caveat since I’ve been doing the functional medicine stuff like you for a long time, and a lot of times when people feel really crappy and whatever it is they ate or what they took, they automatically assume that that means, “I can never eat that food again,” and… Probably try it a few times in a row before you decide for sure the fact that you’re feeling crappy right now has directly to do with that.

Dr. Armine:         It’s a tough one sometimes to figure out where it is, but often the second scenario is where people get confused because the reality is is some people will start taking the, I’m just going to say the methyl vitamins, the methyl vitamins, and they feel, okay they don’t feel, you know whatever. Then within about two weeks they start feeling bad, and it’s very hard to realize that they’ve blocked up all the pathways, if you want to look at it like that, and they need to stop the methyl vitamins. That’s the second scenario, and if you have an ear for it you’ll say, “Okay, just simply stop what you’re doing and see in a few days if you don’t feel better because if that is, then you know what caused it.” Three-

Dr. Weitz:            You know, a lot of multis now have the methyl B vitamins in it.

Dr. Armine:         Yeah, it’s a big deal. It’s a big deal. Methylation, you really need to understand, is big business. This is why before, when we first started-

Dr. Weitz:            Well, everybody’s doing it because we don’t want to give people unmetabolized folic acid, so.

Dr. Armine:         That’s true. That’s true, but when we first started everybody’s like, “Methylation, no big deal.” Soon as the companies grabbed onto the fact that methylation was important, everybody was testing for everything in their trimethyl groups, and it became hard to find a vitamin that didn’t have it. So in the third scenario-

Dr. Weitz:            Are you saying the average person should take a multivitamin that doesn’t have methyl forms of B vitamins?

Dr. Armine:         No, what I’m saying is that when you take your vitamins, be cognizant of the fact whether they have the methyl B’s in there, and if you start taking that vitamin and you feel bad, it’s most probably that, and simply stop taking it.

Dr. Weitz:            Okay.

Dr. Armine:         If you start taking the vitamins and within two weeks you feel bad, then stop. Okay?

Dr. Weitz:            Okay, sounds good.

Dr. Armine:         If you start taking the vitamins and it’s like you start feeling better, and better, and better, you hit the nail on the head. If you start taking the vitamins and you don’t feel better or you don’t feel worse, it means your body is accepting it, but it’s not the answer to your symptom complex.

Dr. Weitz:            Now, is the amount in a multivitamin typically enough to create negative reactions in more than a small number of people?

Dr. Armine:         Yeah, it is, and a lot of times the amount of folate is limited because of the FDA restrictions. You’ll usually see B12 at reasonable amounts. You’ll always know that you’re getting a bad form of B12 when it says that you’re being given 1,667% of the percent daily value. It usually means you’re getting cyanocobalamin, which is very poorly absorbed.  These days, that doesn’t exist, but if you do have a problem with the methyl Bs, there’s a ton of vitamins out there that have things like folinic acid or natural folate, and they have hydroxocobalamin and/or adenosylcobalamin.  People usually don’t respond … we don’t negatively react to those. The reason I’m- The reason I’m making the point is because if you do have a reaction to it, it’s usually in the excitation, anxiety, or if it’s a child increase in hyperactivity, and you’re looking at it, and the mindset is, “I need this for his methylation, yet I’m going to just fork my way through it, and this …” Remember that if you give somebody substrate and you give them what they need to metabolize it, they’ll create the methylfolate.  Maybe a little slower than the next person, but they’ll create it. There’s usually loads of reasons why you’re not creating it, and that includes lack of B2, lack of B3, lack of substrate, lack of folate like the person doesn’t eat green vegetables at all. Those are the reasons that you don’t produce it.  Now, you can give somebody the problem, give somebody the vitamin, but you also remember what we have to do is find out how they got there in the first place. Because they can take vitamins for the rest of their lives, but that’s not fixing anybody. Yeah, we all need a good multivitamin and multimineral, but we’re talking the bigger picture of having to actually fix things and reestablish normal homeostasis which starts at that basic stuff that you were talking about before: good food, good water, good stress relief.

Dr. Weitz:            Well let’s say you have a patient that has elevated homocysteine levels and you want to reduce their risk of heart disease, and you give them a methyl B formula, a homocysteine oriented, product.  Something designed to help lower homocysteine levels, and they don’t feel well on it.  What other choices do you have?

Dr. Armine:         Well remember, the presumption is their high homocysteine is causing symptoms.

Dr. Weitz:            No, no. Let’s say they’re not having symptoms, but they want to reduce their risk of having a heart attack.

Dr. Armine:         Okay…

Dr. Weitz:            And their homocysteine is 15.

Dr. Armine:         If their homocysteine doesn’t come down, then you definitely want to do the methylation panels, you definitely want to do the organic acid test, and you want to find out where the pathway this is being backed up, if you will, and it could be down the transsulfuration pathway. It could be blocked up by CBS going backwards.  There’s loads of reasons, but this is where a good history and reasonable testing comes in. I agree with you, most doctors that I know-

Dr. Weitz:            But what is CBS going backwards mean?

Dr. Armine:         It just means that if CBS is … I said that…

Dr. Weitz:            If NBC goes backwards, is that the same thing?

Dr. Armine:         Homocysteine goes down the transsulfuration pathway past something called cystathione B synthase to become cystathione, and then cysteine to eventually become glutathione, and then glutathione, when it gets used up and gets oxidized, gets recycled. So that whole big, long pathway can get blocked up, if you will, and if you think about it like a highway, it’s going to block up, and where it’s going to block may be one of the reasons for higher homocysteine.  Nevertheless, what happens is if your homocysteine’s not coming down, it’s telling you you’ve got chronic inflammation somewhere, and your practitioner needs to start investigating that, but when you investigate that, you’re going to find out the reason. It’s like looking at TSH, thyroid stimulating hormone. A lot of times I’ll see that up, I’ll see poorer thyroid function, but the thyroid antibodies are not there.  That’s generalized chronic inflammation.  I better start looking for reasons for that whole person to have inflammation and that’s usually under chronic inflammatory response syndrome, and maybe…

Dr. Weitz:            And from a Functional Medicine perspective, typically we start looking for possibilities like mold, heavy metals, other toxins, food sensitivities, leaky gut and other gut problems, etc, right?

Dr. Armine:         Exactly. This is why…

Dr. Weitz:            Other nutritional deficiencies.

Dr. Armine:         This is why functional medicine and allopathic medicine should actually work in concert with one another. Because the allopaths are really, really good at finding out the gross pathologies. You don’t want to miss those. Okay, you don’t want to miss those. But once they don’t find a gross pathology, the typical joke, “All your tests are negative. You’re fine.” Nope. Okay, if you’re still hurting the functional medicine doctor simply goes back, looks at it from a wider point of view, takes care of the basis of the body, the cell wall function, the absorption of nutrients, the absorption of vitamins and minerals, all that stuff, and then starts looking at it from the point of view of, “What could possibly be contributing to this?” And the functional medicine doc never sits there and says, “That can’t happen.” What they say is, “Well, it’s happening. Why may it be happening?”

Dr. Weitz:            Right.

Dr. Armine:         That’s why we find things that other types of practitioners don’t, so we know what to do. If the normal stuff doesn’t work, that’s where we shine. Okay?

Dr. Weitz:            Right, so I just want to pull out, you mention I think is a really good clinical pearl. If you have a patient and they’re taking a modern multivitamin, say from a practitioner or some of these professional brands, pretty much the majority of them have switched over to methyl B vitamins, and they’re not feeling well or they’re feeling anxious, some of the symptoms that might happen from being over-methylated. Then you should try to find a multivitamin that instead of having methylcobalamin has hydroxocobalamin because you don’t want to take cyanocobalamin because that’s small levels of cyanide, right? You want something called NatureFolate as opposed to 5-methylfolate, and they won’t typically have the same reaction.

Dr. Armine:         True. True.

Dr. Weitz:            Okay, good. So what else-

Dr. Armine:         The way you would know that is simply by stopping the vitamin that you’re taking.

Dr. Weitz:            Right, so what else can happen with over-methylation? What are some of the other dangers? Isn’t there a danger of increased risk of cancer?

Dr. Armine:         In the long-term, in the long-term. Over-methylation as well as under-methylation, remember too much and too little in the body is just as bad. It’s easier to understand if something is too low, if you have DNA hypomethylation, if you will, there’s no sense in even using the terms. When you have too little methylation, you know it makes sense that things won’t work. If you have too much methylation, often if you have an acute over-methylation, you’re going to be … And by the way, if that should happen because you’ve taken too many methylated vitamins, you get regular niacin, you know the cheap stuff, nicotinic acid, the one that causes the flush, and you take about 25 mg an hour, and within a few hours that will calm down because it chews up the methyl groups. Okay?

Dr. Weitz:            Oh, interesting.

Dr. Armine:         It’s the first aid for over-methylation. The other thing is you have to realize that if you are taking B3 and you’re taking a large amount, you may be causing the under-methylation. You might be causing the hypomethylation because you’re chewing up the groups. Nevertheless, hypermethylation, over-methylation, just like hypomethylation can cause different things. Sometimes it’s contributing to breast cancer or any of the estrogen loving cancers.  I really would advise people to look for normal methylation function rather than concentrating horribly on over or under methylation, just trying to normalize it. The over-

Dr. Weitz:            How do we know if we’re over-methylating, assuming you don’t have symptoms?

Dr. Armine:         It’s really tough because some people have related it to the histamine levels and so forth. I haven’t seen the correlation with that. If you’re not having symptoms and you are feeling well, for the most part you’re not over-methylating or under-methylating. If you have a high homocysteine and you add methyl groups … Remember, if you’re really having problems with the methylation system, you’re going to have multisystem symptoms. That’s why methylation is important, to treat or at least consider it. It’s not going to be a thing because the DNA production, protein production, is going to be off which is what’s going to cause problems with histamine and metabolism, neurotransmitters, detoxification. You’re not going to have one problem.

                                If you just have a high homocysteine, usually it’s the simple things that will fix it. Yes, you can use the methylated vitamins, but remember, think about why it got there. If you really are under-methylated, if your methylation’s not working, you’re usually going to be sick. You’re usually going to have chronic fatigue. You’re going to have a whole mess of different things going on, and the effect of the root cause, or the effect of what caused that, causes problems in the methylation system. So yeah, you want to treat it. You want to get that person’s homeostasis as stable as you can, but you want to look for the root causes also. Otherwise, it’s just going to come back.

Dr. Weitz:            Okay. You’ve provided us with …

Dr. Armine:         Been very confusing.

Dr. Weitz:            We could go on for hours, but …;

Dr. Armine:         Yes, we could.

Dr. Weitz:            I do have a patient coming up, and-

Dr. Armine:         I know,

Dr. Weitz:            … we’ve talked about a lot of things. We’ve talked about the connection between great white sharks and methylation, and we’ve talked about the problems-

Dr. Armine:         It’s an important point. Let’s face it, it’s an important point.

Dr. Weitz:            I think…

Dr. Armine:         Especially to the shark.

Dr. Weitz:            This is probably the only podcast that has covered the connection between MTHFR and great white sharks.

Dr. Armine:         If you think about it, it could be shark defense also. You get the methylated vitamins, they’re coming at you, you throw them this way, they’re like, “Ahh,” and they go after them. Like, “All right, thanks. That’s what I was looking for.”   I’m like, “I know. I’m out of here.”

Dr. Weitz:            Oh, no. I got methylated before Dr. Armine jumped in.  So we’ve talked about some of the ways to test our genes, and to look at some of the methylation pathways, and some of the things to look at, and then some of the dangers of over-methylation. How can our listeners, patient and practitioners, get a hold of you and find out about some of your programs?

Dr. Armine:         You can go to my website which is DrJessArmine.com.  You can contact my office of Dr. Jess Armine, or call that number, and I’d be happy … I offer a 15 minute get acquainted session. So you can schedule that, and we can have a chat to see if I can help your particular condition. Practitioners, I also run mentoring groups. I do personal mentoring, but I do group mentoring which seems to work out very, very well. I run those on Tuesdays and Thursdays, and they are 12 week courses where we get together every week as practitioners, go over tough cases, and then take the learning points from those cases and talk about those subjects. So, we find out what the group’s issues are, what they want to learn about, and I guide them through that. So I usually can take a practitioner who is not as familiar with functional medicine, and within 12 weeks have them really, really very functional within it without taking an overt amount of formalized courses.

Dr. Weitz:            When is your next group starting? Maybe you could send me a link for that that I could put in the show notes.

Dr. Armine:         I sure will. I’m going to England starting Sunday until October 3rd, so probably the middle of October, but I’ll send you a link for it because yeah, I appreciate that. I’d like to get out most of my groups are in England, and I would like to have some American groups because I know those are a necessity here. Especially for the younger practitioners who are watching who have got all of this knowledge and simply can’t put the puzzle pieces together, which is what I do. If you want to be the master healer and you want to learn how to put the puzzle pieces together, I’d be very happy to be your guide. Plus, it’s cost effective because what I charge for person to person type stuff borders on the silly. Group is much better.

Dr. Weitz:            Right. Sounds good, doc. Thank you so much.

Dr. Armine:         Thanks, brother. Thank you for having me. I really appreciate it. Take care.



Mitochondrial Testing with Dr. Sri Ganeshan: Rational Wellness Podcast 128

Dr. Sri Ganeshan discusses Mitochondrial Testing with Dr. Ben Weitz.

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


Podcast Highlights

4:24  Dr. Ganeshan was on vacation and there was a conference on autism there and he attended some of the lectures and learned that a significant percentage of patients with autism have mitochondrial dysfunction. He found a scientist, who was working on a test and they collaborated and developed the Mitoswab test that uses a buccal swab to measure mitochondrial status. It has been shown to correlate with muscle biopsy, which is the gold standard for measuring mitochondrial disease. Non-invasive evaluation of buccal respiratory chain enzyme dysfunction in mitochondrial disease: Comparison with studies in muscle biopsy 

7:04  The mitochondria are the the organelles that are the main generators of energy for the cells of the body. All cells, except red blood cells, have mitochondria. Red blood cells carry oxygen and mitochondria use oxygen to produce energy, so if red blood cells had mitochondria, they would use up the oxygen.  After age 60, mitochondria tend to decline and that’s when you tend to see chronic diseases, like cardiovascular and neurodegenerative diseases develop. There are tools to optimize mitochondria function, like exercise.

9:55  The food we eat gets into the mitochondria through complex one and the mitochondria convert it into energy.  In complex 3 and 4 the oxygen we inhale gets converted into water. 95% gets converted into water and 5% forms oxygen free radicals, which can be useful signaling molecules in small quantities. If too much oxygen is converted into oxygenated free radicals, it damages proteins and DNA in our cells, which is a problem.  With oxygen, 5% can be useful as a signaling agent, but 20% would cause cell damage.  This can be measured with the Mitoswab test.  Complex 4 is where the energy (ATP) is produced.

12:51  The mitochondria has these five complexes that are part of this chain of processes that leads to ATP energy production and each can be associated with different diseases. Complex one is associated with diabetes, neurodevelopmental and neurodegenerative diseases. Complex 3 is very important for T-regulatory function and endothelial function. Complex 4 is associated with neuromuscular diseases and seizures. 

18:00  For patients with diabetes, we now know that part of the diabetes process involves mitochondrial dysfunction.  And by improving mitchondrial function, the diabetes will also improve.  As part of your workup for patients with diabetes, in addition to measuring blood sugar, Hemoglobin AIC, insulin, advanced lipids, inflammatory markers, etc. you might include the Mitoswab test to assess mitochondrial function.

20:03  In Functional Medicine we want to optimize the patient and optimizing mitchondrial function could help to prevent some neurodegenerative diseases, like Parkinson’s and Alzheimer’s diseases. By 2040 we expect that there will be 14.2 million people with Parkinson’s and 14 million with Alzheimer’s disease.  In particular, Parkinson’s is linked to mitochondrial function and if we see improvements in the Mitoswab test, this is linked with better outcomes for patients and Dr. Ganeshan is in the process of publishing some of this data.

24:39  Mitochondrial function is very important for cardiovascular health. One of the hallmarks of heart failure is reduced mitochondrial function and by improving mitochondrial function, by making the heart muscle pump and function better, we can slow the progress and reverse heart failure.  Nutritional supplements like Coenzyme Q10, L-Carnitine, D-ribose, alpha-lipoic acid can help with this.  They can also play a role in atherosclerosis, since the function of HDL, the reverse cholesterol transport involves the HDL picking up cholesterol and taking it to the liver for degradation requires a lot of ATP, it’s a very energy dependent process.  Here is a related paper: Mitochondrial Oxidative Phosphorylation defect in the Heart of Subjects with Coronary Artery DiseaseDr. Ganeshan said it is important to use the proper cofactors, including NADH for Complex 1, CoQ10 for Complex 1 and 4, and riboflavin for Complex 2.


Dr. Sri Ganeshan is the Chief Medical Officer of ReligenDx, a company focused on Mitochondrial disease research, including the development of the MitoSwab test, a non-invasive way to analyse mitochondrial dysfunction.

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 our Rational Wellness podcast, please go to Apple Podcast, or wherever you get your podcast, and give us a review and a rating. We would really appreciate that. That’ll help move us up in the rankings there, and more people can find out about the Rational Wellness podcast. Also, go to my YouTube page, and you can find a video version. And if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Our topic for today is mitochondrial testing with Dr. Sri Ganeshan. A mitochondrion, mitochondria is plural, is an organelle found in every human cell, except for red blood cells. In fact, most cells have numerous mitochondria. ATP is the main source of energy, chemical energy, used by cells to fuel their functions. And this ATP is generated by the mitochondria, which is why the mitochondria are often referred to as the energy powerhouse of the cell.  Mitochondria have many other roles besides energy production, including heat production, storage of calcium ions, cell signaling through reactive oxygen species, program cell death, regulation of cellular metabolism, and steroid synthesis. There are primary genetic mitochondrial diseases, which are relatively rare, such as Barth syndrome, Aminoaciduria, iron overload, Kearns-Sayre syndrome, and Mitochondrial encephalomyopathy.

But much more common is mitochondrial dysfunction, which is a characteristic of aging and a component of nearly every chronic disease, including neurodegenerative diseases like Alzheimer’s and Parkinson’s, congestive heart failure, autoimmune diseases such as MS and lupus, neurobehavioral diseases including autism, schizophrenia, bipolar disorder, chronic fatigue, fibromyalgia, and even cancer have a mitochondrial component.  Mitochondria can become dysfunctional when we lack the necessary mitochondrial support nutrients. When the energy created by the mitochondria is less than the free radicals they produce, or when mitochondria are damaged by environmental toxins, medications, or the dirty electromagnetic fields that surround us in modern life.  Environmental estrogens like bisphenol A and pesticides, glyphosate from Roundup, and heavy metals like lead and mercury all damage our mitochondria. Also, common medications like acetaminophen or Tylenol, as well as most nonsteroidal anti-inflammatory pain medications, many psychotropic medications like Prozac, cholesterol-lowering statin drugs and even metformin are all known to be toxic to our mitochondria.

Dr. Sri Ganeshan is the chief medical officer of ReligenDX, a company focused on mitochondrial disease research, including the development of the Mitoswab test, a non-invasive way to analyze mitochondrial dysfunction. Dr. Ganeshan, thank you so much for joining me today.

Dr. Ganeshan:                   Thank you, Ben. Thank you for inviting me. Thanks a lot. I thank you so much, it’s very well.

Dr. Weitz:                          So tell us about your personal journey and how you came to become involved with research on mitochondria.

Dr. Ganeshan:                   Yeah. I accidentally… I was on a vacation, and I happened to be at… The same hotel happened to have an autism conference. That’s how I found my way into the autism world. And then by learning about autism, I also found out that a significant percentage of patients with autism have mitochondrial dysfunction, up to 80%.  Now, autism, as you know, thousands of disease, hundreds of disease put into one diagnosis, and there would be different phenotypes.  Some may be because of the folate issue.  Some may be because of the mitochondrial issues.  Another may be because of a gut issue.  So, I think one treatment doesn’t fit all.  We found this scientist, and we collaborated with him and came out with this test, which he has been working on it for a long time.  That’s how the Mitoswab came into picture.  It’s a buccal swab test, very easy to do, non-invasive.  It mimics the muscle biopsy, and it has been compared to the muscle biopsy with a 84% correlation, which is published in a peer-reviewed journal.

Dr. Weitz:                          So, the muscle biopsy is, prior to this test, has been the only real test of a mitochondrial status, right? Where you actually biopsy part of the muscle?

Dr. Ganeshan:                   Yes. The muscle biopsy is being considered the gold standard. But for primary mitochondrial disease, now the genetics is taking over from the muscle biopsy because of the easy nature of doing genetics. But, overall, muscle biopsy is considered the gold standard.

Dr. Weitz:                          Right. But, of course, the average patient who maybe is coming to see a functional medicine practitioner for some mitochondrial or some condition that’s related to mitochondrial dysfunction, they’re not going to be good candidates to get a muscle biopsy?

Dr. Ganeshan:                   Absolutely, and we don’t have the kind of expertise or the knowledge house to even man it. There’re only a few people in the country who can read a muscle biopsy today. It’s going out of favor. So we need new tools and hopefully, this is a good start.

Dr. Weitz:                          I gave a little intro about the mitochondrion, but maybe you can explain a little more about exactly what a mitochondrion is and why is it so important for health?

Dr. Ganeshan:                   Ben, you did a fantastic job. There’s only very, very less I can add to that. The mitochondria, as Ben mentioned, is the primary energy source, the energy currency producers in the cell. He went in depth by telling that only the red blood cells don’t have mitochondrion, and why is that? It’s because red cells carry oxygen and so mitochondria uses this oxygen to produce energy. If that the case, red blood cells can’t carry oxygen. So, that’s God’s gift to humanity, I believe.  But, on a serious note mitochondria, the function from two to 60 years is kind of very standard and then after 60 it starts declining. That’s why when it starts declining you see a series of disease coming into our life, like cardiovascular disease, neurodegenerative disease. These are diseases of the old age. So we see them coming back.  For a healthy aging, you want your mitochondria optimum. You want it optimized. So that’s very important and that’s… The doctors are now realizing that.  The practitioners are treating that very well and there are a lot of tools to do that.  Exercise, for example, is one of them.  It’s shown consistently that it improve mitochondrial function.

Dr. Weitz:                          By the way, are you familiar with particular forms of exercise and which is the most effective form of exercise to improve mitochondria?

Dr. Ganeshan:                   Yeah. There are different studies to show that. What they call as a regular exercise, which is consistent and which is applicable to all humans, everybody, is what is making a difference.

Dr. Weitz:                            So, for example, aerobic or cardiovascular exercise versus resistance or strength training, is one of those better? Or is short bursts of aerobic exercise versus lower intensity, longer duration?

Dr. Ganeshan:                   Low intensity has shown benefit. Resistance exercise has definitely shown… These are studies I am quoting. They have shown that they are better. More intense exercise, I think, we can avoid. It’s not applicable to common… But a sports’ person, yeah, that’s very much applicable. But for a common man, I think, consistent resistance training is definitely important for muscle mitochondrial functions. So resistor, it’s very important. Yeah.

Dr. Weitz:                            Okay. And I’ve heard people discuss strategies for improving mitochondrial density?

Dr. Ganeshan:                   Yes, yes. So, to go back to the basics. The food we eat enters into the mitochondria through complex one. There are five complexes. Enters into the mitochondria through complex one and two as electrons. Now they are transported through the complex three into complex four where the oxygen we inhale is converted into water. So the mitochondria plays two important roles. One is breaking down the food we eat. The other one is converting the oxygen into water, the oxygen we inhale. 95% of the oxygen we inhale is converted into water. 5% escapes and forms oxygen free-radicals. And 5% is okay. They are known to act as signaling molecules like you pointed out.  And beyond that 5%, maybe if it’s 20% of oxygen escapes and forms oxygenated free-radicals, that’s when your body starts getting affected [negatively]. They damage the proteins, DNA in your cells, so that becomes a problem and that might-

Dr. Weitz:                          Let me just stop you for a second, so too much free oxygen is a free-radical and that can cause damage to the cells.  A certain amount is important for signaling, but too much, like you said… For example, 5% might be good as a signaling agent but 20% would be too much and cause cell damage?

Dr. Ganeshan:                   Absolutely right. That’s right. So, we can measure that in the Mitoswab. We can approximately tell you that what’s happening there. Mitoswab is very specific and it just helps you understand better.  But then, the complex four is where the energy is produced, ATP is produced. Because of this energy production, electrons escaping out, hydrogen molecules escaping into the… Creating an electro-chemical gradient in the outer membrane. What happens is the ATP is produced because of that. Because if there is a high electro-chemical gradient outside, it wants to come inside. It’s like putting more pressure, water, it’s like a dam. You save water, it wants to come out and you open up, the turbine moves and it produces electricity. It’s the same mechanism ATP is produced from ADP. Now, ATP is very important for many functions. You pointed out quite a few of them and that’s what the mitochondria does.  So, if there is a problem in the first four complexes, then there is definitely a problem with energy functions. There is leakage. We don’t want to go into complexities but it definitely affects the mitochondria, hence the body, and clinical symptoms manifest.

Dr. Weitz:                          Okay, so these different complexes you’re talking about, there is this complicated chain of processes that leads to ATP energy production, right?  And these are different pathways in that process is by… When you talk about complex one, two, three, four and five?

Dr. Ganeshan:                   Absolutely, absolutely. And certain diseases are associated with certain complexes. For example, the complex one is associated with many diseases including diabetes is one of them, neurodegenerative disease et cetera, neurodevelopmental disease. But complex four is affected with neuromuscular disease, seizures and things like that. So, there’s a lot of evidence, there’s a growing body of evidence as well. The complex three, for example, is very, very important in T-cell regulatory function, endothelial function. So every… They play a very critical role. Your defense against infection, and your defense against inflammation and things like that.  So, mitochondria is not only energy producers but also many other functions, very important, critical to the human survival.

Dr. Weitz:                          You mentioned complex one is related to the cause of diabetes. So diabetes is also considered a disease where mitochondrial dysfunction is important?

Dr. Ganeshan:                   Absolutely and there is a lot of research, ongoing research, and published research as well.  And if you look at drugs, metformin acts on the mitochondria.  It actually boils down to that critical level at that point.  So definitely, yes, diabetes is considered part of a mitochondrial dysfunction.

Dr. Weitz:                          So what does that say, practically, for those of us who are managing patients with diabetes? And by the way, I found in some of the articles that metformin can actually be a negative for mitochondria.

Dr. Ganeshan:                   Yes. So metformin, definitely works through the mitochondrial pathways.  So that’s why when you give every drug, you have to check where the effect is, like for example, statins affect, reduce CoQ10, that’s ubiquinol. And that’s very important for the electron transport from complex one and two to four. So, they’re electron carriers, that’s very important.  Now statins decrease CoQ10.  In the United States it’s not every practitioner prescribes CoQ10 along with statins.  But it’s good when your body is good, let’s say up to 50, 60 years. Then your production, internal production of CoQ10 comes down and then you give statins over that.  Then the long-term effects of that is… We don’t know but definitely we can predict something that if your CoQ10 is low, your mitochondria is not functioning well.  That’s why in countries like Japan, it’s mandatory to give CoQ10 along with statins. So, if you put a statin prescription in Japan, you have to prescribe CoQ10 as well.

Dr. Weitz:                            Yeah, I interviewed Dr. Barrie Tan recently, and he was talking about the importance of having patients who take statins, also take tocotrienols which also helps to protect their CoQ10.

Dr. Ganeshan:                   Absolutely. So there are other compounds have been… Ubiquinol is the most important one. There are other compounds as well. Avidin, is one of them. Definitely it’s easily available and there are a lot of developments which have happened in that space.

This episode of the Rational Wellness podcast is brought to you by Mitoswab which is the only non-invasive test for the mitochondria. We know that the mitochondria are the energy powerhouses of our cells. And that a breakdown of our mitochondria can play a role in many chronic health conditions, including chronic fatigue, congestive heart failure, and even cancer.

But until now, the only way to measure mitochondria has been to do a painful, invasive biopsy of our muscles. But now, by swabbing your cheek, the Mitoswab test can help us to analyze mitochondrial function by measuring the activity of the electron transport chain. And it has an 84% correlation with muscle biopsy. If you are a doctor, go to mitoswab.com to sign up and order a test kit. Or call 484-534-9311.

 If you are a patient and you have interest, you need to see a functional medicine practitioner, like myself, who could order the Mitoswab as part of the testing protocols for an analysis of your overall health to help set you up on a program to improve your health and prevent chronic diseases.



Dr. Weitz:                            So coming back to diabetes, what can we do for managing patients with diabetes, if we now know that part of the diabetes process involves mitochondrial dysfunction?

Dr. Ganeshan:                   Excellent question. You want to think about… When you have a patient with diabetes, your multi-system is affected. It’s not just one system is being affected. Your multi-system is affected. And you want to… Earlier on the cycle I think there are pioneers in this field who are looking at mitochondrial function in diabetes. For this to come to mainstream it’s going to take another 10, 15 years. Because we don’t have the tools to do that, optimized tools and it’s not part of any guidelines.  So right now, treat them as you treat, but also look at the mitochondrial function. By improving the mitochondrial function, you may be able to optimize the drugs, reduce the number of drugs, get the patient better, or reduce the side effects of diabetes, like vascular dysfunction, improve cardiovascular dysfunction, or things like that. You may be too long term, diabetes is not a short-term disease.  It’s effect is long term.  It’s years and years.  So you want to minimize by improving the mitochondrial dysfunction. Your requirement of medications may decrease. It’s not shown in any studies. I am sure somebody is working on that. But definitely that’s something, the pathway to go to improve mitochondrial function. So you optimize the patient overall.

Dr. Weitz:                            Right. So, you’re saying that when we have a patient with diabetes, in addition to looking at a lot of the typical things we might look at like, blood sugar and hemoglobin A1C and advanced lipid analysis and inflammatory markers, we might look at mitochondrial function by say, giving the patient the Mitoswab test as part of better managing their condition?

Dr. Ganeshan:                   Absolutely, this could be one of the tools available, easy tool to see what the mitochondrial… See, in functional medicine you want to optimize the patient, you want to reduce the patient’s disease burden.  You want to be preventing. I think, when you talk of preventing, less medicine, mitochondrial function becomes critical. Like, if you take neurodegenerative disease.  Now, we are expecting to have 14.2 million people with Parkinson’s in 2040 and 14 million people with Alzheimer’s. That’s a huge burden on the society.  If you look at Parkinson’s disease, that’s clearly linked to mitochondrial function.  There is a lot of evidence. You can search the publicly available peer-reviewed evidence.  There is a lot of evidence on Parkinson’s and mitochondria.  In fact, some of the mitochondrial genes have been implicated in Parkinson’s disease.  Now by identifying earlier on, you may… This may be too early to the cycle, but if you may be identifying a vulnerable patient, by taking action and correctly following up, for example, at least this stage, somebody with a family history of neurodegenerative disease or Parkinson’s disease. You may want to identify if there is a mitochondrial dysfunction. And you want to kind of take, at least, that one equation out of your cycle. There may be other factors, environmental and unknown factors, but at least you are taking… By improving mitochondrial function, you are able to clean up your body better. You are able to chelate chemicals better. You are able to remove unwanted substance better.  I think the mitochondrial function plays a critical role in kind of modifying that. I think the future research, if you see the number of publications in mitochondria, they’re tremendously improved. There is a significant improvement of publications on neurodegenerative disease and mitochondrial function.  I think the next 10, 15 years you will see a significant improvement in mitochondrial diagnostics and management of mitochondrial-

Dr. Weitz:                            Interesting. Is there data to show that if we… Let’s say, we work up a patient for Parkinson’s from a functional medicine approach and we’re trying to look at various markers of disease progression. And we add mitochondrial analysis, say through the Mitoswab. If we can improve that, does that correlate with better outcomes for Parkinson’s?

Dr. Ganeshan:                   Yeah, these are long-term studies. We don’t have data at this point of time. We have some animal data showing that improving mitochondrial function, may improve our outcomes. And we have also some human data as well. But we need more work on that. We need to understand more advances there. And I am pretty sure that 10 years ago, 15 years ago, if somebody talked about the microbiome, you were an alien. So, today, mitochondria is kind of the next generation thing.  I think you can definitely decrease the disease burden, improve outcomes. We don’t have evidence because these studies will take 10, 20 years to do, to prove that and so we have to look at large databases. And with the tools like artificial intelligence and data analysis, I’m sure we can come out with some solid data.

Dr. Weitz:                            Right. But do we have data now showing that patients with more advanced Parkinson’s, Alzheimer’s tend to have worse scores, on say the Mitoswab test?

Dr. Ganeshan:                   We are collecting data. We don’t have that published data as of today. But definitely that’s a goal that… We are definitely collecting data that retrospectively ask, talking to physicians consistently doing that. But I am pretty sure that it will be available in, maybe two years’ time.

Dr. Weitz:                          Interesting. Have you talked to Dr. Dale Bredesen, who has his program for prevention and reversal of Alzheimer’s?

Dr. Ganeshan:                   Very briefly, yes. Very brief.

Dr. Weitz:                          I would think he’d probably be interested in this as another marker for being able to gauge progress in making some progress against some patients with some of these very serious neurological diseases.

Dr. Ganeshan:                   Yeah. He had expressed interest. But the contracting and the process takes a long time for clinical studies.

Dr. Weitz:                          Okay. You mentioned cardiovascular disease. What part does mitochondria play in cardiovascular health and disease?

Dr. Ganeshan:                   Many. I mean, if you look at all the heart-failure patients. Mitochondria are significant. So muscle function. Let’s go to the basics again. You mentioned that different parts of the cells have different type, different number of mitochondria per cell. Like if you look at the skin. Skin may have 10 mitochondria per cell. There is only one nucleus per cell. But if you look at the muscle, which has more energy needs, you need thousands of mitochondria per cell. And if you look at the brain cells, it’s similar, it’s more energy needs. So based on the energy needs, the number of mitochondria per cell also differs. Heart cells naturally need more energy and they have more mitochondria.

One of the hallmarks of heart failure and if you look at… There is one actually published paper every month or two or three published papers in heart failure and mitochondrial function. So definitely mitochondrial function plays a critical role in heart failure. So one of the things we are trying to do is validate this test with the heart muscles as well. And also look at whether, by treating these patients, by producing the energy production, by making the heart muscle function better, pump better, making more energy, are we able to have better outcomes? Are we able to delay the process of heart failure? So, we are thinking in that direction.

There is also a recent paper looking at coronary vascular disease and mitochondrial function. Especially the electron transport chain, was published within the last two months. A very nice paper looking at electron transport chain function and cardiovascular disease, heart failure. I am talking of coronary vascular disease.  So, by measuring it, are you predicting that, “Hey, a low mitochondrial function patients may be vulnerable to cardiovascular disease-

Dr. Weitz:                          So, how does the mitochondria play a role in this process that we normally think of as involving an inflammatory, oxidized LDL particles, creating plaque in the arteries?

Dr. Ganeshan:                   Fantastic question. So the LDL deposits the cholesterol in the heart vessel walls and the HDL picks up those cholesterol and takes it to the liver for degradation. And that process involves a process called reverse cholesterol transport. And that process involves ATP.  ATP plays a very significant role there.  And that’s energy dependent process.  So mitochondria definitely plays a role there, in cholesterol transport, and also in the health of those patients.

Dr. Weitz:                          Interesting. So, what you’re saying is some of the nutritional things we do to support the mitochondria, say like nutritional supplements like Coenzyme Q10, L-Carnitine, D-ribose, alpha-lipoic acid. Things like that, that tend to support the health of the mitochondria, it’s now part of functional medicine protocol to use those for patients with congestive heart failure. But you’re saying that those will be beneficial for patients with atherosclerosis as well.

Dr. Ganeshan:                   Yeah, so atherosclerosis is a chronic disease, I would say. It goes for a long period of time. And you only don’t know when it develops and when it kind of ends, right? So you don’t know when it starts. There are very less tools to identify that right now, and there are some tools now, but definitely I am looking at mitochondrial function plays a critical role in that cycle. That’s what that paper also kind of suggested.  Definitely, all the supplements you mentioned, they have critical roles. For example, carnitine helps in the transport of long-chain fatty acids, that is fatty acids with more than 14 carbon atoms, into the mitochondria. Now, the small-chain fatty acids, they enter the mitochondria without any help. But carnitine is used to transport long-chain fatty acids. CoQ10 is an antioxidant and helps in the transport of electrons. It’s an electron transporter. It helps in the transport.

Dr. Weitz:                          By the way, what are some examples of short-chain fatty acids and what are some examples of long-chain fatty acids?

Dr. Ganeshan:                   Yeah. The short-chain fatty acids, you are talking of butyric acid, propionic acid and things like that which is less than six carbon atoms-

Dr. Weitz:                          And those are typically produced by gut bacteria?

Dr. Ganeshan:                   Absolutely right. I mean, there is a lot of evidence on butyric acid especially, very important for the colon function. And butyric acid also improves mitochondrial function, especially. We have papers in the autism kids showing that butyric acid helps the complex four function. And overall modifying the mitochondria. So, very important-

Dr. Weitz:                          And we could probably add medium-chain triglycerides such as from coconut oil as well, right?

Dr. Ganeshan:                   Yes, they have a different role to play. But short-chain fatty, especially the butyric acid is very critical to mitochondrial health and everything and also the mitochondrial function. The large, long-chain fatty acids, palmitic acid and things like that, normally available in your food. So they don’t have-

Dr. Weitz:                          So, these are found in things like saturated fats and polyunsaturated fats, like omega-6’s and omega-3’s.

Dr. Ganeshan:                   Yes. So, carnitine is needed. If you do a carnitine profile and carnitine is low, that means your long-chain fatty acid is not entering the mitochondria. Now if you take fat, they produce more energy per molecule that’s compared to carbohydrates. That’s also very critical technically speaking. So-

Dr. Weitz:                          Nine calories per gram for a fat versus four calories per gram for a carbohydrate and that’s a measure of energy.

Dr. Ganeshan:                   Good, yeah. That’s something like that. Certain diseases for example, you are talking of keto diet and that sort of thing, so you want to be very careful as well. You don’t want to give a supplement just for the sake of giving it.  For example, if you’re looking for carnitine, you want to give carnitine. You want to know if this patient really needs carnitine.  You don’t want to throw in carnitine just like that. You what to know whether the… what is the rule, what supplement you… You don’t want to over-supplement. You don’t want to under-supplement. You want optimal supplementation. And you want to know only what cofactors are needed.  For example, the cofactors for complex one and four are CoQ10 and people have been using NADH. NADH is good for complex one. So it’s supplement riboflavin for complex two. The supplement cofactors differ. You want to be careful on what supplement you give. What is the amount you give. Things like that. To add to that point, we don’t have a FDA approved drug for mitochondrial dysfunction.

There are several companies investigating and focusing that in the next few years. There are several drugs, focusing on mitochondrial functioning into that market. So that will really give a boost to this whole world and education, physician education. In addition to people like you who are trying to get the word out, there is also going to be these companies putting their resources behind, to develop the education tools for physicians to understand.

Dr. Weitz:                          But there are certainly studies say, for example, with congestive heart failure that CoQ10, L-carnitine and D-ribose have all been shown to be beneficial?

Dr. Ganeshan:                   Absolutely. Absolutely. Yeah, absolutely. So-

Dr. Weitz:                          This is something that’s been pointed out a lot of times by Dr. Stephen Sinatra who has written a lot about this.

Dr. Ganeshan:                   … No, absolutely. Definitely, the nutritional supplements which help mitochondria have shown benefit in double-blind placebo-controlled studies. CoQ10 is one of them, which is used. For example just imagine this, this is just… I don’t have the evidence to talk, but look at it, if somebody’s having statins for 30 years or 25 years. And consistently, one point of time, the body is able to keep up producing CoQ10. At one point of time you become a little older and the body’s ability to produce CoQ10 decreases. What happens in that case scenario? There is no studies to prove that, but just we need to be proactive in thinking in that direction. So we are able to… And so research studies have to be designed on that too.

Dr. Weitz:                            Interesting. In addition to your Mitoswab test, since we’ve been talking about cardiovascular disease, you also have been instrumental in bringing to the market a cholesterol efflux capacity test. Can you tell us what that is and…

Dr. Ganeshan:                   Yeah, fantastic. This is a very new test we launched last week. The cholesterol efflux is the first step in the reverse cholesterol transport. As I mentioned earlier, the LDL deposits cholesterol in the blood vessels and HDL picks it up, brings it to the liver for degradation. Now-

Dr. Weitz:                            By the way, for people who are not familiar, for the laypersons who are listening to this, LDL is the so-called bad cholesterol because it tends to be involved in the process of leading to clogging of the arteries. Whereas HDL is the so-called good cholesterol because it takes some of that cholesterol from the arteries and remove it from the body.

Dr. Ganeshan:                   Absolutely. Thank you for pointing this out. So this is a very good way of explaining. LDL is considered the bad cholesterol and HDL is considered the good cholesterol. But, we have traditionally reduced LDL by taking statins. Statins are very successful in reducing LDL. But they don’t have an effect on the HDL. There are several drugs which have been tried-

Dr. Weitz:                            They also don’t do anything about increasing LDL particle size, or…

Dr. Ganeshan:                   … Yeah, so when you go back to the HDL, HDL is very important. You want HDL, that’s the good cholesterol within a particular range. You don’t want to have it too low. You don’t want to have it too high, that means more than 100. I mean, very few people have that kind of level. What you want to do-

Dr. Weitz:                            Usually if the HDL is too high, that’s because it’s not functional, right?

Dr. Ganeshan:                   … Yes, too high is also not functional. Too low is also not getting loose. So you want it somewhere in a good range, somewhere above 40, somewhere less than 90, 80.

Dr. Weitz:                            Now, prior to this test, basically the best measure we have is if the HDL particles are larger, then that’s an indication that they are more likely to be functional?

Dr. Ganeshan:                   Yes, you’re right. And HDL particles has also been examined in double-blind placebo-controlled studies. The cholesterol efflux is studied and published more than 4,800 times in peer-reviewed journals including 14 papers in the New England Journal of Medicine. That’s very well described, but converting that into a commercially available test has been very difficult. The reason being, it’s a cell-culture assay. It’s a very cumbersome process. So we’ve been able to do that. It’s a proprietary test. We’ve been able to do that. Our lab is one of the best, our partner lab, which we kind of collaborate is one of the best labs in the vascular medicine. They mostly work with research groups and pharmaceutical companies. We thought there is a critical need for this test for patients and so we are trying to get it to patients.

So coming back to the HDL transport, in the reverse cholesterol transport the first step is, getting the cholesterol outside the blood vessel walls, the macrophages there. That process is called cholesterol efflux and that process is also energy dependent. There is a mitochondrial component there. But also if that process is not working properly, there’s a problem. You may have a good HDL level. You may have a good HDL level. You may not have a good cholesterol efflux. So that means your HDL level is not going to matter. So there are studies showing that independent of the HDL, LDL and cholesterol particle size, cholesterol efflux is an independent risk factor for patients who do not have diagnosed heart disease and people who have diagnosed heart disease, or coronary vascular disease.

So, it’s considered an independent risk factor. If you look at the drugs which were developed to increase HDL, they all increased HDL. They did that function, but that increase in HDL is not translated into improved cardiovascular outcomes. That’s what many of these drugs fail. Now, one of the reasons for that is that they didn’t translate it into a cholesterol efflux function. They didn’t account for that. So that becomes very important and I hope this marker is going to help a lot of people.  Also recently, this cholesterol efflux has been compared to coronary CT. Now coronary CT is becoming very popular because of it’s cost-effective and it’s producing something called-

Dr. Weitz:                          You’re talking about the coronary calcium scan, right?

Dr. Ganeshan:                   Yes, absolutely. So that’s becoming popular but there was a correlation study recently published within the last five days, looking at whether it’s compared to the… This is the only one which was compared, cholesterol efflux, the only one, which was compared to coronary calcium score. So I think combining, people have come up with scoring systems and things like that and no drug currently available improves cholesterol efflux. The only thing which will improve is exercise, which is showed in a study and also behavioral modification.

So it’s very important to understand your risk score. So somebody comes to you, for example, tomorrow to understand, “Hey I have a family history of heart attacks and what do I do?” So, one of the things you may want to consider for this particular patient is the cholesterol efflux test.  I am hoping that in the next few years, maybe three to five years, this becomes part of the guidelines recommendation by the American Heart Association. That’s the expectation, hopefully. That’s something-

Dr. Weitz:                          So, other than exercise, are there any nutraceuticals or dietary changes that can be beneficial for improving cholesterol efflux?

Dr. Ganeshan:                   Good question. So, we have seen exercise in a very notable study shown to improve cholesterol efflux. That’s the only one which has shown. Nutritionally, there are studies which are shown to improve but I think we need more studies. There are definitely studies that by improving mitochondrial function they have shown to improve cholesterol efflux but definitely we need more robust studies, well-designed studies.

Dr. Weitz:                          What about niacin? Can that improve cholesterol efflux?

Dr. Ganeshan:                   Niacin has been studied but it’s not shown to improve cholesterol efflux.

Dr. Weitz:                          Okay. So right now, we don’t have anything?

Dr. Ganeshan:                   No, nothing. One of the things we may consider, there are studies in corporate and other things, that may be something to consider but we still need that much more well defined double-blind-

Dr. Weitz:                          I see, interesting. The studies that were done with CoQ10, do you know any idea what the dosages used were?

Dr. Ganeshan:                   I don’t know off the top of my head but CoQ10, is a number of factors… CoQ10, the dosage matters, the formulation matters. It’s very sensitive to light, it gets oxidized. So, there are a lot of factors in CoQ10. And I’ve been… Even though we don’t have the evidence to support, selecting a good CoQ10 is also an art, I say. We need standardized protocols for a good CoQ10.

Dr. Weitz:                          What do you mean a good CoQ10?

Dr. Ganeshan:                   How they are transported, how they are protected against light and things like that. What is the formulation? Because we need to… There is also an attempt to make CoQ10 a drug. But I think the supplement companies need to come together and find lot of absorption studies and things like that.

Dr. Weitz:                          So, as far as I know, all I’ve heard is that we have ubiquinone and ubiquinol and then there’s one company that has a product called MitoQ. What are you referring to in terms of formulation?

Dr. Ganeshan:                   For example, MitoQ, they’ve done a fantastic job, do a lot of research studies. They are published as well. So I would give them the benefit, but it’s also… But there also other more CoQ10s which work. There are two main manufacturers of CoQ10, one of them is a company called Kaneka and there’s another one in New York. The New York one is a bacterial fermentation process. Kaneka is a different process. The finer details, we need to understand. And also who is repacking them and things like that? Is the process much more cumbersome? So I am not telling anything bad or anything but definitely some CoQ10s definitely did not see any effect but some when you change the brand, it’s effective. So we need to kind of work on that. For example, the CoQ10 available in Costco works brilliantly.

Dr. Weitz:                          Say that again?

Dr. Ganeshan:                   The CoQ10 available in Costco works very well. Metagenics has a good brand and there are several companies which have good brands. Qunol is good.

Dr. Weitz:                          Okay. And we can monitor this by using the Mitoswab test for its effect, right? Or no, we’re talking about the cholesterol efflux test.

Dr. Ganeshan:                   Cholesterol efflux test is a good test. Cholesterol efflux test is a good test. What we can do-

Dr. Weitz:                          It’s a serum blood test?

Dr. Ganeshan:                   Yes, it’s a serum blood test. It can be used to kind of identify the issue and also monitor the effect of the issue long term.

Dr. Weitz:                          So, practitioners who want to utilize these tests, they can do the tests through your lab, is that right?

Dr. Ganeshan:                   Yes. So currently we are the only lab which are offering commercially these two tests. Cholesterol efflux is offered by some research labs at this point of time. But we think our methodology is kind of superior to the existing methodologies and so we think we offer a very unique methodology and very validated methodology.

Dr. Weitz:                          So, practitioners could call your company and get a test kit and then-

Dr. Ganeshan:                   Yes, absolutely. Absolutely. We launched it last week.

Dr. Weitz:                          Last week? Well, no wonder, I talked to a cardiologist. He said he wasn’t familiar with it. So-

Dr. Ganeshan:                   Yeah, so we are getting a lot of calls. We didn’t even advertise but we are getting a lot of calls because I do believe that this test is going to be used uniformly by everybody.

Dr. Weitz:                          What is the approximate cost?

Dr. Ganeshan:                   We work with insurance mostly. The out-of-pocket maximum should be around $300.

Dr. Weitz:                          Okay. Are you finding that some insurances are picking it up?

Dr. Ganeshan:                   Possibly, yes. For cholesterol efflux we are just awaiting approval. But for Mitoswab, Medicare pays for Mitoswab.

Dr. Weitz:                          Oh, interesting. How about commercial insurance? Are they-

Dr. Ganeshan:                   No, we work in network, but some of them pay. Some states, Medicaid also pays for Mitoswab. We’re waiting to become in-network provider for those insurances. But yeah, our goal is to get it approved by insurance.

Dr. Weitz:                            Great. Great. So how do practitioners get ahold of your lab? Where would they go to? Should they go to the website?

Dr. Ganeshan:                   Yes, we have a website www.religendx.com. Also we have another website-

Dr. Weitz:                            What was that again? www-

Dr. Ganeshan:                   … Religen, R-E-L-I-G-E-N-D-X.com

Dr. Weitz:                            Okay.

Dr. Ganeshan:                   Or they can also visit Mitoswab. We have a separate website for Mitoswab since we started with that. So they can go there, and leave an email.

Dr. Weitz:                            So they can go to Mitoswab, M-I-T-O-S-W-A-B.com?

Dr. Ganeshan:                   Absolutely right. And they can call us. They can email us.

Dr. Weitz:                            What’s your phone number?

Dr. Ganeshan:                   Our phone number is 484-534-9311.

Dr. Weitz:                            Okay. And what’s the approximate cost? What’s the cost of the Mitoswab, if the insurance doesn’t cover it?

Dr. Ganeshan:                   The maximum out-of-pocket for insurance is $400 for the patient.

Dr. Weitz:                            400? Okay.

Dr. Ganeshan:                   That is the maximum out-of-pocket for the patient.

Dr. Weitz:                            Okay. So they supply their insurance, you try to bill the insurance and if the insurance doesn’t cover it, then the max would be 400.

Dr. Ganeshan:                   Yeah. So, some of the patients don’t want to deal with the insurance and so for them the maximum out-of-pocket will be $400.

Dr. Weitz:                            Is there a discount if they just pay cash upfront?

Dr. Ganeshan:                   No.

Dr. Weitz:                            Okay.

Dr. Ganeshan:                   Upfront or later is the same thing. So, no.

Dr. Weitz:                            Okay, sounds good.  So, I appreciate the information you brought us Dr. Ganeshan. This is really interesting, another tool in our arsenal to help manage our chronic disease patients. Now we finally have a non-invasive way to monitor their mitochondrial function. So, I think this is very exciting.

Dr. Ganeshan:                   Thank you. No, no, it’s a very important tool, I think. Last 10, 15 years we heard about microbiome. We learnt a lot and we are still learning. And the next 10 years we continue to learn about microbiome and we’ll also start learning about mitochondria. The good thing is that mitochondrial medicine, there is lot of activity in the recent years. There are companies which are developing drugs, like companies which are developing diagnostics like us. We need a good, healthy competition. We need to get the best for the patient and good tools for the practitioners to identify and take effective action.

So, I think it’s a very exciting time for the mitochondrial medicine world and the experts are coming together. There’s in fact a conference, I’m thinking of attending, the George Washington University of Integrated Medicine is organizing in Dallas next… in October. So, things like that. I think you’ll hear a lot about mitochondrial medicine in the next, coming years.

Dr. Weitz:                            Actually, we’re announcing right here on this podcast that the next decade is the decade of the mitochondria.

Dr. Ganeshan:                   Yeah. Thanks to people like you, yeah. So hopefully that is… Because I think we can solve a lot of problems, unidentified problems. We don’t know why we get this… Why there is an increase in cardiovascular disease. We don’t know why there is an increase in neurodegenerative diseases. We may have an answer. Part of the answer may be lying here, what we know. I think we need more research and we need more evidence to take action. So, I think that we are going in that direction.

Dr. Weitz:                            Awesome. Thank you, Dr. Ganeshan.

Dr. Ganeshan:                   Thank you, Dr. Weitz. Thanks a lot. I appreciate your time and having us in the call.



Tocotrienols with Dr. Barrie Tan: Rational Wellness Podcast 127

Dr. Barrie Tan discusses Tocotrienols 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

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

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

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

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

21:00   Tocotrienols have been shown to improve bone health in post-menopausal women. Dr Tan talked about a study done at Texas Tech University with women with osteopenia that showed that tocotrienols improved bone formation by 100% and reduced bone breakdown by 15% and reduced oxidative stress by 48% [Tocotrienol supplementation suppressed bone resorption and oxidative stress in postmenopausal osteopenic women: a 12-week randomized double-blinded placebo-controlled trial.]  Calcium is a constituent in bone. Vitamin D is a chaperone to escort the calcium into the bone. Vitamin K2 helps to form osteocalcin which helps to trap the calcium in the bone.  Tocotrienol both increases osteoblastic activity and reduces osteoclastic activity, which improves bone density and strength over time.  The bisphosphonate drugs like Fosamax and Actonel reduce osteoclastic activity, so while you get an increase in bone, there is a tendency to get an accumulation of weaker, junky bone and it can cause osteonecrosis of the jaw.  But Dr. Tan has also developed another nutritional product called geranylgeraniol (GG), that will be available from Designs for Health, that can block this breakdown of the osteonecrosis of the jaw caused by bisphosphonate drugs.

25:57  Dr. Tan explained that they have studied delta tocotrienols for osteoarthritis and it improves joint health and cartilage repair and reduces inflammation.  In fact, tocotrienols reduced cartilage erosion by 200%.

27:17  Most plants that are good sources of vitamin E have both tocopherol and tocotrienol, like rice and palm.  Dr. Tan discovered that the annatto plant contains purely tocotrienols. When Dr. Qureshi, the researcher from the University of Wisconsin, found out about this, he told Dr. Tan that he was going to test it to see if it lowered cholesterol levels. Dr. Tan suggested that he also test to see if it also lowered inflammation, since this is a big factor in the pathogenesis of atherosclerosis. The study showed that tocotrienols lowered inflammation by 30% as well as lowering cholesterol by 20% and also lowering triglycerides.  Tocotrienols will also lower oxidized LDL, which is important since oxidized LDL is more atherogenic than LDL.  Here is a good review article on the benefits of tocotrienols for cardiovascular disease:  Tocotrienol is a cardioprotective agent against ageing-associated cardiovascular disease and its associated morbidities

30:55  Tocotrienols can also be beneficial for helping to reverse Non-Alcoholic Fatty Liver Disease (NAFLD).  A study showed that patients taking 600 mg tocotrienols per day and it lowered liver enzymes 15-20% and reduced C-reactive protein, a measure of inflammation.  NAFLD is common in patients who are overweight and tocotrienols also helped with weight loss. After taking tocotrienols for 3 months, patients lost 10 lbs and they lost 20 lbs after only 6 months.

36:05  Recommended dosages for tocotrienols: 600 mg for fatty liver; for cancer 400-500 for stage one but 900 for metastatic disease; for patients with lipidemia or heart disease, 250-300 mg.

43:28  Dr. Tan explained that tocotrienols also kill cancer stem cells and this has been shown with prostate, breast, pancreatic, and skin cancers. Cancer stem cells are rogue cells that can continue even after you get rid of cancer.  Dr. Tan has also edited a text book on tocotrienols called Tocotrienol, Vitamin E beyond Tocopherol.


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

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


Podcast Transcript

Dr. Weitz:            This is Dr. Ben Weitz, with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field.  Please subscribe to the Rational Wellness podcast on iTunes and YouTube, and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness podcasters. Thank you so much for joining me again today. Please, if you like the Rational Wellness podcast, go to Apple podcasts and write us a review. That’ll help us come up in the searches for alternative health in Apple podcasts. Also, if you want to see the video version, go to my YouTube page, and if you go to my website, drweitz.com, there will be detailed show notes and a complete transcript.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Tan:                Yeah. I don’t know who started this idea that if you take antioxidant it will counter the effect of cancer.  I actually have read the opposite. If you go to the study of professor Drisko, Jeanne Drisko from University of Missouri, Kansas City. She came up with a cocktail of antioxidant for women cancer survival, and then they’re able to have better quality of life.  So I’ve seen that more than that it hurts.  If a cancer drug work as a pro-oxidant to kill the cancer just like that, I believe that that will be too simplistic. If it is like that. If you look at most cancer drugs, they are very toxic to the patient. So if it really worked, it worked to kill the cancer and probably also slowly kill the patient themselves. This antioxidant and oxidant thing is too simplistic. It works on other direct mechanism to go after the tumor. But with Tocotrienol in animal study and in humans study, we have done it now over two years, we systematically do not find negative effects of Tocotrienol on the patient, whether they are cancer study or non cancer study.

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

Dr. Tan:                Yes. Bone health. We started a trial after we had many animal studies in Texas Tech University at Lubbock. So at the Lubbock Texas study, we did the osteopenia trial. We gave the women one year, but not more than 10 years after menopause. So we don’t want them to be in the period where they’re osteoporotic.  Only in the osteopenic stage. So we noticed that after three months, the bone turn over, which means the building of the bone, increased by 100% or more.  And the bone resorption, the indicators show drop by 15% or more. That’s resorption, the breakdown of the bone.  And then during this stage where oxidative stress is also increased, and the oxidative stress is reduced by 48%, almost 50%. So we considered that those three combo is fantastic. Now this is unique of Tocotrienol. Why? Because people who know about bone health usually think about calcium, they take above vitamin D and more recently they think about vitamin K2. But we’ve shown that in Tocotrienol, this unique vitamin E is able to do what I just told. And that was published last year. So that’s the bone study. [Tocotrienol supplementation suppressed bone resorption and oxidative stress in postmenopausal osteopenic women: a 12-week randomized double-blinded placebo-controlled trial.]

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

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

Dr. Weitz:            Interesting.  Do you have any idea in humans of what percentage change it would be in bone?

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

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

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

Dr. Weitz:            These are drugs like Fosamax, for example, and Actonel.

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

Dr. Weitz:            Really?

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

Dr. Weitz:            200%. Wow.

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Tan:                Yes.

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

Dr. Tan:                Thank you Dr. Weitz for asking this question. Currently, the reason I got into this was other people who have been studying animal study, and even the clinical trials surmising that this would work. And we already know that Tocotrienol work on metabolic syndrome, diabetes and obesity, and this kind of thing overlap each other. And then the silent group is fatty liver because you don’t feel anything. The liver is the largest solid organ. It performs 600 different function. It’s got so many function.  So if the liver failed to function properly, is a bad news. 20 more years ago, this kind of liver condition is caused by excess amount of alcohol drinking. Mayo clinic discovered it. So they had a patient coming in the doctor surmised that the patient is probably drinking too much alcohol because the liver was fatty. The patient said no. So when they found out that… So because it was not alcohol-related, that’s why they called the disease non-alcohol fatty liver disease, and it’s a dietary thing because the fat back flush into the liver and can go out anywhere.

                                So we knew this. So we did a study and is this fantastic. The study, we gave people 600 milligram per day of annatto Tocotrienol. We found that the liver enzyme dropped about 15, 20%, the fatty liver index dropped, the C-reactive protein dropped, which is a very good… By the way, C-reactive protein is manufactured in the liver.  So it’s a stress protein from the liver, usually is a marker for all inflammation, but for me, is a particular marker for the inflammation of the liver and also drop.  So we did a study, 600 milligram for three months.  We now just completed a study still at 600 milligram for six months, and a dramatic effect on these people is that at the three months, they dropped 10 pounds. Normally I do not subscribe that Tocotrienol help people to lose weight. It’s not lose weight. But after three months, it dropped 10 pounds, and after six months, it dropped almost 20 pound, like 18 pounds. Dr. Weitz, this is very important because if their weight drop, that means that their liver is recalibrating their body. Their enzymes in the liver drop, the weight drop, the C-reactive protein drop, and the fatty liver index drop. I don’t know what’s there not to like. This is fantastic.  Right now there’s no cure for this.

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

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

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

Dr. Tan:               The control group and the normal group were asked to do exercise, eat a normal diet like that, but they’re not on a regiment diet, just have a healthy diet. So we know that it is compared correctly. I would say that this is really quite something. If the audience want to address fatty liver, this would be a good way to reduce the inflammation. Silence the enzyme that is highly inflamed. And in fact, we also check the glucose level, is it called HOMA-IR, it’s a homeostatic something of the glucose function. It’s an American Diabetes Association measurement. Even the HOMA-IR drop.  I am really thrilled about this, and looking much forward to the published study enable to recommend people who have fatty liver to do this, at least to control and contain further the damage to the liver, which is otherwise not good, and enable to help to reverse it possibly.

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

Dr. Tan:                Probably about half that amount. Depending on a person’s weight, two to 300 milligram would suffice. And then fatty liver because a person is already gone that direction on fatty liver, 600 milligram. Many of our clinical study on cancer, they use 900 milligram. But now in the newest study it looked like if they are not end stage cancer, if they’re stage two or three, probably half the dosage will be enough. Four to 500 milligrams. So the extreme thing, 900 milligram, but the one, the frank disease, then probably about midway about 500 or five, 600 milligram. And of people who just have normal lipidemia or have a family history of this but don’t have the disease themselves, probably half that again, from two to 300 milligrams.  And remember, when you take it, it’s a lipid soluble thing. You don’t need to make it any liposomal or other thing, just take it with a meal. There’s enough emulsification in the stomach, bowel sock in the gut, and that should be able to emulsify to absorb the Tocotrienol.

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

Dr. Tan:               Yeah, the bioavailability on-

Dr. Weitz:            That 2019 Tocotrienols Modulate a Life or Death Decision in Cancer. That author talked about the bioavailability.

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

Dr. Weitz:            What about for cardiovascular disease?

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

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

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

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

Dr. Tan:                That’s fine. Yeah.

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

Dr. Tan:                Yeah.

Dr. Weitz:            Can you ask about those?

Dr. Tan:                I’m going to show you. This is a picture of the book here, like that. The Truth About Vitamin E. And it’s a short book. It’s only about 70, 80 pages long. So if you wanted to have a copy of this book here, you can go on barrietan.com, and my name is spelled B-A-R-R-I-E.com. And then if you put the code word, wellness, because we are on your program here, wellness, and then you can download an electronic copy.  So if you wish to have a hard copy, you can email me through that. Otherwise, if you want it faster, you get download and it’s free, and then you can see a lot more study and a lot more things that we discussed here; dosage, this and then what is useful for what area. It should be in there. So I did that as a public service, as a love for this, that I spent almost my whole life studying this, to let people know today of that special vitamin E. That’s why I say the truth about vitamin E is actually Tocotrienol, not tocopherol.  There are just too many problems with tocopherol to find that is any use.  That even if you use it, you have to tiptoe around all the benefit because of the potential negative benefit.  So I decided that I’m done with tocopherol.

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

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

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

Dr. Tan:                Yes. How about while Kim is getting me the textbook for me to show, I know that as a remark that I want to make just in case we didn’t cover it. Currently, we are continuing our study more overweight and obese people, they’re 60, 70 years old, because carrying a lot of heavy fat is not good. They’re healthy. So keep watch, in another year we’ll know that study like that. And another note that you may or may not ask, we also noticed that when you add Tocotrienol, it help… When you address cancer, 1% of cancer is called cancer STEM cell. These are rogue cancer cell that circulate in our body. We now have scientific proof that Tocotrienol actually even nail the cancer STEM cell. We have shown it on prostate cancer, breast cancer, pancreatic cancer, and skin cancer. Can you imagine that? Even if you nail the cancer, the rogue cell will go on. So we even nail after that. I am so thrilled about that.  So for no other reason, for prevention reason, we should be taking… because in our body, even if we don’t have frank cancer, we have cancer, rogue cancer cell floating around to do this. So to answer your question, for the scientists, this is a book that I added here and I’m the main editor here. So this is called Tocotrienol, Vitamin E beyond Tocopherol. And a picture of annatto here. This a summary of all the different professors and scientists on the research work.

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

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

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

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

Dr. Weitz:            It is available, you said.

Dr. Tan:                Yeah. GIG is. The only company is available now is for design for health, and they have a white page. Dr. Weitz, please go on the white page like that or you can even interview Dr. David Brady. He’s the chief medical officer there, or if not, if you bring me on again, I would love to do this, and be among the very first to do that. I will love to talk to you about that. It was so exciting. You know and then when you do this like… let me tell you this, the entire molecule of GG is on Tocotrienol.  Now the human mammal don’t know how to do that. The plant can do that. Next time when you get me a talk, I’ll show a picture about the picture of Tocotrienol. The entire molecule of GG is on the Tocotrienol. So this is my fate. I’m meant for this. I noticed this fun thing, but I wanted to tell you, the audience, I did not make this up. I’m just fortunate to stumble on this Amazonian plant. And if there’s sheer, pure joy to pass to the consumer is to let them know that this is good for their health.

                                So Tocotrienol is good for all the reasons for the past hour we talk about, and GG is an endogenous nutrient. Without GG, we cannot describe life as we know it, and GG, as we grow older, GG drop. Actually the lowering of CoQ10 as we age is actually a biomarker of lowering of GG because GG is required for the synthesis of Q. Forget the statin thing, the statin thing only make the CoQ10 drop even more. But even if you don’t take statin, the lower CoQ10 with age is a maker for lowering endogenous GG.  I know I got carried away, but that is the very exciting thing. So I hope it’s useful to you all. Thank you so much for inviting me to talk.

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

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

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

Dr. Tan:               Thank you. Much obliged.




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

Dr. Ilana Gurevich discusses Inflammatory Bowel Disease with Dr. Ben Weitz.

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


Podcast Highlights

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

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

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

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

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

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

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

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

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

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


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

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


Podcast Transcript

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

Hello, Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to The Rational Wellness Podcast, please go to Apple Podcasts and give us a ratings and review. That way, more people can find out about The Rational Wellness Podcast. Also, you can go to the YouTube page and there’s a video version there, and if you go to my website, drweitz.com, you can get complete show notes and full transcript.

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Gurevich:                     Lucky us. Yep.

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

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

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

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

Dr. Weitz:                          Okay.

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

Dr. Weitz:                          Yeah, cool.

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

Dr. Weitz:                          Prometheus Labs.

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

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

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

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

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

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

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

Dr. Weitz:                          You do a breath test.

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

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

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

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

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

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

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

Dr. Weitz:                            Yeah.

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

Dr. Weitz:                            Right.

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


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

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



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

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

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

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

Dr. Weitz:                          Okay.

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

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

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

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

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

Dr. Weitz:                          What about elemental diet?

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

Dr. Weitz:                          Really? Interesting.

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

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

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

Dr. Weitz:                          D Alpha? Okay.

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

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

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

Dr. Weitz:                          So, liquid, okay.

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

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

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

Dr. Weitz:                          What to do with it?

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

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

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

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

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

Dr. Weitz:                          Right.

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

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

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

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

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

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

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

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

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

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

Dr. Weitz:                          I see. Interesting.

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

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

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

Dr. Gurevich:                     Sometimes you do for other reasons.

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

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

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

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

Dr. Weitz:                          Have you used Low FODMAP?

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

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

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

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

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

Dr. Weitz:                          Okay.

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

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

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

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

Dr. Gurevich:                     Yeah, that’s true.

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

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

Dr. Weitz:                          Oh, you have?

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

Dr. Weitz:                          I just don’t sleep.

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

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

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

Dr. Weitz:                          Awesome.

Dr. Gurevich:                     Thank you.

Dr. Weitz:                          So much.

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